Robert L. Perlman, Evolution & Medicine

In 2012, there were 834 769 active physicians in the USA (http://kff.org/other/state-indicator/totalactive-physicians/). By my generous and unscientific estimate, I would say that physicians outnumber researchers with a primary interest in evolutionary medicine by more than 1000 to 1. Can this quite small subset of scientists convey the power of evolutionary thinking to the medical establishment? In his new book Evolution & Medicine, Robert Perlman sets out to address this important audience. Evolutionary Medicine is emerging as a vibrant research field of its own, with international meetings devoted to the topic, its own journal, and a steady stream of book-length treatments of the topic. The current excitement in the field owes much to early contributions from George Williams and Randy Nesse, starting with their Quarterly Review of Biology paper almost 25 years ago [1], followed by their book-length treatment of the subject [2], a book now translated into at least nine languages (R. Nesse, personal communication), and cited over 800 times according to Google Scholar. Since then, a variety of books have provided updated introductions to the field as a whole [3–7], whereas others have explored more focused questions (e.g. [8–11]). These books have many strengths, and I have taught from parts or all of at least six of them. But none of these is directly aimed at the very doctors (or future doctors) whom we would like to influence. Perlman’s book does much to address this shortcoming. The back flap of my copy of Evolution & Medicine promises a text that is ‘written for physicians, biomedical scientists, and both premedical and medical students’. The field needs books written for this purpose, and Perlman’s book is a move in the right direction. This is not to say that previous books are not up to the task. But in the main, they are written either with a broad general audience in mind, or for evolutionary specialists. Perlman recognizes the need to speak directly to physicians and biomedical scientists. He does so right from the start, pointing out that unlike physicians, evolutionary biologists are necessarily focused on variation, the sine qua non of natural selection. Each individual is unique, and its phenotype is a reflection of the cumulative outcome of over 3 billion years of evolution acting on its ancestors, coupled with its own recent environmental history. Perlman notes that such variation is decidedly not the purview of the practicing physician: