66
THE QUARTERLY REVIEW OF BIOLOGY
Volume 80
tion or flowers with spurs longer than the species seems remarkable. Geckos have toe
tongue of any known pollinator.
pads covered with setae that make use of van
der Waal forces of molecular attraction to
Six Reasons for Disease Vulnerability allow them to walk on ceilings. Other lizards
reproduce asexually in expanding clones
By 1986, I was preoccupied with an evolu-
that are fine in the short run but liable to
tionary perspective on disease; it made no
extinction from epidemic disease. Some
sense that the body so well designed in some
trees monitor the wavelength of light and
respects could be so poorly designed in oth-
allocate more resources to upward growth if
ers. I went looking for an evolutionary biol-
the wavelength indicates the presence of
ogist to help me understand why selection
nearby competitors. Others have limbs so
had left us so vulnerable to disease. Williams,
fragile that they lose many in every wind-
it turned out, was working on the same prob-
storm. The human body concerns us most.
lem and was looking for someone who knew
Our eyes are wonderful but fundamentally
about disease. Our shared interest in senes-
fragile bundles of jury-rigged design. We
cence brought us together, and we soon
have heart valves that stay in an exacting
started work on “The Dawn of Darwinian
leak-proof profile for a hundred years, but
Medicine” (Williams and Nesse 1991). The
far earlier most of us will get Alzheimer’s dis-
magnitude of the knowledge gap in medicine
ease, coronary artery disease, breast cancer
soon became clear. Medical research has
or prostate cancer. Near the early peak of
asked about every conceivable proximate fac-
health, we can run for miles, but at the same
tor that might explain why some people get
age we get impacted wisdom teeth, acne, and
sick and others do not, but evolutionary ques-
the onset of anxiety and mood disorders.
tions about disease were hardly even recog-
These jarring contrasts between remarkable
nized. This now seems less surprising. The
adaptations and examples of hopelessly poor
medical goals of prevention and treatment
design demand attention. They suggest that
are advanced most directly by finding out
our thinking about maladaptation has been
what causes disease in individuals. Seeking
too casual.
evolutionary explanations for diseases seems,
Biologists have recognized the opportuni-
and in most cases is, of less immediate prac-
ties as well as the problems in the study of
tical benefit. Furthermore, diseases represent
adaptation and maladaptation and proposed
failure, and selection shapes things that work,
a variety of strategies to exploit them (Mayr
not things that fail, so the relevance of selec-
tion is not readily obvious. We began making
progress when we changed the object of
explanation from disease to vulnerability to
disease. This apparently small change in per-
spective made all the difference. For disease
after disease we asked ourselves, “Why isn’t
the body better designed?”
1
983; Reeve and Sherman 1993; Rose and
Lauder 1996). In particular, Crespi proposes
bringing phylogeny, teleonomy, develop-
ment, and genetics together in an integrated
quantitative approach to the study of the
selective landscapes that result in maladapta-
tion: “Selection defines the landscape on
which populations move, and to the extent
The usual answer in medicine, as well as in that environments and selective pressures
much of biology, has been that natural selec- change our landscape becomes a sea where
tion is an undirected process whose influence waves rise, sink and move like water in a bath”
is weak because of the stochastic nature of (Crespi 2000:625).
mutations and drift, so we should not expect
Our more medically-derived evolutionary
bodies to be anywhere near optimal. This per- approach to maladaptation asks why selection
spective predicts that most traits in most spe- has not made the body better. The vagaries of
cies will be suboptimal if not severely flawed. a stochastic process and the constant pressure
However, examination of actual traits for spe- from mutation and drift are one possibility,
cific species reveals some that are extraordi- however, there are five other reasons why
narily close to optimal, while others seem so selection leaves bodies with designs that
hopelessly ill wrought that the survival of the appear substandard.