Host organisms can respond to the threat of disease either through resistan
ce defenses (which inhibit or limit infection) or through tolerance strateg
ies (which do not limit infection, but reduce or offset its fitness consequ
ences). Here we show that resistance and tolerance can have fundamentally d
ifferent evolutionary outcomes, even when they have equivalent short-term b
enefit for the host. As a gene conferring disease resistance spreads throug
h a population, the incidence of infection declines, reducing the fitness a
dvantage of carrying the resistance gene. Thus genes conferring complete re
sistance cannot become fixed (i.e., universal) by selection in a host popul
ation, and diseases cannot be eliminated solely by natural selection for ho
st resistance. By contrast, as a gene conferring disease tolerance spreads
through a population, disease incidence rises, increasing the evolutionary
advantage of carrying the tolerance gene. Therefore, any tolerance gene tha
t can invade a host population will tend to be driven to fixation by select
ion. As predicted, field studies of diverse plant species infected by rust
fungi confirm that resistance traits tend to be polymorphic and tolerance t
raits tend to be fixed. These observations suggest a new mechanism for the
evolution of mutualism from parasitism, and they help to explain the ubiqui
ty of disease.