Evolution in Health and Disease

. Stephen C. Stearns (ed.). Oxford University Press, Oxford. 1999. Pp. 328. Price £23.50, paperback. ISBN 0 19 850445 4.

This ambitious text is the result of a conference held in Switzerland in April 1997 which brought together many of those who are leading the quest for evolutionary answers to the problems of modern medicine. It aims to bring evolutionary biology to the attention of those involved in medical education and research and make doctors ‘consider evolutionary thinking a standard part of their toolkit’.

The introductory chapter makes great claims for a Darwinian approach stating ‘evolution combines with physics and chemistry to explain all biological phenomena and it is the only part of biology containing basic principles not implicit in physics and chemistry’. This may be true, but it will be taken by some as a further example of an ultra-Darwinian claim to exclusivity of truth and a denial of other perspectives. In fairness the majority of the book should not be taken in this way as both the benefits and limitations of an evolutionary approach are discussed.

There is great breadth in what is covered — from chapters considering parasite virulence to those on complex genetic disorders (and including the entertainingly titled ‘Putting the stone age in perspective’). That there is something of interest for everyone is its strength, but some chapters (for example on psychiatric disorders) seem brief and leave you wanting more.

In the case of complex genetic diseases such as major psychiatric illness, the full benefit of an evolutionary perspective awaits the discovery of susceptibility genes. However, methodologies are being developed — such as cladistic analysis – which use an evolutionary perspective to locate such genes and illustrate the practical benefits of adopting this approach now.

There is much of interest in this book and I have no hesitation in recommending it. If not to be devoured from cover to cover, it certainly is a rich resource from which to pick chapters of interest. Evolutionary biology was not part of my medical school education in the mid-eighties and I suspect that this situation has not drastically altered. While this is clearly a serious omission, will attention to the ‘ultimate causation’ of evolutionary explanation lead to the major paradigm shift in medical research and practice that the authors expect? A Darwinian perspective providing ‘new insights into old questions’, is important but will not provide a complete account of health and disease. The truth about perspectives is that there are always others.