The New Scientist has recently interviewed Dr Paul Turke, paediatrician and advocate of ‘Darwinian Medicine’: http://www.newscientist.com/article/mg21428600.300-hold-the-painkillers-says-darwinian-paediatrician.html. Dr Turke is working on a book expounding his views, with the working title Bringing Up Baby: A Darwinian View of Pediatrics. It is unfair to form a settled judgment of Dr Turke’s views before he has had a chance to develop them fully in his book. Nevertheless, I think it is worth making a few comments now, as Dr Turke is not the only advocate of Darwinian medicine and his interview raises a cluster of interesting issues.
One good point that Turke makes is that there is benefit to be had by considering the possible evolutionary functions of our bodies’ responses to injuries and infections. Experiencing a fever is unpleasant, but it seems to be part of our bodies’ preparation to fight certain forms of infection. As such, the propensity to experience fever may well be an evolutionary adaptation that we have acquired because of its contribution to our survival. Similarly, the swelling and pain that we experience when we twist a joint looks like an evolutionary adaptation to prevent us from using that joint and so promote healing and ultimately, long term survival. It surely helps medical practice to understand how and why particular bodily responses evolved, as this helps us to better understand what their functions are.
In the interview Dr Turke reveals that when his son twists his ankle playing soccer he prevents others from following conventional procedures and giving his son ibuprofen, and also prevents them from icing the injury. Dr Turke is mindful of the evolutionary benefits of pain and swelling and does not want his son to be deprived of these benefits. But while pain and swelling are our bodies’ evolved responses to injury, and serve to benefit us in the long term, it does not follow that these are the best possible responses to pain and swelling. There is a danger in neglecting to consider the evolutionary history of our bodies’ responses to injuries and infections and potentially depriving ourselves of these benefits, but there is also a danger in thinking that we cannot do better than the solutions that our evolutionary history happens to have provided.
A related point is that our abilities to share information, come collectively to understand our environment, and then alter it in ways that benefit us are, plausibly, a suite of evolutionary adaptations (Kim Sterelny argues for roughly this conclusion in his The Evolved Apprentice, MIT Press, 2012). We have evolved the ability to understand, intervene in and override our bodies’ natural responses; and doing all of this is not to go against evolution; it is in our natures. Once we understand that the purpose of pain and swelling in a twisted ankle is to encourage us not to continue to use the ankle but to rest it, we can intervene to improve upon what evolution initially offers us. By deciding to rest and otherwise immobilise the ankle with compressing bandages, crutches and so on, we can render the need for pain and swelling redundant. And if pain and swelling is redundant then we may as well alleviate our pain and reduce swelling, in so far as we can.
Another issue that needs to be considered here is that evolution is indifferent to our pain and suffering. What matters from an evolutionary point of view is that we survive and reproduce. But we are not obliged to take the evolutionary point of view. We are capable of making decisions with other considerations in mind. The use of contraception makes little sense from an evolutionary point of view (although, no doubt, ‘just so’ stories that attempt to reconcile evolution and the use of contraception could be told). However, the use of contraception can make a lot of sense from the viewpoint of people who are concerned to maximise their well-being. It better enables us to decide when we want to reproduce and when we do not; and thereby helps us – and our offspring – to lead better lives. The same goes for the alleviation of pain. Even if it really was better, from the evolutionary point of view, for Dr Turke’s son to experience on-going pain and inflammation when he twists his ankle, rather than receive the benefits of icing and ibuprofen – and we have seen that there are reasons to doubt this conclusion –; this does not mean that this is also better from his point of view. Unless he has masochistic tendencies, then it is better from his point of view to alleviate his pain and suffering, while also taking appropriate measures to ensure that his ankle recovers.
Thank you, Steve, for your well-argued post – I’m glad that Dr Turke isn’t my dad.
“The use of contraception makes little sense from an evolutionary point of view (although, no doubt, ‘just so’ stories that attempt to reconcile evolution and the use of contraception could be told). ”
When one examines Aboriginal Cultures, based on existing practice and archive materials, what one finds is a pattern of families spacing children, between 3 -5 years apart, such that the new child is born when the previous child is able to be a co-carer. Furthermore, there is ample evidence of the use of plant based preparations as both contraceptives and abortifactants, as well as practices that indicate a high degree of conscious awareness and decision making with regard to sexuality, based on self-empathy, that tend towards active choice rather than ‘happy accident’…..
All of these practices have profound evolutionary meaning, and make sense in that each generation of parents will have practised nurturing from and early age, is much more ‘in touch’ with the needs and inner experience of infancy (they can remember what it was like to be an infant), has a profound comprehension of ageing and community and how they work together, and a greater degree of self-empathy, upon which empathy for others is based.
One of the modern tragedies that is a taboo subject is the lack of awareness and knowledge of most mothers in Industrial Society regarding the realities of infancy, and the fear that emerges which leads mothers to seek ‘advice’ from ‘experts’ rather than trust their own biological abilities and responses…
This includes empathy for the habitat (most habitats are not static, so empathy for the habitat is an essential part of the response-ability that enables learning and adaptation as the habitat changes). All these qualities ensure that the community is responsive, does not over populate and that the long-term thriving of the community is enhanced.
The flip side is that such communities tend to be egalitarian, and are vulnerable to heirachically violent societies, who can and do over-run them.
For most people in Industrialised Society, few if any of these markers are present and we can see from the evidence that Industrialised Society is harming both the people within it, and the habitats it has taken over and it has yet to over-run (including those aboriginal peoples still living within that remaining ‘un-developed’ habitat) and that this harm is running counter to the realities of evolution – that is to say natural evolution in the sense of the long term survival of myriad species who are interconnected and mutually supportive and the incremental build-up of the fecundity of any given habitat.
Nature is replete with self healing systems, and modern medicine tends to reject this approach in favour of external intervention, possibly because of the profits (POWER) and the myriad of jobs associated with it.
Modern medicine tends to reject this approach because there are severe limits to nature’s ‘self healing systems’.
For example, the human body has some rather impressive anti-cancer mechanisms. The immune system often destroys cancerous cells before they become tumours. Some cells self-destruct before they even become cancerous. But as we know, these systems are not perfect. There is still a high risk of getting cancer, and it’s a risk that increases as you get older.
There is evidence that suggests that there is a correlation between the use of refined sugar from when it was first introduced into widespread use in Europe, and the emergence of cancer as an epidemic, and there is evidence that many synthesised chemicals which nature has not yet found ways to metabolise have toxic effects, individually and as a collective.
The concentration of cancers in areas where toxic chemicals have leached into the land, 0r ground water is evidence of this.
There is also evidence that trauma in childhood is directly linked to the emergence of degenerative disease states, and that once that trauma is recognised and steps taken to resolve it, health outcomes improve.
The ACE study is evidence of this.
The resolution of unresolved trauma is mostly the resolution of suppressed feelings, feelings which are suppressed at the time of the trauma.
There are natural processes that enable self healing, and they are for the most part internal, not externally driven processes… however when millions of people’s jobs are on the line, and the profits of very large and powerful organisations at risk, there is quite a lot of pressure to avoid these simple facts.
I don’t doubt that toxic chemicals can cause cancer. And perhaps refined sugar has contributed to an increase in cancer, though the biggest contributing factor to the increase in cancer is the fact that people are living longer because of reduced mortality to other diseases.
But as I said, processes of ‘self-healing’ are severely limited. If they weren’t, there would have been less need for medicine as people would be have been living into their 80s/90s and beyond anyway. But in previous centuries, most people died at a much younger age. Often in childhood. Nature has no reason to evolve a response to those diseases which are typically of old age, because they occur beyond the point of reproduction, meaning there is no selective pressure on older members of the species.
If you look carefully at the issue of longer lives, underneath what you will see is yes there are some longer and a lot more less content lives. Just one look at the generations who survived WWI and WWII , and their children who became the first fully consumerised generations, who are now being farmed for profit in ‘care-homes’ all over Europe, the USA and elsewhere reveals the extent.
Factor in that in most developed countries the one of the top 4 leading causes of death in the 13-24 age bracket is suicide….
Is there a connection between physical disease and psychological stress?
The ACE Study shows there is. Here’s a VERY brief overview of the ACE Study.
http://www.goodworksintrauma.org/blog1/suggested-reading/trauma-the-hidden-impact/a-quick-summary-of-the-ace-study/
So what I am saying here is that ‘ self healing’ requires certain environmentals for it’s best chance, and those environmentals are largely missing, and that it si the environmentals that need addressing.
Ok, so we should be doing more to improve our psychological health, and perhaps being less consumer-driven is one way to do that. I certainly agree with that.
But not being psychologically stressed isn’t going to cure cancer, Alzheimers, malaria etc etc. Perhaps it will improve our chances, but I fail to see how it will have a seriously dramatic impact. We still need to develop medicine.
“All right… all right… but apart from better sanitation and medicine and education and irrigation and public health and roads and a freshwater system and baths and public order… what have the Romans ever done for us? “
Don’t forget the wine.
Sorry, Reg.
Hi Corneilius,
thanks for your long comment. I don’t doubt that many aboriginal peoples used some or other form of contraceptive. What I do doubt is that a coherent Darwinian evolutionary story can be told to explain this. The story you are describing above sounds like it is driven by conscious decisions made by these peoples to improve the quality of their lives, rather than being driven by the evolutionary imperative of increasing the number of offspring that they were able to leave. Your talk of ‘natural evolution in the sense of the long term survival of myriad species who are interconnected and mutually supportive and the incremental build-up of the fecundity of any given habitat’ is far from the usual Darwinian meaning of the term ‘evolution’ and not what I intended.
I understand and take your point. You are correct. I was not placing my commentary from within a Dawinian Evolutionary view, but rather was expressing a more modern – and liberal – understanding of evolution. In the case of humanity, I would suggest that numbers was, and is not the evolutionary aim, but rather fitness, that is to say the natural aptitude, skills, knowledge, understanding, empathy and community that enables long term existence beyond mere survival as part of the biota… this is not to be confused with ‘survival of the fittest’ which is merely Empire Logic projected onto nature to justify it’s aggression on other more vulnerable peoples.
I do not subscribe to the Darwinian (or interpretations thereof that might be ideologically motivated).
My observations of nature, as in what actually happens on a holistic scale, and the vast date now emerging as bio-diversity science looks at the relationships within natural systems tend to suggest a non-linear process.
Darwin was a man of his time, and in his time the ideology of Empire as the latest improvement of nature, over nature, was so deeply embedded he could not have thought otherwise than he did. However, in these times, with so much more known (and so much more yet to be understood), it’s perhaps time to ditch the Darwinian as the apex, and move on.
Were he alive today, he would suggest the same.
I’m sorry, Corneilius, but I don’t understand what you mean by “the evolutionary aim”. It seems to me that either you accept the theory of evolution, or you believe in some form of divinity that has aims.
But the two seem to be mutually incompatible.
A theory is a model and not the actuality. Likewise concepts of divinity. Both are in the realm of the imagination. One can chose to BELIEVE in them, and go no further or one can continue the scientific principle of enquiry …..
What actually happens in Nature is that species, rather than competing, appear to some degree to co-operate in many, many ways, where for example bacterial action operates within organisms, across habitats, carrying out essential processes that metabolise materials such that other organisms can utilise those products in living.
The ‘evolutionary flow or aim or direction’ of the whole is to incrementally increase the fecundity of the habitat such that more life – bio-diversity – flourishes. This is what happens.
The concept of competition or evolutionary success as the flourishing of one species on it’s own, over others, is inadequate, and it’s quite obvious, froma psychological stand point that it all too easily co-incides with Empire Logic – that of expansion and control over the peoples and their habitat as a natural progression.
I think it’s merely a projection of what I call Empire logic. The desire to control always seeks to justify itself.
It’s a VERY POWERFUL projection, and socially cherished, but that does not make it any more descriptive of reality.
So when biologists and others describe nature based on these assumptions, what we see is that a whole raft of enquiry is ditched. They say “x is happening BECAUSE y is the evolutionary drive’ rather than saying ‘x is happening. What does it mean?’
“The ‘evolutionary flow or aim or direction’ of the whole is to incrementally increase the fecundity of the habitat such that more life – bio-diversity – flourishes. This is what happens.”
It is difficult to be sure about this, Corneilius, but most scientists maintain that over 99% of species that have existed on planet earth are extinct, so I’m sceptical about your statement.
On the point of co-operation, I suppose that one could argue that an oncogene “cooperates” with human cells’ genetic material, so I guess you would argue that we should refuse to attempt to cure cancer as it would be an example of “empire logic” against evolution.
I think we often lose sight of the division between our natural state and industrialized state. In the natural world, if one were to sprain their ankle the body’s mechanisms of swelling and inflammation will in fact lead to a forced state of awareness on the existence of an injury. In short, you would be forced, through avoidance of pain and lack of mobility, to rest the affected joint/limb. In a modern medical setting, we artificially support the affected area (wraps,casts, etc..) , and no self respecting professional would advise a patient to return the joint to activity before an appropriate time. So, if we consider the setting of the person, and we align our modern medical procedures as much as possible with the body’s natural healing responses, then I see no reason why we cant both allow for a ‘darwinian’ medicine and a more modernized medicine to coexist. I also agree that we must be able to seperate the diseases and afflictions of mankind that can be traced to industrialized roots, vs. those that have existed from a much more primitive state of mankind. I do not go so far as to blame progress for all medical woes, but I certainly attribute many afflictions (lung cancer, obesity, etc…) to our ‘advancement’ as a race.
Well said, and very well put.
I would make a few clarifying definitions.
‘our ‘advancement’ as a race” – more like our change as a society.
There is very little real difference between a gatherer-hunter (gathering is and was the predominant food sourcing activity) and a modern human in core biological terms.
There are still quite a few Aboriginal people’s around, and as we know, some of them are living as they have done for so long, quite healthfully, whilst those whose lives are being affected by encroachment of the changes our society is creating are suffering dreadfully.
As for disease, the use of sugar, which the body metabolises as a fat AND a carbohydrate, is a huge factor correlated to the ‘advancement’ of industrialised societies, and when connected with the incidence of traumatising events in peoples lives (as the ACE study revealed) we can see how addictions, eating food for ‘comfort’ etc are linked to heart disease, diabetes, obesity etc etc and to some extent rooted in unresolved trauma.
Healing these would involve a sea change in how society relates to and treats children, as well as a sea change in how food is processed, prepared and marketed – it is a question of whether or not foods are seen as a profit center (specualtion, mcdonalds, etc) or as primary health support.
It’s important to remember that Darwin’s ideas are theory, that is to say they are a model we are using to describe what we know. There is so much about adaptation that we don’t know – we have yet to adequately describe the mechanisms that lead to such precise adaptations as we see all the time and are seeing more and more of.
You seem to have missed the doctor’s argument, which he specifically stated has nothing to do with reproduction, rather it is his belief that longer term health is promoted by not taking painkillers or measures to reduce fevers or swelling. With regards to pain killers, I agree. One has only to look at the longer term health of athletes to see that those who play though the pain tend to end up worse than those who take time to rest and heal. Also look at the extreme example of those individuals born with a sense of pain. They often end up with extremely undesirable outcomes.
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