Evolutionary Medicine

Terry R. McGuire, Professor, Dept. of Genetics, Rutgers University. Piscataway NJ 08854

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Evolutionary Medicine focuses on many shared traits that leave all members of a species vulnerable to a disease. Humans are vulnerable to diseases because of evolutionary mismatches, coevolution with pathogens and parasites, evolutionary trade offs, and evolutionary constraints. This course will also look at traits that favor reproduction at the expense of health and defenses (e.g., pain, fever, nausea) which are not medical problems but responses shaped by natural selection.

There are many pressing problems of sickness and health that have some of their roots in evolutionary biology. These include so-called “Western diseases” (e.g., diabetes, obesity) and emerging infectious diseases (e..g, SARS, Ebola, avian flu). Evolutionary theory can provide a theoretical foundation for epidemiology and public health. It can unify research from many different disciplines and provide a framework for understanding disease from the perspective of evolutionary as well as proximate biology.

This course was designed to meet goals in the revised Core Curriculum within the school of Arts and Sciences (SAS) at Rutgers University. It also had to meet goals of the Department of Genetics and the Division of Life Sciences (DLS).

SAS Goals:

  1. Analyze the relationship that science and technology have to a contemporary social issue.
  2. Identify and critically assess ethical and societal issues in science.

For SAS, the course had to be taught at the Junior or senior level. The course met two goals of the more specialized curriculum of the Genetics department.

Genetics Department Goals:

  1. “Knowledge specific goals: Know the terms, concepts and theories in genetics.”
  2. “Integrate the material from multiple courses and research. That is, to think holistically and to see the whole as well as the part.”

HHMI./AAMC

The DLS at Rutgers is beginning to modify the Life Sciences Curriculum according to the guidelines of the HHMI/AAMC report. This course meets, in part, competency E8

Competency E8: Demonstrate an understanding of how the organizing principle of evolution by natural selection explains the diversity of life on earth.”

Specific Course Goals:

  1. Students are expected to learn the terms, concepts and theories of evolutionary biology and to apply those terms, theories and concepts to issues in sickness and wellness.
  2. Evolutionary ideas have implications not only for medicine but also for educational, legal and social issues. By the end of this course, starting with an evolutionary premise, students will be able to design or redesign social institutions such as schools, to maximize health.
  3. By the end of this course a student will be able to suggest experiments and evidence that would support or not support a hypothesis in the area of evolutionary medicine.

Linking Science and Social Issues

This course, in some ways, is the reverse of a “typical” SENCER course. Rather than choose a single civic issue and then drill down to the science, I started with the science (Evolutionary Biology) and then used public health issues to illustrate and amplify various scientific processes. There were a number of issues relevant to public health issues that were discussed throughout the course. These included obesity and diabetes, cancer, heart disease, asthma, allergies, and reproduction and pregnancy. I also discussed the coevolution of humans with parasites and pathogens.

For example, I had several lectures on pregnancy and reproduction. These lectures covered theories of human mate choice, problems of pregnancy, and neonatal care from an evolutionary perspective. Issues included possible inappropriate treatments (e.g., drugs for morning sickness, aggressive treatment of neonatal jaundice) and the benefits of breast feeding and “rooming in” for neonates. In order to put the biologically relevant ideas into perspective, I discussed the history of “scientific infant care” as proposed by J.B Watson, Frederick King, Arnold Gessell and the more evolutionarily-appropriate child rearing methods of Benjamin Spock (1946). I also presented scientific evidence that development of an early physical relationship between mothers and infants (for weeks and months) is important for both infant survival and normal development. At the end of these lectures a number of students further discussed the social and personal issues surrounding breast feeding.

Another example, obesity and diabetes were generally taught as related subjects. Both obesity and diabetes are increasing in frequency as “Western diseases” or diseases of civilization”. Generally, the obesity is portrayed solely as a “blame the victim” disease. Tahat is, obese people eat too many calories and don’t exercise enough. I discussed the experimental evidence that obesity and diabetes were genetic disorders (from the perspectives of several genetic theories), as a mismatch between ancestral diets and modern diets (e.g., fiber, omega3/omega 6 ratios), as a chronic viral or bacterial infection, as a result of lack of sleep or circadian rhythm mismatch, as a result of environmental stress, and as result of exposure to organic pollutants and endocrine disruptors. Students learned about different competing theories and social and political policies that encourage diabetes. Students had to demonstrate their knowledge of these theories by designing a school or society to maximize obesity and diabetes. As one of my students commented on his final exam ” Thinking about it, a lot of these so-called “changes ” are almost already present or expanding in American society so maybe this is not such a mythical society after all …”

Current events played an extremely important part in the course. Every class started with a current event. The current event did not have to relate to that day’s lecture. I merely indicated where in the course the event might fit. (“You remember when we discussed…” or, “In three weeks we will talk about…”). Unfortunately many courses use only textbooks which discuss what has already been done (generally years ago). It is not obvious to students that scientific discovery is ongoing. Current events also allow me to introduce new topics. For example, near the end of the course I discussed work by Stephanie Soscia and her colleagues that plaque formation in Alzheimer disease might be part of the brain’s immune response. This led to a discussion of theories that chronic infectious diseases (e.g., Chlamydia pneumoniae, a cause of pneumonia, Helicobacter pylori (gastric ulcers and stomach cancer), and Borriela “Lyme disease”) might play a large role in “western” diseases.

I also discussed media coverage of current events vs. the scientific papers those events were based on. In other cases, I highlighted current events that got little media coverage. For example, in March 2010 the media was widely reporting that up to a third of breast cancer cases in Western countries could be avoided if women are less and exercised more”. The main author, Carlo La Vecchia even speculated that 2/3 of all breast cancer could be prevented by diet and exercise. This was based on a non-peer reviewed paper given at a conference. At the same time, another peer-reviewed report showed that “Thin Girls Have Higher Breast Cancer Risk” especially for the more aggressive breast cancers. This second report got almost no popular press. The first report played to our general “blame the victim” mentality coupled with the “fat taboo”. I added another dimension to the discussion and showed them work that Bisphenol A (BPA) is correlated with both obesity and breast cancer. This reinforced that the idea that correlation between obesity and cancer does not mean causality.

Li J, Humphreys K, Eriksson L, Czene K, Liu J, Hall P. (2010) Effects of childhood body size on breast cancer tumour characteristics Breast Cancer Research 2010, 12:R23 (15 April 2010)

Soscia, S., et al. (2010). The Alzheimer’s Disease-Associated Amyloid β-Protein Is an Antimicrobial Peptide. PLoS ONE 5(3) DOI: 10.1371/journal.pone.0009505.

The Course

Syllabus Evolutionary Medicine
Topics Evolutionary Medicine
Attendance Policy Evolutionary Medicine

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Group Projects Evolutionary Medicine

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Current Events Evolutionary Medicine

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Final Exam Evolutionary Medicine

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MERLOT Content Builder

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Evaluating Learning

Assessment: I used many assessments in this class. These assessments included on-line quizzes, one-minute assessments, subject pretests, in-class questions, group work, and reflective writing. Most of the assessments were formative; that is; they were intended to track both student learning and my teaching. The midterm and the final exam were summative assessments which measured the gains in understanding made during this course.

On-Line Quizzes: Students were expected to read the assignments and the assigned papers before they came to class. They completed a very short, online quiz before the start of every class (multiple choice or short answers) on those readings. These quizzes were open notes. The class performance was discussed at the start of each class. We discussed the right answers and why the other answers were wrong.

Group Work: Students were assigned to a Group immediately after the add/drop period. In most classes they were given 10-15 minutes to work as a group and to answer a detailed question. The group work problems were written in blue books. Some group sessions were used to work on their annotated bibliography. Group answers were graded and returned by the next class. The group questions allowed me to ask more “in depth” questions. (See group questions – attached.).

Class Discussion: I expected the class to ask questions and discuss the material. I am fully aware that many students will not talk in class. This may be due to cultural issues or personality issues. From other assessments I know that it is generally due to the feeling that “Everyone else knows more than I do” or “” I am afraid of holding the class back” or “I don’t want to appear stupid.” These issues are unfounded. I work with the class to overcome some of these fears. However, if a student was uncomfortable with speaking in class, they could hand me questions on 3 X 5 cards.

One Minute Assessment: The premier assessment tool! Students needed to provide their own 3 x 5 cards in lecture (approximately 25). At the end of every class, they answered a single question such as “What was the most interesting thing that you learned today?” Or “What was the muddiest point?” They had one to three minutes to write on this topic.
Instructions: All cards should be filled out the same way. These cards will be filed and they will be a record of both your attendance and your progress through the course. This exercise has to be done but the responses themselves are not graded.

In-class questions: “I knew the material but I couldn’t apply it!” I lectured for short periods of time but then stopped to have students work on problems. This was done individually or with others in the class. Such questions were in addition to the group work. The question might deal with research questions or with social issues.

Reflective Writing: Throughout the semester students were asked to post several pieces of reflective writing on the Sakai website. These included two opinion pieces and corrections to group work and information on the annotated bibliography.

The Midterm: Genetics and evolutionary biology are best learned by being prepared for class discussion and completing the assessment exercises in a timely manner. Everyone had the possibility of learning genetics. I expected that everyone could get an A. By the date of the midterm students had completed several pieces of reflective writing, a number of group work assignments, and quizzes. Those students who had no unexcused absences and had completed the assessments with a B+ average or better (roughly 85%) were excused from the in-class midterm. The rest of the class had the opportunity to show me what they have learned through their performance on the midterm exam. Note: The midterm exam questions were made available to everyone in the class.

Annotated Bibliography:

This group project measured a student’s ability to select a representative sample of articles that addressed a single topic. The articles could be both classic and recent. A good annotated bibliography provided a commentary on the articles’ usefulness and importance. The better bibliographies placed each article within the broader context of Evolutionary medicine. The bibliographies were constructed using the MERLOT content builder (formerly KEEP toolkit) hosted by MERLOT. (www.merlot.org). The Content Builder allowed group collaboration online. More details of the annotated bibliographies are attached.

Background and Context

This course was eight years in the making. In 2002, I attended SENCER SSI as an “advanced team” member. I have recounted my experiences in a backgrounder (http://ncsce.net/reinventing-myself-as-a-professor-the-catalytic-role-of-sencer/). Briefly, after returning from SENCER I made two changes in a large introductory genetics courses (150+ students). These changes were simple – current events at the start of every class and a one-minute paper at the end of every class. I was extremely surprised by two recurrent ideas from my students:

  1. Even life science majors did not realize that the science that they were studying has any application to the “real world” and
  2. Life science majors were generally unable to see the connections between different areas of study.

Many students and faculty members are quite content to keep their courses into discipline-specific areas. In all my courses I have worked to change that.

Since 2002 I have had the opportunity to design or redesign courses for science majors which incorporated some SENCER ideals (see McGuire 2005). I have also had the opportunity to teach two non-majors courses, “Genetics and Fiction” (an Honors course) and “Blue Gold: Water Issues in a Water-Deprived World” (a first-year Byrne seminar). The latter two courses were definitely SENCER courses.

I still wanted to develop a SENCER style course for science majors. I have even spoken about such a course at SENCER summer institutes. Implementation, however, proved to be difficult within the existing DLS curriculum. In 2008 this changed. First, the School of Arts and Sciences adopted a goal-oriented core curriculum. One requirement called for junior-level courses that taught “21st century challenges”. In the life sciences, a junior level course will have many science prerequisites and be taken only by Life Science majors. Rutgers has recently increased enrollments and these increases have severely affected the life sciences. In all departments within the Division of Life Science have nearly 1580 majors – a 50% increase since 2003. We needed to develop large upper-level courses to handle the demand. Finally, the HHMI/AAMC report on changing undergraduate education has suggested that pre-professional students need to have competency in evolution.

I decided to design a course in “Evolutionary Medicine” for a number of reasons. Recently, a number of authors have stressed the importance of Evolutionary Medicine (e.g., Nesse et al 2009). First, many of the questions in evolutionary medicine are public health issues (i.e., “real world” issues). Second, evolution is the unifying theme of biology. This course allowed me to connect genetics to many areas of the life sciences (e.g., microbiology, immunology, parasitology) as well as a variety of other disciplines (e.g., geology, anthropology, psychology and sociology). Finally, in a time when many Americans do not believe in evolution (2009 Pew report) I thought that it was extremely important to show how evolutionary thought informs medical practice and research.

References:

Scientific Foundations for Future Physicians: Report of the AAMC-HHMI Committee. http://www.hhmi.org/grants/sffp.html

McGuire, T. R, (2005). Reinventing Myself as a Professor: The Catalytic Role of SENCER http://ncsce.net/reinventing-myself-as-a-professor-the-catalytic-role-of-sencer/.

Nesse RM, Bergstrom CT, Ellison PT, Flier JS, Gluckman P, Govindaraju DR, Niethammer D, Omenn GS, Perlman RL, Schwartz MD, et al. 2010. Making evolutionary biology a basic science for medicine. Proceedings of the National Academy of Sciences 107(suppl 1):1800-7.

Overview: The Conflict Between Religion and Evolution (2009). The PEW Forum on Religion and Public Life.
http://pewforum.org/Science-and-Bioethics/Overview-The-Conflict-Between-Religion-and-Evolution.aspx.

Rather than choose a single civic issue and then drill down to the science, I started with the science (Evolutionary Biology) and then used public health issues to illustrate and amplify various scientific processes. There were a number of issues relevant to public health issues that were discussed throughout the course. These included obesity and diabetes, cancer, heart disease, asthma, allergies, and reproduction and pregnancy. I also discussed the coevolution of humans with parasites and pathogens.

For example, I had several lectures on pregnancy and reproduction. These lectures covered theories of human mate choice, problems of pregnancy, and neonatal care from an evolutionary perspective. Issues included possible inappropriate treatments (e.g., drugs for morning sickness, aggressive treatment of neonatal jaundice) and the benefits of breast feeding and “rooming in” for neonates. In order to put the biologically relevant ideas into perspective, I discussed the history of “scientific infant care” as proposed by J.B Watson, Frederick King, Arnold Gessell and the more evolutionarily-appropriate child rearing methods of Benjamin Spock (1946). I also presented scientific evidence that development of an early physical relationship between mothers and infants (for weeks and months) is important for both infant survival and normal development. At the end of these lectures a number of students further discussed the social and personal issues surrounding breast feeding.

Another example, obesity and diabetes were generally taught as related subjects. Both obesity and diabetes are increasing in frequency as “Western diseases” or diseases of civilization”. Generally, the obesity is portrayed solely as a “blame the victim” disease. Tahat is, obese people eat too many calories and don’t exercise enough. I discussed the experimental evidence that obesity and diabetes were genetic disorders (from the perspectives of several genetic theories), as a mismatch between ancestral diets and modern diets (e.g., fiber, omega3/omega 6 ratios), as a chronic viral or bacterial infection, as a result of lack of sleep or circadian rhythm mismatch, as a result of environmental stress, and as result of exposure to organic pollutants and endocrine disruptors. Students learned about different competing theories and social and political policies that encourage diabetes. Students had to demonstrate their knowledge of these theories by designing a school or society to maximize obesity and diabetes. As one of my students commented on his final exam ” Thinking about it, a lot of these so-called “changes ” are almost already present or expanding in American society so maybe this is not such a mythical society after all …”

Current events played an extremely important part in the course. Every class started with a current event. The current event did not have to relate to that day’s lecture. I merely indicated where in the course the event might fit. (“You remember when we discussed…” or, “In three weeks we will talk about…”). Unfortunately many courses use only textbooks which discuss what has already been done (generally years ago). It is not obvious to students that scientific discovery is ongoing. Current events also allow me to introduce new topics. For example, near the end of the course I discussed work by Stephanie Soscia and her colleagues that plaque formation in Alzheimer disease might be part of the brain’s immune response. This led to a discussion of theories that chronic infectious diseases (e.g., Chlamydia pneumoniae, a cause of pneumonia, Helicobacter pylori (gastric ulcers and stomach cancer), and Borriela “Lyme disease”) might play a large role in “western” diseases.

I also discussed media coverage of current events vs. the scientific papers those events were based on. In other cases, I highlighted current events that got little media coverage. For example, in March 2010 the media was widely reporting that up to a third of breast cancer cases in Western countries could be avoided if women are less and exercised more”. The main author, Carlo La Vecchia even speculated that 2/3 of all breast cancer could be prevented by diet and exercise. This was based on a non-peer reviewed paper given at a conference. At the same time, another peer-reviewed report showed that “Thin Girls Have Higher Breast Cancer Risk” especially for the more aggressive breast cancers. This second report got almost no popular press. The first report played to our general “blame the victim” mentality coupled with the “fat taboo”. I added another dimension to the discussion and showed them work that Bisphenol A (BPA) is correlated with both obesity and breast cancer. This reinforced that the idea that correlation between obesity and cancer does not mean causality.

Li J, Humphreys K, Eriksson L, Czene K, Liu J, Hall P. (2010) Effects of childhood body size on breast cancer tumour characteristics Breast Cancer Research 2010, 12:R23 (15 April 2010)

Soscia, S., et al. (2010). The Alzheimer’s Disease-Associated Amyloid β-Protein Is an Antimicrobial Peptide. PLoS ONE 5(3) DOI: 10.1371/journal.pone.0009505.

Related Resources

This course has encouraged me to develop a second course – Social, Legal and Ethical Issues of the New Genetics . The “New Genetics courses” is also a course for Life Science majors that will move from basic science to ethical and social issues. As with Evolutionary Medicine, it will fulfill the 21st century challenge goals of SAS as well as meet specific goals of the Genetics department.