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Why disease persists: an evolutionary nosology.

Robert L Perlman¹

¹Department of Pediatrics, The University of Chicago, 5841 S. Maryland Ave., MC 5058, IL 60637, USA. r-perlman@uchicago.edu

Medicine, Health Care, and Philosophy

|November 12, 2005

Summary

Evolutionary processes beyond natural selection, like mutation and gene flow, explain persistent diseases. Genetic factors and environmental changes also contribute to the prevalence of human diseases.

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Area of Science:

Evolutionary biology
Medical genetics
Population genetics

Background:

Natural selection is expected to decrease disease incidence and severity.
However, diseases persist in populations despite evolutionary pressures.

Purpose of the Study:

To explore the evolutionary mechanisms maintaining disease.
To understand why natural selection does not eliminate all diseases.

Main Methods:

Review of evolutionary theory and genetic principles.
Analysis of factors influencing allele frequencies and disease persistence.

Main Results:

Mutation, gene flow, pleiotropy, epistasis, and linkage disequilibrium can maintain deleterious alleles.
Life history strategies and trade-offs can favor traits that increase disease risk later in life.
Selection acting at different biological levels and environmental changes contribute to disease persistence.

Conclusions:

An evolutionary perspective is crucial for understanding disease persistence.
Evolutionary nosology enhances the comprehension of human variation and disease.

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