Evolution—a most historical subject – is starting to have an impact on clinical understanding and decision-making. Applying evolutionary principles to medicine has led to new insights, particularly in the treatment of infections, cancer, and autoimmune disease. For instance, the hallowed dictum of using high doses of antibiotics or chemotherapeutic agents for prolonged periods in an attempt to eradicate every pathological bacterium or cancer cell is often fruitless and may rather facilitate the domination of resistant strains once the more sensitive ones are eliminated. A different dosage strategy may be better. Autoimmune disease may be influenced by a hyperactive immune system that evolved over the eons to deal with a more infection-prone world – the so called “hygiene hypothesis”. (This has led to such startling studies as feeding roundworm eggs to patients with multiple sclerosis or inflammatory bowel disease to ameliorate the illness.) Just as the biologist Theodosius Dobzhansky thought that “nothing in biology makes sense except in the light of evolution,” the same may apply to the medicine of the future, and evolutionary principles should become part of the medical curriculum.

Submitted by Ron Fishman from the Cogan Ophthalmic History Society .