Were used to controversies around the teaching of evolution but heres one place you might be surprised to learn Darwinian thinking is still struggling to take hold: medical schools. Its not that the medical establishment doubts evolution, its just that traditionally it hasnt viewed it as particularly relevant to taking care of patients.

Its not too hard to demonstrate that doctors are ignorant about real fundamentals of evolution, says Randolph Nesse. Theyd flunk their first quiz in an evolution course.

Nesse, who teaches evolutionary biology at the University of Michigan and was trained as a physician, has for more than two decades been leading the charge to make evolution a bigger part of how doctors are trained. He argues medical schools do a good job teaching doctors the mechanisms by which diseases attack the body, but pay insufficient attention to the more general question of why our bodies have evolved with vulnerabilities to pathologies like cancer and diabetes in the first palce.

A doctor who has a deep foundation in evolution will think different about disease, says Nesse. Instead of just seeing disease as some screw-up in the machine, they will ask of every disease, why didnt natural selection make the body more resistant to this particular problem?

Evolutionary thinking about health can be flimsy sometimes. Recent years have seen the rise of the so-called paleodiet, based on the idea that since most of our evolution took place in prehistoric time, we should eat like prehistoric people. In her new book Paleofantasy biologist Marlene Zuk reveals the lack of evidence supporting the paleodiet and other evolutionary health fads. For their part, evolutionary biologists say that their jobs are only made harder by this loose appropriation of their thinking.

A lot of people in the lifestyle world want to use the label of evolutionary medicine to describe things that are loose-goosey, says Stephen Stearns, an evolutionary biologist at Yale University and a leading advocate for evolutionary medicine. It makes my life more difficult, because the more rigorous insights tend to get lumped in with the less rigorous insights.

And its those more rigorous insights that proponents of evolutionary medicine claim medical students arent getting. Stearns, Nesse, and Jeffrey Flier, Dean of Harvard Medical School, were among 13 co-authors of a 2010 paper called Making evolutionary biology a basic science for medicine. The core of their argument is that evolutionary medicine provides doctors with a unified way to think about the human body, as opposed to considering each part of the body in terms of its discrete function. Evolutionary biologists also argue that evolutionary thinking has the potential to help crack some of the biggest health problems of our time, including the increase of autoimmune disorders, the rising menace of antibiotic resistance, and the intransigence of cancer.

Not everyone agrees. Skeptics of evolutionary medicine argue that understanding why human beings evolved with a vulnerability to something like obesity doesnt change the way a doctor would treat an obese patient. They agree that evolutionary biology is a useful perspective for doctors to have, but dont think its necessarily any more essential than many other disciplines vying for space in crowded medical school course schedules.

I think evolutionary biology could be taught to a much greater extent, but as a dean who has many passions about education, there are many competing priorities for the time in the curriculum, says Robert Alpern, Dean of Yale Medical School. As to whether additional medical training in evolution would improve the way doctors treat patients or conduct research, Alpern says, I dont think theyd change a lot.

And this is one of the most interesting things of all about evolutionary medicine: how widely opinions differ about its usefulness. For evolutionary biologists like Nesse and Stearns, evolutionary medicine is tantamount to a revolution in the way we think about health and disease. For Alpern and others in the medical establishment, its an interesting perspective without significant practical implications thats already being taught sufficiently in most medical schools.

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Evolution in medical school: Do we need more of it?