 Well, it's a pleasure to be here today, and I'm going to be talking about the implications of evolutionary mismatch for the field of public health. And so I help found and I co-direct an undergraduate program in public health at a liberal arts college, and we now have about 70 majors and minors. And I've been teaching courses, including evolutionary health, for about a dozen years. In this spring, I taught one called Environmental and Evolutionary Health. And that was a public health course, and the purpose is including encouraging public health students to question what they hear, and I'm trying to introduce them to evolutionary or ancestral health ideas. So just to make sure we're all on the same page, public health is a field that focuses on preventing disease and injury, prolonging life, and promoting health in human populations. And it has a quite different emphasis than clinical medicine. It's focusing on prevention, and it really focuses at the population rather level rather than treating individuals. And if we look at major public health successes and we think about the increase in life expectancy over the past couple of centuries, we see that much of the increase in life expectancy, and in fact most of it, is actually due not to clinical intervention, but rather to public health measures. Basically, just doing hygiene, getting people to understand hygiene, control of infectious and vector-borne diseases, that gets you a tremendous part of the way. And then vaccinations, tobacco reduction, and a whole host of other things, more recent things, have had tremendous impact. Now, just for a bit of temporal getting us set in a time frame, one of the main founders of epidemiology, and also of public health, was a man named John Snow, and he worked in the mid-1800s, and he's famous for solving the London cholera epidemic by mapping. That's actually his map, and he mapped out where these cases were and found out there was a well. That was the source of the infection. A broke the handle off the well to make a long story short. But I mention this because the germ theory of disease only developed, fully developed, from the middle to the late 1800s, and so much of what we think about and assume today, it just wasn't like that relatively recently. So evolutionary mismatch, that's kind of one of the, probably the underlying concept for what we're all doing, and we all understand evolutionary mismatch, a disconnect between an organism's adaptations in the past and the present. We understand many modern things, like modern foods, attraction to a sweet taste, was a match in the past. It's a mismatch now. And I always like to give an animal example as a biologist, and I wanted to give one that probably most of you are not familiar with, something called the Carolina Parakeet, and it went extinct in the early 1900s. So the Carolina Parakeet occurred broadly across the whole eastern U.S., all as far west as Texas, where I live, and even to Colorado. And it was very widespread and fairly abundant in many areas. But unfortunately it had a number of mismatches in the new conditions where Europeans came to North America. It unfortunately had bright feathers. Now that's great for a bird, but it's not great if that makes you a target for the feather trade for making women's hats, as was the case at the time, or if it makes you a target for capture by the pet trade. And that decreased their numbers. It also evolved to be attracted to fruit. But in the new context, crops and farmer-grown fruit caused it to be hunted and persecuted, but it had an interesting behavioral mismatch. And I think for us, we have a lot of behavioral mismatches. And in this case, it's a very social bird, and when one of them was killed, the others would do this flocking behavior, and they would just be flocking around their fallen colleague, and that literally made them sitting ducks. Very easy to kill, and so it quickly went extinct. Now, David Sloan Wilson has divided evolutionary mismatch into two types, and the kind that we're all familiar with is the genetic mismatch, and that's where the genetics and organism evolved in its ancestral environments is now detrimental. In other words, it reduces fitness, reduces survival and reproduction. It's detrimental in the very different modern environments. And so that's what we're all familiar with, but there's another concept called cultural mismatch, which I'm going to define in just a moment. But I want to spend just a minute on some genetic mismatches that I'm trying to get across to my students, and this is just a few of them, but I just wanted to highlight several that you're all very familiar with. The last two are things that have been emphasized at this conference in excellent presentations. But we have genetic coding for endogenous opioid receptors. That makes us, unfortunately, susceptible in a world where we use plant defense chemicals from the opium poppy, and it has an effect on our nervous system. That's an unfortunate thing. Talked about sugar. That's now a mismatch with unlimited sugar. We have a very important built-in stress response. But in a world with continual stress, chronic stress, that becomes a serious mismatch. Likewise, visual cues and nervous system responses, our dopamine system for sexual attraction, that's a mismatch with unlimited access to online pornography. And in some cultures, that's become quite serious. Talking about what's happening in Japan is quite disturbing. There are two things. The last two are ones that I think would be well served to get that into a public health message. I've been talking about susceptibility to, I've been calling it malocclusion, but I want to start using the term craniofacial dystrophy more, but I've been talking about this in my classes for many years. And this is obviously from our speakers, a mismatch with childhood food texture, but many other factors as well. And so that's something that we've all learned more about at this symposium. Likewise, a susceptibility to macular degeneration. That is one I was not familiar with before hearing the excellent talk the other day. And that's something that I'm going to be talking to my students about in the future. So now let's think about cultural mismatch. This is a culturally transmitted idea, or meme, whatever you want to call it, a meme, a practice, a belief, or a belief system that is detrimental in the modern environment. So we can think of some religious or political affiliations, various harmful practices, pseudoscientific beliefs, erroneous beliefs. These things are actually detrimental to those believing or practicing it, often to their relatives and sometimes to their whole societies. Now this is a fairly new concept, and the operational definition is not settled. So I was talking to Erin Blaisdale about this a couple of days ago, because there's some wiggle room in this definition, and I just want to be completely up front about that. It's not yet well-defined, the scope is not completely clear, but I think it's a valuable way of framing some problems, particularly to help put things in context, talking to people who are not familiar with these ideas. So I'm going to give some very different examples from small scale things to ones that affect whole societies. So let's think about, let's develop this idea about thinking about cultural change. And this is a, this is something from Dr. Wilson. If we think about our species, cultural change or cultural evolution is much, much faster than genetic change. And as a rapid process of adaptation, cultural change often provides solutions to genetic mismatches. So let's think of humans moving into arctic environments. They did not evolve dense coats of fur, okay? There wasn't the time. They did though come up with a cultural adaptation, a solution. So this is an Inuit from the early 1900s. The cultural solution, we can call that a match if we will. Let's look at another solution or match, and we, I could have picked an example from anywhere on the globe, but Native Americans in Florida learned to detoxify a plant called Florida arrowroot. And they used a starchy underground stem by grinding it into flour, but they removed a toxin, a glycoside, by soaking. And so that expanded their food supply. So this is a solution or match. Now let's think about cultural mismatch. Just as there can be solutions or matches, likewise cultural change can decrease fitness, and we'd call that a cultural mismatch. Now there are many cultural mismatches, and that's what I'm going to focus on for the rest of my presentation, because I think many of them are relevant to public health. Let's think, for example, about female genital mutilation. This is a culturally transmitted practice that results in serious injury, disability, suffering, and death. It definitely reduces fitness. We know it decreases survival and reproduction. Some women die from it. So this is a cultural practice that is mismatched in the modern world. It may never have been a match, probably was never a match. Likewise, in contrast to hunter-gatherer societies, in many agricultural and modern societies, women are considered inferior in various ways. And this has profound implications. How does this manifest? Well, one example is female genital mutilation. The other is shunning or isolation of unclean women during their periods. But we can extend this further, spousal abuse, women forced into the sex trade, lack of access to education or health and reproductive care, even infanticide of female babies. This is a recent headline. It comes from January of this year from the New York Times and rural Nepal. The menstruation taboo claims another victim. A young woman was forced to stay outside in a cold hut and she unfortunately froze to death. This is another very recent example that came to my attention. And I was very curious about this and so I actually looked to try to think about it a little bit. As you heard during this Thai cave rescue, a lot of those boys couldn't swim. And I found that kind of unusual because in many parts of the world, children learn to swim quite early. It varies. But so in looking into this, I found that there's a belief in some parts of Southern Asia that teaching children how to swim is actually dangerous. And this is a quote from the New York Times. Many mothers in the region believe that teaching their children to swim will increase the risk of them drowning because maybe it lures them to the water. But that's a cultural belief. Now that's unfortunate because the result is that drowning is a leading cause of death among children in Southern Asia. And that's those of UNICEF data. Now this is one that's from a few decades ago, but it's about as clear an example of a detrimental cultural practice as one can think of. And in that area, it was a public health crisis, not in a broader context. And this is ritual funerary cannibalism. So this was formally practiced until the 60s by the Foray people of the highlands of Papua New Guinea. Now this is not where they were eating other people to increase calories. That's not what was going on. This was a ritual where women and children, women would prepare the bodies. The women and children were going to eat small amounts of brain tissue of deceased relatives as a sign of respect and mourning. And the result was Khuru, which is a horrifying, I see Linda nodding over there, horrifying incurable neurodegenerative disorder that's transmitted by prions. And that's similar to, that's the cause of mad cow disease, if you remember that from a few years ago. So this is something in the past, but is a pretty clear example of a detrimental cultural practice. Now another example are anti-vaccination beliefs. And this is a child receiving an oral polio vaccine. And from the public health perspective, vaccination is one of the most effective public health interventions of all time. And it's saved literally untold millions and continues to do so. This, for example, polio vaccination in Sweden in 1957. Now we have protection against polio, smallpox, measles, tetanus, whooping cough, and many others. And a few of you in the room are in the mature category like I am. And you may remember when you were children that polio was something that was greatly feared. Parents were extremely paranoid about polio. They would often not allow kids to go swimming in the summer, because the mode of transmission wasn't clear and there was just a lot of fear. Now vaccination is a complicated topic and we have a poster session here. Now we have children being vaccinated with very large numbers of vaccines and we can argue about quality of vaccines. We do know there are allergic and other side effects. Same is true for antibiotics and virtually every other prescription and non-prescription drug, Tylenol, by the way, is a major cause of liver failure. And the need for liver transplants, Tylenol overdose, it's a very serious problem. Aspirin and other NSAIDs also cause many deaths each year. But the bottom line is in the poster session also talked about the cost-benefit ratio, when Andre, I'm sure you've talked to Andre. But yes, but just to give you a little more impression of the historical context here, when I was young, everybody knew what an iron lung was. This is a technically a negative pressure mechanical respirator, but this would allow, your head would stick out of these tubes, but it would allow you to breathe because the even the respiratory muscles would be paralyzed. And so you can see why this was such a fear and when vaccines became available. That was a very big deal. And if we look back at the history of this, we can go back to the early 1800s, when the cow pox was used as a way to vaccinate against smallpox. And it's rather horrifying to think of the crudeness of those early vaccines and how many people were probably, it probably wasn't pretty. But nobody had the growth of a cow like a appendage. And so this is an 1802 caricature. So there's been misunderstanding is in many fields for a long time. Let me focus in on one part of this and you can see that here we have a cow sprouting out of the arm out of the hip. This one looks like out of the mouth and the nose. So there's been a lot of misunderstanding over the years. Now, what is the evidence and what is the true cost benefit ratio? That's where we can argue. And I want, I like to question everything. And this, for example, I pulled offline the other day. California mandatory vaccine law causes 17% increase in autism. And this was said to be over a two-year period. What is the evidence of this? Well, I have a student who, former student who has headed up an autism institute. And there's argument over what is, how do you define autism? I think many of you know this and that has all kinds of political and financial implications. But I've not seen clear evidence where over a two-year span autism in a clearly defined way has increased by such amounts. So what is the true cost benefit ratio? And from the public health perspective, over the longer term, vaccination has been a tremendous benefit. I had a recent, this was driven home to me recently at the personal level. I have two nieces. Both of them had their first baby in the past month. And one of them, I guess from talking to the pediatrician, said that the grandparents and uncles and aunts, everybody had to make sure your pertussis or whooping cough vaccine was up to date. And we've all had that if you've ever had a tetanus shot, you get that. But babies are very susceptible. They have some passive immunity from their mother. But babies, they're the most susceptible individuals. And so there's some reason to be careful. Now, here's another one that I've also had some personal experience in with. And this is in the past that getting your bell rung, in other words, getting hit in the head was not very significant. That was a common belief in American football at all levels. Now, I would say this is both a genetic and a cultural mismatch. First, it's a genetic mismatch because our cranial structure did not evolve for numerous high-impact, high-velocity traumas. We are not mountain sheep that crack their heads together. And if you look at the anatomy of those animals, they have all kinds of adaptations as shock absorbers and to prevent the brain from being damaged. We're not like that. It's a cultural mismatch because it was widely believed that this was no big deal. And the result is chronic traumatic encephalopathy. So I was on a scholarship as an undergraduate, worked my way through college as what's called a student athletic trainer. And I worked with the team physician and the head trainer, who is a physical therapist, in actually caring for athletic injuries. I wasn't training them and how to build muscles. I was actually helping care for their injuries. And at that time, students, you know, the players, and this was in college, I was doing this at the college level, but at high school level, players would have a collision, they'd get knocked down, they would be stunned. Sometimes they would even black out. You'd get them up, they'd come over, and unless there was something really obvious, they were staggering around or the pupillary differences, in a little while they were let back in. That would be something, you could, it would be a, lawyers would go crazy over that today. That was a commonly accepted practice. This is a paper from the Journal of the American Medical Association from last year, clinical pathological evaluation of chronic traumatic encephalopathy in players of American football. And this is where they examined the brains, post-mortem, of about 200 individuals. Now, 111 of them were professional football players, but the rest were not, they were from all levels. Okay. And this is a popular press synopsis of that. The generative brain disease found in 87% of former football players. I want to emphasize this was not just professional athletes. It was 87% of all the players were diagnosed with this, but among the NFL players, 99% of the brains showed this degenerative condition. Now, fortunately, there's increasing awareness of chronic traumatic encephalopathy, but where I live in Texas, little boys, six years old are still going out there, whacking together, and it's rather disturbing. We also have a cultural mismatch, and you're all familiar with this one, the bias against fat, especially saturated fat, and it's often called lipophobia. And this is a larger-scale whole society problem. And we know the story well as a result of a number of things, including poorly done science, politics, and collusion of the sugar industry. But what I'm interested in is the idea gained a life of its own. So this is an idea. Once it had a life of its own, it's culturally transmitted. I frankly don't know how long this idea is going to be culturally transmitted. We know it's not correct now, right? It's the cause of the obesity, one of the big cause of the obesity hematomic, but if you go in any store, you can still just try to get yogurt, try to get full fat yogurt, and it's almost an impossibility. So this was one that affects us at the whole society level. It affects individuals. It affects the whole society as well. I know Brett Smith well, and we've had some discussions, and one that he felt I should emphasize was what we can call the one pill or one drug, one disease model. And that's a cultural belief. It's often not stated as such, but that's kind of one of the big mindsets in modern interventional medicine. Fortunately, it's not held by all physicians. I know there are many enlightened physicians in the audience. But this is now a widespread, culturally transmitted belief for practice. Many patients expect they go in, they expect a pill, they expect one thing, or in the case of dentistry, they expect to have braces put on, and that cures everything, not to have to look at it from a multifactorial perspective. Most chronic diseases, most of our serious conditions, are indeed multifactorial, and it would be surprising that you would have one magic pill. Work sometimes that way with antibiotics, but that was a lure. That was like a, it helped us in many ways, but it caused many problems. My final specific example of a cultural mismatch is climate change denial. And this now is a culturally transmitted belief despite overwhelming evidence. Here's a quote at the bottom. This is from Margaret Chan. She was a World Health Organization, director general, so pretty well-placed, and she said that for public health, climate change is the finding issue for the 21st century. Now, you might be wondering why, and I think it's certainly one of the most important defining issues, but it, why, thank you, why did she say this? Let me build a little bit of background first. So this is something I'm personally very interested in, and so I've spent a lot of time looking at the evidence, because I have taught environmental studies, starting more than 30 years ago, and the evidence for this now is fairly overwhelming. And I've also been fortunate to be able to do some personal observations, obviously anecdotal, but nonetheless. And I've spent a lot of time in the Arctic, in the high Arctic. I've gone across Arctic Canada. I've been a number of places along the coast of Greenland. I climbed up onto the Greenland ice cap, spent time in Svalbard, which is an island complex that gets up to about 80 degrees north. If you go to places, you see that the world is changing. That's as clear, it's about as clear as it gets. You can see it yourself, and as a biologist, you can see ecological change in ecosystems. There are tremendous numbers of papers. So it's quite clear. Now, why would Margaret Chan say what she did? Well, climate change has tremendous downstream public health implications. And it's mind-boggling, actually. So these are just a few. Heat simply causing mortality. Drowth, storms and flooding, sea level rise, and climate refugees. Vector or disease biology, it's very interesting. In some places in the world now, diseases are moving further north. We've had examples like that in Texas. Impact on food supply, and then quality of air and drinking water, both quantity and quality. So there are tremendous public health implications for this now deeply entrenched cultural idea. So I've tried to give you a range of what I consider our cultural image. Cultural mismatches, these are culturally transmitted things that are detrimental in the modern environment. And we're going to have a whole other session on why are we so susceptible? And I'm fascinated in this area. I would say we have many genetically based mismatches, many inherited cognitive biases, and these have been studied at length in many fields, particularly things like behavioral economics. We have a host of cognitive biases. This is just a short list, things like recency bias, discounting the future. Confirmation bias is a big one. We're all susceptible to confirmation bias. We have to fight it in ourselves. Tendency to follow a strong leader figure. And one of the most important in many of the cultural mismatches is that we tend to mimic our group. We're very sensitive to social signals. We follow the group. We conform to the group. And this can have highly detrimental effects. So what can we do? Well, one thing that we're doing is we work to understand. We try to educate others about mismatches. All of you are carrying that banner. And we try to develop strategies to lessen the negative impacts of these inherited weaknesses or susceptibilities, inherited cognitive biases, these mismatches. We try, all in our individual ways, to try to counter some of these. Some doing it in ways that risk their careers. Like Mike talked about to us. So thanks to AHS and thanks to you for your attention. And I'll be happy to address a couple of several questions. Thanks for that, George. So I'm glad, in one of those final slides, you put that there's this idea of groupthink. And so one of the things I think we're seeing is another way of expressing it is a social norm. Right. Okay. And I sometimes get to talk to folks in public health. And right now it seems to me that there's a social norm that's working against us. And I'm introducing the idea that we're past the crossover point with vaccinations. In other words, there was a time when we added the next vaccine and it actually caused more harm to our immune systems and actually the benefit of reducing it. What is the social norm in public health such that I can't bring this up? This is a pretty clear, easy concept. There's a point where you give a person too many drugs and it's going to damage their immune system instead of helping them. What's going on there? Why can't I get that out there? Well, I guess folks in public health and I, even though I helped found a program and I hired people to, you know, the people I hired are have PhDs in public health. So for example, one of my most important colleagues is a young woman who is an epidemiologist and she is extraordinarily data driven. She's very open to ideas. And so she did not come to our program understanding things about ancestral health but I, in talking to her and showing her evidence, she's very comfortable now with many of the things that all of us are familiar with. So I would say the thing to do with public health people is to try to pull together the best evidence that you have and try to remove the emotional appeal, try to make sure you don't have things that appeal in ways that are going to put people off initially. There's a whole body of study on how do you convince people about things. And that work is kind of disturbing because it's very hard to change people's minds. But there are ways to do it and I would say that would be my best advice is to try to think about and try to learn about the, look at the studies on how do you convince people and in the case of public health folks and I think in medical folks in general, you have to give them what they consider, what in their world is evidence, not what in your world is evidence but what in their world. And so I guess that's what I would say. Yeah, no, and it seems like I'm dealing with basically what we've been dealing with in the ancestral conversation for the last 15 years. They didn't want to hear that saturated fat was actually healthy and they don't want to hear that there's a point where you shouldn't be adding more vaccines to the schedule from me. Right, yeah. And yeah, thanks. Good morning, George. Sally Norton. Yes. Could you just let's just keep on the evidence thing for just a second because I've been, I've written a lot of NIH grants and know about how it works to try to get funding to gather the evidence that we think is evidence. There's a whole social norm about what evidence is cool and what isn't. And Cochran is like on the mountaintop, which is really questionable. We train doctors when they write up a case. They don't actually describe the patient. They just pontificate. And so you can't even bring up real world as evidence. It has to be some artificial design and it has to be pre-approved by peers who already have an agenda of their own. Right. So what do we do? So I guess I'll tell you what one of my closest colleagues who's an ecologist we kind of each, we flip roles on this. I sometimes get very discouraged, say with environmental things and think, my gosh, we're not making any progress. We're going backwards. But I think back to when I was young and rivers caught on fire. Some of you may remember that in the 50s and even up into the early 60s. Rivers were so polluted with petrochemicals they would actually catch on fire. Air pollution was so bad in some American cities that trees died. St. Louis, for example. Those things changed and there was, at some point, there was a shift. And I think that what I hope will happen with the ancestral movement, for example, is that there at some point, there's gradually building, there can be a shift in society. And we see that a bit with, there's a lot more sensitivity now to low-carbon ketogenic ideas than there was just a few years ago. So I don't know, I try not to get too discouraged because things can turn around quickly. When I say, at the end of the day, all we can do is keep plugging along and hope for the best. But I wish I had a better answer. I just want to say that we need to recognize that that's a major obstacle and find a way to lift reality as actual evidence. Absolutely. Thank you. And I would just add one thing to this. So I like to think of what I'm doing with these. Undergrads, in a sense, as inoculating them against the BS that they're going to get later on. Because they, at least, they will have been exposed to some of these ideas and told, don't believe what you hear. You'll hear some things. And what I'm telling you, some of it's going to be wrong, but take it that way with everything you hear. So I emphasize with them the most important thing if you're a scientist is being able to admit you're wrong and say, okay, I'm wrong. What can we do now? And so. So beginning of the AHS conference, the leaders said, everyone will be questioning themselves and we should all be questioning what we hear. And that's been an absolutely fantastic message I've heard. And along those lines, why is three quarters of the grocery store yogurt nonfat? We have to ask, why is that? Is it because of demand and disinformation? Actually, you have to understand what goes on in the dairy industry. Fat or butter has a 10 times higher value. So they removed the fat from the yogurt and then they created pseudoscience to make low-fat yogurt desirable because it was what was available. Question if all of the yogurt on the shelf is full fat. Most of that fat won't be dairy-based. There are definitely perverse economic incentives for many of the things we face. There's no question about that. Brett? Hi George, great talk. It may be a little bit early in the morning to get into the weeds of multi-level selection theory and cultural evolutionary theory. I personally haven't had enough coffee. Yeah, so one thing about advisor Dr. David Sloan-Wilson would say is that part of the problem is that these groups, you know, they enforce these norms because there's like a sort of competition among groups. And if you, as an individual, try to challenge the group from within, you're seen as a cheater or a defector. You're not cooperating with a group. So really, he would point out that it's really not a, evolution in general is not always a pretty process. And like, you know, what's good for the group may be very bad for the individual and vice versa. So, like something like religious fundamentalism is, you know, it may be very detrimental for the individuals involved in it, but these things, these cultural group systems evolve because they're in competition with other groups. You know, so it's really, I applaud you for having introduced this topic. It's really complicated and people might be interested and there's a new society called the Cultural Evolution Society and I think they had their inaugural meeting last year. So you might want to check there. We, hopefully you and I can both attend that conference one of these days. I hope so. Thank you, Brett. Any other questions? Well, thank you.