New hope for diabetics?
I am not from the field of medicine which this book is mostly about, but I am an avid science reader particularly fond of anything in evolution. I picked up the book both because of its Darwinian affiliation and because I am a diabetic myself. What I found astonishing is that unlike most Darwinians whose arguments stop at the organismal level, this book goes to reason out intricacies in biochemical pathways, metabolism, immunity and molecular signaling on an evolutionary, ecological and behavioral platform. Evolutionary biologists have tried to explain obesity and diabetes before, but none of the prior biologists appear to have gone into this much depth and tried to explain every minute detail about the complex interactions in diabetes. With the title saying "Darwinian interpretation of type 2 diabetes" I had expected thrifty gene, thrifty phenotype etc. But the author criticizes all these concepts and comes up with a very different interpretation which is centered around behavior than around diet and obesity.
But more than that, I am more struck by the list of expectations from an evolutionary theory of a disease that is spelt out in the beginning of chapter 4. This goes much beyond what evolutionary biologists have been doing so far. The expectations in the author's words are
"(1) It should address the basic riddle why a disorder that has strong familial tendencies and so has some presumably genetic components has suddenly increased its prevalence in the last couple of generations. (2) It should explain the apparent polymorphism in the population, i.e., individual differences in the tendency to become obese and/or diabetic. (3) It should explain the observed epidemiological associations and patterns, for example, the strong association between birth weight and metabolic syndrome. (4) It should not stop at explaining the origins of obesity but also explain why obesity is associated with insulin resistance and its numerous consequences with both proximate and ultimate components of reasoning; more specifically, there needs to be an ultimate reasoning for why obesity induces insulin resistance (if it does) and other metabolic and endocrine changes. (5) It should give logical and testable solutions to all the paradoxes that we saw in the last chapter. (6) It should help us find out why T2D is found to be largely "incurable," at least with the current therapeutic approach. (7) It should be falsifiable and either be supported by existing evidence and/or make a series of predictions that can be tested sooner or later. (8) Optimistically ...... it should lead to some fundamental breakthrough of clinical importance. If it leads to a long-term solution or "cure" for diabetes, sooner or later, it would be really fascinating."
So far evolutionary explanations have generally not interfered with the "how" question. They try to explain only the "why" of it and leave the "how" questions to physiologists, geneticists, molecular biologists and pharmacologists. Often the evolutionary explanations are only stories that are difficult to experimentally test. This book is an exception in that it makes a large number of testable predictions and suggests experiments. It also goes on cutting across fields widely. As a result I am afraid whether any single reader would be able to grasp it sufficiently well. As for myself I find the evolutionary arguments fascinating but I am unable to judge whether the author's views about the clinical implications would be equally well received by clinicians. If the author's logic is correct (which researchers have to decide in the coming decades by testing a large number of testable predictions that the book spells out) there should be a "cure" for diabetes in near future and as a long standing diabetic I would urge diabetes researchers to read the book and do experiments to test the new ideas. If they stand the test of time, many diabetics like me could be greatly benefited.
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