Utilizing the Delphi method, 56 experts from a variety of disciplines, including anthropology, medicine, and biology agreed upon 14 core principles intrinsic to the education and practice of evolutionary medicine.[5] These 14 principles can be further grouped into five general categories: question framing, evolution I and II (with II involving a higher level of complexity), evolutionary trade-offs, reasons for vulnerability, and culture

  • Both proximate (mechanistic) and ultimate (evolutionary) explanations are needed to provide a full biological understanding of traits, including those that increase vulnerability to disease.
  • All evolutionary processes, including natural selection, genetic drift, mutation, migration and non-random mating, are important for understanding traits and disease.
  • Natural selection maximizes reproductive success, sometimes at the expense of health and longevity.
  • Several constraints inhibit the capacity of natural selection to shape traits that are hypothetically optimal for health.
  • Evolutionary changes in one trait that improve fitness can be linked to changes in other traits that decrease fitness.
  • Life history traits, such as age at first reproduction, reproductive lifespan and rate of senescence, are shaped by evolution, and have implications for health and disease.
  • Vulnerabilities to disease can result when selection has opposing effects at different levels (e.g. genetic elements, cells, organisms, kin and other levels).
  • Cultural practices can influence the evolution of humans and other species (including pathogens), in ways that can affect health and disease (e.g. anti-biotic use, birth practices, diet, etc.).
  • Disease risks can be altered for organisms living in environments that differ from those in which their ancestors evolved.
  • Many signs and symptoms of disease (e.g. fever) are useful defenses, which can be pathological if dysregulated.
  • Environmental factors can shift developmental trajectories in ways that influence health and the plasticity of these trajectories can be the product of evolved adaptive mechanisms.
  • Coevolution among species can influence health and disease (e.g. evolutionary arms races and mutualistic relationships such as those seen in the microbiome).
  • Tracing phylogenetic relationships for species, populations, traits or pathogens can provide insights into health and disease.


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Journal of evolutionary medicine