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The accidental evolutionary clinical trial

This conversation was led by Dr. Joe Alcock, Professor in the Department of Emergency Medicine at the University of New Mexico. An increasing number of randomized controlled trials (RCTs) inform the practice of evidence-based medicine and evolutionary medicine. These RCTs fall into three categories. First, a handful were undertaken to explicitly test evolutionary hypotheses. Of these, the evolutionary rationale can be minimized in the final publication, as in Young et al.’s 2015 NEJM study testing whether fever reduction with acetaminophen improves outcomes in critical illness (It doesn’t). A second category of trials are “evolution-adjacent,” drawing some inspiration from evolutionary concepts such as antibiotic resistance or mismatch and diet, for example. A third category is the accidental evolutionary clinical trial. These include studies aimed at “correcting” deficiency syndromes associated with life history events, such as estrogen deficiency in menopause, and the idea that an overwhelming majority of adults require intervention for deficiency of vitamin D. Using several of these trials as examples, I will describe what lessons can be taken from these accidental evolutionary trials, especially when they produce results their authors did not expect.

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