Evolutionary Medicine: Is it Important?
Updated: Jul 16
Is the Theory of Evolution vital for good medical practice?
"Not one example can be put forth of the need for evolution (or belief in its tenets) in order to practice modern medicine." ~ Robert Mitchell, MD. Answers in Gen., 11/22/2005
"If evolution were thrown out of consideration, it would have no negative impact (in medicine)—it plays no necessary role in either the teaching or practice of medicine." ~ David Menton, PhD. Answers In Genesis, 7/21/2008
"No biological problem is solved until both the proximate and the evolutionary causation has been elucidated. Furthermore, the study of evolutionary causes is as legitimate a part of biology as is the study of the usually physicochemical proximate causes." ~ Ernst Mayer, 1982.
Are those statements by Drs. Mitchell and Menton true? That there are no examples where an evolutionary context adds to understanding of the human body, behavior or disease? Where evolution plays no role in treating patients or developing new treatments? I often hear the religious tell me that evolution has no role in the practice of medicine, and indeed can be harmful. I would like to assert that the answer is yes and no. A medical provider can practice clinical medicine without considering evolution; it just won’t be the best medicine. One can’t really understand the anatomy, physiology and psychology of humans without evolution. And for researchers at medical schools and other research institutions, it’s vital for them to ground their medical work in evolution. For example, a surgeon can be taught to diagnose a gallbladder problem and to remove it laparoscopically. Someone can learn to change a tire on a car without knowing how the car works or even how to drive it. But that person would be unable to diagnose a problem in the auto’s electrical or transmission, let alone work on improved designs for future models. Likewise, surgeons for example don’t necessarily need to know the origins of this organ or why we are built the way we are with all kinds of clues to our evolutionary past (see the section on unintelligent design). In that case ultimate “whys” do not matter much and the providers are acting like highly paid technicians only (not that technicians don’t need to know why something is in their work). But as I will discuss, in basic medical research such as oncology (the study of cancer) and many other areas, evolutionary principles are vital. Mitchell, Menton and other antievolutionists who claim that evolution is not important in modern medicine would do a severe disservice to the medical field by their deleterious approach to health and disease. After all, medicine is an applied discipline that is grounded in biology and biology’s foundation is evolution.
American medical providers (and probably those in other countries) are now pressured more and more to use algorithms in medicine - without necessarily knowing why the steps are there. Theoretically this should help medicine to be more standardized by various providers that are trained differently (MD, DO, DNPs, PAs e.g.), reduce unnecessary testing, and reduce missed diagnoses. However, it also potentially disconnects the provider from novel thinking and curiosity. For example, if you had a complicated problem with your car transmission, would you want someone who has actually taken one apart, who knows how they work, what factory it was made in (its origin) and if that year the factory had manufacturing issues? Or would you use a mechanic who just knew it was broken and supposedly had been taught what to do only to fix it? Today that can mean just replacing part after part until it is fixed. Expensive diagnostic tools to read error codes can help narrow the origin of the problem, but auto systems are interconnected so one still needs to understand the basic interplay and integration of the car systems. Knowing ultimate “whys” is a much superior approach.
What if a problem arises that does not fit the medical algorithms? I can tell you from experience that the human body has not read the medical books. And that transmission problem? I’m sure that someone who actually knows how that complicated machine works will be much better at diagnosing and fixing it properly. The “why” can be so important. Have a patient with an anemia? What about just giving them iron without knowing what type of anemia it is? If it is an iron deficiency anemia isn’t it mandatory that you find out why -where the red blood cells are being lost or why they not being produced?
Anti-evolutionists insist that medical providers don’t need to understand the evolutionary history of life and disease to practice medicine. Some claim that there is not even one example of why knowing evolution is important in medicine. But is that true?
This new field of medicine became established in the 1990s, especially with the publication of the 1996 book by Nesse and Williams, “Why We Get Sick: The New Science of Darwinian Medicine”(1). Nesse, now at the Center for Evolution and Medicine at Arizona State University, notes that Evolutionary Medicine (EM) “… is the field at the intersection of evolution and medicine… Instead of only asking how bodies work and why some people get sick, EM also asks why natural selection has left all of us with traits that make us vulnerable to disease. Why do we have wisdom teeth, narrow coronary arteries, a narrow birth canal, and a food passage that crosses the windpipe? Evolution explains why we have traits that leave us vulnerable to disease, as well as why so many other aspects of the body work so well.”(2).
Low notes that EM “… infuses traditional medical thinking, which primarily centers on proximate explanations and reductionist approaches, with evolutionary concepts to offer ultimate explanations for why diseases may occur, thus providing a more complete framework for understanding the origins of disease risk”. (3)
As has been noted, “An evolutionary view of medicine can be extremely useful to help patients understand the “whys” of medicine… why are many cancers more common now than they used to be? Why do so many people struggle with obesity? [they’ve inherited survivor genes]. Why does depression exist?”. (4)
Centers for Evolutionary Medicine
This new field is so promising that multiple departments and centers for EM have been established at medical schools and universities in America and around the world (in the UK for example). UC Berkeley includes a section on evolution and medicine in its Understanding Evolution course. Johns Hopkins University offers a PhD through their Center for Functional Anatomy and Evolution. UCLA has established an Evolutionary Medicine Program and interdisciplinary center that combines faculty from Biology, Medicine, Geography, Psychiatry and Psychology, Anthropology, Veterinarian Medicine, and other allied disciplines (5). As previously noted, a significant research center for EM is located at Arizona State University and its Center for Evolution and Medicine.
Several top American medical schools use or have used paleontologists to teach anatomy to their medical students. Why would top medical schools like The University of Chicago’s Pritzker School of Medicine have a fish paleontologist teaching anatomy to medical students (Neil Shubin, author of “Your Inner Fish”)? Why would the Northeastern Ohio Medical University have probably the most famous cetacean paleontologist alive today teaching anatomy to medical students (Hans Thewissen)? Because a doctor won’t understand the crazy course of the Recurrent Laryngeal Nerve in the human neck without evolution (see the section on unintelligent design), nor why our ears are attached to our heads with vestigial muscles, why human males develop inguinal hernias (embryologically the testes develop at the level of the heart as they are in adult sharks for example, and in humans they must move all the way down into the scrotal sac at birth, leaving a tract that can later delaminate and open), why our coccyx (tail bone) is derived from smaller fused bones that hark back to when our ancestors had tails, why humans are rarely born with tails that can even be moved, why the plantaris muscle in the human calf is vestigial in humans and even missing in about 10% of the population (it flexes all the digits at once in the monkey - good for swinging in trees), why we form goose bumps to cold and surprise, and other anatomical features that can only rationally be explained by our evolutionary roots.
We can’t really understand human behaviors unless Psychology and Psychiatry are ultimately rooted in evolutionary theory. For example, why do people not understand correct odds and continue to invest badly? Where does nationalism and tribalism come from if not from millions of years of selection that kept us alive and those we love safe when we were hunter-gatherers? Why do men and women often approach partnership so differently due to biological factors of investment cost in offspring - which can, like tribalism, be overcome. We don’t need to be slaves to what was successful in our past evolution but may be harmful to us now.
Journals have been established for publishing research in EM. These include ISEMPH, the International Society For Evolution, Medicine & Public Health which publishes through Oxford University Press a journal of the same name, and The Evolution & Medicine Review. There is a database of 1600 online teaching resources for EM in EvMedEd.
Perhaps in no other field of medicine has an area of research benefitted more from an evolutionary perspective than oncology. Oncology is the study and treatment of cancer. Cancer is basically cells that are no longer under control by the body. In order to grow, spread (metastasize), and evade the immune system they must acquire a whole host of mutations beneficial to them. As they grow they crowd out normal cells, use up precious energy, and cause destruction. Joshua Swamidass, MS, MD, PhD and on the faculty of the Washington University School of Medicine in St. Louis where he is an Associate Professor of Laboratory and Genomic Medicine, writes about the importance of EM to understanding cancer:
“Evolutionary theory “makes sense” of cancer, giving us critical insight into how it works. This has become particularly clear in recent years. Now, we can sequence all the genes in a patient’s cancer, and see how they change over time as cancer evolves. Cancer evolves with the same evolutionary mechanisms that drive the evolution of new species. Like breadcrumbs marking a path through a forest, cancer evolution leaves information in cellular genomes that evolutionary theory can decode.
Going the other direction, cancer makes sense of evolution too. Cancer itself is not evolution at the species level. However, it validates the mathematical framework underlying modern evolutionary theory. Cancer cells evolve multiple new functions in an evolutionary process, creating precise genetic signatures of common descent. At both a genetic and functional level, cancer follows patterns explained by evolutionary theory…In cancer… we can directly verify that evolutionary theory correctly reconstructs a cancer’s history, including its ancestry. We see all the same patterns in cancer evolution that we do in the evolution of species: neutral drift, nested clades, novel functions, and positive selection. The same math, software, and theory that is used to study the evolution of species works for cancer too.
From a biological point of view, it is now clear that cancer is an evolutionary disease. Cancer biologists use evolutionary theory because it is useful and accurate, not because they are pushing an “evolutionary agenda.” In cancer, cells evolve a set of new functions. These functions are beneficial to the cancer cell, but ultimately lethal to their host. And cancer must do much more than just grow quickly.
Nonetheless, in all cases, more than just rapid growth is required for cancer to develop. Several new functions are required. Ultimately, many cancers will acquire more than ten beneficial (to the cancer cell) mutations that enable these new functions. Evolution, it turns out, is a much more useful framework for understanding cancer. From the cell’s point of view, cancer is evolving new functions in the environment of the host’s body. It evolves these functions in an evolutionary process. Cancer exists only because biological systems, including humans, have the intrinsic ability to evolve.”
He further writes: “A common misconception about evolution is that it is dominated by natural selection acting on beneficial mutations (this is often what is meant by “Darwinian” mechanism). However, brilliant mathematical work and genetic experiments in the 1960s and 1970s by scientists like Haldane and Kimura demonstrated that evolution, at the genetic level, is usually dominated, instead, by the drift of neutral or near-neutral mutations. So most of the genetic differences between different lineages were either non-functional or not beneficial enough for natural selection…This is one reason biologists say that Darwinian evolution is quantitatively less important than non-Darwinian evolution (e.g. neutral drift, neutral draft, and other mechanisms) in explaining the complexity in genetic differences between species. Cancer evolution independently confirms that neutral theory is correct. We see the same patterns here, but the terminology is different.”
“Phylogenetics is foundational to modern evolutionary theory, with deep roots in information theory, population genetics, and neutral theory. It bears repeating, the exact same math, software, and theory that so accurately reconstructs a cancer’s history, is also used to reconstruct the evolutionary history of species…cancer demonstrates that evolutionary theory itself is useful. Going a small step farther, understanding evolution is centrally important in medical research. Fundamentally, cancer is an evolutionary disease. It only arises because life evolves.”(6) [all emphasis mine].
Many other authors agree. “Neoplasms are microcosms of evolution. Within a neoplasm, a mosaic of mutant cells compete for space and resources, evade predation by the immune system and can even cooperate to disperse and colonize new organs. The evolution of neoplastic cells explains both why we get cancer and why it has been so difficult to cure. The tools of evolutionary biology and ecology are providing new insights into neoplastic progression and the clinical control of cancer.” (7)
“The dynamics of evolution are fully in play within the environment of a tumor, just as they are in forests and meadows, oceans and streams. This is the view of researchers in an emerging cross-disciplinary field that brings the thinking of ecologists and evolutionary biologists to bear on cancer biology.”(8) Aktipis notes in her article “How Evolution Helps Us Understand Cancer and Control it” how cancer cells break down normal cooperation and increase cellular cheating in the body, similar to species that must evolve to move onto other resource areas. She writes, “This ecological and evolutionary perspective highlights new ways of identifying cancerous cells, beyond the typical hallmarks such as excessive replication.”(9). Her book is a wonderful journey through why evolution is so important to modern medicine (24).
Somarelli et. al. also note the importance of ecology and evolutionary concepts in understanding cancer: “Cancer progression is an evolutionary process. During this process, evolving cancer cell populations encounter restrictive ecological niches within the body, such as the primary tumor, circulatory system, and diverse metastatic sites. Efforts to prevent or delay cancer evolution - and progression - require a deep understanding molecular evolutionary processes. Herein we discuss a suite of concepts and tools from evolutionary and ecological theory that can inform cancer biology in new and meaningful ways.” (10).
Tollis, Boddy, and Maley in 2017 wrote about how evolution solved Peto's Paradox - why some large long lived animals did not develop cancer, since cancer tends to develop in longer lived organisms as the cells age and total more cell divisions. (11).
How Cancer Shapes Evolution and How Evolution Shapes Cancer https://evolution-outreach.biomedcentral.com/articles/10.1007/s12052-011-0373-y
Other than oncology perhaps no other area of medicine has benefited from evolutionary principles the past few decades than the study of human genetic diseases and population genetics.
Mitochondria - these are small organelles in cells that produce energy for the cell to survive and grow. They are basically only inherited matrimonially (through the mother’s egg). Biologists noted something strange about them early in the study of cytology (cells) compared to the many other cellular organelles. They have their own DNA and it’s in a circular configuration, unlike the chromosomes in the nucleus of the cell, but like bacteria. They have their own ribosomes and tRNAs and these look bacterial. Unlike other cell organelles, they have two membranes, an outer and inner. They reproduce by fission, just like bacteria. They lack the protective mechanisms found in the cell’s nucleus. For these reasons and others it became apparent that mitochondria were bacteria at one time and then were captured in the past. This theory is called the endosymbiotic theory of their origin in our cells and when approaching mitochondria diseases, this evolutionary past is important (15,16). For example, as you might expect they can be affected by antibiotics we give for bacterial infections. Mitochondria are discussed in a separate blog here.Knowing ultimate origins informs the “why" of medical aspects of disease and treatment. Many mitochondrial diseases are genetic due to various mutations (17) and current medical research to cure mitochondrial genetic diseases using CRISPR-Cas9 gene editing techniques look promising (18). This would potentially offer a cure and not just treatment. Knowing the evolutionary bacterial origin of mitochondria is important in treating mitochondrial diseases.
Retroviruses - These are viruses that parasitize us differently than other viruses. In the ultimate evil to us, they insert their genetic material into our chromosomes and use the cell’s normal copying systems to instead make more copies of themselves, eventually killing the infected cells and spilling millions more viruses to invade other cells. An example is HIV, the virus that can produce AIDS if untreated. If a retrovirus inserts into a cell destined to become an egg or sperm the insertion will even be passed onto offspring. It can then spread throughout the population to the point it becomes fixed or endogenized. To the surprise of many, it turns out after the human genome was sequenced, 8% of our genome is made up of dead, fossilized retroviruses that we call endogenous retroviruses or ERVs because they no longer can make retroviral offspring. A few years later when the chimp genome was sequenced and compared to our genome, it was observed that 200,000 of these were in the exact same location and many had the exact same mutations. Since retroviruses insert randomly to DNA address (locus) in the chromosomes the only rational conclusion is that these inserted before humans and chimps split from a common ancestry (see the discussion of how this essentially proves human evolution). Common design as an explanation for similarity of DNA across the great apes is thus dead.
Besides knowing the origin of ERVs and how it’s only explained rationally by evolution, ERVs are responsible for disease. We already know that some non retroviral genes can cause cancer, such as in breast and cervical cancer. Human ERV (HERV) genetic material has been found in tissue associated with Lou Gehrig’s disease, MS, and schizophrenia (19) and Kurt et. al. note that
“The resulting production of envelope (env) proteins from HERV-W and HERV-K appears to engage pathophysiological pathways leading to the pathognomonic features of MS and ALS, respectively. Pathogenic HERV elements may thus provide a missing link in understanding these complex diseases. Moreover, their neutralization may represent a promising strategy to establish novel and more powerful therapeutic approaches.” (20). Many ERVs are silenced by the host using methylation and other mechanisms as a defense against them. This however, is far from a complete evaluation of ERVs and human co-evolution over millions of years. We have used parts of ERVs to our advantage and co-opted many of them for beneficial uses. For example, one env gene is necessary for producing the placenta and others have been used to help fine tune our immune system in a process called exaptation. It is estimated that 50 - 70% of our genome is derived from viral components and outside elements.
Alus - our genome is full of one type of transposable element (TE) called an Alu. They constitute 10% of our genome alone. These are pieces of DNA that can jump in and out of our DNA. We have over a million copies of this TE alone. If we add up all the TE insertions, about 45% of our genome is made up of these elements that jump in and out of our genome, often causing damage. Over a 100 million years ago a gene called 7SL fused to another 7SL at the same time a retroviral infection was occurring. The retrovirus picked up this double 7SL RNA and began to make copies of it and inserting it back into the host DNA. Most of the insertions did not cause problems, but a million insertions did occasionally land into expensive DNA territory. We can identify today damaged gene alleles from Alu and other TE insertions that are responsible for such diseases as hemophilia A & B, familial hypercholesterolemia, severe combined immunodeficiency, porphyria, and Duchenne muscular dystrophy. Many other diseases such as type 2 diabetes, Alzheimer’s disease and cancers of the colon, breast, and lung are victims of genetic susceptibilities due to TE damage. In this case the genes are damaged but not completely destroyed (21). Knowing human evolution is necessary for understanding certain genetic diseases, when and how they entered our germ line and possibly how to correct or control them.
Pseudogenes - It has been noted that we have about 20,000 genes that are directly involved in making “us”. These are the genes that produce proteins, commonly enzymes, that control almost everything in our cells. This only represents about 1.5% of all our DNA. Much of the rest is derived from TEs as discussed above and probably mostly “junk” DNA. Indeed, about 98% of our DNA is exactly the same as a chimp’s. But outside that 1.5% are many regulatory and other sequences in our genome that instruct when for example to make products and how long so those elements are probably what really differentiate us from other apes. Scientists have also identified thousands of genes that are damaged and not functional but look like similar normal, active genes. It is thought that there are about 20,000 of these broken, duplicated genes (pseudogenes) but functions have been found for many now that can be partially read so the total may be closer to about 12,000. Christina Sisu notes: “Integrative analyses of cancer data have shown that pseudogenes can be transcribed and even translated, and that pseudogenic DNA, RNA, and proteins can interfere with the activity and function of key protein coding genes, acting as regulators of oncogenes and tumor suppressors. Capitalizing on the available clinical research, we are able to get an insight into the spread and variety of pseudogene biomarker and therapeutic potential. In this chapter, we describe pseudogenes that fulfill their role as diagnostic or prognostic biomarkers, both as unique elements and in collaboration with other genes or pseudogenes. We also report that the majority of prognostic pseudogenes are overexpressed and exert an oncogenic [cancer] role in colorectal, liver, lung, and gastric cancers.”
Sen wrote in his paper titled “Relevance of Pseudogenes to Human Genetic Disease”:
“Pseudogenes are observed to harbour sequence variations that become degenerative disease-causing mutations when transmitted to their colocalised progenitors through gene conversion event. The issue of pseudogene deregulation in several genetic diseases including cancer is now of the essence in the context of disease progression in humans. Different aspects of the involvement of pseudogenes and their relevance to human genetic disease are recaptured here… Pseudogenes can partially retain or totally resurrect their original functions. Being the paradigm of neutral evolution pseudogenes provide snapshots of the evolutionary history of the human genome. The neutral characteristic of all pseudogenic regions renders them relevant to determine the nature of neutral sequence evolution among different regions in the genome.”(23)
Scientists have been using comparative pseudogene analysis for decades to look back at our evolutionary past since we share some of the same pseudogenes (same locations, same mutations) with our ape cousins and thus they confirm our evolutionary history with them. Knowing the ultimate reasons for why we have shared pseudogenes with other apes can explain the origins of some human deficiencies such as our need for vitamin C due to a shared defective gene. We even still make an egg yolk sac and have egg yolk pseudogenes, in the same homologous location as in chickens. And as Sisu writes above, it appears now many of the pseudogenes can have a role in cancer. However, both Moran and Finlay note that pseudogenes can have functions and a proper definition has been confused by more recent researchers. See pseudogenes, this site. Here again a deep dive into where this DNA damage occurred and how will help target therapies. Damage after a mythological “Fall” will not produce a nested pattern of genetic damage; only evolution will.
Obesity - I wrote earlier that many people in developed countries are obese and obesity has been called a pandemic. Many are obese because food is abundant and activity can be diminished. Basically we’ve inherited survivor genes that served our ancestors well thousands of years ago when starvation was always looming but these genes for promoting eating and the efficient extraction of calories are now killing us. Researchers Salazar-Tortosa and Fernandez-Rhodes wrote about this in their 2019 article “Obesity and climate adaptation" where they note using evolutionary perspectives that include genetic changes in metabolic rates, the leptin receptor and brown adipose tissue uncoupling proteins after our ancestors left Africa to increase survivability in colder climates helps us to understand this pandemic via ultimate causes" (12). This will allow medical researchers to attack the problem from its root causes and not just apply drugs or surgery to the issue.
Women’s Healthcare - Power, Michael L. et.al. write in their 2020 abstract: “Evolution is a fundamental principle in biology; however, it has been neglected in medical education. We argue that an evolutionary perspective is especially important for women’s health care providers, as selection will act strongly on reproductive parameters, and the biological costs of female reproduction are generally more resource expensive than for men (e.g. due to gestation and lactation) with greater effects on health and wellbeing. An evolutionary perspective is needed to understand antibiotic resistance, disease and health risks associated with mismatches between our evolved adaptations and current conditions, and the importance of breastmilk as a biochemical signal from mothers to their babies. We present data that obstetrician-gynecologists’ views regarding inclusion of evolution within their training is generally positive, but many barriers are perceived. Requiring coursework in evolutionary medicine prior to enrollment in medical school may be a solution.” (13)
Sickle Cell Disease and Malaria - 1 million people were dying every year from malaria as of 2010, especially children. Individuals with sickle cell trait, a genetic defect, have red blood cells that are less accommodating to the Plasmodium parasite’s life stage that infects red blood cells. A homozygote normal hemoglobin (HbA/HbA) individual will suffer from malaria more than an heterozygote individual (one HbA and one HbS gene). Those who are homozygous for sickle cell trait having two HbS genes (HbS/HbS) suffer and die more frequently from sickle cell anemia and disease. Thus it is impossible to understand why sickle cell disease persists and is not removed by natural selection without understanding the evolutionary roots of the disease. In this case the carrier state, the heterozygous condition, is being selected for at the expense of the homozygous normal and homozygous sickle cell diseased individuals (14).
Ancient DNA As a Tool for Medical Research - "Paleogenomics can help elucidate the genetic basis of modern diseases, including inborn errors of immunity that impair the response to infections, providing a tool for drug development... These discoveries have shed new light on the origins of human populations, their migratory history, and the extent of admixture between humans and ancient, now-extinct hominins, such as Neanderthals, and between modern human populations. However, ancient genomics is also of value for medical research, making it possible to reconstruct the history of human health over time, including past epidemics. This research allows increased understanding of the present-day links between genomic diversity and disease... It is increasingly clear that paleogenomics is a discipline of interest well beyond purely anthropological questions, as it can provide answers to questions of fundamental importance in medical research. It may be time to adopt a slightly rephrased version of Theodosius Dobzhansky’s famous phrase: “Nothing in medicine makes sense except in the light of evolution.”
Anti-evolutionists, who are often creationists and cannot admit that human evolution is true, have claimed that evolutionary theory has no use in modern medicine. A review of the many Centers for Evolutionary Medicine would indicate otherwise. It is true that one can practice medicine on a more superficial level without considering evolutionary principles if all that is required is a “fix it” mentality. However, in research and often in clinic settings, needing to know ultimate causes is necessary to apply potential effective treatments for various human conditions and this requires an evolutionary context and lens. Ernst Mayer was correct. Numerous examples were discussed revealing the willful ignorance of those physicians who think the best medicine can be practiced without an evolutionary perspective. The study of cancer especially is incredibly illuminated by an evolutionary approach along with the newer genetic medical disciplines, as Swamidass especially discusses.
1. Darwin in medical school. 2009. Baker, Mitzi. Stanford Medicine Magazine. Stanford School of Medicine. https://sm.stanford.edu/archive/stanmed/2006summer/evolutionary-medicine.html
2. What is Evolutionary Medicine: Ten Questions Answered. 2016. Randolph Nesse.
21. Human Errors: A Panorama of Our Glitches, from Pointless Bones to Broken Genes. 2019. Lents, Nathan H. Houghton Mifflin Harcourt. 223pp.
24. The Cheating Cell: How Evolution Helps Us Understand Cancer and Treat It
2020. Princeton University Press. 256pp. Amazon books
Summary: "When we think of the forces driving cancer, we don’t necessarily think of evolution. But evolution and cancer are closely linked because the historical processes that created life also created cancer. The Cheating Cell delves into this extraordinary relationship, and shows that by understanding cancer’s evolutionary origins, researchers can come up with more effective, revolutionary treatments.
Athena Aktipis goes back billions of years to explore when unicellular forms became multicellular organisms. Within these bodies of cooperating cells, cheating ones arose, overusing resources and replicating out of control, giving rise to cancer. Aktipis illustrates how evolution has paved the way for cancer’s ubiquity, and why it will exist as long as multicellular life does. Even so, she argues, this doesn’t mean we should give up on treating cancer―in fact, evolutionary approaches offer new and promising options for the disease’s prevention and treatments that aim at long-term management rather than simple eradication. Looking across species―from sponges and cacti to dogs and elephants―we are discovering new mechanisms of tumor suppression and the many ways that multicellular life-forms have evolved to keep cancer under control. By accepting that cancer is a part of our biological past, present, and future―and that we cannot win a war against evolution―treatments can become smarter, more strategic, and more humane.
Unifying the latest research from biology, ecology, medicine, and social science, The Cheating Cell challenges us to rethink cancer’s fundamental nature and our relationship to it."