Evolutionary Approach to Medicine

Marcelo Turkienicz Berlim, MD, Alberto Mantovani Abeche, MD, Department of Gynecology and Obstetrics, Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, RS, Brazil

South Med J. 2001;94(1) 

In This Article


Darwinian Medicine is a new and revolutionary discipline of medical thinking that has gradually brought new evidence to support the principle that the interaction between the human organism and its environment is absolutely essential to the understanding of health and disease. One of the most important aims of this incipient science is to apply evolutionary principles to daily medical practice. However, this undertaking has faced several obstacles, the most important of which is physicians' difficulty in accepting the essential role of man's evolutionary history in the present panorama of health and disease. Nevertheless, many prevalent clinical entities have been discussed in the light of the Theory of Evolution, and new fields of biomedical research have arisen daily. Among topics of unquestionable interest not discussed in this article are (1) hormone replacement therapy seen, in some situations, as antagonistic to the possible adaptive value of menopause; (2) the icterus of the newborn seen, in milder cases, as an adaptation mechanism and not as a disease; (3) human emotions implicated in the genesis of psychologic disturbances taken as possibly negative aspects of sophisticated adaptive mechanisms essential for human survival in the past; (4) the abuse of illicit substances, so common nowadays and no longer a cause for moral judgment, which is beginning to be analyzed through man's evolutionary history; (5) the host-parasite-environment relationship from the evolutionary viewpoint stimulating new therapeutic approaches to fight viral and bacterial infections; (6) allergy studied as the "price paid" by humankind to develop immediate hypersensitivity mediated by IgE (molded by natural selection in fighting helminthic parasitic infections); and (7) rigid dietary recommendations suggested by health care professionals confirmed by humankind's nutritional experience throughout evolution.49

Even though today this new discipline is not extensively applied in medical practice (because of its newness), what becomes clear is that it offers medicine an additional perspective, based on the scientific knowledge of evolutionary biology -- so long treated as uninteresting by physicians. Nevertheless, evolutionary thinking applied to medicine does not aim to stimulate an alternative to medical practice. On the contrary, it seeks to add a new dimension, useful and inclusive to the understanding of health and the disease process. This field of research offers new opportunities to understand the etiologic mechanisms of a number of clinical entities. As stated by Smith,50 the ideas presented by evolutionary medicine stimulate and encourage our questioning of why and how. As observed by Nesse and Williams,[1,2,4] it teaches us that disease does not result from malevolent and random forces but from a historical process of natural selection.


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