Evolutionary medicine and clinical reasoning

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Mechanisms in Medicine are key to explain diseases based on anatomy and physiology. This static view of the human body is practical for teaching but the body is not a perfect machine designed by an engineer. Evolution has played its role. What we describe as diseases are sometimes a consequence of genetic traits, anatomical structures or adaptative mechanism. The knowledge of these particularities can help to fix concepts and to improve clinical reasoning.

Evolutionary medicine or Darwininan  medicine is the application of modern evolutionary theory to understanding health and disease. The goal of evolutionary medicine is to understand why people get sick, not simply how they get sick. Modern medical research and practice has 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 (from Wikipedia).

Look at the anatomical structure of the eye. If you considere the optic nerve enclosed in a narrow path, surrounded by blood vessels you,ll be aware about a small amount of pressure that can damage the nerve, Why no more room for the nerve? Imagine also a central arteria as the principal blood supply that can be blocked with a thrombus and the devastating effect on the retinal area.

Another critical point inside the globe is the cilliary area, Why not a double circuit of drainage? If you remember this fact you,ll never miss a glaucoma.

Teaching methods must improve in medical schools but this is not an easy task. The next reference from Nesse is a clear expression of the concept and the goals of evolutionary medicine:

The great opportunity: Evolutionary applications to medicine and public health
Randolph M. Nesse1 and Stephen C. Stearns2

“Bodies are not designed; they are shaped by natural selection. There is no blueprint, no ideal type. Variation
is intrinsic. There is no normal genome. There is no normal body. There is no separate manufacturing facility;
there is just the process of development – genes interacting with environments to create adult forms”.