1. Evolutionary Classification of Diseases and Similar Conditions Libertini G. (M.D., Independent Researcher) 6 th Congress SIBE – Bologna 2015, August 31 – September 3 REFERENCES: [1] Dobzhansky T (1973) Am. Biol. Teach. 35:125–9; [2] Varki A (2012) J. Mol. Med. (Berl.) 90:481-94; [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.) 77:707-715; [8] Skulachev VP (1997) Biochem. (Mosc.) 62:1191-5; [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. 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) 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. 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). 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. 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. 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. 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. 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] 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. Number of troubles Mean frequency Primary preventionCare or treatment I - Diseases deriving from alterations of the genotypeVery highVery lowOnly for some diseasesGenetic terapy or care of manifestations II - Diseases deriving from alterations of the ecological nicheManyHighAlways possibleCare of manifestations when prevention has failed III - Diseases deriving from ‘extremes’ of the ecological nicheManySignificantAlways possibleCare of manifestations when prevention has failed IV - Diseases deriving from interactions with other living beingsManyHighPossible in many casesLimited to essential cases V - Physiologic phenomena that cause troubles and sufferings, or death V-1 - Defences against trauma, infections, toxic substances, etc.SomeHighNot necessaryLimited to curb excessive expressions V-2 - Mental and behavioural disorders as adaptations to particular situations SomeLowPossibleLimited to essential cases V-3 - Pregnancy, childbirth, puerperiumSomeLowNot necessaryLimited to essential cases V-4 - Phenoptotic phenomena, aging excludedFewLowNot necessary V-5 - AgingOneUniversalImpossibleGenetic 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. 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. Evolutionary Classification of Diseases and Similar Conditions Comparison between the different Categories of Diseases and Similar Conditions 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] 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] Theodore Dolbzhansky Randolph Nesse 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.