Nothing in medicine makes sense, except in the light of evolution
The practice of medicine is a fruitful marriage of classic diagnostic and healing arts with modern advancements in many relevant sciences. The scientific aspects of medicine are rooted in understanding the biology of our species and those of other organisms that interact with us in health and disease. Thus, it is reasonable to paraphrase Dobzhansky, stating that, "nothing in the biological aspects of medicine makes sense except in the light of evolution." However, the art and science of medicine are also rooted in the unusual cognitive abilities of humans and the cultural evolutionary processes arising. This explains the rather bold and inclusive title of this essay. The near complete absence of evolution in medical school curricula is a historical anomaly that needs correction. Otherwise, we will continue to train generations of physicians who lack understanding of some fundamental principles that should guide both medical practice and research. I here recount my attempts to correct this deficiency at my own medical school and the lessons learned. I also attempt to summarize what I teach in the limited amount of time allowed for the purpose. Particular attention is given to the value of comparing human physiology and disease with those of other closely related species. There is a long way to go before the teaching of evolution can be placed in its rightful context within the medical curriculum. However, the trend is in the right direction. Let us aim for a day when an essay like this will no longer be relevant.
J Mol Med (Berl). 2012 May;90(5):481-94. doi: 10.1007/s00109-012-0900-5. Epub 2012 Apr 27.
Department of Medicine, Department of Cellular and Molecular Medicine, Center for Academic Research and Training in Anthropogeny, UC San Diego, La Jolla, CA 92093-0687, USA. a1varki@ucsd.edu
