New medical insights have arisen from the recognition of evolutionary conflicts among relatives. 1

Third, disruptions of the equilibria achieved in evolutionary conflicts of interest among relatives may be the basis of some mental diseases, particularly autism and schizophrenia, a possibility presented at this meeting, placed in context later in this introduction, and discussed in detail in Crespi et al. The classic view of the genome architecture was that each of us had the same number of copies of each of the genomic regions. The case studies in this section illuminate how evolutionary approaches can make a difference in the world of medicine. Exploring issues and controversies in the relationship between science and medicine. demonstrate that Ashkenazi centenarians have unusual ability to maintain the length of their telomeres, the caps on the chromosomes made up of repeat DNA sequences that are shortened in each cell division (20). Kosova, Abney, Ober report data from a Hutterite population where birth control is not used and social stratification is minimized by cultural constraints (41). In the second, Finch argues that we have achieved a doubling of our lifespan since our last common ancestor with chimpanzees, in part because of evolutionary changes in genes that mediate infection, inflammation, and nutrition (21). Thus, diphtheria infections and clinical isolations still occur, but the extant strains lack toxin production. Finch focuses in particular on the compromises implicit in the complex effects of apolipoprotein E alleles, which affect immunity, cardiovascular disease, Alzheimer’s disease, and brain development, a striking example of the basic insight that our bodies are bundles of evolutionary compromises, not perfect machines designed by engineers (1, 11, 22).

<< This finding is important because it means that real biological systems are more likely to be able to attain fitness maxima that had previously been thought inaccessible; they can get across rougher topography in the fitness landscape than we had thought. Another important branch of evolutionary medicine consists of studies that deepen our understanding of basic, general, evolutionary processes. Three themes at the intersection of evolution and medicine are so well developed they can be considered classic. One puts down their article with a sense that structural variation in the genome, and its consequences for health and disease, will be a rich source of research results for a long time to come. In an article that carefully applies basic ideas in evolutionary genetics, Eyre-Walker shows that when we consider how selection acts on the sources of genetic variance in a trait, we find that most of the genetic variance of a trait—most of its heritability—is contributed by mutations at low frequency in the population, and that the effects of rare mutations tend to be much larger than those of common mutation (34). 0 Requiring competency in evolutionary biology on the Medical College Admissions Test (MCAT) will probably improve understanding of evolutionary issues among clinicians more than any other single measure.


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