Darwinian Medicine Diarrhea helps us remove pathogens quickly.

[Subjects
given Shigella took twice as long to recover when given
Disclaimers: while many of the specific examples are pretty anti-diarrheal medication as when left untreated.]
solidly supported by research, some could still be thought of as Morning sickness (and other vomiting responses) allows
scientific “just-so stories.” They make logical sense in light of the
principles of evolution, but they have not been studied to the extent removal of potentially harmful substances before harm
that we can state that they are conclusive to the highest scientific can be done. In pregnant women morning sickness occurs
standards. Often people, including scientists, use language that mainly during the first trimester when the embryo is most
seems to imply intent; of course no actual intent or ‘design’ is in vulnerable to effects of toxic or teratogenic [causing birth
effect. One more thing: Darwinian medicine deals with ultimate defects] agents. [Studies indicate fewer birth defects
(i.e. evolutionary) causes and not immediate or proximate ones. It occur in women having more pronounced morning
can be confusing to distinguish between these.
sickness.]
Allergic responses (‘hay fever,’ etc.) represent the
Exploring Darwinian medicine is one of the best
body’s overkill response to relatively harmless
ways to see the connection of evolution to the lives of
substances. [This is often likened to having a smoke
each one of us. Darwinian medicine is the search for
detector that may give false alarms when you burn your
evolutionary explanations for human ailments. Its main
toast but is there when you actually have a fire that could
premise is that we, as organisms that have evolved, have
kill you.]
various features that are a result of our evolutionary past,
Coughing and sneezing help remove organisms that can
and that many of these affect our health. A good account
cause disease. [However, some organisms have
of Darwinian medicine can be found in the article,
developed the ability to use these responses to spread
“Evolution and the Origins of Disease,” by Randolph
themselves to new hosts. This situation would then fall in
Nesse and George Williams which was published in
the next category of Darwinian medicine – especially as it
Scientific American (November 1998). [This article is
relates to virulence.]
essentially an updated synopsis of their groundbreaking
2) Interactions with other organisms have produced a wide
book, Why We Get Sick.]
range of structures, functions, and situations that are often
There are five main categories of Darwinian
important in medical conditions.
medicine as described in the Nesse and Williams article:
Antibiotic resistance shows a selection for pathogens
1) Evolved defenses, 2) Interactions with other
that withstand even very powerful chemical defenses.
organisms, 3) Novel situations, 4) Trade offs, and 5)
Virulence. Some pathogens take advantage of bodily
Historical constraints. Below, in more detail, are the
defenses to help in their own spread. Thus, the level of
five main categories of Darwinian medicine:
virulence depends on the mode and situations involved in
1) Evolved defenses. Some apparent problems may be
their spread. [Pathogens spread by direct contact tend to
evolutionary responses that help us cope with various
evolve reduced virulence, while pathogens using a vector
assaults.
tend to evolve greater virulence. For example, in societies
Pain is a signal that we are doing something harmful that
where there is good sanitation, cholera strains are
we need to stop doing. The ability to ignore such stimuli
relatively benign. Where sanitation is not good, cholera is
often results in serious long-term damage.
much more virulent. In the case of insect-borne disease
Fever helps kill pathogens that can cause life-threatening
such as malaria, individuals with disease are easier to be
diseases. [In lizards that have infections, they will spend
reached by mosquito vectors, and malaria is quite
more time in hotter areas, thus increasing body
virulent.]
temperature above normal levels. In old rats, which have
Predator and prey interactions often take the form of an
reduced ability to increase body temperature, there is a
evolutionary race. [Faster rabbits with eyes on the sides
similar tendency to select warmer areas, thus increasing
of the head; faster foxes; and so on. This example may
body temperature.]
not fit exactly into the realm of Darwinian medicine, but
Anemia can result when the body sequesters iron in the
such interactions may be useful in understanding some
liver; this withholds a vital nutrient from bacteria.
ways our body does things.]
[Providing iron to undernourished, anemic peoples has
Parasite and host interactions can often evolve into a
caused a high level of infection, inasmuch as they lack
more mutualistic relationship. There even exist conflicts
proteins for the immune system, and the iron feeds the
between a mother and her child – both before birth and
bacteria.]
after. [Perhaps many mother-child interactions can be
Anxiety allows even relatively simple animals to avoid
viewed in terms of parasitism. Parasitism is a grossly
hazardous situations. [A study with guppies having a
underestimated force in the lives of all organisms,
genetic difference in “boldness” showed a survival rate of
accounting for many attributes of most living things on
40% for timid guppies, 15% for normal guppies, and 0%
this planet. This likely includes the evolution of sexual
for fearless guppies after 60 hours in a tank with a small
reproduction as a way to “out run” the parasites by having
mouth bass.]
a ready source of genetic variation within a population.]
3) Novel situations are those that have arisen relatively
recently (some time in the past 8-10,000 years), and there
 has been insufficient time for mutations to arise or
become widely established. Many of these situations
revolve around the dramatic change in food supply and
lifestyles that occurred after agriculture was developed.
The diet of hunter-gatherers is much different than what
modern agricultural societies have. We suffer from the
effects of having much more ready access to meat, sugar,
and refined grains, and in having a much more sedentary
life style than hunter-gatherer peoples had. The
availability of various drugs is new – including even
fairly ancient ones like alcohol and tobacco. The later
age and lower rates of pregnancy – traits associated
with modern, industrialized societies – seem related to an
increased rate of breast cancer. Myopia is associated with
increased amounts of close work found in literate
societies. Increased and/or misplaced anxiety and
depression can be correlated with increased crowding
and pace of living associated with modern society or as
throwbacks to more perilous times. Possibly excessive
cleanliness can be seen in a similar way: the hygiene
hypothesis postulates that children exposed to more
bacteria, etc. are less likely to have conditions such as
asthma. Another view holds that asthma, arthritis,
allergies [mentioned in the previous category], and
Crohn’s disease may also be thought of in this way. All
of these conditions involve the antibody IgE
(immunoglobulin E), which seems to have evolved as a
defense against worm infestations, particularly in the
digestive tract. Now that industrialized societies have
eliminated most of these parasites, the IgE seems to spend
its time attacking parts of our own bodies.
4) Trade offs represent situations where improvements come
at too great a cost, or in which a bad situation/mutation is
better than an alternative. Stronger bones, for example,
would necessitate a level of calcium intake that would be
almost impossible to sustain. Improved hearing
sensitivity would cause constant distraction by
insignificant stimuli. The genetic “disorder,” sickle cell
trait (heterozygous for sickle cell anemia) confers
resistance to malaria and is therefore a good mutation in
areas where malaria is common but a detriment where it
is not. PKU is associated with reduced miscarriages.
Cystic fibrosis heterozygotes have reduced susceptibility
to asthma and cholera. Gout (due to increased levels of
uric acid in the blood) seems to prevent aging and to
permit higher mental activity. A more active immune
system would likely cause more auto-immune disease.
Fragile-X syndrome is associated with increased fertility
in females, but it causes males to have some significant
problems. Tay-Sachs heterozygotes resist tuberculosis.
Hemochromatosis, the most common genetic disease
among those of European descent, causes the body to
store excessive amounts of iron - this helps females avoid
anemia, and even more importantly, it may have resulted
as a defense against the plague. Melanin skin
pigmentation has been associated with protection from
UV light damage; however, some suggest it may be more
important in heat regulation, but in northern latitudes it
may have been selected against because it reduced
vitamin D formation. Colorblindness may allow better
visualization of camouflaged organisms.
5) Historical constraints show that evolution must build on
or modify existing structures or characteristics. A less-
than-desirable ‘design’ for a structure arises because the
organisms cannot “rethink” its design to make one that is
optimal once it has made an earlier “choice.” Examples
include the vertebrate eye when compared to an
invertebrate eye (e.g. squid). The vertebrate eye has its
“wiring” in front of the receptive surface (retina); this
results in having a blind spot created where the nerves
leave the eye; it also creates a significant risk for retinal
detachment. In squid eyes the nerve connections are on
the backside of the retina, thus they have no blind spot,
and, they have almost no risk of retinal detachment. In
vertebrates the result of terrestrial animals having lungs
that developed from the swim bladder of fish has
produced a crossover zone between the trachea and
esophagus; this has meant that people have a significant
chance of choking on food. The human spine seems ill-
suited to an upright posture; our knees also are subject to
various problems due to usage; in women the ligament
holding the bladder seems inadequate to support it after a
few pregnancies; the male prostate gland often restricts
the urethra in later life; and the vermiform appendix
creates problems when it becomes inflamed. (What was
once a useful fermentation chamber seems to be a
superfluous source of problems; however, its size seems
unlikely to decrease due to the increased hazard of
infection, if the appendix were to get smaller.) [See also
the article, “If Humans Were Built to Last,” in Scientific
American (March 2001).]
One key topic not covered above has to do with
the evolution of cancers within an organism. Various
principles of natural selection may be seen here as
well.
For further reading on this and related topics:
Williams, George; Nesse, Randolph M. (1996). Why we
get sick: the new science of Darwinian medicine
Stearns SC, Koella JK (2008). Evolution in health and
disease (2nd ed.).
McKenna, James J.; Trevathan, Wenda; Smith, Euclid O.
(2008). Evolutionary medicine and health: new
perspectives (2nd ed.)
O'Higgins, Paul; Sarah Elton (2008). Medicine and
Evolution: Current Applications, Future Prospects
(Society for the Study of Human Biology Symposium
Series (Sshb)).
Ewald, P. W. (1996). Evolution of Infectious Disease.
Diamond, Jared. (1997) Guns, Germs, and Steel: The
Fates of Human Societies.
Moalem, S. (2007). Survival of the Sickest.
Links:
http://en.wikipedia.org/wiki/Evolutionary_medicine
https://www.britannica.com/science/Darwinian-medicine