Show notes from Podcast #17. No love for evolution in medical school. Discussion with Joe Alcock and Coffee Brown. This podcast discusses topics raised in the recent post “Why isn’t evolutionary medicine more popular.”

Joe Alcock (left), Coffee Brown (background) and students learning the evolutionary biology of prehospital medicine

From: Why is evolution so hard to understand

This is the TED talk by Dorothy Roberts who I mentioned in the podcast – The problem with race-based medicine

Here are Coffee Brown’s reasons for resistance to evolution in medical school.

1. People reject evolution. Evolutionary solutions seem at once too perfect and too imperfect for many people to accept. Nature is an idiot savant.
2. Understanding “the Selfish Gene” explains so much, but people do not want to see themselves as puppets of insentient snippets of DNA.
3. Many transitional systems retain some functionality – but may be problematic as well: The tonsils function as Waldeyer’s lymphatic rings. The tradeoffs are too nuanced for people to understand.
4. As we change the environment we evolved into, our adaptions get obsoleted: The mismatch hypothesis is not taught in medical school.
5. Hard to see adaptation in disease. One answer is antagonistic pleiotropy: Mechanisms important in trauma are counterproductive when they occur in congestive heart failure later in life. Natures’ plan for us more or less ends when our offspring can reproduce.
6. People find simpler, more comfortable/catchy answers to be also more credible. We often judge an idea by how it fits our existing world, rather than by how it expands that world.
7. Many people underestimate the complexity which can result from the relatively simple laws of evolution.
8. Simple as these concepts truly are, they are not quite as simple as most non-scientists think.
9. People wrongly believe there is not experimental evidence for evolution
10. Misunderstanding of the origin of human variability, e.g. pharmacogenetics and nutritional genetics.
11. “Cancer and aging are not adaptive, so why do they exist?” Evolution does not lead to perfect health.
12. We are not obliged to provide an evolutionary explanation in all cases to say it may be useful to hunt for one.
13. Most attributes distribute according to a bell-shaped curve, with greater deviation becoming more problematic: Exaggerated benefits become outweighed by exaggerated deficits, since evolution tends to sort for “Best Practices” or optimized trade-offs.
14.  Is evolution as useful to clinicians as to researchers? To patients? To the general public?
15. “Darwinian medicine”? Seriously?
16. We want to be careful of either/or medicine. Evolutionary contributions may be relevant to some, but not necessarily all, pathologies, and their presence or absence does not directly speak to how hard we should look other, often more proximate causes.” Randolph M. Nesse summarizes its relevance to medicine: all biological traits need two kinds of explanation, both proximate and evolutionary”

18. The subtle and unexpected Nash equilibria of evolution ought to inspire caution with regard to genetic engineering. Do we really want all our sons to be 6’8” tall? Or every girl to be blue-eyed?

19. The fallacy of just-so-stories and the need for hypothesis testing.

20. Religion.

How and why we should teach evolution in medicine is a debate we will explore this summer in Park City Utah at the 4th annual meeting of ISEMPH – The International Society for Evolution, Medicine and Public Health.

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Joe Alcock

Emergency Physician, Educator, Researcher, interested in the microbiome, evolution, and medicine