In this review essay, we consider the interplay between evolutionary biology, on the one hand, and the biomedical sciences on the other. With certain exceptions (drug resistance in bacteria being an example) the ties between evolutionary theory and the biomedical sciences, though perhaps implicitly recognized, have until relatively recently, not been coherently articulated. In the last 15 years numerous books and articles have been written which have attempted to define "the new science of Darwinian medicine." Our aim in this review is thus to delineate the contours of this new branch of biomedical inquiry, and to draw out some of its philosophical significance.
The relationship between evolutionary biology and the biomedical sciences has not always been a comfortable one. Consider comparative physiology – a discipline with enormous implications for the biomedical sciences, given the importance of comparative animal studies. Over a decade ago, Burggrem and Bemis could lament:
Unfortunately comparative physiology traditionally has been, and continues to be, outside the framework of contemporary evolutionary biology, often embracing theories, positions or approaches that contemporary morphologists, evolutionary biologists, and geneticists have abandoned [[1]:193].
The relevance of evolutionary biology to medicine is also poorly understood by educated members of the public. Perhaps more disturbing are misunderstandings – and even a lack of understanding – of the relevance of evolutionary biology for medicine (in theory and in practice) by medical professionals. As Ewald has observed:
Evolutionary biology is so firmly integrated with the rest of biology that it is not possible to mark a boundary between them. But modern medicine has been a peninsula. It is broadly and firmly connected with most regions of biology. . . but has just a few thin bridges traversing the gulf to evolutionary biology. Knowledge about the evolution of antibiotic resistance is perhaps the best developed bridge between the disciplines. The discovery of the evolutionary basis for sickle cell anemia – protection against malaria – is another [[2]:7].
Ewald continues:
There are probably many reasons for the paucity of bridges. One stems from the inadequate appreciation of the pervasiveness of evolutionary principles. From secondary school through medical school, the fundamental relevance of evolution to all human life has often been ignored or even suppressed [[2]:7].
We believe it is important for the public, as consumers of medical services, and for medical practitioners themselves to have a greater appreciation of the medical implications of evolutionary biology. At its cutting edge, evolutionary biology has serious consequences for our understanding of human health and well-being – consequences that we ignore at our peril. The issues here will take us into the doctor's office and the hospital – places a long way away from the study of fossils of long-dead animals.
Evolutionary biology is a major research specialty in its own right, and a full review of the matters at hand would take many volumes. In this essay we focus on some key areas where evolution has had an impact on our understanding of medical phenomena. We begin with a discussion of some aspects of evolutionary biology.
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