In 1991 Randolph Nesse and George C. Williams opened their classic article on “The Dawn of Darwinian Medicine” with the following assertion (Plates LI and LII):
While evolution by natural selection has long been a foundation for biomedical science, it has recently gained new power to explain many aspects of disease.(Williams and Nesse 1991).
The optimistic statement of the two pioneers of modern “Darwinian” or “evolutionary medicine” raises many questions. Was evolution indeed a foundation for biomedical science? Historians have traditionally located the foundations of modern medicine in clinical disciplines, anatomy, and physiology – or, from the institutional perspective, in the hospital, morgue, and the laboratory. Evolutionary and field studies do not figure in any of the major medical-historical accounts (Bynum 1994; Porter 1999; Cooter and Pickstone 2000). And, if evolutionary studies indeed gained new power to explain disease, why was Nesse and Williams’s “manifesto” published in the Quarterly Review of Biology, a journal with a traditional emphasis on evolution and, at the time of publication, edited by Williams himself, rather than in a medical journal. Why has evolutionary medicine remained marginalized from the medical community?
Certainly in the two decades following the publication of this article, a new field at the junction of evolutionary biology, molecular and developmental biology, genetics, epidemiology, and clinical medicine has gained in strength, with numerous articles, books, and first advances into medical school curricula (Nesse and Williams 1995; Stearns and Koella 2008; Gluckman, Beedle, and Hanson 2009). The appeal of evolutionary medicine is in providing a coherent framework to organize and explain facts about human biology and disease and in pointing out the importance of ultimate as well as proximal causation in understanding the human condition.