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“Core principles of evolutionary medicine” still clinically useless

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New paper:

Abstract

Background and objectives

Evolutionary medicine is a rapidly growing field that uses the principles of evolutionary biology to better understand, prevent and treat disease, and that uses studies of disease to advance basic knowledge in evolutionary biology. Over-arching principles of evolutionary medicine have been described in publications, but our study is the first to systematically elicit core principles from a diverse panel of experts in evolutionary medicine. These principles should be useful to advance recent recommendations made by The Association of American Medical Colleges and the Howard Hughes Medical Institute to make evolutionary thinking a core competency for pre-medical education.

Methodology

The Delphi method was used to elicit and validate a list of core principles for evolutionary medicine. The study included four surveys administered in sequence to 56 expert panelists. The initial open-ended survey created a list of possible core principles; the three subsequent surveys winnowed the list and assessed the accuracy and importance of each principle.

Results

Fourteen core principles elicited at least 80% of the panelists to agree or strongly agree that they were important core principles for evolutionary medicine. These principles over-lapped with concepts discussed in other articles discussing key concepts in evolutionary medicine.
Daniel Z Grunspan Randolph M Nesse M Elizabeth Barnes Sara E Brownell, Core principles of evolutionary medicine: A Delphi study, Evolution, Medicine, and Public Health, Volume 2018, Issue 1, 1 January 2018, Pages 13–23, https://doi.org/10.1093/emph/eox025 Published: 26 December 2017 pdf.

Neurosurgeon Michael Egnor noted some while back:

Defenders of Darwinian medicine assert that understanding the evolutionary cause of a disease process, beyond the understanding of the proximate cause (i.e. the scientific cause, traditionally understood) is of significant value in medicine.

I believe that the evolutionary cause is a matter of speculation, and of no real value to medicine. It may be of value to evolutionary biology, but that’s a different matter.

Here’s my challenge:

Please provide examples of evolutionary speculation offered for any disease that has provided medical scientists with information valuable for management of the disease that was not already available from the proximate evidence. More. (2011)

Translating from medspeak, Dr. Egnor means, how does this stuff help the patient sitting on the examining table who is seeking diagnosis and treatment?

Science historian Michael Flannery writes to say,

A few things about this piece are worth noting. First, the study asserts that evolutionary medicine will help “to better understand, prevent and treat disease,” but nowhere does it actually demonstrate HOW it will do this clinically. It merely restates evolutionary assumptions and sometimes not even that. For example, one of its so-called “core principles” states that fever is a “useful defense” mechanism reacting to a pathological condition. How is this noteworthy? Physicians have been writing about this very thing since Hippocrates. In another of its “core principles” it says disease risks differ for those in different environments from their ancestors. The notion of environment conditioning disease susceptibility and response is not new either. Third, the panel of “experts” who made these “core principle” determinations was generated by an original six “initial experts” who were presumably all convinced of the priority of evolutionary principles in the first place. Furthermore, the final panel of 56 was NOT primarily composed of physicians; 26 were described as “primarily biologists” with another 11 described as “anthropologists.” In fact, of the 56 panelists only 12 were physicians, so that whatever this panel determined it was hardly the voice of medical consensus. The panel merely affirmed a priori positions held by the vast majority of the panelists in the first place. Finally, its main conclusion is that these “core principles” will be helpful “for researchers and instructors in evolutionary medicine.” In other words, we’ve established 14 principles that will affirm and justify ourselves. Again, there is no indication of specific, practical clinical application.

Medicine historically has been dominated (plagued one might say) with theory-first doctrines. Humoral pathology was one, but there have been many others (e.g., Paracelsus’s “archeus and mysterious iatrochemistry, William Cullen’s “solidism,” Samuel Hahnemann’s homeopathy, etc.). The idea was come up with a theory of disease and then marshal all your therapeutics through that theoretical construct. I fail to see how the procedure and recommendations of this paper differs.

It’s worth asking, why would anyone invest in this stuff, given all the controversies around human evolution? It would be easy to come up with a list of more urgent but more costly medical priorities. Think about that, will you?

See also: Evolutionary medicine: Insomnia in the elderly is due to evolution?

and

What exactly does “evolutionary medicine” do that requires this expensive outlay?

15 Replies to ““Core principles of evolutionary medicine” still clinically useless”

  1. 1
    bornagain77 says:
    March 2, 2018 at 5:28 pm

    a few notes

    (Ancient) Cave bacteria resistant to antibiotics – April 2012
    Excerpt: Antibiotic-resistant bacteria cut off from the outside world for more than four million years have been found in a deep cave. The discovery is surprising because drug resistance is widely believed to be the result of too much treatment.,,, “Our study shows that antibiotic resistance is hard-wired into bacteria. It could be billions of years old, but we have only been trying to understand it for the last 70 years,” said Dr Gerry Wright, from McMaster University in Canada, who has analysed the microbes.
    http://www.scotsman.com/news/h.....1-2229183#

    “Certainly, my own research with antibiotics during World War II received no guidance from insights provided by Darwinian evolution. Nor did Alexander Fleming’s discovery of bacterial inhibition by penicillin. I recently asked more than 70 eminent researchers if they would have done their work differently if they had thought Darwin’s theory was wrong. The responses were all the same: No.
    I also examined the outstanding biodiscoveries of the past century: the discovery of the double helix; the characterization of the ribosome; the mapping of genomes; research on medications and drug reactions; improvements in food production and sanitation; the development of new surgeries; and others. I even queried biologists working in areas where one would expect the Darwinian paradigm to have most benefited research, such as the emergence of resistance to antibiotics and pesticides. Here, as elsewhere, I found that Darwin’s theory had provided no discernible guidance, but was brought in, after the breakthroughs, as an interesting narrative gloss.
    In the peer-reviewed literature, the word “evolution” often occurs as a sort of coda to academic papers in experimental biology. Is the term integral or superfluous to the substance of these papers? To find out, I substituted for “evolution” some other word – “Buddhism,” “Aztec cosmology,” or even “creationism.” I found that the substitution never touched the paper’s core. This did not surprise me. From my conversations with leading researchers it had became clear that modern experimental biology gains its strength from the availability of new instruments and methodologies, not from an immersion in historical biology.,,,
    Darwinian evolution – whatever its other virtues – does not provide a fruitful heuristic in experimental biology.”
    Philip S. Skell – (the late) Emeritus Evan Pugh Professor at Pennsylvania State University, and a member of the National Academy of Sciences. – Why Do We Invoke Darwin? – 2005

    Of related note to developing an antibiotic that is beyond Dr. Behe’s ‘Edge of Evolution’, ‘drug cocktails’ seem to surpass the 1 in 10^40 double protein-protein binding site limit that Dr. Behe found for the ‘edge of evolution’, i.e. for the 1 in 10^40 limit of what Darwinian processes could be expected to accomplish over the entire history of the earth.

    Guide of the Perplexed: A Quick Reprise of The Edge of Evolution – Michael Behe – August 20, 2014
    Excerpt: If there were a second drug with the efficacy of chloroquine which had always been administered in combination with it (but worked by a different mechanism), resistance to the combination would be expected to arise with a frequency in the neighborhood of 1 in 10^40 — a medical triumph.
    http://www.evolutionnews.org/2.....89161.html

    Using Behe’s ‘Edge of Evolution’ to Fight Disease

    Fighting Cancer with Intelligent Design – Casey Luskin – December 25, 2015
    Excerpt: “In fighting antibiotic resistance, Darwin’s theory actually provides little guidance. Indeed, quite the opposite. As SUNY Professor of Neurosurgery Michael Egnor has written here, “Darwinism tells us that … bacteria survive antibiotics that they’re not sensitive to, so non-killed bacteria will eventually outnumber killed bacteria. That’s it.”
    To create drugs that outsmart evolving bacteria or cancer cells, biomedical researchers must use a process of intelligent design. They create drug cocktails that bank upon the fact that there are limits to how much living things can evolve on their own. Far from being evidence for Darwinian theory, antibiotic resistant bacteria point to what Michael Behe has called “the edge of evolution,” beyond which unguided Darwinian processes are powerless.”
    In simple terms, Darwinian evolution tends to work fine when only one mutation is needed to give an advantage. But when you need multiple mutations to gain an advantage, the process tends to get stuck. By throwing lots of antibiotic drugs at an organism, we force it to evolve lots of mutations — more than Darwinian evolution can produce — in order to survive. In this way, we can beat antibiotic-resistant microbes.,,,
    Dr. M. William Audeh at UCLA School of Medicine. He makes the same point with regard to fighting cancer.,,,
    He says we kill cancer cells by using many (“combinations of”) drugs — more than they can possibly evolve resistance to.
    When he says that we can “overcome the adaptive potential of the population,” he means there are limits to how much cancer cells can evolve. If we intelligently design combinations of drugs that would require more mutations than could possibly arise via Darwinian evolution, then we kill cancer cells before they evolve mutations to evade our therapy techniques.
    http://www.evolutionnews.org/2.....01861.html

    Moreover, the multiple drug cocktail that has been so effective in controlling HIV uses much the same strategy of being beyond the ‘edge of evolution’ that Dr. Behe has elucidated:

    When taking any single drug, it is fairly likely that some mutant virus in the patient might happen to be resistant, survive the onslaught, and spawn a resistant lineage.
    But the probability that the patient hosts a mutant virus that happens to be resistant to several different drugs at the same time is much lower.,,,
    it “costs” a pest or pathogen to be resistant to a pesticide or drug. If you place resistant and non-resistant organisms in head-to-head competition in the absence of the pesticide or drug, the non-resistant organisms generally win.,,,
    This therapy has shown early, promising results — it may not eliminate HIV, but it could keep patients’ virus loads low for a long time, slowing progression of the disease.
    http://evolution.berkeley.edu/.....edicine_04

    Thus it seems readily apparent that some of the most effective strategies and medicines for fighting some of the most horrific diseases are developed primariy by taking into account the strict limits for what Darwinian evolution can do, and then developing medicines that present barriers that evolutionary processes cannot overcome.

    Moreover, in so far as Darwinian presuppositions have influenced medical opinions in the past they have been a disaster, besides the medical travesty of Eugenics in Nazi Germany (and even America), the Darwinian presupposition of so called vestigial organs has led to much medical malpractice in the present day:

    Evolution’s “vestigial organ” argument debunked
    Excerpt: “The appendix, like the once ‘vestigial’ tonsils and adenoids, is a lymphoid organ (part of the body’s immune system) which makes antibodies against infections in the digestive system. Believing it to be a useless evolutionary ‘left over,’ many surgeons once removed even the healthy appendix whenever they were in the abdominal cavity. Today, removal of a healthy appendix under most circumstances would be considered medical malpractice” (David Menton, Ph.D., “The Human Tail, and Other Tales of Evolution,” St. Louis MetroVoice , January 1994, Vol. 4, No. 1).
    “Doctors once thought tonsils were simply useless evolutionary leftovers and took them out thinking that it could do no harm. Today there is considerable evidence that there are more troubles in the upper respiratory tract after tonsil removal than before, and doctors generally agree that simple enlargement of tonsils is hardly an indication for surgery” (J.D. Ratcliff, Your Body and How it Works, 1975, p. 137).
    The tailbone, properly known as the coccyx, is another supposed example of a vestigial structure that has been found to have a valuable function—especially regarding the ability to sit comfortably. Many people who have had this bone removed have great difficulty sitting.
    http://www.ucg.org/science/god.....-debunked/

    Moreover, testing medicines on animals is largely a huge, and very expensive, failure in developing medicines precisely because of the false evolutionary assumption of common ancestry that underlies such animal testing:

    What scientific idea is ready for retirement? – Mouse Models
    Excerpt: A recent scientific paper showed that all 150 drugs tested at the cost of billions of dollars in human trials of sepsis failed because the drugs had been developed using mice. Unfortunately, what looks like sepsis in mice turned out to be very different than what sepsis is in humans. Coverage of this study by Gina Kolata in the New York Times incited a heated response from within the biomedical research community.
    AZRA RAZA – Professor of medicine and director of the MDS Centre, Columbia University, New York
    per the guardian

    Animal Testing Is Bad Science: Point/Counterpoint
    Excerpt: The only reason people are under the misconception that animal experiments help humans is because the media, experimenters, universities and lobbying groups exaggerate the potential of animal experiments to lead to new cures and the role they have played in past medical advances.,,,
    The Food and Drug Administration (FDA) has noted that 92 percent of all drugs that are shown to be safe and effective in animal tests fail in human trials because they don’t work or are dangerous.,,,
    Physiological reactions to drugs vary enormously from species to species. Penicillin kills guinea pigs but is inactive in rabbits; aspirin kills cats and causes birth defects in rats, mice, guinea pigs, dogs, and monkeys; and morphine, a depressant in humans, stimulates goats, cats, and horses.
    – per peta

    Comparing the human and chimpanzee genomes: Searching for needles in a haystack – Ajit Varki1 and Tasha K. Altheide – 2005
    Excerpt: we have many characteristics that are uniquely human. Table 1 lists some of the definite and possible phenotypic traits that appear to differentiate us from chimpanzees and other “great apes”2. For the most part, we do not know which genetic features interact with the environment to generate these differences between the “phenomes”3 of our two species. The chimpanzee has also long been seen as a model for human diseases because of its close evolutionary relationship. This is indeed the case for a few disorders. Nevertheless, it is a striking paradox that chimpanzees are in fact not good models for many major human diseases/conditions (see Table 2) (Varki 2000; Olson and Varki 2003).
    http://genome.cshlp.org/content/15/12/1746.full

    In other words, the basic physiology of different species are not nearly as similar as people are falsely led to believe under Darwinian presuppositions. And this false Darwinian presupposition is costing billions of dollars in needless research.

  2. 2
    Latemarch says:
    March 2, 2018 at 8:44 pm

    As a recently retired pathologist after 38 years of practice. I would like to second BA77’s comment. Never found any use for Darwinian speculation. It was always just a superficial gloss on the findings.

  3. 3
    News says:
    March 2, 2018 at 9:37 pm

    Latemarch at 2: It’s a reasonable inference that the typical patient doesn’t care what happened to long-gone life forms. The future (typically, his own near future) is the focus.

    What if the trilobites all died of cancer? What follows?

  4. 4
    gpuccio says:
    March 3, 2018 at 3:02 am

    Latemarch:

    “Never found any use for Darwinian speculation. It was always just a superficial gloss on the findings.”

    I agree.

    Moreover, some of the “core principles” listed in the paper are really funny:

    Many signs and symptoms of disease (e.g. fever) are useful defenses, which can be pathological if dysregulated.

    —

    Disease risks can be altered for organisms living in environments that differ from those in which their ancestors evolved.

    —

    Cultural practices can influence the evolution of humans and other species (including pathogens), in ways that can affect health and disease (e.g. anti-biotic use, birth practices, diet, etc.).

    Great news indeed! Whoever would have thought that? 🙂

    Now that we know that immune responses are a form of defense, but that autoimmune diseases also exist, and that migrants can be specially exposed to infections that were not present in their homeland, and that the use of antibiotics and birth practices can have some influence on public health, new avenues of thought certainly open to medical research.

    We are lucky that evolutionary thinking provides us with such unexpected intuitions! 🙂

  5. 5
    Bob O'H says:
    March 3, 2018 at 4:29 am

    Some of Flannery’s criticisms are just silly. A group got a team together to work out some core principles for a subject. And Flannery criticises them for … getting some experts in that subject together.

  6. 6
    gpuccio says:
    March 3, 2018 at 5:08 am

    Bob O’H:

    I think that the point is: if you are trying to detect the “Core principles of evolutionary medicine”, one expects that you stick to specific principles, IOWs ideas that are provided by the evolutionary network, not only that are vaguely compatible with it.

    And, above all, you expect ideas that are new and not trivial, not just that fever can be useful or deleterious, and so on.

    Now, I am not saying that the problem is with the authors of the paper. The problem is more probably with the experts, or maybe with the discipline itself. 🙂

  7. 7
    bornagain77 says:
    March 3, 2018 at 5:57 am

    Of related note to the disastrous effect that Darwinian presuppositions have had on influencing medical opinions,,, a new video was just posted on ENV:

    History and the Euthanasia Problem
    https://www.youtube.com/watch?v=L1NuCKkLMNY

    Weikart: “History and the Euthanasia Problem” – March 3, 2018
    It’s not possible to understand current controversies about physician-assisted suicide, euthanasia, eugenics, and related subjects without appreciating the long history behind these ideas. Without this history, it might seem that current trends — the increasingly apparent and catastrophic failure to appreciate the value of human life — have simply sprung upon us out of nowhere. That is not the case. As Weikart explains, Judeo-Christian culture going back to antiquity was clear on the sanctity of life, without exception. That clarity was gradually undermined by countervailing philosophical and ideological forces, including in science, notably the rise of Darwinism.
    https://evolutionnews.org/2018/03/weikart-history-and-the-euthanasia-problem/

    Also of related note to this “catastrophic failure to appreciate the value of human life”, that is inherent within the Darwinian worldview,,, mental health is itself severely negatively effected by the atheistic presuppositions inherent within Darwinism:

    “ I maintain that whatever else faith may be, it cannot be a delusion.
    The advantageous effect of religious belief and spirituality on mental and physical health is one of the best-kept secrets in psychiatry and medicine generally. If the findings of the huge volume of research on this topic had gone in the opposite direction and it had been found that religion damages your mental health, it would have been front-page news in every newspaper in the land.”
    – Professor Andrew Sims former President of the Royal College of Psychiatrists – Is Faith Delusion?: Why religion is good for your health – preface
    https://books.google.com/books?id=PREdCgAAQBAJ&pg=PR11#v=onepage&q&f=false
    “In the majority of studies, religious involvement is correlated with well-being, happiness and life satisfaction; hope and optimism; purpose and meaning in life; higher self-esteem; better adaptation to bereavement; greater social support and less loneliness; lower rates of depression and faster recovery from depression; lower rates of suicide and fewer positive attitudes towards suicide; less anxiety; less psychosis and fewer psychotic tendencies; lower rates of alcohol and drug use and abuse; less delinquency and criminal activity; greater marital stability and satisfaction… We concluded that for the vast majority of people the apparent benefits of devout belief and practice probably outweigh the risks.”
    – Professor Andrew Sims former President of the Royal College of Psychiatrists – Is Faith Delusion?: Why religion is good for your health – page 100
    https://books.google.com/books?id=PREdCgAAQBAJ&pg=PA100#v=onepage&q&f=false

    Indeed longevity itself is severely negatively effected by Atheistic Darwinian presuppositions:

    Atheism and health
    A meta-analysis of all studies, both published and unpublished, relating to religious involvement and longevity was carried out in 2000. Forty-two studies were included, involving some 126,000 subjects. Active religious involvement increased the chance of living longer by some 29%, and participation in public religious practices, such as church attendance, increased the chance of living longer by 43%.[4][5]
    http://www.conservapedia.com/Atheism_and_health

    Can attending church really help you live longer? This study says yes – June 1, 2017
    Excerpt: Specifically, the study says those middle-aged adults who go to church, synagogues, mosques or other houses of worship reduce their mortality risk by 55%. The Plos One journal published the “Church Attendance, Allostatic Load and Mortality in Middle Aged Adults” study May 16.
    “For those who did not attend church at all, they were twice as likely to die prematurely than those who did who attended church at some point over the last year,” Bruce said.
    https://www.usatoday.com/story/news/nation-now/2017/06/02/can-attending-church-really-help-you-live-longer-study-says-yes/364375001/

    Since mental, and physical, health is so detrimentally effected by the Atheistic/Darwinian worldview, might I suggest that the scientific evidence itself, contrary to what Darwinists may want to believe, clearly indicates that humanity is not nearly as inconsequential as Darwinian atheists have tried to portray us to be?

    Humanity – Chemical Scum or Made in the Image of God?
    https://www.youtube.com/watch?v=ElBWAwjPzyM

  8. 8
    Flannery says:
    March 3, 2018 at 10:15 am

    Bob O’H

    Now that’s not what I criticized them for at all. What I basically said was a panel was put together to develop “core principles” on evolutionary medicine that had 1) ALREADY assumed the value of evolutionary medicine, and 2) was composed of “experts” largely outside medicine itself. In fact, the largest single group of “experts” were biologists. That is not “silly,” that is empaneling confirmation bias.

  9. 9
    Bob O'H says:
    March 3, 2018 at 10:25 am

    Flannery – I don’t think you’re helping yourself. Why wouldn’t you want a panel that are putting together some core principles to start from the assumption that this is an important problem? And why wouldn’t you want the group to consist of biologists, i.e. people who study organisms (including humans) and their evolution, to provide input?

    If the panel was put together to assess whether evolutionary medicines was important, then you might have an argument. But that clearly wasn’t the intention.

  10. 10
    Flannery says:
    March 3, 2018 at 10:48 am

    Right. So what this empaneled group did was establish “core principles” based upon their assumption that evolutionary medicine was important. That actually compounds the problem. Not only did they engage in confirmation bias, but, not surprisingly, a fair amount of question begging.

  11. 11
    critical rationalist says:
    March 3, 2018 at 12:30 pm

    I think that the point is: if you are trying to detect the “Core principles of evolutionary medicine”, one expects that you stick to specific principles, IOWs ideas that are provided by the evolutionary network, not only that are vaguely compatible with it.

    We cannot predict the impact of genuinely new knowledge. So, it’s unclear how you can expect it to predict any “new” in the sense you’re implying.

    For example, Evolution doesn’t predict that goats will eventually appear based on the initial conditions of the universe. That’s untraceable. But it does have a few principles by which evolution is the best explanation.

    And, as I’ve pointed out, ID’s designer is abstract and has no defined limitations. As such, virtually all of the “predictions” ID proponents here make do not follow from it. For that to be the case, assumptions would need to be made about the designer that we supposedly cannot know. IOW, ID proponents seem to simultaneously hold two conflicting positions.

    For example, ID is not about the designer, but is supposedly a clear, distinct and superior response to eugenics. However, not being about the designer, it cannot exclude one that intervened via eugenic techniques to improve the design of organisms or even entire species, including human beings.

  12. 12
    Latemarch says:
    March 3, 2018 at 3:06 pm

    CR@11

    We cannot predict the impact of genuinely new knowledge. So, it’s unclear how you can expect it to predict any “new” in the sense you’re implying.

    For example, Evolution doesn’t predict that goats will eventually appear based on the initial conditions of the universe. That’s untraceable. But it does have a few principles by which evolution is the best explanation.

    Precisely the problem with Evolution. It fails to predict anything. Rapid extinction = Evolution. Stasis for millions of years = Evolution. Feature unique = Evolution. Feature in multiple lines = Convergent Evolution. The fit survive – those that survive are fit – the fit survive…..tautology much?

    Apparently, the main principal of evolution is stuff happens.

    Perhaps you’d like to lay out some of those weighty principals I’ve overlooked. The authors of the paper, as gpuccio@4 pointed out, only gave us trivialities.

  13. 13
    aarceng says:
    March 3, 2018 at 10:12 pm

    I think it would be easy to come up with a list of more urgent but less costly medical priorities.

  14. 14
    critical rationalist says:
    March 4, 2018 at 9:26 am

    @laremsrch

    ID’s designer could have decided to design organisms as if evolution was true for some reason we cannot understand. “That’s just how the abstract designer with no defined limitations wanted it to turn out” is compatible with anything.

    On the other hand, Neo-Darwinism has limitations. Knowledge grows from variation and criticism of some form. That’s the simple principle. So, there are necessary consequences, where there are none for ID.

  15. 15
    Latemarch says:
    March 4, 2018 at 2:39 pm

    CR@14

    ID’s designer could have decided to design organisms as if evolution was true for some reason we cannot understand.“That’s just how the abstract designer with no defined limitations wanted it to turn out”

    How convenient. Another evolution just so story.

    On the other hand, Neo-Darwinism has limitations.

    Yes it does. Well defined limitations which were written about in Behe’s The Edge of Evolution.
    Good to see that you have finally gotten around to admitting that “;^)

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