Questioning the role of Darwinian medicine

Abstract

Darwinian medicine as a distinct scientific discipline can be traced to George Williams' and Randolph Nesse's paper 'The Dawn of Darwinian Medicine' (Q Rev. Biol. 66: 1-22, 1991). Ten years on, at what is still the dawn of a new millennium, it is timely to review the current state of Darwinian medicine and to assess some of its still latent potentialities. Nesse remains the main protagonist of a Darwinian approach to medicine. Important work by others has appeared but his and Williams' 'Evolution and Healing' (Weidenfeld and Nicolson, 1995)†, although written for the popular press, remains the primary text of the whole discipline. Distinct lines of academic interest and inquiry are, however, emerging within Darwinian medicine and it has found inclusion in a number of undergraduate curricula. Sufficient interest exists to suggest that it will survive as a discipline. But as a discipline, Darwinian medicine needs more than a single protagonist – it needs serious critical attention. It is important, therefore, to ask in what form the discipline is to persist and into what new areas it might go. Fundamental to such questions is the relationship between Darwinian medicine (as a scientific discipline) and Western clinical medicine (as a profession). It is suggested that, rather than try to gain direct acceptance by the medical profession, Darwinian medicine might seek to establish itself more firmly within the academic disciplines of evolutionary and human biology. It is suggested that it give special attention to identifying and making its own distinctive voice heard as a biological science of health and disease distinct from medicine – a voice that clinical medicine, drawing as ever from allied sciences, cannot then afford to ignore. To this end, the question of what might be the “zeroth law” of Darwinian medicine is posited.