Patients and Evolutionary History


Evolution has revolutionized our modern scientific understanding of natural history and how our bodies came to be. Yet evolutionary insights regarding health and disease are not typically emphasized with patients.

Medical education focuses on proximate causes of disease — infection, trauma, cellular regulation, etc. — as opposed to evolutionary understandings of how our traits and responses came to be in the first place. What evolutionary insights are there for clinical medicine?

Medical conditions can occur when there is a mismatch between our evolved bodies and our particular society and environment. This idea challenges some of our notions of disease.

Hardly a day goes by when I don’t see patients with lactose intolerance, allergies, obesity, anxiety, near-sightedness, ADHD, and flu symptoms. The lactase gene spread rapidly in historical populations with dairy husbandry. But 70% of the world’s population is lactose intolerant, all of whom are “normal” in the context of their environments that were, until recently, lactose-free.

Allergies and autoimmune conditions are more common in developed societies where infections occur less frequently. This suggests a mismatch between our evolved immune system and our current environment. Recent evidence suggests that the incidence of autoimmune Crohn’s disease has risen in places where the incidence of gastrointestinal worm infection has fallen.

Written By: Lawrence Rifkin
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  1. In the past year I have read two books on this very subject. I found them both to be fascinating. The first book was Why We Get Sick The New Science of Darwinian Medicine, by Randolph Nesse and George Williams.

    From the book cover: “The next time you get sick, consider this before you pick up the aspirin: your body may be doing exactly what it’s supposed to. In this ground breaking book, two pioneers of the emerging science of Darwinian medicine argue that illness as well as the factors that predispose us toward it are subject to the same laws of natural selection that otherwise make our bodies such miracles of design. Among the concerns they raise: When may a fever be beneficial? Why do pregnant women get morning sickness precisely when they are supposed to be nourishing their developing babies? How do certain viruses “manipulate” their hosts into infecting others? What evolutionary factors may be responsible for depression and panic disorder?”

    I saw R. Nesse speak on this subject at Harvard some time back. Here is the video of his lecture from the lecture series archives:

    The second book on this subject that I really enjoyed is Zoobiquity by Barbara Natterson-Horowitz and Kathryn Bowers.

    From the Amazon description page: “Joining forces with science journalist Kathryn Bowers, Natterson-Horowitz employs fascinating case studies and meticulous scholarship to present a revelatory understanding of what animals can teach us about the human body and mind. “Zoobiquity” is the tem the authors have coined to refer to a new, species spanning approach to health. Delving into evolution, anthropology, sociology, biology, veterinary science,and zoology, they break down the walls between disciplines, redefining the boundaries of medicine. Zoobiquity explores how animal and human commonality can be used to diagnose, treat, and heal patients of all species. Both authoritative and accessible, offering cutting-edge research through captivating narratives, this provocative book encourages us to see our essential connection to all living beings.”

  2. Side note: Can anyone advise me on how to get space between paragraphs? I shows up correctly on the preview but between preview and submit I am losing those spaces which makes my comment appear as one massive lump of text. What am I missing?

  3. As a nurse, I find this fascinating. Nurses assess, diagnose, plan for, intervene in, and evaluate human response to disease and injury – not the disease itself. Knowing the evolutionary roots of human response to disease and injury can only help evidence-based practice and move us away from the superstitious woo that unfortunately still seems to pervade some areas of healthcare.

  4. Thanks for the info on the fascinating books, LaurieB.

    I just hit ‘Return’ three times for paras, not sufficient but that’s the best I can do.

    In reply to #1 by LaurieB:

    In the past year I have read two books on this very subject. I found them both to be fascinating. The first book was Why We Get Sick The New Science of Darwinian Medicine, by Randolph Nesse and George Williams.

  5. For spacing the lines,

    Hold your keyboard’s “caps lock” or “shift” and press “Enter” for spacing the lines.

    You can use the tags you see in Help with formating click here.

    for links, use the tag:


    Nesse lecture at Harvard

    Nice video

  6. A good resource for information in this field is:

    They’re only recently established and now run a popular yearly conference. Most previous presentations are on YouTube somewhere.

    A couple of related interviews on TVOL:

    An interesting aspect of the evolutionary aspect to health is that nutrition and exercise are crucial. But because of sometimes counter-intuitive nutritional implications there’s lots of extreme political fanaticism, typified by the vilification and trolling via YouTube comments. There’s a very active and vociferous vegan Internet community targeting many of the people working in this area. Everyone involved seems to be some kind of personal trainer running boot camp sessions. (Possibly the 21st century equivalent of religious clerics and church attendance.)

    There seems to be an emerging environmentalist religion whose followers believe the relevant science is already settled. It hasn’t really taken force yet but it seems to be pretty much ready to go. Perhaps just needs a suitable messiah to appear.

    I highly recommend taking an interest in this stuff. It might not help much with eliminating existing irrational religions. But it sometimes seems like the fewer people who get caught up in the traditional religions the more who end up joining something even more ridiculous that remains unchallenged because it hasn’t really been noticed. Some light in this area might help slow down the emergence of yet another one of these millennial cults. Plus these guys looking at the evolutionary approach can indicate a range of simple steps that seem to fix various health problems people might not be aware can be attributable to modern food-related practises.

    Another guy who working in this area is Dean Ornish, who has achieved substantial health enhancements via nutrition – some excellent presentations on TED. Particularly on heart disease, which would have to be one of the biggest health issues entirely attributable to a modern lifestyle.

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