Diapositiva 1

1
Evolutionary Classification of Diseases and
Similar Conditions Libertini G. (M.D.,
Independent Researcher) 6th Congress SIBE
Bologna 2015, August 31 September 3
Modern biology, e.g. the classification of living
species, the understanding of their physiology
and every other feature of a living being, is
centred on the concepts of evolutionism.
The medicine, which is an applicative branch of
biology, should also be centred on evolution. If
"Nothing in biology makes sense, except in the
light of evolution" 1 is true, why "Nothing in
medicine makes sense, except in the light of
evolution 2 should not be true? Evolutionary
Medicine is the enterprise of using evolutionary
biology to address the problems of medicine 3
For current medicine, the knowledge of
evolutionism is considered useful only for
particular diseases or phenomena. On the
contrary, for Evolutionary Medicine, it is
unthinkable to disregard a complete integration
of evolutionism in the core of medicine in order
to effectively understand, prevent and treat
diseases and similar phenomena 4, 5. This
implies a radical change of the whole medicine,
and, among other things, an evolutionary
classification of diseases and similar conditions.
Theodore Dolbzhansky
Randolph Nesse

• The current International Classification of
  Diseases (ICD-10) 6, as the preceding ones,
  classifies empirically the diseases and various
  similar phenomena
• - Categories III-XIV mirror the affected organic
  system (e.g. circulatory, respiratory,
  digestive)
• - Categories I, II, XV-XVII, XIX mirror specific
  medical specializations (e.g. oncology,
  traumatology)
• Categories XVIII, XX-XXII include all other
  troubles.

The "modern" classification of diseases is
pre-Darwinian and follows empirical and customary
criteria in short, it is largely based on the
organic system affected or on the competence
attributed to some specializations. This
traditional type of disease classification
mirrors the historical development of medicine
and its gradual subdivision in various
specializations and has no rational
justification, i.e. it is not based on scientific
criteria. Here, an evolutionary classification
is proposed.
III - Diseases deriving from extremes of the
ecological niche (trauma burns, etc.) Conditions
that are beyond the adaptive range of the species
cause troubles or death.
I - Diseases deriving from alterations of the
genotype The transfer of genetic information
from a generation to the next is imperfect, a
fact that is fundamental for the whole
evolutionary theory. As these modifications are
changes in a very complex and ordinate system,
they are, when not neutral, a likely cause of
physiologic dysfunctions.
IV - Diseases deriving from interactions with
other living beings (infections, parasitosis,
etc.) There is a continuous competition among the
species, in particular conflictual evolutionary
exigencies between an organism and its parasites
(bacteria, virus, fungi, worms, etc.). The
relationship between an organism and its
parasites is analogous to that between a prey and
its predators. So, it is predictable that, such
as it happens in prey-predator case, parasites
will damage more very young, sick and old
individuals and much less healthy and of
intermediate ages individuals, to minimise
disadvantages and maximise advantages both for
hosts and for parasites.
Evolutionary Classification of Diseases
and Similar Conditions
II - Diseases deriving from alterations of the
ecological niche, i. e. consequences of
mismatches between adaptation and modified
lifestyles As the modifications of the
ecological conditions to which a species is
adapted are changes in a very complex and
ordinate system, they are, when not neutral, a
likely cause of disease.
V - Physiologic phenomena that cause troubles and
sufferings, or death V-1 - Defences against
trauma, infections, toxic substances, etc. (i.e.
pain, fever, cough, sneezes, nausea, vomit,
diarrhoea, etc.) V-2 - Mental and behavioural
disorders as adaptations to particular situations
V-3 - Pregnancy, childbirth, puerperium V-4 -
Phenoptotic phenomena, aging excluded 7 V-5
Aging 7-10
Such a classification implies that the focus is
on the primary causes of the troubles and not on
trouble manifestations. It follows that
Evolutionary Medicine is mainly aimed at
preventing disease and considers the cure as the
last remedy for cases where prevention has
failed. Primary prevention is a rational and
effective way to reduce the growing health
deterioration, a tragic colossal disaster masked
by the rising technical triumphs of current
medicine (fig. 1).
Comparison between the different Categories of
Diseases and Similar Conditions
Number of troubles Mean frequency Primary prevention Care or treatment
I - Diseases deriving from alterations of the genotype Very high Very low Only for some diseases Genetic terapy or care of manifestations
II - Diseases deriving from alterations of the ecological niche Many High Always possible Care of manifestations when prevention has failed
III - Diseases deriving from extremes of the ecological niche Many Significant Always possible Care of manifestations when prevention has failed
IV - Diseases deriving from interactions with other living beings Many High Possible in many cases Limited to essential cases
V - Physiologic phenomena that cause troubles and sufferings, or death
V-1 - Defences against trauma, infections, toxic substances, etc. Some High Not necessary Limited to curb excessive expressions
V-2 - Mental and behavioural disorders as adaptations to particular situations Some Low Possible Limited to essential cases
V-3 - Pregnancy, childbirth, puerperium Some Low Not necessary Limited to essential cases
V-4 - Phenoptotic phenomena, aging excluded Few Low Not necessary Not necessary
V-5 - Aging One Universal Impossible Genetic modifications, if ethically accepted
When there is more than one primary cause, the
attention must be focused on the main cause. For
example, changes in the ecological niche
(Category I) may induce a sudden diffusion of
diseases of Category IV, i.e. epidemics, or the
acceleration of the aging process (Category V-5).
For such cases, prevention is always possible,
and care should be reserved for cases where
prevention has failed. This also means that
"epidemics" and "accelerated aging" should be
viewed primarily in the context of Category II.

This classification appear to be 1) rationale,
as it is based on the pivotal biological theory
2) effective, as it focuses the attention on the
primary causes and on the prevention of diseases
(or the possible contrast of similar conditions)
REFERENCES 1 Dobzhansky T (1973) Am. Biol.
Teach. 351259 2 Varki A (2012) J. Mol. Med.
(Berl.) 90481-94 3 Nesse RM, in Trevathan et
al. eds (2008) Evolutionary Medicine new
perspectives. New York, Oxford Univ. Press, Ch.
23 4 Libertini G (1983) Ragionamenti
Evoluzionistici in Italian. Naples (Italy),
Soc. Ed. Nap. English edition (2011)
Evolutionary Arguments on Aging, Disease and
Other Topics. Crownsville, MD (USA), Azinet Ed.
5 Nesse RM et al. (2010) Proc. Natl. Acad. Sci
USA 107(S1)1800-7 6 ICD-10, WHO 2015 7
Libertini G (2012), Biochem. (Mosc.) 77707-715
8 Skulachev VP (1997) Biochem. (Mosc.)
621191-5 9 Libertini G (2014) Biochem.
(Mosc.) 79(10)1004-16 10 Libertini G (2015)
Curr. Aging Sci. 8(1)56-68 11 Vos T et al.
(2015) The Lancet pii S0140-6736(15)60692-4.
Fig. 1 Growing Sickness. Although people are
living longer, they are also living with more
chronic conditions, as seen here in data for the
developed world. 11