Two decades ago, the eminent evolutionary biologist George C. Williams and his physician coauthor, Randolph Nesse, formulated the evolutionary medicine research program. Williams and Nesse explicitly made adaptationism a core component of the new program, which has served to undermine the program ever since, distorting its practitioners’ perceptions of evidentiary burdens and in extreme cases has served to warp practitioner’s understandings of the relationship between evolutionary benefits/detriments and medical ones. I show that the Williams and Nesse (...) program more particularly embraces the panselectionist variety of adaptationism (the empirical assumption that non-adaptive evolutionary processes are causally unimportant compared to natural selection), and argue that this has harmed the field. Panselectionism serves to conceal the enormous evidentiary hurdles that evolutionary medicine hypotheses face, making them appear stronger than they are. I use two examples of evolutionary medicine texts, on neonatal jaundice and on asthma, to show that some evolutionary medicine practitioners have allowed their fervent panselectionism to directly shape their recommendations for clinical practice. I argue that this escalation of panselectionism’s influence is inappropriate under Williams’ and Nesse original stated standards, despite being inspired by their program. I also show that the examples’ conflation of clinical and evolutionary considerations is inappropriate even under Christopher Boorse’s controversial evolution-rooted concepts of disease and health. (shrink)

This book analyses the concept of disease, as defined in the context of evolutionary medicine. Upon introducing the reader to evolutionary medicine in its current form and describing its approach to disease instances, the book leverages thoughts and instruments of knowledge of epistemology, social sciences, and ethics to answer the question: “How can we build a timely and appropriate concept of disease?” At first, it looks at the social concerns of medicalization, for example focusing on the (...) suffering of people who have not been diagnosed, or whose suffering is not caused by certain elements that falls under the definitions of disease. In turn, it merges different, both conceptual and empirical considerations in one comprehensive analysis, with the aim of fostering a multidisciplinary understanding of the phenomenon of disease. This book also highlights certain kinds of epistemic injustices that are taking place in the healthcare system, as this is currently conceived in post-industrial societies, thus offering a timely contribution to the current debate around social justice in healthcare. (shrink)

Mismatch is a prominent concept in evolutionary medicine and a number of philosophers have published analyses of this concept. The word ‘mismatch’ has been used in a diversity of ways across a range of sciences, leading these authors to regard it as a vague concept in need of philosophical clarification. Here, in contrast, we concentrate on the use of mismatch in modelling and experimentation in evolutionary medicine. This reveals a rigorous theory of mismatch within which the (...) term ‘mismatch’ is indeed used in several ways, not because it is ill-defined but because different forms of mismatch are.distinguished within the theory. Contemporary evolutionary medicine has unified the idea of ‘evolutionary mismatch’, derived from the older idea of ‘adaptive lag’ in evolution, with ideas about mismatch in development and physiology derived from the Developmental Origins of Health and Disease (DOHaD) paradigm. A number of publications in evolutionary medicine have tried to make this theoretical framework explicit. We build on these to present the theory in as simple and general a form as possible. We introduce terminology, largely drawn from the existing literature, to distinguish the different forms of mismatch. This integrative theory of mismatch captures how organisms track environments across space and time on multiple scales in order to maintain an adaptive match to the environment, and how failures of adaptive tracking lead to disease. Mismatch is a productive organising concept within this theory which helps researchers articulate how physiology, development and evolution interact with one another and with environmental change to explain health outcomes. (shrink)

Evolutionary medicine (EM) is an emerging field of medical studies that uses evolutionary theory to explain the ultimate causes of health and disease. The field’s main objective is to reconceptualize bodily vulnerabilities and pathophysiologies as evolutionary tradeoffs—many the result of an evolutionary mismatch between our ancient genome and modern lifestyle. This conceptual shift allows EM to describe health and disease in terms of adaptive functions and to prescribe treatments that best complement our evolved bodies. The (...) goal is to “transform the way patients and doctors see disease” (Nesse and Williams 1994, p. 245) in order to harness a renewed “feeling for the organism as a product of natural selection” .. (shrink)

In this paper, I will briefly summarize the history and current accounts of Evolutionary Medicine (EM). I will show that EM, in its current forms, is using an evolutionary understanding that carries the explanatory framework, as well as explanatory limits, of the Modern Synthesis (MS). I will then point out some essential elements that need to be seen as limiting factors within EM and analyze the limitations that are brought about by the MS understanding of it. On (...) this basis, I will argue that if the latest developments in evolutionary theory are considered – in particular, those pertaining to the inheritance mechanisms highlighted by the Extended Evolutionary Synthesis (EES), and the newly introduced evolutionary entities – EM will have a much broader explanatory scope and increased explanatory power in addition to greater relevance, which will enable its application in medical explanations. (shrink)

Recently, two research traditions that bring together evolutionary biology and medicine, that is to say, Darwinian medicine and evolutionary medicine, have been identified. In this paper, I analyse these two research traditions with respect to explanatory and interdisciplinary integration. My analysis shows that Darwinian medicine does not integrate medicine and evolutionary biology in any strong sense but does incorporate evolutionary concepts into medicine. I also show that backward-looking explanations in Darwinian (...) medicine are not integrated proximate-and-ultimate explanations but functional explanations that include reference to evolutionary concepts. Nevertheless, explanations in Darwinian medicine have heuristic roles as they potentially contribute to conceptual change and tie pieces of knowledge from different fields of medical research together. I argue that Darwinian medicine is an “interfield” that fosters cross-disciplinary exchange between evolutionary biologists and medical researchers and practitioners based on division of labour and separation, rather than unity. Research in evolutionary medicine, on the other hand, happens at the intersection of evolutionary biology and medicine where the two disciplines are already integrated and is designed to produce entangled proximate-evolutionary explanations. My analysis thus adds another important aspect to the philosophical discussion on the distinction between Darwinian medicine and evolutionary medicine. (shrink)

Defenders of evolutionary medicine claim that medical professionals and public health officials would do well to consider the role of evolutionary biology with respect to the teaching, research, and judgments pertaining to medical theory and practice. An integral part of their argument is that the human body should be understood as a bundle of evolutionary compromises. Such an appreciation, which includes a proper understanding of biological function and physiological homeostasis, would provide a crucial perspective regarding the (...) understanding and securing of human health needs currently lacking in the medical arena. (shrink)

There is an active research program currently underway, which treats cancer progression as an evolutionary process. This contribution investigates the ways that cancer progression is like and unlike evolution in other contexts. The aim is to take a multi-level perspective on cancer, investigating the levels at which selection may be acting, the unit or target of selection, the relative roles of selection and drift, and the idea that cancer progression may be a by-product of selection at other levels of (...) organization. (shrink)

In this article, I argue that distinguishing ‘evolutionary’ from ‘Darwinian’ medicine will help us assess the variety of roles that evolutionary explanations can play in a number of medical contexts. Because the boundaries of evolutionary and Darwinian medicine overlap to some extent, however, they are best described as distinct ‘research traditions’ rather than as competing paradigms. But while evolu- tionary medicine does not stand out as a new scientific field of its own, Darwinian (...) class='Hi'>medicine is united by a number of distinctive theoretical and methodological claims. For example, evolutionary medicine and Darwinian medicine can be distinguished with respect to the styles of evolutionary explanations they employ. While the former primarily involves ‘forward looking’ explanations, the latter depends mostly on ‘backward looking’ explanations. A forward looking explanation tries to predict the effects of ongoing evolutionary processes on human health and disease in contem- porary environments (e.g., hospitals). In contrast, a backward looking explanation typically applies evolutionary principles from the vantage point of humans’ distant biological past in order to assess present states of health and disease. Both approaches, however, are concerned with the prevention and control of human diseases. In con- clusion, I raise some concerns about the claim that ‘nothing in medicine makes sense except in the light of evolution’. (shrink)

A basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of the common morality to medicine or whether some of these norms are internal or proper to medicine. In this article we describe and defend an evolutionary perspective on the internal morality of medicine that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical (...) practice in pursuit of these goals. This perspective is developed by means of a critical examination of the essentialist conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp. (shrink)

In order to understand involuntary autobiographical memories and déjà vu experiences, we argue that it is important to take an evolutionary medicine perspective. Here, we propose that these memory anomalies can be understood as the outcomes of an inevitable design trade-off between type I and type II errors in memory processing.

In recent years, an increasing number of medical books and papers attempting to analyse the concepts of health and disease from the perspective of evolutionary biology have been published.This paper introduces the evolutionary approach to health and disease in an attempt to illuminate the premisses and the framework of Darwinian medicine. My primary aim is to analyse to what extent evolutionary theory provides for a biological definition of the concept of disease. This analysis reveals some important (...) differences between functional explanations in the field of evolutionary biology and functional explanations in the field of medicine. Moreover, I shall argue that the biological functions relevant to the health of an organism cannot be determined on the basis of evolutionary theory. Accordingly, it seems that Darwinian medicine does not provide for the definition of a biological concept of disease. Still,Darwinian medicine may suggest why we are susceptible to certain diseases; it might also prove a suggestive heuristic on the basis of which new hypotheses concerning relevant treatments of various diseases might be advanced. (shrink)

The conditions animals experience during the early developmental stages of their lives can have critical ongoing effects on their future health, welfare, and proper development. In this paper we draw on evolutionary theory to improve our understanding of the processes of developmental programming, particularly Predictive Adaptive Responses (PAR) that serve to match offspring phenotype with predicted future environmental conditions. When these predictions fail, a mismatch occurs between offspring phenotype and the environment, which can have long-lasting health and welfare effects. (...) Examples include metabolic diseases resulting from maternal nutrition and behavioral changes from maternal stress. An understanding of these processes and their evolutionary origins will help in identifying and providing appropriate developmental conditions to optimize offspring welfare. This serves as an example of the benefits of using evolutionary thinking within veterinary science and we suggest that in the same way that evolutionary medicine has helped our understanding of human health, the implementation of evolutionary veterinary science (EvoVetSci) could be a useful way forward for research in animal health and welfare. (shrink)

Three decades ago, interactions between evolutionary biology and physiology gave rise to evolutionary physiology. This caused comparative physiologists to improve their research methods by incorporating evolutionary thinking. Simultaneously, evolutionary biologists began focusing more on physiological mechanisms that may help to explain constraints on and trade‐offs during microevolutionary processes, as well as macroevolutionary patterns in physiological diversity. Here we argue that evolutionary physiology has yet to reach its full potential, and propose new avenues that may lead (...) to unexpected advances. Viewing physiological adaptations in wild animals as potential solutions to human diseases offers enormous possibilities for biomedicine. New evidence of epigenetic modifications as mechanisms of phenotypic plasticity that regulate physiological traits may also arise in coming years, which may also represent an overlooked enhancer of adaptation via natural selection to explain physiological evolution. Synergistic interactions at these intersections and other areas will lead to a novel understanding of organismal biology. (shrink)

In evolutionary medicine, researchers characterize some outcomes as evolutionary mismatch. Mismatch problems arise as the result of organisms living in environments to which they are poorly adapted, typically as the result of some rapid environmental change. Depression, anxiety, obesity, myopia, insomnia, breast cancer, dental problems, and numerous other negative health outcomes have all been characterized as mismatch problems. The exact nature of evolutionary mismatch itself is unclear, however. This leads to a lack of clarity about the (...) sorts of problems that evolutionary mismatch can actually explain. Resolving this challenge is important not only for the evolutionary health literature, but also because the notion of evolutionary mismatch involves central concepts in evolutionary biology: fitness, evolution in changing environments, and so forth. In this paper, I examine two characterizations of mismatch currently in the literature. I propose that we conceptualize mismatch as a relation between an optimal environment and an actual environment. Given an organism and its particular physiology, the optimal environment is the environment in which the organism’s fitness is maximized: in other words, the optimal environment is that in which the organism’s fitness is as high as it can possibly be. The actual environment is the environment in which the organism actually finds itself. To the extent that there is a discordance between the organism’s actual and optimal environments, there is an evolutionary mismatch. In the paper, I show that this account of mismatch gives us the right result when other accounts fail, and provides useful targets for investigation. (shrink)

Disease represents a principal tentacle of natural selection and a staple theme of evolutionary medicine. However, it is through a small portal of entry and a very long lineage that disease as sickness entered behavioural spaces and human consciousness. This has a long evolutionary history. Anyone interested in the origins of medicine and psychiatry as social institution has to start with analysis of how mind and body were conceptualised and played out behaviourally following the pongid/hominin split (...) and thereafter. The early evolution of medicine provides a template for clarifying elemental characteristics of mind and minding. Sickness and healing in chimpanzees represents an early manifestation of (ethno) medicine, termed a behavioural tradition, which is found played out in routines of helping, caring, and healing as well as other social behaviours. Chimpanzees seem to know they are sick since they resort to self-medication when exhibiting signs and symptoms of disease. Also, they help those exhibiting physical and cognitive disability. Among hominins, awareness of consequences and implications of sickness and coping with them represented an important feature of human consciousness and a major factor in the origins of vaunted human abilities involving language, cognition, and culture as we know them. A philosophical examination of the early evolution of sickness and healing provides a window into an understanding of evolving human capacities such as self-awareness, awareness and implications of suffering, theory of mind, altruism, conceptual grasp of sickness and healing and morality. (shrink)

In the last few decades, there has been a genuine ‘adaptive turn’ in psychiatry, resulting in evolutionary accounts for an increasing number of psychopathologies. In this paper, I explore the advantages and problems with the two main evolutionary approaches to depression, namely the mismatch and persistence accounts . I will argue that while both evolutionary theories of depression might provide some helpful perspectives, the accounts also harbor significant flaws that might question their authority and usefulness as explanations.

A common worry about the genetic engineering of human beings is that it will reduce human genetic diversity, creating a biological monoculture that could not only increase our susceptibility to disease but also hasten the extinction of our species. Thus far, however, the evolutionary implications of human genetic modification remain largely unexplored. In this paper, I consider whether the widespread use of genetic engineering technology is likely to narrow the present range of genetic variation, and if so, whether this (...) would in fact lead to the evolutionary harms that some authors envision. By examining the nature of biological variation and its relation to population immunity and evolvability, I show that not only will genetic engineering have a negligible impact on human genetic diversity, but also that it will be more likely to ensure rather than undermine the health and longevity of the human species. (shrink)

Epidemiology is a science of disease which specifies rates (illness prevalences, incidences, distributions, etc.). Evolution is a science of life which specifies changes (gene frequencies, generations, forms, function, etc.). Evolutionary Epidemiology is a synthesis of these two sciences which combines the empirical power of classical methods in genetical epidemiology with the interpretive capacities of neo-darwinian evolutionary genetics. In particular, prevalence rates of genetical diseases are important data points when reformulated for the purpose of analysis in terms of their (...) evolutionary frequencies. Traits which exceedprevalences beyond the rates of mutation (in Hardy-Weinberg calculations) or evidence unusualrange of phenotypic reaction are of special interest. This is because traits which did not confer advantages in the environment of evolutionary adaptation cannot accede, through natural selection, to anything but low rates of genomic prevalence.Evolutionary epidemiology is, in all of medicine, of particular promise in ongoing efforts to better understand psychopathology. Many complexities of phenotypic adjustment arise when new developmental demands are placed on an old genome. The new and complex biosocial ecology of human mass society now evokes different phenotypes than those in the prehistorical ecology to which the genome is structurally and functionally better adapted. Some of these new phenotypes are darwinian failures. In this paper, the theoretical implications of evolutionary epidemiology are extended and some tentative points of clinical application (particularly to psychiatry) are offered. (shrink)

What kind of knowledge is medical knowledge? Can medicine be explained scientifically? Is disease a scientific concept, or do explanations of disease depend on values? What is ‘evidence-based’ medicine? Are advances in neuroscience bringing us closer to a scientific understanding of the mind? The nature of medicine raises fundamental questions about explanation, causation, knowledge and ontology – questions that are central to philosophy as well as medicine. In this book Paul R. Thompson and Ross E. G. (...) Upshur introduce the fundamental issues in philosophy of medicine for those coming to the subject for the first time. They introduce and explain the following key topics: Understanding the physician-patient relationship: the phenomenology of the medical encounter. Models and theories in biology and medicine: what role do theories play in medicine? Are they similar to scientific theories? Randomised controlled trials: can scientific experiments be replicated in clinical medicine? What are the philosophical criticisms levelled at RCTs? The concept of evidence in medical research: what do we mean by ‘Evidence-based medicine?’ Should all medicine be based on evidence? Causation in medicine What do advances in neuroscience reveal about the relationship between mind and body? Defining health and disease: are explanations of disease objective or do they depend on values? Evolutionary medicine: what is the role of evolutionary biology in understanding medicine? Is it relevant? Extensive use of empirical examples and case studies is made throughout the book. These include debates about smoking and cancer, the use of placebos in randomised controlled trials and controversies about research into the causes of HIV and autism. This is an indispendable introduction to those teaching philosophy of medicine and philosophy of science. (shrink)

Epidemiology is a science of disease which specifies rates . Evolution is a science of life which specifies changes . ‘Evolutionary Epidemiology’ is a synthesis of these two sciences which combines the empirical power of classical methods in genetical epidemiology with the interpretive capacities of neo-darwinian evolutionary genetics. In particular, prevalence rates of genetical diseases are important data points when reformulated for the purpose of analysis in terms of their evolutionary frequencies. Traits which exceedprevalences beyond the rates (...) of mutation or evidence unusualrange of phenotypic reaction are of special interest. This is because traits which did not confer advantages in the environment of evolutionary adaptation cannot accede, through natural selection, to anything but low rates of genomic prevalence.Evolutionary epidemiology is, in all of medicine, of particular promise in ongoing efforts to better understand psychopathology. Many complexities of phenotypic adjustment arise when new developmental demands are placed on an ‘old’ genome. The new and complex biosocial ecology of human mass society now evokes different phenotypes than those in the prehistorical ecology to which the genome is structurally and functionally better adapted. Some of these new phenotypes are darwinian failures. In this paper, the theoretical implications of evolutionary epidemiology are extended and some tentative points of clinical application are offered. (shrink)

When the environment in which an organism lives deviates in some essential way from that to which it is adapted, this is described as “evolutionary mismatch,” or “evolutionary novelty.” The notion of mismatch plays an important role, explicitly or implicitly, in evolution-informed cognitive psychology, clinical psychology, and medicine. The evolutionary novelty of our contemporary environment is thought to have significant implications for our health and well-being. However, scientists have generally been working without a clear definition of (...) mismatch. This paper defines mismatch as deviations in the environment that render biological traits unable, or impaired in their ability, to produce their selected effects. The machinery developed by Millikan in connection with her account of proper function, and with her related teleosemantic account of representation, is used to identify four major types, and several subtypes, of evolutionary mismatch. While the taxonomy offered here does not in itself resolve any scientific debates, the hope is that it can be used to better formulate empirical hypotheses concerning the effects of mismatch. To illustrate, it is used to show that the controversial hypothesis that general intelligence evolved as an adaptation to handle evolutionary novelty can, contra some critics, be formulated in a conceptually coherent way. (shrink)

Utilizing an evolutionary perspective has proven fruitful in a number of areas of interest outside of the standard psychological or anthropological topics. This includes a wide range of fields from applied disciplines such as law, criminology, medicine, and marketing, to the study of the imagined worlds found in art and literature, the domains of the humanities. A number of excellent books, as well as numerous articles, detail the impressive work done in applying evolutionary insights to the study (...) of art and literature. This article focuses on evolutionarily informed explorations of popular culture, an area that, only relatively recently, has benefited from research taking this approach. The existing scholarship in this area will be reviewed, and future directions and challenges highlighted. (shrink)

The ecofeminist critique of dualism is applied to a consideration of two alternative paths that we might take in transplantation medicine: the utilization of organs and tissues taken from nonhuman animals, and/or further development of techniques for employing human organs and tissues, including human fetal tissue. It is concluded that from an evolutionary perspective, the assumption of a vast value disparity between human and nonhuman life is untenable, and from a moral point of view the establishment of yet (...) another institution based on a dualistic opposition between human life, postulated to be of ultimate value, versus devalued, disposable "other" life is unacceptable. We are urged to forego xenotransplantation and instead take responsibility for whatever manipulations we choose, respectfully, to make with life that is already valued as "self" rather than "other.". (shrink)

Research in infection biology aims to understand the complex nature of host–pathogen interactions. While this knowledge facilitates strategies for preventing and treating diseases, it can also be intentionally misused to cause harm. Such dual-use risk is potentially high for highly pathogenic microbes such as Risk Group-3 (RG3) bacteria and RG4 viruses, which could be used in bioterrorism attacks. However, other pathogens such as influenza virus (IV) and enterohemorrhagic Escherichia coli (EHEC), usually classified as RG2 pathogens, also demonstrate high dual-use risk. (...) As the currently approved therapeutics against these pathogens are not satisfactorily effective, previous outbreaks of these pathogens caused enormous public fear, media attention and economic burden. In this interdisciplinary review, we summarize the current perspectives of dual-use research on IV and EHEC, and further highlight the dual-use risk associated with evolutionary experiments with these infectious pathogens. We support the need to carry out experiments pertaining to pathogen evolution, including to gain predictive insights on their evolutionary trajectories, which cannot be otherwise achieved with stand-alone theoretical models and epidemiological data. However, we also advocate for increased awareness and assessment strategies to better quantify the risks-versus-benefits associated with such evolutionary experiments. In addition to building public trust in dual-use research, we propose that these approaches can be extended to other pathogens currently classified as low risk, but bearing high dual-use potential, given the particular pressing nature of their rapid evolutionary potential. (shrink)

The relation and collaboration of human and animal medicine had its ups and downs throughout history. The interaction between these two disciplines has been especially fruitful in the broad areas of patho-physiology and of epidemiology. An exploration of the interaction between the two disciplines, using historical and contemporary examples in comparative medicine, zoonoses, zooprophylaxis, and human-animal bond, reveals that a better understanding of animal and human disease, as well as societal changes such as interest in non-conventional medicine, (...) are leading to a broader concept of one medicine that includes animal and human medicine as well as social and other sciences. (shrink)

Human beings are a marvel of evolved complexity. Such systems can be difficult to enhance. When we manipulate complex evolved systems, which are poorly understood, our interventions often fail or backfire. It can appear as if there is a “wisdom of nature” which we ignore at our peril. Sometimes the belief in nature’s wisdom—and corresponding doubts about the prudence of tampering with nature, especially human nature—manifests as diffusely moral objections against enhancement. Such objections may be expressed as intuitions about the (...) superiority of the natural or the troublesomeness of hubris or as an evaluative bias in favor of the status quo. This chapter explores the extent to which such prudence-derived anti-enhancement sentiments are justified. We develop a heuristic, inspired by the field of evolutionary medicine, for identifying promising human enhancement interventions. The heuristic incorporates the grains of truth contained in “nature knows best” attitudes while providing criteria for the special cases where we have reason to believe that it is feasible for us to improve on nature. (shrink)

One way to detect, monitor and prevent adverse events with the help of Information Technology is by using ontologies capable of representing three levels of reality: what is the case, what is believed about reality, and what is represented. We report on how Basic Formal Ontology and Referent Tracking exhibit this capability and how they are used to develop an adverse event ontology and related data annotation scheme for the European ReMINE project.

According to some evolutionary theorists human prosocial dispositions emerged in a context of inter-group competition and violence that made our psychology parochially prosocial, ie. cooperative towards in-groups and competitive towards strangers. This evolutionary hypothesis is sometimes employed in bioethical debates to argue that human nature and contemporary environments, and especially large-scale societies, are mismatched. In this article we caution against the use of mismatch theories in moral philosophy in general and discuss empirical evidence that puts into question mismatch (...) theories based on parochial prosociality. Evolutionary mismatch theories play at best a rhetorical role in these moral debates and may misrepresent the status of relevant evolutionary research. We finally recommend that moral philosophers interested in the evolutionary literature also engage with dispositions such as xenophilia and social tolerance to counterbalance the focus on psychological mismatches adopted so far. (shrink)

This paper is unusual for this journal because most readers do not deal professionally with animals. Information from primatology, however, is relevant to consideration of violence between people. I will focus mainly on aggression and peacemaking among nonhuman primates, but will address related topics as well. I do not use the term “aggression” to refer only to violent behavior, but to any overt conflict between individuals. Although I am a professor of psychology, I am a biologist by training. When I (...) was a student many years ago, the major scholarly work on this topic was Konrad Lorenz’s On Aggression. It set into motion contemporary research on aggression from a biological perspective by making the controversial claim that aggression is an instinct not only in animals, but also in human beings. My own research and that of others suggests a slightly different view, namely, that aggression between individuals is a last resort when conflict resolution fails. (shrink)

Although natural selection might be expected to reduce the incidence and severity of disease, disease persists. Natural selection leads to increases in the mean fitness of populations and so will reduce the frequency of disease-associated alleles, but other evolutionary processes, such as mutation and gene flow, may introduce or increase the frequency of these deleterious alleles. The pleiotropic actions of genes and the epistatic interactions between them complicate the relationship between genotype and phenotype, and may result in the preservation (...) of disease-associated alleles. Deleterious alleles may also be maintained because of linkage to beneficial alleles. The inability of natural selection to eliminate diseases of aging is a reminder that fitness – success in producing progeny, or in contributing genes to the population gene pool – is not equivalent to the absence of disease. Nutritional or psychosocial cues may lead to life history strategies that maximize survival to reproductive maturity at the expense of disease later in life. Natural selection acts on genes, cells, and groups, as well as on organisms; the outcome of evolution reflects selection at different levels of biological organization. Finally, the human environment is constantly changing, largely because of the evolution of our parasites and because of changes in cultural beliefs and practices; genetic evolution is comparatively slow and lags behind environmental change. An evolutionary nosology complements traditional medical nosologies and enhances our understanding of the persistence of disease and the meaning of human variation. (shrink)

Physico-chemical sciences are dominated by the deterministic interpretation. Scientific medicine has generally been assigned to the area of functional biology and thence to the physico-chemical sciences. In as much as diseases are alterations of physiological processes, they share the ontological status of the latter. However, many diseases cannot be accommodated within a deterministic interpretation. First, many diseases are initiated by errors in transmission of information and followed by natural selection. These diseases, such as tumoural transformations and autoimmune processes, behave (...) as evolutionary processes. Second, physiological processes do not cause irreversible changes while diseases may do so when not followed by restitutio ad integrum. The tendency of living organisms to maintain stationary states of great stability and minimum energy dissipation is largely due to intermolecular forces-stabilized structures, the information for which is selected during phylogenesis and decodified during ontogenesis. Diseases cause alterations of the biological structures, thereby shifting living organisms toward stationary states of lower stability and increased dissipation. The shift, reversible or irreversible, to less stable and efficient stationary states is a common thermodynamic feature of diseases. In spite of the uniqueness of their genotype, living organisms, during ontogenetic development, form spatio-temporal unrestricted classes of infinite membership. Neither stationarity nor environment-induced perturbations and consequent adaptations are sources of historicity because of the genomic programme constraint. Historicity is conferred, however, to each organism by the permanent record of such unique events as: a) the variation-selection processes occurring in the brain-mind and immunological systems; and b) irreversible alterations induced by diseases. The disease-induced changes have ontological and epistemological consequences. Since biological structures and functions are transformed into individual, historical entities, the laws of scientific medicine must be applied in clinical practice to higher levels of organization, namely to the ensembles or groups of individuals affected by the diseases. (shrink)

This book critically assesses the implications of modern medicine's claim to be a natural science. Medicine models its scientific and clinical self-understanding on an obsolete positivist conception of science, reality, and consciousness. In this view, the body is modeled as a biological machine, disease as breakdown of the machine, and therapy as physical measures to fix the machine. The problems besetting medical science and practice are rooted in the inadequacy of the positivist philosophical assumptions regarding the nature of (...) science, reality and consciousness To base the diagnostic practices and therapeutic regimes purely on knowledge of physical processes in the human body is, in view of this analysis, at best grossly inadequate, at worst thoroughly dehumanizing (Anton van Niekerk: Editorial Foreword). This means that medicine's clinical method cannot be transformed without transforming the underlying view of science, of reality, and of the human person. The book proposes a broader model of science which overcomes the outdated dichotomy between human and natural sciences. Science is viewed as an interdisciplinary exercise generating multiple perspectives. The insights of the human sciences are essential for scientific clinical medicine. Utilizing evolutionary biology and complexity theory, the author proposes an alternative understanding of reality and human consciousness as a basis for a transformed clinical method. Reality is a hierarchy of systems of increasing complexity. Different levels can be distinguished, namely material systems, living material systems, conscious living material systems and self-conscious living material systems. Each level represents a new manner of being which requires a different scientific discourse of understanding. Using this model of reality the author argues against understanding human consciousness as a byproduct of physical processes in the brain. The human person is a self-conscious, complex, psycho-somatic system, whose well-being is conditioned by much more than physical processes. (shrink)

In this review we consider the new science of Darwinian medicine. While it has often been said that evolutionary theory is the glue that holds the disparate branches of biological inquiry together and gives them direction and purpose, the links to biomedical inquiry have only recently been articulated in a coherent manner. Our aim in this review is to make clear first of all, how evolutionary theory is relevant to medicine; and secondly, how the biomedical sciences (...) have enriched our understanding of evolutionary processes. We will conclude our review with some observations of the philosophical significance of this interplay between evolutionary theory and the biomedical sciences. (shrink)

I said that the cure itself is a certain leaf, but in addition to the drug there is a certain charm, which if someone chants when he makes use of it, the medicine altogether restores him to health, but without the charm there is no profit from the leaf.

While evidence-based medicine (EBM) is often accused on relying on a paradigm of 'absolute truth', it is in fact highly consistent with Karl Popper's criterion of demarcation through falsification. Even more relevant, the first three steps of the EBM process are closely patterned on Popper's evolutionary approach of objective knowledge: (1) recognition of a problem; (2) generation of solutions; and (3) selection of the best solution. This places the step 1 of the EBM process (building an answerable question) (...) in a pivotal position for the understanding of the whole process, and underscores a few aspects which are often overlooked in EBM courses. First in this step internal evidence (including personal expertise) must be appraised and integrated in the problem. Second, issues of applicability of the possible solution should be anticipated. Third, and possibly more important, the goal of the intervention should be set at this stage (typically by choosing the outcome in a PICO question). Depending whether or not goals depend on the goals of others, and whether they concern others' voluntary behaviour, goals may be classified as self-serving, moral, altruistic or moralistic. Thus, delicate ethical questions must be addressed at this stage, which means that patient preferences and values must be carefully sought, so that empathy, counselling and narrative medicine must be mastered to be able to formulate correctly an answerable question. The need to modify the current description of the EBM process to increase the recognition of implicit assumptions and increase the consistency of this model is discussed. (shrink)

Evidence shows that knowledge concerning medicinal plants is heterogeneous, as the majority of people in a medical system know only a few plants. This heterogeneity may make sense from an adaptive viewpoint, as human beings tend to keep a small set of information that offers adaptive advantages because our brains can store limited amounts of data. From this scenario, we developed the structural core concept for medical systems: a group of medicinal plants with adaptive characteristics that affect the structure and (...) function of medical systems. We created a set of hypotheses based on the structural core concept to guide future studies investigating the structure and dynamics of local medical systems. Concerning the dynamics of medical systems, we suggest that the structural core is the part of the system that changes least over time, i.e., it is the most conservative. Thus, we can expect that species substitution events mainly occur outside of the structural core. From the medical system structure, we indicate that core plants tend to be favored in the transmission of knowledge. These plants also serve as a model for the selection of novel medicinal plants and are therefore an important factor for the medical system structure. Analysis of the structural core can help the understanding of the structure and dynamics of medical systems and can aid future bioprospecting studies, which can search for plants with pharmacological potential using the structural core. (shrink)