Despite recent rapid advances in medical knowledge that have improved survival, conventional medical science's understanding of human health and disease relies heavily on people of European descent living in contemporary urban industrialized environments. Given that modern conditions in high-income countries differ widely in terms of lifestyle and exposures compared to those experienced by billions of people and all our ancestors over several hundred thousand years, this narrow approach to the human body and health is very limiting. We argue that preventing and treating chronic diseases of aging and other mismatch diseases will require both expanding study design to sample diverse populations and contexts, and fully incorporating evolutionary perspectives. In this paper, we first assess the extent of biased representation of industrialized populations in high profile, international biomedical journals, then compare patterns of morbidity and health across world regions. We also compare demographic rates and the force of selection between subsistence and industrialized populations to reflect on the changes in how selection operates on fertility and survivorship across the lifespan. We argue that, contrary to simplistic misguided solutions like the PaleoDiet, the hypothesis of evolutionary mismatch needs critical consideration of population history, evolutionary biology and evolved reaction norms to prevent and treat diseases. We highlight the critical value of broader sampling by considering the effects of three key exposures that have radically changed over the past century in many parts of the world-pathogen burden, reproductive effort and physical activity-on autoimmune, cardiometabolic and other mismatch diseases.

中文翻译：

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奇怪的机构：不匹配、医学和缺少多样性

尽管最近医学知识的快速进步提高了生存率，但传统医学科学对人类健康和疾病的理解在很大程度上依赖于生活在当代城市工业化环境中的欧洲人后裔。鉴于高收入国家的现代条件在生活方式和暴露方面与数十亿人和我们所有祖先数十万年来所经历的情况有很大不同，这种对人体和健康的狭隘方法非常有限。我们认为，预防和治疗衰老慢性病和其他失配疾病既需要扩大研究设计以对不同人群和背景进行抽样，也需要充分结合进化观点。在本文中，我们首先评估高知名度的国际生物医学期刊对工业化人口的偏见程度，然后比较世界各地区的发病率和健康状况。我们还比较了生存人口和工业化人口之间的人口比率和选择力，以反映选择如何影响整个生命周期的生育率和生存率的变化。我们认为，与 PaleoDiet 等简单的误导性解决方案相反，进化不匹配的假设需要对种群历史、进化生物学和进化反应规范进行批判性考虑，以预防和治疗疾病。