Darwin in Medical School–Finally!

After following Ed’s advice to read some stuff by and about Randolph Nesse, I am still following up on the academic response to him. However, for the short term, we may look at this article from last summer in Stanford Medicine Magazine, written in response to Nesse’s editorial in Science last year, calling for the formal inclusion of evolutionary biology in US medical school curricula.

Nesse’s editorial concludes, with my emphasis:

These and other examples make a strong case for recognizing evolution as a basic science for medicine. What actions would bring the full power of evolutionary biology to bear on human disease? We suggest three. First, include questions about evolution in medical licensing examinations; this will motivate curriculum committees to incorporate relevant basic science education (34). Second, ensure evolutionary expertise in agencies that fund biomedical research. Third, incorporate evolution into every relevant high school, undergraduate, and graduate course. These three changes will help clinicians and biomedical researchers understand that both the human body and its pathogens are not perfectly designed machines but evolving biological systems shaped by selection under the constraints of tradeoffs that produce specific compromises and vulnerabilities.

The last sentence is a compelling argument for a doctor to pay attention to his actual patient instead of his theory about the insurance company’s client. However, I stumbled over the highlighted items.

  • Why does evolutionary biology need to make “a strong case” to be recognized as a “basic science for medicine”? Has the Big Bad Theocracy been so effective in brainwashing all those doctors? Isn’t it more urgent to ask how we have survived this long with a medieval healthcare system that doesn’t even utilize basic science?
  • The “full power of evolutionary biology” appears to consist mostly of administrative procedures that should be imposed upon hapless researchers and medical school faculties in order to persuade them of its importance.
  • There is no suggestion about how biomedical researchers are able to do their jobs at present despite the crippling lack of evolutionary expertise among them and their funding agencies.

So, Stanford Medicine Magazine responds with a very friendly article about this topic. The first part describes the epiphany of a medical resident as he realizes the importance of evolutionary biology for medical science.

He comes to his conclusion after years of painstaking data collection and broad-based, carefully designed clinical studies . . . OK, I’m joking: “His mind wandered to the early days of humans . . .” (his time machine must have been broken, so a little speculation follows). “Returning his attention to the modern times, Yun observed that predation as a trigger of the trauma response had virtually disappeared in modern humans.” Apparently he doesn’t get downtown much, and it isn’t clear where he observed this. “The idea dawned: Perhaps a little respect for human evolution was in order.” Finally, after all these years of scientists dissing Darwin! There is absolutely nothing substantial here, except to explain the motivation for Yun to later set up his own research investment firm.

The second part of the article approvingly quotes Stephen Lewis, a British “evolutionary medicine proponent” passing his judgment on the antiquated US healthcare system, dominated as it is by Christian fundamentalists. But then the author unwisely decides that Lewis is a congenial authority on every aspect of the question at hand:

Lewis agrees with Parsonnet that specific evolutionary medicine courses probably aren’t necessary, but that the basic biological principles on which medicine is based should be infused with evolutionary concepts.

So Lewis disagrees with Nesse, and once again we see the call for basic biological science, and medicine in particular, to finally start including evolutionary concepts. I feel so . . . so 13th-century suddenly, as I peck on my computer.

This is emphasized by the quote in the sidebar from Nesse:

“If someone were 20 years behind the times in understanding genes, we would just throw our hands up, but for some reason we don’t do it for evolutionary medicine.”

Again with the distinction between science (understanding genes) and evolutionary theory! Won’t they ever give up?

But Lewis indirectly provides a response to Nesse in the third part of the article:

Perhaps part of the problem in convincing medical practitioners to embrace evolution is the nature of the science. Evolutionary hypotheses about human physiology are notoriously hard to investigate, given humans’ long generation times.

Add to this the fact that the field has failed so far to provide clinically useful findings and you see why medical schools lack interest, says Lewis. “There is much about explanation and understanding but little about treating and curing,” he says.

I stand by my opinion that honest scientists are worth paying attention to on these issues.

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