Evolutionary Medicine - 1st Edition
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H.L. Menken once said that "A teacher is one, who in his youth, ad-
mired teachers."
Indeed, if you are lucky, somewhere at sometime, you encounter
those incredible teachers who inspire as they teach, and who leave
you with an irrepressible desire to want to learn more. Such teachers
give you an added reason to want to succeed, and they make it pos-
sible for you to do so.
In Jim McKenna's life those Professors were Larry Leach (San Diego
State), Phyllis Dolhinow (University of California, Berkeley), and
Sarah Mosko (UC Irvine School of Medicine).
Wenda Trevathan acknowledges Jack Kelso (University of Colorado),
who encouraged his students to think outside the box.
Neal Smith remembers Lena M. Grain who made him understand
that big ideas are important, but attention to detail is also essential.
Richard M. Prenshaw introduced him to the importance of music in
the tapestry of the human experience, and Irwin S. Bernstein (Uni-
versity of Georgia) patiently taught him about the rigor of scientific
inquiry.
To these teachers, scholars and researchers, we owe a tremendous
intellectual and personal debt. It is to them that we dedicate this
book.
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FOREWORD
Historical Overview
MICHAEL H. DAY
Iaccounted
t is one of the minor mysteries of medicine that the publication by Darwin
(1859) that identified evolution as a continuing biological process and that
for the diversity and successive change in living organisms was not
immediately taken up by the physicians of the day. Their daily work then, as
now, related to the whole animal biology of one species: one species that was
better known in terms of its anatomy, physiology, and behaviour than any
other species known to zoology at the time and indeed since. This failure to
recognise the significance of the idea of evolution and the explanatory power
of its mechanism, natural selection, may relate to the opposition of the estab-
lished church, which focused all of its disbelief upon the perceived contra-
diction the theory posed to the biblical explanation of the universe as set out
in the Book of Genesis. Be that as it may, it is still a matter of wonder that it
has, until recently, been rare to hear an evolutionary reason put forward as an
aetiological factor in any but a few disorders, and when they have been cited,
it has often disclosed an ignorance of adaptation as a process—for example,
backache is caused by incomplete evolution to upright posture.
Perhaps the most notable exception to the position of physicians and
surgeons with regard to evolution was John Hunter (1728-1793), the father
of scientific surgery, who had no doubt about the mutability of species. He
wrote:
To attempt to trace any natural production to its origin, or its first pro-
duction, is ridiculous; for it goes back to that period, if ever such existed,
of which we can form no idea. viz. the beginning of time. But, I think
we have no reason to suppose that there was a period in time in which
every species of natural production was the same; there being no variety
in any species; but the variations taking place on the surface of the earth.
. . . (Owen, 1861)
vii
viii FOREWORD
It is clear that Hunter accepted the principle of the change of species
through time. In other writings he accepted, in Darwin's words, the "theory
of descent with slow and slight successive modifications," that fossils are the
remains of extinct species, and that mankind and the monkeys bore a physical
relationship, and that within species there are a great number of varieties. Even
further, Hunter's evolutionary view is exemplified by his choice of the back-
ground of a portrait of him by Sir Joshua Reynolds that shows a folio of draw-
ings that illustrate an evolutionary series of skulls and hands (Qvist, 1981).
Since Hunter's time there has been no shortage of medical men who have,
through the study of comparative anatomy, accepted and contributed to an
evolutionary view of the natural world. Perhaps much of the reason for this,
at least in Europe, is that dissection of the human cadaver was almost entirely
confined to those in medical practice and that opportunities for comparative
study were available in the great schools of medicine in London and on the
continent. This tradition is one that continued into the modern era with names
such as Frederick Wood-Jones, Sir Arthur Keith, Raymond Dart, Sir Wilfrid
LeGros Clark, Lord Zuckerman, John Napier, Philip Tobias, and many others.
Interestingly, the contribution of these scholars has usually depended on their
special knowledge of primates and human osteology coupled with soft tissue
anatomy in making the interpretations of fossil materials with which they were
presented, not on their training as doctors, other than an acceptance of the
scientific method upon which modern orthodox medicine is based. It seems
that it is in this sense that the application of Darwinian principles to the prac-
tice of medicine has slipped through the intellectual net of medical education,
and it has been left to the evolutionary biologists to point out the need to take
natural selection into account in an increasing number of fields of medical
practice.
It is well known that Darwin formulated the theory of evolution without
the benefit of any knowledge of genetics because his work preceded that of
the founders of that science, but he was influenced by the writing of Malthus
(1826), the country parson who feared that population increase would outstrip
the means of the world to produce food for the people. While the worst fears
of Malthus have not yet been realised, a link between genetics and population
studies has been forged that is a powerful factor in our understanding of the
way in which evolution works. It is an equally powerful factor in our under-
standing in our appreciation of the effects of evolutionary theory on the eti-
ology and natural history of disease in the form of infection and epidemiology,
resistance to infection, responses to allergens, cellular dynamics, and the de-
velopment of tumours. A number of chapters in this volume address these
problems directly.
It is equally well known that Darwin (1872) was interested in sexual selec-
tion and the expression of the emotions in humans and animals. Once again,
the sciences of normal behaviour such as psychology and ethology as well as
the medical science of abnormal behaviour, psychiatry, have been remarkably
slow to take into consideration the consequences of the application of the idea
of natural selection in these fields. An understanding of the origins and mean-
FOREWORD ix
ing of innate or genetically determined behaviour, as well as that of acquired
or learned behaviour would seem to be central to any attempt to modify or
"correct" what is diagnosed as an abnormality. The reasons for the range and
the limits of what may, or may not, be acceptable should, at the very least, be
understood before parents, doctors, or society outlaw behaviour for their own
reasons or convenience. Several chapters address problems of this kind from
fretful infants to substance abuse.
Finally, we all know that longevity brings its own problems, problems that
most of us would rather face than the alternative. But it is clear that medical
science has, over the centuries, increased potential life span and even more
dramatically has increased the proportion of the population that reaches that
potential, at least in affluent societies. This has resulted in changes of the
proportion of the elderly in a given population and in turn a rise in the inci-
dence of chronic and degenerative diseases and a rise in the number of post-
menopausal women. (Menopause itself is a mystery, is it a "good" thing, a
"bad" thing or a chance consequence of an exceptional biological longevity?)
All of these topics—life span, chronic disease, reproductive death—are in-
tensely bound with the Darwinian view of biology and the ways in which
environmental change, nutritional change, and reproductive patterns are al-
tering our perceptions of the normal and abnormal and of health and disease.
The doctors of the future will find it necessary to take account of the biological
imperatives that Darwin revealed if they are to have any real understanding
of their trade as it will be practiced in the new millenium.
References
Darwin, C. (1859) On the Origin of Malthus, T. R. (1826) An Essay on the
Species by Means of Natural Selec- Principle of Population: or a View of
tion, or the Preservation of Favoured Its Past and Present Effects on Hu-
Races in the Struggle for Life. Lon- man Happiness, with an Inquiry into
don: Murray. Our Prospects respecting the Future
Owen, R. (1861) Essays and Observa- Removal or Mitigation of the Evils
tions on Natural History, Anatomy, Which it Occasions, 6th Ed. London:
Physiology, Psychology and Geology Murray.
by John Hunter. Vol. 1, p. 4. Ed. R. Darwin, C. (1872) On the Expression of
Owen. London: John Van Voorst. Emotions in Man and Animals. Lon-
Qvist, George (1981) John Hunter, don: Murray.
1 728-1793. London: Heinemann.
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CONTENTS
Foreword: Historical Overview v
Michael H. Day
Contributors xv
Introduction 3
1 Is Neonatal Jaundice a Disease or an Adaptive Process? 7
John Brett
Susan Niermeyer
2 Infant Crying Behavior and Colic:
An Interpretation in Evolutionary Perspective 27
Ronald G. Barr
3 Breastfeeding and Mother-Infant Cosleeping in Relation
to SIDS Prevention 53
fames McKenna
Sarah Mosko
Chris Richard
4 Otitis Media: An Evolutionary Perspective 75
Half. Daniel III
5 The Evolutionary Ecology of Childhood Asthma 101
A. Magdalena Hurtado
I. Arenas de Hurtado
Robert Sapien
Kim Hill
xii CONTENTS
6 Evolutionary Perspectives on the Onset of Puberty 135
Carol M. Worthman
7 Incest Avoidance: Clinical Implications of
the Evolutionary Perspective 165
Mark T. Erickson
8 Evolutionary Obstetrics 183
Wenda R. Trevathan
9 Darwinian Medicine and the Emergence of Allergy 209
Kathleen C. Barnes
George J. Armelagos
Steven C. Morreale
10 Using Evolution as a Tool for Controlling
Infectious Diseases 245
Paul W. Ewald
11 Evolutionary Control of HIV and Other
Sexually Transmitted Viruses 271
Paul W. Ewald
12 Paleolithic Nutrition Revisited 313
S. Boyd Eaton
S. B. Eaton III
Melvin J. Konner
13 Human Evolution, Low Back Pain, and
Dual-Level Control 333
Robert Anderson
14 What Darwinian Medicine Offers Psychiatry 351
Randolph Nesse
15 Evolution, Substance Abuse, and Addiction 375
E. O. Smith
16 Menopause in Evolutionary Perspective 407
Lynnette E. Leidy
17 Breast Cancer in Evolutionary Context 429
S. Boyd Eaton
S. Boyd Eaton HI
CONTENTS xiii
18 Evolutionary Perspectives on Chronic
Degenerative Diseases 443
Linda M. Gerber
Douglas E. Crews
Index 471
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CONTRIBUTORS
Robert Anderson, D.O., Ph.D. Douglas E. Crews, Ph.D.
Department of Anthropology and Department of Anthropology
Sociology The Ohio State University
Mills College Columbus, OH 43210
Oakland, CA 94613
Hal J. Daniel III, Ph.D.
George J. Armelagos, Ph.D. Departments of Biology and
Department of Anthropology Anthropology
Emory University East Carolina University
Atlanta, GA 30322 Greenville, NC 27834
Kathleen C. Barnes, Ph.D.
Michael H. Day, M.B.B.S., D.Sc.,
Division of Clinical Immunology
Ph.D., M.R.C.S., L.R.C.P., F.C.S.P.
Department of Medicine
(Hon)
The Johns Hopkins University
Department of Palaeontology
School of Medicine
The Natural History Museum
Baltimore, MD 21224
Cromwell Road
Ronald G. Barr, MA, MDCM, London, SW7 5BD, England
FRCP (C)
Departments of Pediatrics and S. Boyd Eaton, M.D.
Psychiatry Departments of Anthropology
McGill University and Montreal and Radiology
Children's Hospital Emory University
Montreal, Quebec H3H 1P3 Canada Atlanta, GA 30322
John Brett, Ph.D. S. Boyd Eaton III
Department of Anthropology School of Education
University of Colorado at Denver Marshall University
Denver, CO 80217-3364 Huntington, WV
xv
xvi CONTRIBUTORS
Mark T. Erickson, M.D. Sarah Mosko, Ph.D.
Alaska Psychiatric Institute Department of Neurology
Anchorage, Alaska 99508-4677 School of Medicine
University of California, Irvine
Paul W. Ewald Orange, CA 92668
Department of Biology
Amherst College
Amherst, MA 01002-5000 Randolph Nesse, M.D.
Institute for Social Research
Linda M. Gerber, Ph.D. University of Michigan
Department of Public Health Ann Arbor, MI 48106
Cornell University Medical College
New York, NY 10021
Susan Niermeyer, M.D.
A. Magdalena Hurtado, Ph.D. Department of Pediatrics
Department of Anthropology Section of Neonatology
University of New Mexico University of Colorado School of
Albuquerque, NM 87131 Medicine
Denver, CO 80262
I. Arenas de Hurtado, M.D., Ph.D.
Centre de Microbiologia
Institute Venezolano de Chris Richard, Ph.D.
Investigaciones Cientificas Sleep Disorders Laboratory
Caracas, Venezuela School of Medicine
University of California, Irvine
Kim Hill, Ph.D. Orange, CA 92668
Department of Anthropology
University of New Mexico
Albuquerque, NM 87131 Robert Sapien, M.D.
Department of Emergency Medicine
Melvin J. Konner, M.D., Ph.D. University of New Mexico Hospital
Departments of Anthropology Albuquerque, NM 87131
and Psychiatry
Emory University
Atlanta, GA 30322 E. O. Smith, Ph.D.
Department of Anthropology
Lynnette E. Leidy, Ph.D. Emory University
Department of Anthropology Atlanta, GA 30322
University of Massachusetts at
Amherst
Amherst, MA 01003-4805 Wenda R. Trevathan, Ph.D.
Department of Sociology and
James McKenna, Ph.D. Anthropology
Department of Anthropology New Mexico State University
University of Notre Dame Las Cruces, NM 88003
Notre Dame, IN 46556
Steven C. Morreale Carol M. Worthman, Ph.D.
Department of Anthropology Department of Anthropology
Emory University Emory University
Atlanta, GA 30322 Atlanta, GA 30322
Evolutionary
Medicine
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INTRODUCTION
E volutionary medicine takes the view that many contemporary
social, psychological, and physical ills are related to incompat-
ibility between the lifestyles and environments in which humans currently
live and the conditions under which human biology evolved. Unfortunately,
much of modern medical practice demonstrates a misunderstanding of the
evolution of physical responses to stresses that were faced by our ancestors.
The contributions in this book explore these topics, proposing ways in which
questions about disease and disorders can be refrained to consider the evo-
lutionary perspective and suggesting new approaches to treatment.
First and foremost, evolutionary medicine accords human beings their ev-
olutionary past; but it also accords evolutionary histories and strategies to
viruses and bacteria to which humans play host. This means that concepts of
natural selection, life-history strategies, ecological effects of development, and
distribution of disease and disorders are pertinent to the ideas discussed in
this volume. The natural history of our species is a fundamental beginning
point for new analyses of human disorders and degenerative disease, as well
as the effects of culture on human environments. This sets the stage for ex-
ploring the notion of mismatches or discordances between more evolution-
arily stable or "expected" human physical, social, and psychological environ-
ments and the "actual" environments encountered by modern humans.
Our biology, and many of our behaviors, are the result of millions of years
of evolutionary history, beginning with the earliest forms of life. Characteris-
tics that identify us as mammals (e.g., viviparity, mammary glands, homoioth-
ermy, hair) may have appeared with the earliest mammals 225 million years
ago. Characteristics that place us in the taxonomic order Primates (e.g., pre-
hensile digits, structure of the middle ear, arboreal adaptations) trace their
origins to the earliest primates 65 million years ago. Selection for visual acuity,
