New Scientist has an interview with Dr. Paul Turke, a "Darwinian" pediatrician. When asked what, exactly, is Darwinian medicine, he responds:
It means we look at humans as being well-adapted, so we don't just jump to the conclusion that signs and symptoms of illness need to be targeted. We don't always think of them as the enemy. There are lots of subtle things that we do differently from conventional medicine.Some examples he offers include not always using ibuprofen and ice when someone twists an ankle or not always taking medicine to reduce a fever. His rationale is that our bodies adapted certain responses to combat disease and sickness. Fever, for example:
It arises via the activation of exquisitely evolved mechanisms, suggesting that it is an adaptation every bit as much as pain and swelling, yet many physicians continue to tell their febrile patients to take a fever-reducer and call them in the morning.He, of course, mentions that there are always exceptions, and cites malaria as an example. (Malarial parasites thrive in hot environments, so reducing fever is a valid medical therapy.)
Two questions come to mind: 1) Is he really using a consistent Darwinian view of medicine, and 2) Is this really a response to our culture's obsession with medication, but simply couched in Darwinian language, rather than a novel view of medicine?
The fundamental goals of medicine can be summarized as:1
- Prevention of disease and untimely death;
- Cure of disease, when possible;
- Improvement or maintenance of functional status when cure is not possible;
- Palliation (relief from pain and suffering), pursuits of peaceful death,* and comfort care in all situations;
- Patient education and counseling.
*This does not mean to imply support for physician-assisted suicide, but pain management and comfort care toward the end of life, as per the Hippocratic tradition.
None of these goals requires a Darwinian perspective, and might actually be contrary to some interpretations of Darwinism. They are derived from the Hippocratic tradition, which pre-dates theistic religions such as Christianity, Judaism, and Islam. However, the Hippocratic tenets are compatible with Christianity and other theistic religions and have been adapted to those traditions.
Dr. Turke can, of course, call himself whatever he wants -- a Darwinian pediatrician, a Christian pediatrician, an atheistic pediatrician. Rather than offering a whole new medical paradigm, however, he seems to be using Darwinism to explain what people already do in medicine. Sometimes it's good to use ice and ibuprofen for inflammation, but not in every case. Sometimes you want to reduce a fever, but the fever does indicate the body is fighting infection. It sounds like he is using clinical judgment, which doctors are supposed to do, and then decorating his judgments with just-so stories.
Be that as it may, so-called Darwinian medicine has increased in popularity, though the way physicians and researchers choose to apply their Darwinism varies. One article from The Western Journal of Medicine asks "How is Darwinian Medicine Useful?"
This article cites example after example, where every medical malady from obesity to anxiety to nausea can be explained in terms of natural selection. In each case, the story template is "Our bodies adapted ________ to do ________ because in prehistoric times we did ________ that is different from how we live today." According to the article, a historical evolutionary context is supposed to help us understand medicine today, and to counter the "traditional" view of the body: the body as a machine. The author's definition of "traditional" is apparently recent and modernistic (the last 200 years) because during the time when the Hippocratic Oath was written (5th century BC), the body was not viewed as a machine.
Historical speculations aside, we run into a problem when a physician starts using Darwinism for current diagnosis, therapy, and prognosis. A patient or ethicist would be correct to question a physician who says he is bringing a particular worldview to bear, and is this thus pursuing different goals from those in normal medicine. If he starts applying Darwinism, as a worldview, consistently (not just tacking it on as an after-the-fact embellisment), then his medical practice may look very different from what we are accustomed to.
For example, Charles Darwin himself was against vaccinations, not because of potential developmental risks to children, but because he believed disease was part of the process of evolution. Dr. Turke specifically denies that Darwinian medicine is about the strong surviving over the weak. In answer to the question of whether Darwinian medicine has anything to do with survival of the fittest, he says: "Not in the sense of favoring the 'strong' over the 'weak' or endorsing reproductive competition."
But Darwin's own writing in the Descent of Man indicates that the concept of survival and reproductive competition is fundamental to his view. He extends the concept to human beings. Darwin's argument in the Descent holds that humans are only different from animals in degree, so all of the same rules of nature apply, including survival of the fittest.
The article from the Western Journal of Medicine, mentioned above, specifically uses the idea of reproductive competition to explain certain maladies that appear in old age. So either Dr. Turke has a different interpretation of Darwinian medicine, or he is choosing to practice it inconsistently, or he has decided that natural selection is to be countered as a foe.
A growing concern is the over-use of prescription medication. The pill-for-everything idea stems from a time of scientific optimism where the prevailing view was that science and technology were going to solve our problems. There will be a pill for happiness, a pill for anxiety, a pill for colds, a pill for fatigue, a pill to help you sleep.
Today's postmodern culture is more skeptical of the advances of science, and perhaps there is a time and place when a little pain is good and maybe taking a pill for everything causes, on balance, more harm than good. We do not need to invoke an overly pliable theory such as Darwinism to mold a justification for not medicating anything and everything. That really has nothing to do with Darwinism; it has everything to do with sound clinical judgment. For specific patients in specific circumstances, the burdens that come with a particular medical therapy may outweigh the benefits. Some people would rather tolerate a little pain than take a blood thinner.
Perhaps the "Darwinian" physician is doing nothing more at the moment than responding to the over-medicalization of society. But then using Darwinism as his justification for medical decisions moves him into some dangerous ethical territory. He can easily slip into the claim that natural selection is so ingenious that we need not do anything to relieve pain and suffering. Natural selection should be allowed to do its work, and who are we to get in the way?
1. Junkerman, et al., Practical Ethics for Students, Interns, and Residents, 3rd ed, p. 78.
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