evolutionary medicine evolutionary medicine evolutionary medicine or darwinian medicine is the application of modern evolutionary theory to understanding health and disease. modern biomedical research and practice have focused on the molecular and physiological mechanisms underlying health and disease, while evolutionary medicine focuses on the question of why evolution has shaped these mechanisms in ways that may leave us susceptible to disease. the evolutionary approach has driven important advances in the understanding of cancer, autoimmune disease, and anatomy. medical schools have been slower to integrate evolutionary approaches because of limitations on what can be added to existing medical curricula. the international society for evolution, medicine and public health coordinates efforts to develop the field. it owns the oxford university press journal evolution, medicine and public health and the evolution and medicine review. part of a series onevolutionary biologydarwin's finches by john gould index introduction main outline glossary evidence history processes and outcomes population genetics variation diversity mutation natural selection adaptation polymorphism genetic drift gene flow speciation adaptive radiation co-operation coevolution coextinction divergence convergence parallel evolution extinction natural history origin of life common descent history of life timeline of evolution human evolution phylogeny biodiversity biogeography classification evolutionary taxonomy cladistics transitional fossil extinction event history of evolutionary theory overview renaissance before darwin darwin origin of species before synthesis modern synthesis molecular evolution evo-devo current research history of speciation history of paleontology (timeline) fields and applications applications of evolution biosocial criminology ecological genetics evolutionary aesthetics evolutionary anthropology evolutionary computation evolutionary ecology evolutionary economics evolutionary epistemology evolutionary ethics evolutionary game theory evolutionary linguistics evolutionary medicine evolutionary neuroscience evolutionary physiology evolutionary psychology experimental evolution phylogenetics paleontology selective breeding speciation experiments sociobiology island biogeography systematics universal darwinism social implications evolution as fact and theory social effects creation–evolution controversy theistic evolution objections to evolution level of support evolutionary biology portal category the bacterium mycobacterium tuberculosis can evolve to subvert the protection offered by immune defenses core principles utilizing the delphi method, 56 experts from a variety of disciplines, including anthropology, medicine, nursing, and biology agreed upon 14 core principles intrinsic to the education and practice of evolutionary medicine. these 14 principles can be further grouped into five general categories: question framing, evolution i and ii (with ii involving a higher level of complexity), evolutionary trade-offs, reasons for vulnerability, and culture. additional information regarding these principles may be found in the table below. core principles of evolutionary medicine topic core principle types of explanation (question framing) both proximate (mechanistic) and ultimate (evolutionary) explanations are needed to provide a full biological understanding of traits, including those that increase vulnerability to disease. evolutionary processes (evolution i) all evolutionary processes, including natural selection, genetic drift, mutation, migration and non-random mating, are important for understanding traits and disease. reproductive success (evolution i) natural selection maximizes reproductive success, sometimes at the expense of health and longevity. sexual selection (evolution i) sexual selection shapes traits that result in different health risks between sexes. constraints (evolution i) several constraints inhibit the capacity of natural selection to shape traits that are hypothetically optimal for health. trade-offs (evolutionary trade-offs) evolutionary changes in one trait that improve fitness can be linked to changes in other traits that decrease fitness. life history theory (evolutionary trade-offs) life history traits, such as age at first reproduction, reproductive lifespan and rate of senescence, are shaped by evolution, and have implications for health and disease. levels of selection (evolution ii) vulnerabilities to disease can result when selection has opposing effects at different levels (e.g. genetic elements, cells, organisms, kin and other levels). phylogeny (evolution ii) tracing phylogenetic relationships for species, populations, traits or pathogens can provide insights into health and disease. coevolution (evolution ii) coevolution among species can influence health and disease (e.g. evolutionary arms races and mutualistic relationships such as those seen in the microbiome). plasticity (evolution ii) environmental factors can shift developmental trajectories in ways that influence health and the plasticity of these trajectories can be the product of evolved adaptive mechanisms. defenses (reasons for vulnerability) many signs and symptoms of disease (e.g. fever) are useful defenses, which can be pathological if dysregulated. mismatch (reasons for vulnerability) disease risks can be altered for organisms living in environments that differ from those in which their ancestors evolved. cultural practices (culture) cultural practices can influence the evolution of humans and other species (including pathogens), in ways that can affect health and disease (e.g. anti-biotic use, birth practices, diet, etc.). human adaptations adaptation works within constraints, makes compromises and trade-offs, and occurs in the context of different forms of competition. constraints adaptations can only occur if they are evolvable. some adaptations which would prevent ill health are therefore not possible. dna cannot be totally prevented from undergoing somatic replication corruption; this has meant that cancer, which is caused by somatic mutations, has not (so far) been eliminated by natural selection. humans cannot biosynthesize vitamin c, and so risk scurvy, vitamin c deficiency disease, if dietary intake of the vitamin is insufficient. retinal neurons and their axon output have evolved to be inside the layer of retinal pigment cells. this creates a constraint on the evolution of the visual system such that the optic nerve is forced to exit the retina through a point called the optic disc. this, in turn, creates a blind spot. more importantly, it makes vision vulnerable to increased pressure within the eye (glaucoma) since this cups and damages the optic nerve at this point, resulting in impaired vision. other constraints occur as the byproduct of adaptive innovations. trade-offs and conflicts one constraint upon selection is that different adaptations can conflict, which requires a compromise between them to ensure an optimal cost-benefit tradeoff. running efficiency in women, and birth canal size encephalization, and gut size skin pigmentation protection from uv, and the skin synthesis of vitamin d speech and its use of a descended larynx, and increased risk of choking competition effects different forms of competition exist and these can shape the processes of genetic change. mate choice and disease susceptibility genomic conflict between mother and fetus that results in pre-eclampsia lifestyle humans evolved to live as simple hunter-gatherers in small tribal bands, while contemporary humans have a more complex life. this change may make present-day humans susceptible to lifestyle diseases. diet in contrast to the diet of early hunter-gatherers, the modern western diet often contains high quantities of fat, salt, and simple carbohydrates, such as refined sugars and flours. trans fat health risks dental caries high gi foods modern diet based on "common wisdom" regarding diets in the paleolithic era among different countries, the incidence of colon cancer varies widely, and the extent of exposure to a western pattern diet may be a factor in cancer incidence. life expectancy main article: aging-associated diseases examples of aging-associated diseases are atherosclerosis and cardiovascular disease, cancer, arthritis, cataracts, osteoporosis, type 2 diabetes, hypertension and alzheimer's disease. the incidence of all of these diseases increases rapidly with aging (increases exponentially with age, in the case of cancer). age-specific seer incidence rates, 2003-2007 of the roughly 150,000 people who die each day across the globe, about two thirds—100,000 per day—die of age-related causes. in industrialized nations, the proportion is much higher, reaching 90%. exercise many contemporary humans engage in little physical exercise compared to the physically active lifestyles of ancestral hunter-gatherers. prolonged periods of inactivity may have only occurred in early humans following illness or injury, so a modern sedentary lifestyle may continuously cue the body to trigger life preserving metabolic and stress-related responses such as inflammation, and some theorize that this causes chronic diseases. cleanliness