Medical students may soon be tested on evolution

January 26, 2010, National Evolutionary Synthesis Center (NESCent)
Evolutionary theory can help us tackle diverse problems in medicine and public health, says a growing body of researchers and physicians. Credit: Photo from Wikimedia commons

What does evolution - a field that often deals with changes over many generations - have to do with preventing and treating disease in our lifetime? A lot, some scientists say. If recent recommendations are implemented, future physicians may soon be tested on evolution in medical entrance and licensing exams, says an international group of doctors and researchers.

A collection of articles in the January 26 issue of illustrates recent progress in applying evolutionary theory to a range of questions in medicine and public health, from why some people age slower and live longer than others, to why humans suffer from mental illnesses like autism and schizophrenia, to why we have higher rates of cancer than other species.

"There are many ways you can use evolution to improve medical care and medical research," said psychiatrist Randolph Nesse of the University of Michigan.

Nesse is one of a growing number of scientists who since the mid-1990s have been urging medical doctors and researchers to consider human health from an evolutionary perspective. Evolutionary training may benefit researchers in the lab, skeptics argue, but what use is evolution for everyday medical care in the clinic?

"In terms of immediate payoffs, right up at the top of the list are and cancer," said Stephen Stearns, a biologist at Yale University. Because of their rapid rates of reproduction, both bacteria and quickly evolve resistance to the drugs we use to fight them. "Some develop resistance in just one or two years after drug release," explained Diddahally Govindaraju of the Boston University School of Medicine. "Antibiotic resistance and resistance to chemotherapy are problems that cause enormous suffering and death and also sky-high costs," added Stearns. "We can alleviate these problems if we manage the way we use and antibiotics so as to slow or prevent the evolution of resistance."

Meanwhile in the world of infectious disease, techniques developed by evolutionary biologists - such as methods for reconstructing genetic relationships, or family trees - have been used to trace the origins of pathogens like flu, SARS, and HIV. By uncovering where these diseases came from and how they spread, public health officials can better prepare for outbreaks in the future.

Evolutionary thinking can also yield surprising medical therapies, the authors explain. Throughout much of our history, for example, humans coexisted with beneficial bacteria and intestinal worms. Reduced exposure to these bugs due to improved hygiene leaves many with immune systems that don't respond appropriately, scientists say. Research suggests we may be able to reduce our susceptibility to allergies, asthma, and many auto-immune diseases — from inflammatory bowel disease to multiple sclerosis — by giving patients "cocktails" of parasite eggs. "There are now 4000 people in a clinical trial to test the efficacy of worm eggs," said Stearns.

"It's an insight that comes right out of left field," Stearns added. "Unless you were thinking about coevolution of humans and their gut flora, you never would have thought you could treat an autoimmune disease by making the immune system think the body is inhabited by parasites."

Given the numerous ways evolutionary concepts can inform medical practice, the authors argue, it's time to transmit those lessons to those best positioned to put them to use — future physicians. Though anatomy, physiology and biochemistry have long been mainstays of medical education, evolutionary biology is largely absent from the medical school curriculum, studies find. "No medical school in the United States offers evolutionary biology as a medical science, and most have no evolution at all in the curriculum," said Nesse.

In the final paper, Nesse, Stearns, Govindaraju, and 10 other physicians and researchers - including Jeffry Flier, the Dean of the Harvard Medical School - call for greater evolution education both before and during medical school. "We're urging that evolutionary biology be recognized as something that all entering medical students should have a good grasp of," said co-author Peter Ellison of Harvard University.

"It's a basic science like embryology and biochemistry and all the rest," added Nesse. "We insist on students learning many of these basic sciences not because doctors need embryology everyday in the clinic, but because we want them to understand what's going on in normal functioning and disease."

Their ideas may be gaining ground. This past summer, the American Association of Medical Colleges (AAMC) and the Howard Hughes Medical Institute (HHMI) published a joint report, titled Scientific Foundations for Future Physicians. The report calls for ambitious changes in the science content in the premedical curriculum and on the Medical College Admission Test (MCAT), including increased emphasis on evolution. "For the first time, the AAMC and HHMI are recommending that evolution be one of the basic sciences students learn before they come to medical school," Nesse explained.

If the recommendations take hold, future physicians may soon be tested on evolution in the Medical College Admission Test (MCAT). "The MCATs are currently under review, and changes will be made in the next two years," said Stearns. "Those recommendations will affect thousands of colleges and universities across the country," Stearns added.

"Pre-med students often say: 'What on earth does this have to do with me? Fossils aren't going to help me get into medical school,'" said biologist Jay Labov of the National Academy of Sciences. "But without an , a doctor's tools are somewhat limited."

More information: "Evolution in Health and Medicine Special Feature." Proceedings of the National Academy of Sciences, 2010 107(4).

Related Stories

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.