The same powerful force that shaped our species is largely absent from the clinics where we treat its ailments.
Imagine visiting a mechanic who understands how to change your oil and rotate your tires but has never learned how a car engine works. They might fix the immediate problem, but they'd be baffled by deeper issues—why the car struggles on hills, how the transmission interacts with the engine, or what design flaws make certain models break down more often. For decades, much of modern medicine has operated in a similar way. We have become brilliant at treating immediate symptoms but often overlook the fundamental question: why are we vulnerable to disease in the first place?
The answer lies in our evolutionary history. Every organ, cell, and molecule in the human body is the product of millions of years of evolution, a process shaped by variation, heredity, and natural selection 1 . This isn't just an academic theory; it has life-or-death consequences for how we understand and treat cancer, antibiotic resistance, and even pandemics. Yet, a quiet revolution is stirring in the halls of medicine, pushing for a simple but profound shift: to see our bodies not as perfect machines, but as dynamic, historical products of evolution. This is the field of evolutionary medicine, and it holds untapped potential to spark transformational innovation in biomedicine and public health 5 .
How prevalent is evolutionary thinking in medicine? A team of researchers decided to find out by conducting a massive bibliometric analysis—a scientific way of mapping the landscape of published research 1 . Their goal was simple but ambitious: to determine what percentage of articles in top medical journals genuinely use concepts from biological evolution.
Top Medical Journals Analyzed
Papers with Evolutionary Perspective
Of Medical Literature
The methodology was meticulous. Scientists scoured the top 50 medical journals, searching for keywords like "evolution" and "evolutionary." But there was a catch: the word "evolution" is often used in medicine to describe the progression of a patient's illness (e.g., "the patient's clinical evolution"). The team had to manually sift through thousands of articles, filtering out this clinical jargon to find only those referring to biological evolution 1 . It was a painstaking process of separating the signal from the noise.
The results were startling. Out of a vast sea of medical research, only a tiny fraction of articles—from just 1,647 papers in the top-tier journals—incorporated a true evolutionary perspective 1 . This discovery revealed a significant gap: the powerful lens of evolution is being largely ignored in the places where it could have the most immediate impact on human health.
The research revealed that evolutionary concepts are not absent from medicine, but they are concentrated in specific specialties. The chart below breaks down the medical fields where evolutionary perspectives most frequently appear, based on the published literature analysis 1 .
The data shows a clear pattern: evolution is most readily applied to infectious diseases and cancer, where the "arms race" dynamic is easiest to see. Viruses, as the most rapidly evolving biological entities, were the most frequently studied microorganisms from an evolutionary perspective, followed by bacteria, fungi, and protozoans 1 . This makes intuitive sense—during a pandemic, we watch the SARS-CoV-2 virus evolve in real time, making the relevance of evolution impossible to deny 5 .
When medicine operates without an evolutionary perspective, it's like trying to complete a puzzle with a missing piece. You might see parts of the picture, but the full context remains elusive. This gap has real-world consequences, primarily because it leads to a fundamental misunderstanding of the root causes of disease.
Evolution acts through mechanisms like trade-offs and historical contingencies, not to achieve perfection, but to maximize reproductive success 8 . Our bodies are not perfectly engineered machines; they are patchworks of compromises.
"The inclusion of evolutionary concepts in the medical curriculum could benefit the formation of physicians with skills to understand how evolution shapes human disease" 1 . Yet, most medical schools still treat evolution as a subject for biology undergraduates.
Physicians are unprepared to think about why a disease emerges and evolves, limiting them to treating its symptoms as they appear 8 .
The natural world is a vast library of solutions to the very problems that plague human health. By ignoring this "phylogenetic diversity," we are overlooking countless blueprints for novel treatments 5 .
Without understanding evolutionary trade-offs, medicine often focuses on symptom management rather than addressing root causes shaped by our evolutionary history.
While the integration of evolution into medicine has been slow, the areas where it is being applied are producing groundbreaking results. Evolutionary medicine is moving from a theoretical field to an applied science, offering powerful new tools for some of our most pressing health challenges.
The most immediate application is in the fight against evolving enemies. Both cancer cells and pathogenic microbes evolve resistance to our treatments through natural selection. Evolutionary medicine is countering this not with stronger drugs, but with smarter strategies.
Oncology is now viewing cancer as an ecological and evolutionary problem. Cancer cells are "cheaters" that bypass the rules of cellular cooperation 5 . Instead of always trying to eradicate every last cancer cell (which selects for resistant mutants), new adaptive therapies use evolutionary principles to control tumor growth.
Similarly, the field is exploring innovative ways to treat bacterial infections without generating resistance. Phage therapy—using viruses that infect and kill bacteria—is a remarkable opportunity to "evolution-proof" treatments 5 .
Evolutionary medicine also recasts many modern chronic diseases as "mismatch" diseases. These are conditions that arise because our stone-age bodies are struggling to cope with modern, rapidly changed environments 5 .
The epidemic of obesity, type 2 diabetes, and heart disease can be understood through this lens. Our bodies evolved to crave salt, fat, and sugar in a world of scarcity, but we now live in a world of abundance. This isn't a moral failing; it's a predictable evolutionary mismatch.
This insight provides a powerful framework for public health strategies focused on prevention through environmental and lifestyle adjustments, rather than just treating symptoms after they appear.
So, what tools do scientists use to apply evolutionary principles to medicine? The toolkit is diverse, blending classic biological reagents with advanced computational models.
Reconstructing the evolutionary history and relationships of genes, pathogens, or species to track outbreaks and understand disease origins.
Studying evolution in real-time in the lab (e.g., evolving bacteria or cancer cells) to test hypotheses about drug resistance.
Reading the complete DNA blueprint to identify evolutionary signatures, genetic variations, and mutations driving disease.
Studying physiological adaptations across animal species to find natural models of disease resistance (e.g., an animal resistant to cancer).
A conceptual tool for understanding diseases that arise from disparities between our evolved biology and modern environments.
This toolkit is now being taught in specialized programs like the Evolutionary Medicine Summer Institute (EMSI), which trains health practitioners and scientists in computational approaches and evolutionary methods applicable to cancer, infectious disease, and more 6 . Furthermore, summer schools, like one in Cargèse, France, focus on "Molecular Evolution and Design," bridging the gap between computational models, machine learning, and medical applications 2 . This represents a growing effort to formalize the training needed for this interdisciplinary field.
The evidence is clear: evolutionary biology is not a dusty academic relic, but a vibrant and necessary lens for modern medicine. While the dissemination of its core concepts has been lacking, the tide is beginning to turn.
"The collection of our results, considering the importance of evolutionary medicine in the medical field, highlights the need for a decisive change in perspective in medical research" 1 .
The future of medicine depends on embracing our evolutionary history. It means training doctors who understand why we get sick, not just how to treat the sickness. It means developing therapies that anticipate and manage evolution, rather than being defeated by it. It means looking to the natural world for inspiration, knowing that the solutions to many human ailments have already been field-tested by millions of years of evolution. By integrating this powerful perspective, we can spark the transformational innovation needed to tackle the most complex health challenges of the 21st century 5 . The question is no longer if evolution is relevant to medicine, but how quickly we can bring this indispensable tool into every clinic and research lab.