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