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Understanding the nature classic as well as more recent collections Stearns and and process of science informs personal and policy decisions, Koella ; Trevathan et al. The website Evolution and Medicine Review of biology can be helpful for everyone in making life decisions.

The December issue of ford et al. Other articles in the same issue provide ex- transfer information. The ability to categorize and connect infor- cellent examples of the synthesis of evolution and medicine in mation is one of the traits that enable experts to navigate easily cancer Casas-Selves and DeGregori , vaccine development through disciplinary content. Evolution Under- sion to medical school.

Students who are not typically excited by Although this is a positive step forward, indicating support from basic evolutionary concepts may be drawn in by focusing on hu- the medical community for increasing evolutionary thinking in man health. Our undergraduate pre- In particular, this approach demonstrates that premedical students medical students should be willing to learn evolutionary medicine, should learn evolutionary biology for the same reasons they study but greater synthesis is possible.

Examples from evolutionary variation in disease presentation is a familiar way to demonstrate medicine demonstrate that fitness depends on how rates of repro- genetic variation. In-depth genetic studies generally show that duction and environmental circumstances interact see Boxes 3, 4, even commonly taught diseases that at first appear to have a rel- and 6. Mul- hypothesis: alleles that cause disease in modern times may have tiple functional and mutant alleles combine with environmental been adaptive in the past, but produce traits that are maladaptive effects to cause variable symptoms and disease severity Tem- mismatched under current diet and living conditions.

A corollary pleton This is clearly demonstrated by phenylketonuria is that modern humans may be changing their environment more PKU , a condition caused by mutations in the single-copy gene rapidly than potential responses to selection can occur.

The mis- encoding phenylalanine hydroxolase and tested for in neonatal match hypothesis provides some of the best ultimate explanations health screening. PKU arises from the inability to metabolize for modern rates of obesity, heart disease, type-2 diabetes, breast the amino acid phenylalanine, the buildup of the amino acid and and prostate cancer, goiter, iodine deficiency, birth defects, and phenylketones, and eventually microcephaly, incomplete brain aging Harper ; Eaton et al.

Although Greaves ; Diamond ; Swynghedauw ; Gluckman in most cases, disease can be avoided by excluding foods rich in et al. This is a familiar prob- explain the persistence of maladies in the face of improved sani- lem to evolutionary biologists: although genetic variation is the tation and living standards. Genetic disease varies among human stuff of evolution, it is seldom straightforward to map genotypic populations because both long-term population sizes and histories now genomic variability onto phenotypic differences between of natural selection determine how many disease-causing muta- individuals and populations see Boxes 3 and 4.

This is similar to the can help drive this idea home. Common ancestry explains why long-established link between sickle cell anemia in individuals biomedical research in animals is applicable to humans Antolin who inherit at least one copy of the S allele of the HBB globin But some caution is in order, as in the case of differences gene, but where heterozygotes have some degree of resistance to between humans and mouse strains in the P family of en- malaria Allison In addition to leading to better diagnoses zymes important for drug metabolism, which limits the mouse as and treatments, seeing diseases as unfortunate genetic legacies in- a model for drug testing for humans Nelson et al.

Further, herited from the past may also help ameliorate some of the social it is important for medical practitioners to be aware that each pa- stigma associated with genetic diseases. In gathers, before the domestication of plants and animals. Nonetheless, the concepts of a mismatch and an ease and morbidity, especially if infections are chronic. Whether EEA provide opportunities to introduce students to the scientific the correlation between testosterone and altered immune function process, with discussion, gathering of information, and forming represents a genetic trade-off, or whether reallocation represents testable hypotheses.

In health and medicine, Evolutionary rate is dependent on generation times phenotypic plasticity may explain why early developmental prob- Exploring evolution on a microbial time scale can help students lems may lead to disease in adults Bateson et al.

An understand the roles of genetic variation and reproductive suc- example of developmental trade-offs leading to disease in later cess in evolution Box 9.

Short generation time, huge popula- life is increased susceptibility to heart disease in adults related to tions, high mutation rate, genetic reassortment, and horizontal periods of nutritional deficiencies and slowed growth in fetal de- gene transfer in microbes and viruses ensures that infectious dis- velopment and early childhood.

The damage is potentially higher eases will evade therapies and vaccines in the future, and that if subsequent weight gain catch-up growth is too rapid when new diseases will continue to emerge from reservoirs in wild an- better nutrition becomes available. This dynamic view of disease accounts for the variabil- nutritional stress, and should be considered during care of low ity in human-adapted pathogens such as influenza viruses and birth weight or premature babies Bateson et al.

Understanding how pathogen variabil- Weak selection on the diseases of aging helps explain their persis- ity arises leads to public health interventions that may reduce tence in modern times, especially as postreproductive longevity exposure and limit chains of transmission Galvani The evolutionary the- In our germophobic society, students need to realize that we have ory of aging suggests that early-life fitness components including a long evolutionary history with microbes and parasites, and that developmental rate, age at first birth, and fecundity early in life these organisms are not always debilitating even if they cause mild are linked by trade-offs to fecundity and mortality later in life.

In some cases, microbes are helpful, If these trade-offs result from the same genes acting at both life and removing all commensals can be unhealthy: consider the oc- stages, selection on early-life traits will increase their frequency currence of vaginal yeast infections in conjunction with systemic even if they negatively impact fitness-related traits later in life, a antibiotic use Eckert et al.

As we learn more genetic effect called antagonistic pleiotropy cf. Williams Although microbial species that colonize our bodies, we discover just how increased testosterone has clear benefits for maximizing male important commensal organisms are to our well-being e.

This hypothesis predicts that restoration of helminth in- struction occurs, to explore relationships between evolution and fections, or some facsimile thereof, should relieve symptoms of health. We encourage evolutionary biologists to reach out to pre- at least some of these diseases. Particularly, striking is the observation that patients with Financial support for this symposium was provided by the Education both multiple sclerosis and worm infections experience a much and Outreach Committee of the Society for the Study of Evolution, by slower development of disease than do those lacking worm infec- the National Evolutionary Synthesis Center, and by the co-authors home tions Correale and Farez Finally, our long evolutionary institutions.

We thank the local organizers of the Evolution meetings, history with pathogens has led to many defensive adaptations, in- particularly R. Broughton, I. Schlupp, and L.

Weider special thanks for the use of the bicycle! American Association of Williams and Nesse ; Carey Flores-Dorantes, J. Kruit, T. Villarreal-Molina, O. Arellano-Campos, T. Hunemeier, A. Moreno-Estrada, M. Villamil-Ramirez, P. Leon-Mimila, et al.

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