Evolutionary explanations in medicine: how do they differ and how to benefit from them.

Evolutionary explanations, many of which have appeared on the pages of this journal, are becoming more pervasive and influential in medicine, so it is becoming more important to understand how these types of explanations differ from the proximate approach that is more common in medicine, and how the evolutionary approach can contribute to medicine. Understanding of any biological phenomenon can occur at four levels: (1) ontogeny (2) causation, (3) function and (4) evolution. These approaches are not mutually exclusive, and whereas the first two are more common in medical practice, a complete explanation requires all four levels of analysis. Two major differences among these approaches are the apparent degree of immediacy associated with them, and the extent to which they apply to individuals rather than populations. Criticisms of adaptive explanations often arise from a failure to understand the complementary nature of these four types of explanations. Other unwarranted criticisms result from a failure to appreciate that adaptive explanations often apply to populations, not individuals. A third type of criticism is driven by the mistaken belief that adaptive explanations somehow justify morally reprehensible behaviours. Finally, evolutionary explanations sometimes face the criticism of "personal incredulity". Adaptive explanations must be consistent with basic evolutionary concepts and must adhere to the physical reality of the phenomenon in question. Their value, however, comes not in devising a seemingly rational explanation, but in their predictions. Testable predictions must be explicitly stated and clearly articulated. They must differ from those of arising from other hypotheses and must not only be interesting to evolutionary biologists, but also useful to medical practitioners. Integration of the proximate and the ultimate approaches is possible and potentially beneficial to both evolutionists and physicians, but it requires some basic understanding of our differences and a desire to co-operate.