The first ever description of how evolutionary principles can be applied to questions of health and sickness.

Recently, two research traditions that bring together evolutionary biology and medicine, that is to say, Darwinian medicine and evolutionary medicine, have been identified. In this paper, I analyse these two research traditions with respect to explanatory and interdisciplinary integration. My analysis shows that Darwinian medicine does not integrate medicine and evolutionary biology in any strong sense but does incorporate evolutionary concepts into medicine. I also show that backward-looking explanations in Darwinian (...) class='Hi'>medicine are not integrated proximate-and-ultimate explanations but functional explanations that include reference to evolutionary concepts. Nevertheless, explanations in Darwinian medicine have heuristic roles as they potentially contribute to conceptual change and tie pieces of knowledge from different fields of medical research together. I argue that Darwinian medicine is an “interfield” that fosters cross-disciplinary exchange between evolutionary biologists and medical researchers and practitioners based on division of labour and separation, rather than unity. Research in evolutionary medicine, on the other hand, happens at the intersection of evolutionary biology and medicine where the two disciplines are already integrated and is designed to produce entangled proximate-evolutionary explanations. My analysis thus adds another important aspect to the philosophical discussion on the distinction between Darwinian medicine and evolutionary medicine. (shrink)

As Dobzhansky wrote, nothing in biology makes sense outside the context of the evolutionary theory, and this truth has not been sufficiently explored yet by medicine. We comment on Shanks and Pyles' recently published paper, Evolution and medicine: the long reach of "Dr. Darwin", and discuss some recent advancements in the application of evolutionary theory to carcinogenesis. However, we disagree with Shanks and Pyles about the usefulness of animal experiments in predicting human hazards. Based on the darwinian (...) observation of inter-species and inter-individual variation in all biological functions, Shanks and Pyles suggest that animal experiments cannot be used to identify hazards to human health. We claim that while the activity of enzymes may vary among individuals and among species, this does not indicate that critical events in disease processes occurring after exposure to hazardous agents differ qualitatively between animal models and humans. In addition, the goal is to avoid human disease whenever possible and with the means that are available at a given point in time. Epidemics of cancer could have been prevented if experimental data had been used to reduce human exposures or ban carcinogenic chemicals. We discuss examples. (shrink)

In this review we consider the new science of Darwinian medicine. While it has often been said that evolutionary theory is the glue that holds the disparate branches of biological inquiry together and gives them direction and purpose, the links to biomedical inquiry have only recently been articulated in a coherent manner. Our aim in this review is to make clear first of all, how evolutionary theory is relevant to medicine; and secondly, how the biomedical sciences have (...) enriched our understanding of evolutionary processes. We will conclude our review with some observations of the philosophical significance of this interplay between evolutionary theory and the biomedical sciences. (shrink)

Two decades ago, the eminent evolutionary biologist George C. Williams and his physician coauthor, Randolph Nesse, formulated the evolutionary medicine research program. Williams and Nesse explicitly made adaptationism a core component of the new program, which has served to undermine the program ever since, distorting its practitioners’ perceptions of evidentiary burdens and in extreme cases has served to warp practitioner’s understandings of the relationship between evolutionary benefits/detriments and medical ones. I show that the Williams and Nesse program more particularly (...) embraces the panselectionist variety of adaptationism (the empirical assumption that non-adaptive evolutionary processes are causally unimportant compared to natural selection), and argue that this has harmed the field. Panselectionism serves to conceal the enormous evidentiary hurdles that evolutionary medicine hypotheses face, making them appear stronger than they are. I use two examples of evolutionary medicine texts, on neonatal jaundice and on asthma, to show that some evolutionary medicine practitioners have allowed their fervent panselectionism to directly shape their recommendations for clinical practice. I argue that this escalation of panselectionism’s influence is inappropriate under Williams’ and Nesse original stated standards, despite being inspired by their program. I also show that the examples’ conflation of clinical and evolutionary considerations is inappropriate even under Christopher Boorse’s controversial evolution-rooted concepts of disease and health. (shrink)

In this article, I argue that distinguishing ‘evolutionary’ from ‘Darwinian’ medicine will help us assess the variety of roles that evolutionary explanations can play in a number of medical contexts. Because the boundaries of evolutionary and Darwinian medicine overlap to some extent, however, they are best described as distinct ‘research traditions’ rather than as competing paradigms. But while evolu- tionary medicine does not stand out as a new scientific field of its own, Darwinian (...) class='Hi'>medicine is united by a number of distinctive theoretical and methodological claims. For example, evolutionary medicine and Darwinian medicine can be distinguished with respect to the styles of evolutionary explanations they employ. While the former primarily involves ‘forward looking’ explanations, the latter depends mostly on ‘backward looking’ explanations. A forward looking explanation tries to predict the effects of ongoing evolutionary processes on human health and disease in contem- porary environments (e.g., hospitals). In contrast, a backward looking explanation typically applies evolutionary principles from the vantage point of humans’ distant biological past in order to assess present states of health and disease. Both approaches, however, are concerned with the prevention and control of human diseases. In con- clusion, I raise some concerns about the claim that ‘nothing in medicine makes sense except in the light of evolution’. (shrink)

Evolutionary debunking arguments draw on claims about the biological origins of our moral beliefs to undermine moral realism. In this paper, I argue that moral disagreement gives us reason to doubt the evolutionary explanations of moral judgment on which such arguments rely. The extent of cross-cultural and historical moral diversity suggests that evolution can’t explain the content of moral norms. Nor can it explain the capacity to make moral judgment in the way the debunker requires: empirical studies of folk moral (...) judgments show that they lack the kind of objectivity debunkers point to as an evolutionary contribution to our capacity for moral judgment. Thus, the empirical premise of debunking arguments lacks empirical support. (shrink)

In recent years, an increasing number of medical books and papers attempting to analyse the concepts of health and disease from the perspective of evolutionary biology have been published.This paper introduces the evolutionary approach to health and disease in an attempt to illuminate the premisses and the framework of Darwinian medicine. My primary aim is to analyse to what extent evolutionary theory provides for a biological definition of the concept of disease. This analysis reveals some important differences between (...) functional explanations in the field of evolutionary biology and functional explanations in the field of medicine. Moreover, I shall argue that the biological functions relevant to the health of an organism cannot be determined on the basis of evolutionary theory. Accordingly, it seems that Darwinian medicine does not provide for the definition of a biological concept of disease. Still,Darwinian medicine may suggest why we are susceptible to certain diseases; it might also prove a suggestive heuristic on the basis of which new hypotheses concerning relevant treatments of various diseases might be advanced. (shrink)

There is a venerable philosophical tradition that views human beings as intrinsically rational, though even the most ardent defender of this view would admit that under certain circumstances people’s decisions and thought processes can be very irrational indeed. When people are extremely tired, or drunk, or in the grip of rage, they sometimes reason and act in ways that no account of rationality would condone. About thirty years ago, Amos Tversky, Daniel Kahneman and a number of other psychologists began reporting (...) findings suggesting much deeper problems with the traditional idea that human beings are intrinsically rational animals. What these studies demonstrated is that even under quite ordinary circumstances where fatigue, drugs and strong emotions are not factors, people reason and make judgments in ways that systematically violate familiar canons of rationality on a wide array of problems. Those first surprising studies sparked the growth of a major research tradition whose impact has been felt in economics, political theory, medicine and other areas far removed from cognitive science. In Section 2, we will sketch a few of the better known experimental findings in this area. We’ve chosen these particular findings because they will play a role at a later stage of the paper. For readers who would like a deeper and more systematic account of the fascinating and disquieting research on reasoning and judgment, there are now several excellent texts and anthologies available. (shrink)

Galatea, or the Future of Darwinism W Russell Brain Originally published in 1927 "A brilliant exposition…of the evolutionary hypothesis." The Guardian "Should prove invaluable…" Literary Guide This non-technical but closely-reasoned book is a challenge to the orthodox teaching on evolution known as Neo-Darwinism. The author claims that although Neo-Darwinian theories can possibly account for the evolution of forms, they are quite inadequate to explain the evolution of functions. 88pp ************** Daedalus or Science and the Future J B S Haldane (...) Originally published in 1924. "The essay is brilliant. Sparkling with wit and bristling with challenges." British Medical Journal "Predicts the most startling changes." Morning Post This volume examines the future of scientific research from religious, philosophical social and economic standpoints. 94pp Automaton, or the Future of Mechanical Man H Stafford Hatfield Originally published in 1928 "It is impossible to do justice to his volume in a brief review…"Daily Herald At the time of original publication mankind’s chief inventions had been extensions of his senses or limbs. This work prophesies the dawn of an era in which substitutes will gradually be found even for the human brain. 96pp Gallio or the Tyranny of Science J W N Sullivan Originally published in 1927 "So packed with ideas it is not possible to give any adequate résumé of its contents." Times Literary Supplement "Remarkable monograph…devastating summary of materialism…" Spectator An attack on the values which science is so successfully imposing upon civilization. 90pp. (shrink)

Evolutionary theory has been a very popular topic in recent years and it has been claimed that it can make a major contribution to the advance of several sciences such as medicine, psychology, psychopathology and sociology: even providing them with new paradigms. This paper explores the possibility that nursing could benefit similarly by adopting an evolutionary perspective. After sketching the scientific and philosophical background to the recent developments concerning evolution, and briefly mentioning the chief features of evolutionary theory, the (...) paper discusses whether it makes sense to talk of ‘evolutionary nursing’, and whether there are any benefits in doing so. It uses a comparison with Darwinian medicine and evolutionary psychology. Several problems and objections are considered. The modest conclusion is reached that nurses need to adopt an evolutionary perspective to serve as a guide for some of their research and a source for research hypotheses. They also need to be informed about evolutionary ideas so as to be aware of the developments in the disciplines with which they work, and this understanding will assist them in maintaining vigilance against the misuse of science, religion and politics on behalf of their patients. (shrink)

La théorie étiologique définit les fonctions biologiques en faisant référence à l'action passée de la sélection naturelle. Elle peut ainsi permettre de définir les pathologies comme des dysfonctionnements : il y a pathologie lorsqu'un composant x de l'organisme ne fait plus ce qu'il est censé faire et qui a conduit à le retenir dans le passé de l'histoire évolutive. On peut distinguer trois problèmes qui attendent les partisans de cette solution. Le premier est celui de la conciliation entre deux visées (...) différentes : la théorie de l'évolution peut-elle à la fois contribuer à l'explication du fait récurrent de la maladie (ce que vise une « médecine darwinienne ») et permettre une démarcation entre normal et pathologique ? Le second problème est celui des exceptions : en certains cas, une incapacité acquise a bien valeur de pathologie, mais la présence de la capacité correspondante ne s'explique pas par la sélection, ce qui ôte à la proposition initiale son caractère de nécessité conceptuelle. Enfin, la réalisation d'un trait peut être à la fois atypique et adaptative, ce qui fragilise la notion de normalité biologique impliquée par la théorie étiologique. Ces problèmes sont sérieux et l'article examine pour conclure si un autre concept de fonction, le concept systémique, ne pourrait pas mieux convenir moyennant quelques ajustements, à la philosophie de la médecine. Etiological theory defines biological functions in reference to the past action of natural selection. Accordingly, it may define pathological states as dysfunctional states : component x being in a pathological state would mean x no longer does what it is still supposed to do, that is, what it has been designed to do in past evolutionary history. There are three problems with this solution. First, it may prove difficult to reconcile the evolutionary explanation of the recurring fact of disease (the purpose of a « Darwinian medicine ») and the suggested demarcation between the normal and the pathological. Second, we may think of cases where a certain capacity is impaired, this impairment being clearly a pathology, and where, nonetheless, the explanation of why the corresponding capacity is there is by no means selective. This weakens the initial proposition because it thereby loses its alleged conceptual necessity. Thirdly, a biological feature may be expressed in a way that is both atypical and adaptive, i.e. a challenge to the idea of biological normality involved in etiological theory. These seem to be quite serious problems and one may ask if another concept of function, the systemic concept with a number of adjustments, would not be better suited to the ends of the philosophy of medicine. (shrink)

The development of animal ethics has been characterized by both progress and absurdity. More activity in animal welfare has occurred in the past 50 years than in the previous 500, with large numbers of legislative actions supplanting the lone anti-cruelty laws. Nonetheless, there remains a tendency to confuse animal ethics with human ethics. I found this to be the case when my colleagues and I were drafting federal law requiring control of pain in invasive research. The history of animal ethics (...) vacillates between Descartes’ denial of thought and feeling in animals and British empiricism, including the great skeptic David Hume, who affirmed in no uncertain terms the existence of animal mind. This approach was continued in British empiricism, culminating in the work of Charles Darwin. But despite Darwinian domination of biology and psychology, psychology was captured by denial of mind and consciousness by JB Watson, father of behaviorism. Denial of thought and feeling in animals continued in 20th century science and medicine while society in general became ever more firm in asserting their existence. (shrink)

Epidemiology is a science of disease which specifies rates . Evolution is a science of life which specifies changes . ‘Evolutionary Epidemiology’ is a synthesis of these two sciences which combines the empirical power of classical methods in genetical epidemiology with the interpretive capacities of neo-darwinian evolutionary genetics. In particular, prevalence rates of genetical diseases are important data points when reformulated for the purpose of analysis in terms of their evolutionary frequencies. Traits which exceedprevalences beyond the rates of mutation (...) or evidence unusualrange of phenotypic reaction are of special interest. This is because traits which did not confer advantages in the environment of evolutionary adaptation cannot accede, through natural selection, to anything but low rates of genomic prevalence.Evolutionary epidemiology is, in all of medicine, of particular promise in ongoing efforts to better understand psychopathology. Many complexities of phenotypic adjustment arise when new developmental demands are placed on an ‘old’ genome. The new and complex biosocial ecology of human mass society now evokes different phenotypes than those in the prehistorical ecology to which the genome is structurally and functionally better adapted. Some of these new phenotypes are darwinian failures. In this paper, the theoretical implications of evolutionary epidemiology are extended and some tentative points of clinical application are offered. (shrink)

The Human Genome Project is nearing completion, and shortly we will have access to the complete genetic sequence of an average human being. Hopes are high that the sequence will contribute profoundly to medicine in particular, but also to our understanding of our evolutionary past. Of course, detractors have long insisted that because the HGP represents a victory for formalism in biology, determining the function of DNA sequences will remain an outstanding problem for at least the next several decades. (...) Moreover, it is not clear that having the complete sequence will be significantly useful to biologists seeking to understand gene function in the first place. What can we expect in the postgenomic era? ;I reject the very idea that a complete, encapsulated sequence of a human genome is foundational to biological understanding. I set my investigation within the framework of the ancient debate between preformationists and epigenecists. I survey and conceptually analyze arguments on both sides, especially as they relate to the separation of genetics and embryology in the early part of the twentieth century. I identify modern variants of both preformationism and epigenesis, and note their reconciliation in the form of a Modern Consensus on development established after the neo-Darwinian Synthesis in biology in the 1940s. ;Drawing on recent work in molecular and developmental biology, I challenge the seeming intuitiveness of the Modern Consensus and its subsumption of developmental concerns under the aegis of molecular genetics. I then propose and defend an alternative synthesis of preformationism and epigenesis, and of genetics and developmental biology, according to which development does not reduce to mere gene activation. I underscore the practical benefit of my perspective through a lengthy discussion of the psychiatric genetics approach to schizophrenia. (shrink)

Human rights are universally acknowledged to be important, although they are, of course, by no means universally respected. This universality has helped to combat racism and sexism and other arbitrary and vicious forms of discrimination. Unfortunately, as we shall see, the universality of human rights is both too universal and not universal enough. It is time to take the “human” out of human rights. Indeed, it is very probable that in the future there will be no more humans as we (...) know them now, because the further evolution of our species, either Darwinian or more likely determined by human choices, will, we must hope, result in the emergence of new sorts of beings better able to cope with the intellectual and physical challenges of the future. One example of the ways in which this is already happening is the sorts of cognitive enhancement that are already coming on stream. Another is signaled by stem cell research and the birth of regenerative medicine. (shrink)

Liberal proponents of genetic engineering maintain that developing human germline modification technologies is morally desirable because it will result in a net improvement in human health and well-being. Skeptics of germline modification, in contrast, fear evolutionary harms that could flow from intervening in the human germline, and worry that such programs, even if well intentioned, could lead to a recapitulation of the scientifically and morally discredited projects of the old eugenics. Some bioconservatives have appealed as well to the value of (...) retaining our “given” human biological nature as a reason for restraining the development and use of human genetic modification technologies even where they would tend to increase well-being. In this article, I argue that germline intervention will be necessary merely to sustain the levels of genetic health that we presently enjoy for future generations—a goal that should appeal to bioliberals and bioconservatives alike. This is due to the population-genetic consequences of relaxed selection pressures in human populations caused by the increasing efficacy and availability of conventional medicine. This heterodox conclusion, which I present as a problem of intergenerational justice, has been overlooked in medicine and bioethics due to certain misconceptions about human evolution, which I attempt to rectify, as well as the sordid history of Darwinian approaches to medicine and social policy, which I distinguish from the present argument. (shrink)

Introduction A Brief Conceptual Framework for Biology PART ONE: UNDERSTANDING NATURE 1. The Antecedents of Scientific Thought Animism, Totemism, and Shamanism The Paleolithic View Mesopotamia Egypt 2. Aristotle and the Greek View of Nature The Science of Animal Biology The Parts of Animals The Classification of Animals The Aristotelian System Basic Questions 3. Those Rational Greeks? Theophrastus and the Science of Botany The Roman Pliny Hippocrates, the Father of Medicine Erasistratus Galen of Pergamum The Greek Miracle 4. The Judeo-Christian (...) Worldview The Bishop of Hippo Scholastic Thought Islamic Science Books on Beasts Antecedents of a Revolution 5. The Revival of Science Andreas Vesalius and the Study of Structure William Harvey and the Study of Function Sir Francis Bacon’s Great Instauration Induction, Hypothesis, Deduction The Very Small--Animalcules Robert Hooke and the Discovery of Cells 6. Figur’d Stones and Plastick Virtue Marine Life on Mountain Tops? Figured Stones of Unknown Creatures Baron Cuvier Quarries of the Paris Basin Catastrophism and Uniformitarianism William Smith and the Geological Column Understanding Nature in 1850 PART TWO: THE GROWTH OF EVOLUTIONARY THOUGHT 7. The Paradigm of Evolution First Questions The Paradigm of Natural Theology First Answers 8. Testing Darwins Hypotheses Have Life Forms Changed over Time? Do Species Evolve into Different Species over Time? Has There Been Time Enough for Evolution? Is Natural Selection the Mechanism of Change? The Genetic Basis of Natural Selection Accounting for the Diversity of Life 9. In the Light of Evolution Comparative Anatomy Embryonic Development Classification Microstructure Molecular Processes 10. Life over Time The Origin of Life The Rise of Multicelled Organisms What Is a Phylum? Burgess Shale Metazoans Early Evolution of the Vertebrates The Age of Dinosaurs Birds, Mammals, and Flowering Plants The Rancho La Brea Tar Pits Human Evolution The Role of Extinction in Evolution PART THREE: CLASSICAL GENETICS 11. Pangenesis What Is the Question? Hippocrates and Aristotle The Darwinian Answer Assembling the Data Formulating the Hypothesis by Induction Galton’s Rabbits 12. The Cell Theory The Discovery of Cells: Robert Hooke Schwann and Cells in Animals Gametes as Cells Omnis cellula e cellula? The Technology of Cell Research 13. The Hypothesis of Chromosomal Continuity The Ephemeral Nucleus Schneider, Flemming, and Cell Division The Chromosomes and inheritance Gamete Formation Fertilization 14. Mendel and the Birth of Genetics Model for Monohybrid Crosses Model for Dihybrid Crosses Mendel’s Laws Initial Opposition to Mendelism 15. Genetics + Cytology: 1900-1910 Sutton’s Model The Cytological Basis of Mendel’s Laws Boveri and Abnormal Chromosome Sets Variations in Mendelian Ratios The Discovery of Sex Chromosomes 16. The Genetics of the Fruit Fly Morgan’s First Hypothesis Morgan’s Second Hypothesis The Fly Room Linkage and Crossing-Over The Cytological Proof of Crossing-Over Mapping the Chromosomes The Final Proof The Determinants of Sex The Conceptual Foundations of Classical Genetics 17. The Structure and Function of Genes One Gene, One Enzyme The Substance of Inheritance The Watson-Crick Model of DNA Genes and the Synthesis of Proteins The Genetic Code PART FOUR: THE ENIGMA OF DEVELOPMENT 18. First Principles The Peripatetic Stagirite The Death and Rebirth of Scientific Thought Harvey and Malpighi A Two-Millennial Summing Up Preformation versus Epigenesis 19. The Century of Discovery Von Baer’s Discovery of the Mammalian Ovum Darwin’s Contribution to Embryology Haeckel and Recapitulation 20. Descriptive Embryology Germ Layers The External Development of the Amphibian Embryo The Internal Development of the Amphibian Embryo 21. The Dawn of Analytical Embryology His, Roux, and Mosaic Development Driesch and Regulative Development Novelty in Development Cell Lineage Nucleus or Cytoplasm? Fin de Siècle 22. Interactions during Development Amphibian Organizers Secondary Organizers The Reacting Tissue The Chemical Nature of the Organizer Putting It All Together Conclusion Further Reading References Illustration Credits Index. (shrink)

Are there parallels between the "moment of insight" in science and the emergence of the "unknowable" in religious faith? Where does scientific insight come from? Award-winning biologist Robert Pollack argues that an alliance between religious faith and science is not necessarily an argument in favor of irrationality: the two can inform each other's visions of the world. Pollack begins by reflecting on the large questions of meaning and purpose--and the difficulty of finding either in the orderly world described by the (...) data of science. He considers the obligation to find meaning and purpose despite natural selection's claim to be a complete explanation of our presence as a species--a claim that calls upon neither natural intention, nor design, nor Designer. Next, the book focuses on matters of free will, from the choice of a scientist to accept evidence, to the choice of a religious person to accept a revelation, to a patient's loss of free will in medical treatment. Here Pollack addresses questions of ethics and offers a provocative comparison of two difficult texts whose contents remain incompletely understood: the DNA "text" of the human genome and the Hebrew record of Jewish written and oral law. In closing, Pollack considers the promise of genetic medicine in enabling us to glimpse our own future and offers a reconsideration of the possible utility of the so-called placebo effect in curing illness. Whether refuting a DNA-based biological model of Judaism or discussing the Darwinian concept of the species, Pollack, under the banner of free inquiry, presents a genuine, vital, and well-argued assay of the intersection of science and religion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Darwin Meets Literary TheoryEllen DissanayakeEvolution and Literary Theory, by Joseph Carroll; xi & 518 pp. Columbia: University of Missouri Press, 1995, $44.95.In my experience, most literary theorists, even those who participate in conferences called “Literature and Science,” know little about evolution, and don’t want to know. For them, “science” means information theory, chaos or catastrophe theory, fractals, pataphysics, “autopoeisis” or self-organization, emergence, cyborgs, hypertext, virtual signs and other aspects (...) of sci-fi, or techno-politics. (I encountered these subjects at a comparative literature conference I attended in March 1995.) These “scientific” positions are used as trendy metaphors for talking about chance, uncertainty, accident, ideology, and multidimensionality in literary works or in the aims of their authors. In other words, the buzzwords of contemporary science become one more angle from which to view or project another facet onto the glassy, self-reflective edifice of contemporary literary theory, rather than a means from which to shatter it and build again from scratch with more earthy, substantial materials. Joseph Carroll’s book provides the view and the means for this genuinely new and constructive (if initially destructive) possibility.It is ironic that in the present critical climate the very virtues of the book might be seen by some as faults—e.g., the lucid, elegant writing and the erudition and interdisciplinarity of the work as a whole. Carroll [End Page 229] writes clearly, authoritatively, without jargon, and with frequent, delicious wit. His values, aims, explanations, evidence, and criticisms are concisely and plainly stated. This is in marked contrast to the enigmatic and idiosyncratic nature of much recent criticism, and might have the initially disorienting effect of returning to earth and breathing pure oxygen after one has become accustomed to the thin and rarefied atmosphere of remote, icy peaks.Carroll offers wide-ranging and illuminating discussions of standard literary and critical works from both the European and Anglo-American tradition over the past several centuries, and refers to dozens of writers from diverse periods and nationalities. Additionally he enlists, and criticizes where appropriate, ideas from such diverse nonliterary figures as Darwin himself and writers about Darwin, T. H. Huxley, Konrad Lorenz, John Bowlby, Sir John Eccles, the prominent sociobiologists and evolutionary psychologists, S. J. Gould, Richard Lewontin, Derek Bickerton, Piaget, Karl Popper, Thomas Kuhn, Clifford Geertz, H. J. Eysenck, Cardinal Newman, Thorstein Veblen, Trotsky, Raymond Williams, and Richard Rorty, among others.One can be forgiven for wishing to forego an exploration of this demanding array of knowledge argued from the unfamiliar perspective of evolutionary biology. For in order seriously to consider Carroll’s new way of looking at human endeavor (including literature) one must also look critically at what was laboriously mastered during all those years of graduate school and tenure-driven writing for publication. No one wants to be persuaded to give up a view of the world that has been mastered with painstaking diligence. Still less does anyone want to spend time with something that according to conventional academic wisdom is downright wrong-headed. This is really the challenge of Carroll’s book—because such minor matters as the plain unfashionable title, clear writing, impressive erudition, and dated or forgotten thinkers can be overcome if the stakes are high enough.I wish to suggest that the stakes are high enough and that the time is right for this inevitable change of viewpoint. Along with others in diverse fields such as cognitive and developmental psychology, personality theory, neurology, medicine, sociology, political science, epistemology, cultural anthropology, ethics, and linguistics, I find the Darwinian perspective to offer the most comprehensive and viable possibility for an understanding of human behavior and culture, including the arts. Joseph Carroll admirably articulates this position and applies it to literary theory. I invite scholars who think that evolutionary explanations [End Page 230] are erroneous, dangerous, reductionist, simplistic, or irrelevant to read Carroll and deal seriously with his arguments. His book should be the central text for theory classes and seminars, as well as the subject of conferences. Those who would dismiss it should have the courage and curiosity to lay aside their misgivings and have a look. Especially those who are dissatisfied with the surfeit... (shrink)

Friedrich Nietzsche''s will to power, and the philosophical ediface built on this foundation, is formulated on a biologicism that is indebted to a particular post-Darwinian vision of the organism. Of the various models that attempt to formulate a comprehensive organismal biology, Nietzsche unknowingly grasped that of Elie Metchnikoff, who authored the theoretical foundation of modern immunology. Metchnikoff regarded the organism as a disharmonious entity, in constant inner strife between competing cellular activities. Immune functions were responsible for mediating harmonization, which (...) however remains an elusive ideal. This view of the organism posited an ever-changing, self-defining entity striving for self-actualization while in ceaseless inner struggle as well as in competition with the environment. The theory is no less than an epistemological response of how to establish the subject-object relation in a construct where the subject''s boundaries are dialectical and evolving. The similarity of the philosophical positions of Nietzsche and Metchnikoff regarding the Self offers rich resonance in current attempts to formulate a biomedical language appropriate to address the issues raised by these problems. (shrink)

Many philosophers invoke the "wisdom of nature" in arguing for varying degrees of caution in the development and use of genetic enhancement technologies. Because they view natural selection as akin to a master engineer that creates functionally and morally optimal design, these authors tend to regard genetic intervention with suspicion. In Part II, we examine and ultimately reject the evolutionary assumptions that underlie the master engineer analogy (MEA). By highlighting the constraints on ordinary unassisted evolution, we show how intentional genetic (...) modification can overcome many of the natural impediments to the human good. Our contention is that genetic engineering offers a solution that is more eff icient, reliable, versatile, and morally palatable than the lumbering juggernaut of Darwinian evolution. In Part III, we evaluate a recent attempt to ground precautionary enhancement heuristics in adaptive etiology. Our problem with this approach is two-fold: first, it is based on the same "strong adaptationist" interpretation of evolution that motivates the flawed MEA, and second, the etiological concept of function on which it relies provides indirect and potentially misleading information about the likely consequences of genetic intervention. We offer instead enhancement criteria based on causal relationships in ontogeny. We conclude that rather than grounding a presumption against deliberate genetic modification, the causal structure of the living world gives us good moral reason to pursue it. (shrink)

The etiology of schizophrenia remains heavily contested despite extensive research, huge quantities of data, and heavy investment in time and material resources around the world. Not only is there little agreement about the causes of this most devastating of psychiatric conditions, but there is disagreement as to whether the condition exists at all as a coherent entity (Bentall 2006). Evolutionary theorists have had the added problem of explaining how a severe mental illness that causes a significant reproductive disadvantage can continue (...) to exist in human populations, where it is claimed to have a uniform prevalence across the world. Many Darwinian formulations have suggested various forms of tradeoffs where the .. (shrink)

Volume 24, Issue 9, September 2024, Page 48-50.

Volume 24, Issue 12, December 2024, Page 6-7.

Volume 24, Issue 11, November 2024, Page 1-3.

The best things in my Ufe have come to me by accident and this book results from one such accident: my having the opportunity, out of the blue, to go to work as H. Tristram Engelhardt, Jr. 's, research assistant at the Institute for the Medical Humanities in the University of Texas Medi cal Branch at Galveston, Texas, in 1974, on the recommendation of our teacher at the University of Texas at Austin, Irwin C. Lieb. During that summer Tris "lent" (...) me to Chester Bums, who has done important schol arly work over the years on the history of medical ethics. I was just finding out what bioethics was and Chester sent me to the rare book room of the Medical Branch Library to do some work on something called "medical deontology. " I discovered that this new field of bioethics had a history. This string of accidents continued, in 1975, when Warren Reich (who in 1979 made the excellent decisions to hire me to the faculty in bioethics at the Georgetown University School of Medicine and to persuade Andre Hellegers to appoint me to the Kennedy Institute of Ethics) took Tris Engelhardt's word for it that I could write on the history of modem medical ethics for Warren's major new project, the Encyclopedia of Bioethics. Warren then asked me to write on eighteenth-century British medical ethics. (shrink)

The puzzling case of the broken arm -- Hernias, diets, and drugs -- Why physicians cannot know what will benefit patients -- Sacrificing patient benefit to protect patient rights -- Societal interests and duties to others -- The new, limited, twenty-first-century role for physicians as patient assistants -- Abandoning modern medical concepts: doctor's "orders" and hospital "discharge" -- Medicine can't "indicate": so why do we talk that way? --"Treatments of choice" and "medical necessity": who is fooling whom? -- Abandoning (...) informed consent -- Why physicians get it wrong and the alternatives to consent: patient choice and deep value pairing -- The end of prescribing: why prescription writing is irrational -- The alternatives to prescribing -- Are fat people overweight? -- Beyond prettiness: death, disease, and being fat -- Universal but varied health insurance: only separate is equal -- Health insurance: the case for multiple lists -- Why hospice care should not be a part of ideal health care I: the history of the hospice -- Why hospice care should not be a part of ideal health care II: hospice in a postmodern era -- Randomized human experimentation: the modern dilemma -- Randomized human experimentation: a proposal for the new medicine -- Clinical practice guidelines and why they are wrong -- Outcomes research and how values sneak into finding of fact -- The consensus of medical experts and why it is wrong so often. (shrink)

The general aim of this paper is to provide insight into the relevance of critical phenomenology for the study of the patient-provider relationship in health care systems in U.S. jails, prisons, and detention facilities. In particular, I utilize tools from the work of scholars studying phenomenological approaches to health care and structural forms of oppression to analyze several harms that arise from the provision of medical care under the punitive constraints of carceral facilities.

This essay focuses on the meaning that the term “experimental” acquires within spiritualism during the second half of the nineteenth century. It builds upon Paul Janet’s notions of “experience” and “experimentation” in psychology, by stressing the role of physiology and pathology in his reflection. Regardless of the role the concept of “experimentalism” took on in Victor Cousin’s psychology, which arguably indicated more an “internal affection” than actual experimentation, in Janet’s spiritualism the term regains its original meaning of empirical verification. Janet (...) highlights the importance of madness to the development of a new psychological paradigm that could reconcile philosophy and medicine, reason and experience, by taking up pathology as a form of natural and indirect experimentation. (shrink)

This book explores the tradition of the 'science of man' in French medicine of the era 1750-1850, focusing on controversies about the nature of the 'physical-moral' relation and their effects on the role of medicine in French society. Its chief purpose is to recover the history of a holistic tradition in French medicine that has been neglected because it lay outside the mainstream themes of modern medicine, which include experimental, reductionist, and localistic conceptions of health and (...) disease. Professor Williams also challenges existing historiography, which argues that the 'anthropological' approach to medicine was a short-term by-product of the leftist politics of the French Revolution. This work argues instead that the medical science of man long outlived the Revolution, that it spanned traditional ideological divisions, and that it reflected the shared aim of French physicians, whatever their politics, to claim broad cultural authority in French society. (shrink)

Historically, one of the most controversial aspects of Darwinian evolution has been the prominent role that randomness and random change play in it. Most biologists agree that mutations in DNA have random effects on fitness. However, fitness is a highly simplified scalar representation of an enormously complex phenotype. Challenges to Darwinian thinking have focused on such complex phenotypes. Whether mutations affect such complex phenotypes randomly is ill understood. Here I discuss three very different classes of well-studied molecular phenotypes (...) in which mutations cause nonrandom changes, based on our current knowledge. What is more, this nonrandomness facilitates evolutionary adaptation. Thus, living beings may translate DNA change into nonrandom phenotypic change that facilitates Darwinian evolution. (shrink)

In this paper, an argumentative pattern that is prototypical for the communicative practice of over-the-counter medicine advertisements will be discussed. First, a basic argumentative pattern for this type of advertisement will be identified. In addition, an overview of various types of extensions of this basic pattern will be presented. Finally, it will be made clear how combinations of the basic pattern and specific extensions can be analysed as the result of strategic choices made by the advertisers concerning the type (...) of arguments that are advanced, the argumentation structure and the presentation of their arguments. (shrink)

This article adopts Husserl’s transcendental phenomenology to explore the complex relationship between patients and physicians. It delves into the coexistence of two distinct voices in the realm of medicine and health: the “voice of medicine” and the “voice of life-world.” Divided into three sections, the article emphasizes the importance of shifting from a scientific-medical attitude to a more personalistic approach in physician–patient interactions. This shift aims to prevent depersonalization and desubjectification. Additionally, it highlights the equal and irreducible nature (...) of patients while acknowledging the vital role physicians hold in the realm of illness. The article stresses the need for a balanced and equitable relationship between both parties, rooted in the shared life-world. Moreover, empathy is underscored as a crucial element in fostering meaningful dialogue, wherein understanding diverse perspectives and attitudes towards illness is paramount. The article argues that differences between patients and physicians are necessary for empathy, while shared similarities form its foundation. Ultimately, a harmonious relationship facilitates empathy and enables the constitution of a new sense of life for both patients and physicians. (shrink)

Precision medicine is emerging as a scientific bandwagon within the contemporary biomedical sciences in the United States. PM brings together concepts and tools from genomics and bioinformatics to develop better diagnostics and therapies based on individualized information. Developing countries like China and Brazil have also begun pursuing PM projects, motivated by a desire to claim genomic sovereignty over its population. In spite of commonalities, institutional arrangements produced by the history of genomics research in China and Brazil are ushering PM (...) along different trajectories. In the Chinese case, we identify a strong state-backed push for PM combined with a dynamic network of international academic and private actors along the lines of networked technonationalism that has made large-scale, speculative PM projects possible. The Brazilian case is characterized by an institutional void at the federal level in which PM is driven by domestic academic actors in universities in the regional level, resulting in smaller scale, needs-driven PM projects. Through these cases, this paper shows how a scientific bandwagon adapts to national histories and institutions. Through this peripheral translation of the scientific bandwagon, the global infrastructure of biomedical knowledge has the potential to be transformed. (shrink)

Edmund D. Pellegrino has played a central role in shaping the fields of bioethics and the philosophy of medicine. His writings encompass original explorations of the healing relationship, the need to place humanism in the medical curriculum, the nature of the patient’s good, and the importance of a virtue-based normative ethics for health care. In this anthology, H. Tristram Engelhardt, Jr., and Fabrice Jotterand have created a rich presentation of Pellegrino’s thought and its development. Pellegrino’s work has been dedicated (...) to showing that bioethics must be understood in the context of medical humanities, and that medical humanities, in turn, must be understood in the context of the philosophy of medicine. Arguing that bioethics should not be restricted to topics such as abortion, third-party-assisted reproduction, physician-assisted suicide, or cloning, Pellegrino has instead stressed that such issues are shaped by foundational views regarding the nature of the physician-patient relationship and the goals of medicine, which are the proper focus of the philosophy of medicine. This volume includes a preface by Dr. Pellegrino and a comprehensive Introduction by the editors. Of interest to medical ethicists as well as students, scholars, and physicians, _The Philosophy of Medicine Reborn_ offers fascinating insights into the emergence of a field and the work of one of its pioneers. “After a long period of dormancy, philosophy of medicine has blossomed with new life. The single most important physician-philosopher in that rebirth has been Edmund Pellegrino. His contributions to virtue theory, the concept of beneficence, the dispute over the internal and external sources of a morality for medicine, and the role of the Hippocratic tradition are all critical. The essays collected in this volume have changed the history of the philosophy of medicine. He shows that philosophy of medicine can be done with both passion and compassion.” —_Robert M. Veatch, Kennedy Institute of Ethics, Georgetown University_ “Edmund Pellegrino's words have helped medical students, faculty, scholars and patients address the challenges they encounter in medicine and medical practice. His personal support has also been critical for many of us in developing programs in medical ethics and philosophy of medicine in our universities. Dr. Pellegrino combines the wisdom of a great physician with those of a great philosopher to produce a body of writing that will continue to inspire us all. This volume contains some of his best and most influential work.” —_Loretta Kopelman, The Brody School of Medicine, East Carolina University_ _ _ “Edmund Pellegrino has been a leading light in the philosophy of medicine for a generation. He was instrumental in the birth of bioethics, founded one of the leading journals, and provided able leadership in organizing early activities of the profession. He has served as department chairman, dean, and university president. Most recently, he chairs the President’s Council on Bioethics. In all this, first and foremost, he has been a physician. Those who are ill and suffering make a claim upon him. To respond to this claim, Pellegrino creatively brings together the worlds of science and of the humanities. For him, that is what medicine is about, making it the most scientific of the humanities and the most humane of the sciences. Fortunately for us, Pellegrino brings these worlds together in thought, as well as in practice. In this selection from his writings, Engelhardt and Jotterand have captured the heart of Pellegrino’s project, both in depth and breadth, so we can also hear that claim of the ill and so we can see what worlds must come together if we are to respond in the appropriate way.” —_George Khushf, University of South Carolina_ “Pellegrino’s work is both a treasure and important for understanding bioethics. His work in philosophy of medicine addresses the crucial questions that are so important to understanding the practice of medicine and the ethics of health care.” —_Kevin Wildes, President, Loyola University_ _ _. (shrink)

Medicine does not usually consider the human body from an aesthetic point of view. This article explores the notion of the lived body as aesthetic object in anthropological medicine, concentrating on the views of Buytendijk and Straus on human uprightness and gracefulness. It is argued that their insights constitute a counter-balance to the way the human body is predominantly approached in medicine and medical ethics. In particular, (1) the relationship between anthropological, aesthetic and ethical norms, (2) the (...) possible danger of a naturalistic fallacy, (3) the implications for the care of disabled people and (4) the intrinsic aesthetic quality of the human body are dealt with. (shrink)

사상의학(四象醫學, Sasang Constitutional Medicine)은 동무 이제마(1937∼1900)가 창안한 것으로, 사상철학(四象哲學, Four Quadrants Philosophy)을 바탕으로 성립된, 사상(史上) 유래 없는 독특한 특징을 보이는 의학이다. 동무가 ‘사상한(四象限)’이라는 발상을 정확히 언제 떠올렸는지 문헌상에 나타나는 기록으로는 확인되지 않는다. 동무의 대표적인 저작으로는 『격치고(格致藁)』(1880∼1893)와 『동의수세보원(東醫壽世保元)』(1894)이 있는데, 『격치고』 첫 내용부터 ‘사상한’ 도식이 나오는 것을 보면, 초기 발상은 『격치고』 찬술(撰述) 이전이었을 것이다.BR이미 널리 알려진 바와 같이, 세계적인 철학자이자 통합 심리학자인 켄 윌버(Ken Wilber, 1949∼)의 학문적 내용을 전체적으로 언급하는 개념은 “사상한(四象限, AQAL(All Quadrant, All Level))”이다. 윌버는 이 ‘AQAL’을 자신이 만들어낸 새로운 (...) 창안이라고 주장한다. 그의 말대로 근(近) 20년의 오랜 숙고기간(윌버 모델 1기(1977∼1979)∼4기(1995∼2001))을 통해 나온 발상이다.BR하지만, 동무의 『격치고』(1880∼1893)에 나타나는 사상한 모델은 윌버의 것과 동일한 것이다. 그래서 동무 의학의 특징이 한마디로 ‘사상(四象)’으로 표징(表徵)되기에, 후대 학자들에 의하여 공식적으로 “사상의학(四象醫學)”으로 불린다. 윌버의 “AQAL(All Quadrant, All Level)” 또한 마찬가지다. ‘AQAL’의 구체적인 의미는 ‘온상한(All Quadrant)’, ‘온수준(All Level)’이지만, ‘AQAL’ 모형의 가장 큰 특징이 ‘네 상한’이기에 ‘사상한(四象限)’으로 번역한다. 이와 같이 동무의 의학과 윌버의 AQAL을 모두 ‘사상(四象)’이라고 명명하는 것은 우연의 일치가 아니라, 기의(記意)가 같기 때문이다.BR그런데 현재 사상의학의 영문 표기는 “Sasang Constitutional Medicine(SCM, 四象體質醫學)”으로 통용되고 있다. 이로써 국내외적으로 동무의 ‘사상의학(四象醫學)’이 윌버 ‘사상한(四象限, AQAL)’의 전범(典範)이 된다는 사실이 간과되고 있다.BR이에 본 논문에서는 동무의 사상의학과 윌버의 사상한의 기의(記意, signifié)와 기표(記標, signifiant)를 검토하고 그 대안을 제시하는 데서 인식 전환의 출발점을 찾는다. (shrink)