Evolutionary Pediatrics

Published on September 29, 2016   41 min

Other Talks in the Series: Evolution and Medicine

0:00
I'm Paul Turke. I'm going to be telling you a little bit about Evolutionary Pediatrics.
0:05
I started off as an anthropologist, worked and helped to develop a field called cooperative breeding in humans. That required me to understand some evolutionary life theory but specially trade-offs between early and late-life events. That led me down the hall to an immunologist at the University of Michigan named Richard Miller, and I collaborated with him as a Postdoc for a while on planning evolutionary theory to the problem of T cells senescence. From that my interests in medical complex peaked, and so I moved to the Michigan State University, where I went to medical school, and after that I came back to the University of Michigan to complete my pediatric residency. And then finally in 1999, I bought a small private pediatric practice. And today, I and our partner Suzanne Thomashow in the small town of Dexter, which is next to Ann Arbor, we take care of over 1,000 different families.
1:06
Before I tell you a lot about evolutionary pediatrics, I want to talk just for a minute about science in general and how science is done. As most people know science has two main components, there's the ideas or theory side and then there's the data or evidence side. And in reality they are all wrapped together but we separate them from time to time when we're actually doing science. And in fact, on a given day, a scientist may work purely on the data side or purely on the theory side. And similarly, fields of science can be somewhat out of balance with respect to one or the other at any given point. So string theory, for example, in physics is heavily weighted on the theory side right now. The technology tests a lot of the theories there just aren't available. That's not bad, they will be, and so right now, theory is pointing the way to the kind of data to look at, so there is not a problem. Medicine on the other hand is over-weighted in terms of evidence and data. Medical doctors, medical scientists are the best in the world probably at collecting data and analyzing it and culling it, and putting it into usable formats and so on, but they're fairly light on the theory.
2:25
So medical science is sort of summarizes is evidence-based but light on theory. And that's okay for now, there's nothing wrong with evidence, but those of us who know something about evolution and are interested in evolutionary medicine have been arguing for a while that what medical science really needs is to pay more attention to Darwin's theory and that will help to put the science back into balance. And I think it will help us to advance medical knowledge and also to prevent some of the mistakes that go on when we try to use evidence that don't have the right theoretical context from which to understand it.
3:05
So let me talk a little bit about what evolutionary pediatrics is. Basically, it's evolutionary medicine done on smaller or younger people. And in general, it's using the ideas of evolution, evolutionary theory, and the information that we have, the evidence that we have, and applying it to understanding problems that have to deal with human health and wellbeing or their apposite. In a very practical sense, what many of us who are involved in evolutionary medicine do is we tend to divide the world into clinic least into defenses and mismatches, and I'm going to explain what those are beginning with the next slide.
3:49
So defenses are adaptations. And how do we recognize an adaptation? Well, the first clue that we're dealing within adaptation is complexity, something that has complex design. The late Stephen J. Gould said, "An engineer's criterion of good design," in the sense, engineers build things that work or design things that work that brings function into their picture, too, and ultimately, what an adaptation's function is, is to do something adaptive to increase the organism's fitness in one way or another. So evolutionary biologists are pretty good at finding adaptations and coming to an understanding of them, whereas medical science, medical doctors, really, again because they're not so much explicitly evolution minded, they kind of fall down on the job when it comes to this. They don't look for adaptations as carefully as they should and perhaps they don't know how to recognize them as readily as they should. And therefore, they end up sometimes attacking adaptations, the defenses in particular when what they really should be doing is letting them go and letting them to do their job.
4:58
So let me in the next slide go through and give some examples here. Let's start with fever. So fever has all the hallmarks of an adaptation. It's complicated. And I put this slide up not that I want anybody to remember the pathways here, but just to show that a complex cluster of signals has to be carried out in order to produce fever. At the top, we have LPS or lipopolysaccharide, which is a component of the cell walls of gram-negative bacteria. It's a strong inducer of fever, so when the immune system sees it, the series of pathways is activated and the body temperature rises. So it has the complexity component we require for something to be an adaptation. About fever it's also been learned over the years, it has a function. Fever, sort of, revs up the metabolism, revs up the immune system, and helps us to fight germs. Now when my children were young, in the late '80s and early '90s, doctors didn't at all recognize this. In fact, when I would take them to their doctor when they would have a fever, before they even saw the doctor, someone in the office was trying to offer them a fever reducer like acetaminophen or ibuprofen. And I would step in and say, "No, they don't need that." And, of course, they would roll their eyes, and I'm sure they said plenty of things about me in the backroom, but although I wasn't a doctor then, I knew that fever looked a lot like an adaptation. And I had a pretty strong feeling that it was functional. And I met the Evolutionary Physiologist Matthew Kluger at around that time, and he started to tell me about the actual evidence showing that fever is helpful. And nowadays, we have a lot of evidence that fever helps to fight illness. And doctors nowadays are much more cognizant of that, and so they're not so quick to recommend fever reducers as they once were. I'd like to say that they've come to that conclusion because they've become good evolution-minded adaptationists but I don't think that's what it is for the most part, I think it's because doctors, you know, are very tuned in to the evidence. And the evidence has now been gathered showing that that's what fever does but there was this time when the evidence wasn't all that clear. But we did have a strong theoretical reason for believing fever was an adaptation, and I think if we had combined those two, we would have stopped giving fever-reducing medicines as often sooner. So I think theory would have helped to move our understanding along in a way that would have been beneficial to a lot of patients.
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Evolutionary Pediatrics

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