Wednesday, October 22, 2008

News: Evolution in Health and Disease, Aging and Longevity

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Dear All:

I am pleased to announce that today the New England Journal of Medicine has published our invited review of this new book:

Evolution in Health and Disease
by Stephen C Stearns and Jacob C Koella
Oxford University Press, 2008

Here is the reference to our new published book review:

Gavrilov L.A., Gavrilova N.S.
Evolution in Health and Disease [Book Review].
The New England Journal of Medicine, 2008, 359(17): 1856-1857.

Also here is our initial original text of the book review, which is somewhat more detailed and informative when compared to the abridged final edited text published by the journal:

This book introduces evolutionary approach to medicine, and it provides almost encyclopedic coverage of all medical topics where the evolutionary principles are applied. The book consists of 23 chapters written by a large international team of 47 leading researchers from the United States, United Kingdom, France, Switzerland, and New Zealand. This latest second edition of the book has an extensive updated bibliography of over 1,500 references, and it is organized in 5 major parts:

(1) Introducing evolutionary thinking for medicine;
(2) The history and variation of human genes;
(3) Natural selection and evolutionary conflicts;
(4) Pathogens: resistance, virulence, variation, and emergence;
(5) Noninfectious and degenerative diseases (including aging).

The book is provided with a detailed Subject Index (10 pages), which really helps to navigate in a great diversity of covered topics.

The main content of this book is well summarized in its first, introductory chapter, which overviews evolutionary approach to complex medical issues in a reader-friendly way. The authors seem to be acutely aware of the current healthy skepticism among medical experts regarding practical usefulness of evolutionary theory. Therefore, they start to address these concerns from the very beginning of the book:

"Should doctors and medical researchers think about evolution? Does it bring useful insights? Would doctors and researchers who learned a substantial amount about evolution be more effective than a control group that learned only the usual rudiments? Would providing such education improve health enough to justify the costs?"

They acknowledge that evolutionary theory is not helpful to surgeons, but it may be useful to internists, pediatricians, epidemiologists and geneticists, when "prescribing antibiotics, managing virulent diseases, administrating vaccinations, advising couples who have difficulty conceiving and carrying offspring to term, treating diabetes and high blood pressure of pregnancy, treating cancer, understanding the origins of the current epidemics of obesity, diabetes, and autoimmune diseases, and answering patients' questions about aging."

This statement is further justified in the introductory chapter with several particular examples and evolutionary insights, which then concludes with 12 'commandments' on "What doctors need to know about evolution and why."

The first introductory chapter is so well written that it may be a sufficient reading for busy practicing doctors. The authors themselves "acknowledge that much medical practice proceeds just fine with little need for a theoretical foundation. Medicine is a profession that offers practical help. .... Evolution is not an alternative to existing medical training and research. It is a useful basic science that poses new medical questions, contributing to research while also improving practice." (page 3).

Therefore this book is of a particular interest to researchers involved in biomedical studies and developing new treatments.

The major evolutionary insight of this book is that many diseases in developed countries (obesity, diabetes, breast cancer, autoimmune and heart diseases, etc.) are promoted by mismatch of human bodies to modern environment, because the environment is changing far more rapidly than humans can evolve. This insight may have some useful practical implications, like convincing patients that physical inactivity, which is so common in developed countries, is a very serious health issue and has to be vigorously avoided, to the same extend as smoking.

The same reasoning justifies the urgent need for a radical revision of the modern diet to a healthier standard, which matches better the ancestral needs of human body, by providing foods with much lower glycemic index (load) and much higher proportion of omega-3 unsaturated fatty acids. These important topics are very well covered in the chapter 20 "Lifestyle, diet, and disease: comparative perspectives on the determinants of chronic health risks" by William R. Leonard from the Northwestern University Department of Anthropology.

Another notable chapter of the book is chapter 9 "Perspectives on human health and disease from evolutionary and behavioral ecology" by Beverly I. Strassmann (Institute for Social Research & Department of Anthropology, Ann Arbor, USA), and Ruth Mace (University College London Department of Anthropology, UK). It presents a thoughtful review of trade-offs between longevity and fertility, and refutes the highly publicized claims that human longevity comes with the cost of impaired fertility among long lived persons.

One minor weakness of this book may be related to some neglect of alternative, non-evolutionary explanations. For example, human aging is discussed mostly in narrow evolutionary terms, while ignoring a more general theory of systems failure (systems reliability theory), which is included now in the Handbook of the Biology of Aging (Academic Press, 2006), and other biomedical publications on aging.

This book will be useful to biomedical students, researchers and doctors, because it stimulates fresh thinking and new approaches to traditional medical problems.

Leonid Gavrilov, Ph.D.
Natalia Gavrilova, Ph.D.
Center on Aging, University of Chicago
Chicago, IL 60637

Key words:
New books, New England Journal of Medicine, Evolution in Health and Disease, Evolution, Health, Disease, Leonid Gavrilov, Natalia Gavrilova, Stephen Stearns, Jacob Koella, Oxford University Press, evolutionary medicine, evolutionary genetics, human behavioral ecology, evolutionary microbiology, evolution of aging and degenerative disease, diabetes, obesity, cardiovascular disease, asthma, allergies, autoimmune diseases, aging, evolutionary (Darwinian) medicine, evolutionary biology, anthropology, developmental biology, genetics

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