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Evolution in medical school: Do we need more of it?

Posted by Kevin Hartnett  April 29, 2013 09:56 AM

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We’re used to controversies around the teaching of evolution but here’s one place you might be surprised to learn Darwinian thinking is still struggling to take hold: medical schools. It’s not that the medical establishment doubts evolution, it’s just that traditionally it hasn’t viewed it as particularly relevant to taking care of patients.

“It’s not too hard to demonstrate that doctors are ignorant about real fundamentals of evolution,” says Randolph Nesse. “They’d flunk their first quiz in an evolution course.”

Nesse, who teaches evolutionary biology at the University of Michigan and was trained as a physician, has for more than two decades been leading the charge to make evolution a bigger part of how doctors are trained. He argues medical schools do a good job teaching doctors the mechanisms by which diseases attack the body, but pay insufficient attention to the more general question of why our bodies have evolved with vulnerabilities to pathologies like cancer and diabetes in the first palce.

“A doctor who has a deep foundation in evolution will think different about disease,” says Nesse. “Instead of just seeing disease as some screw-up in the machine, they will ask of every disease, why didn’t natural selection make the body more resistant to this particular problem?”

Evolutionary thinking about health can be flimsy sometimes. Recent years have seen the rise of the so-called “paleodiet,” based on the idea that since most of our evolution took place in prehistoric time, we should eat like prehistoric people. In her new book “Paleofantasy” biologist Marlene Zuk reveals the lack of evidence supporting the paleodiet and other evolutionary health fads. For their part, evolutionary biologists say that their jobs are only made harder by this loose appropriation of their thinking.

“A lot of people in the lifestyle world want to use the label of evolutionary medicine to describe things that are loose-goosey,” says Stephen Stearns, an evolutionary biologist at Yale University and a leading advocate for evolutionary medicine. “It makes my life more difficult, because the more rigorous insights tend to get lumped in with the less rigorous insights.”

And it’s those more rigorous insights that proponents of evolutionary medicine claim medical students aren’t getting. Stearns, Nesse, and Jeffrey Flier, Dean of Harvard Medical School, were among 13 co-authors of a 2010 paper called “Making evolutionary biology a basic science for medicine.” The core of their argument is that evolutionary medicine provides doctors with a unified way to think about the human body, as opposed to considering each part of the body in terms of its discrete function. Evolutionary biologists also argue that evolutionary thinking has the potential to help crack some of the biggest health problems of our time, including the increase of autoimmune disorders, the rising menace of antibiotic resistance, and the intransigence of cancer.

Not everyone agrees. Skeptics of evolutionary medicine argue that understanding why human beings evolved with a vulnerability to something like obesity doesn’t change the way a doctor would treat an obese patient. They agree that evolutionary biology is a useful perspective for doctors to have, but don’t think it’s necessarily any more essential than many other disciplines vying for space in crowded medical school course schedules.

“I think evolutionary biology could be taught to a much greater extent, but as a dean who has many passions about education, there are many competing priorities for the time in the curriculum,” says Robert Alpern, Dean of Yale Medical School. As to whether additional medical training in evolution would improve the way doctors treat patients or conduct research, Alpern says, “I don’t think they’d change a lot.”

And this is one of the most interesting things of all about evolutionary medicine: how widely opinions differ about its usefulness. For evolutionary biologists like Nesse and Stearns, evolutionary medicine is tantamount to a revolution in the way we think about health and disease. For Alpern and others in the medical establishment, it’s an interesting perspective without significant practical implications that’s already being taught sufficiently in most medical schools.

There are signs that medicine is moving in the direction of evolutionary thinking. Both the revised Advanced Placement Biology curriculum and the new version of the MCAT, which debuts in 2015, will feature more questions about evolution. And Arizona State University, the University of California, San Francisco, and the University of California, Los Angeles all now have centers devoted to evolutionary medicine.

But overall, boosters of evolutionary medicine remain an insurgent force making a difficult argument—that medical school administrators de-emphasize evolutionary medicine because they don’t quite understand it.

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About brainiac Brainiac is the daily blog of the Globe's Sunday Ideas section, covering news and delights from the worlds of art, science, literature, history, design, and more. You can follow us on Twitter @GlobeIdeas.
Brainiac blogger Kevin Hartnett is a writer in Columbia, South Carolina. He can be reached here.

Leon Neyfakh is the staff writer for Ideas. Amanda Katz is the deputy Ideas editor. Stephen Heuser is the Ideas editor.

Guest blogger Simon Waxman is Managing Editor of Boston Review and has written for WBUR, Alternet, McSweeney's, Jacobin, and others.

Guest blogger Elizabeth Manus is a writer living in New York City. She has been a book review editor at the Boston Phoenix, and a columnist for The New York Observer and Metro.

Guest blogger Sarah Laskow is a freelance writer and editor in New York City. She edits Smithsonian's SmartNews blog and has contributed to Salon, Good, The American Prospect, Bloomberg News, and other publications.

Guest blogger Joshua Glenn is a Boston-based writer, publisher, and freelance semiotician. He was the original Brainiac blogger, and is currently editor of the blog HiLobrow, publisher of a series of Radium Age science fiction novels, and co-author/co-editor of several books, including the story collection "Significant Objects" and the kids' field guide to life "Unbored."

Guest blogger Ruth Graham is a freelance journalist in New Hampshire, and a frequent Ideas contributor. She is a former features editor for the New York Sun, and has written for publications including Slate and the Wall Street Journal.

Joshua Rothman is a graduate student and Teaching Fellow in the Harvard English department, and an Instructor in Public Policy at the Harvard Kennedy School of Government. He teaches novels and political writing.


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