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I read with great interest the article by Dr. Brunham recommending a conceptual change in how we see medicine, from a mechanistic view to an evolutionary view. Although mostly descriptive, the final section suggests major changes to medical education and research funding, and summarizes by stating: "Evolution focuses on genes and clinicians focus on patients. Health is not directly selected by natural selection; rather, it is an indirect effect of organisms selected for reproductive success. Health is the central goal of medicine."
Two comments come to mind. One relates to the way in which natural selection is typically understood - that certain traits (or genes, simply put) provide a selective "advantage" in the context of survival of the fittest. I believe it's more accurate to say that certain traits (or genes) exist because they ended up being passed on by previous generations. The difference is important, particularly for a proposal to view medicine through an evolutionary lens. If evolution is forward-looking, then all kinds of interventions to change it's course might be reasonable. If evolution, instead, truly exists only the past-tense, insofar as selective advantages are only real in retrospect, then evolutionary medicine is open to the same critique of being somewhat nihilistic as is the evolutionary perspective in general.
The second comment is related. If evolutionary natural selection inexorably works on pat...
Show MoreCompeting Interests: None declared.