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The principles of evolution by natural selection are finally beginning to inform medicine Evolution and the Origins of Disease

with perplexity. The eye, for instance, has long been an object of wonder, with the clear, living tissue of the cornea curving just the right amount, the iris adjusting to brightness and the lens to distance, so that the optimal quantity of light focuses exactly on the surface of the retina. Admiration of such apparent perfection soon gives way, however, to consternation. Contrary to any sensible design, blood vessels and nerves traverse the inside of the retina, creating a blind spot at their point of exit. The body is a bundle of such jarring contradictions. For each exquisite heart valve, we have a wisdom tooth. Strands of DNA direct the development of the 10 trillion cells that make up a human adult but then permit his or her steady deterioration and eventual death. Our immune system can identify and destroy a million kinds of foreign matter, yet many bacteria can still kill us. These contradictions make it appear as if the body was designed by a team of superb engineers with occasional interventions by Rube Goldberg. In fact, such seeming incongruities make sense but only when we investigate the origins of the body’s vulnerabilities while keeping in mind the wise words of distinguished geneticist Theodosius Dobzhansky: “Nothing in biology makes sense except in the light of evolution.” Evolutionary biology is, of course, the scientific foundation for all biology, and biology is the foundation for all medicine. To a surprising degree, however, evolutionary bi-