Evolutionary biology within medicine: a perspective of growing value
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7671 (Published 19 December 2011) Cite this as: BMJ 2011;343:d7671
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Gluckman and Bergstrom's article on the value of evolutionary biology within medicine excellently highlights the importance of different levels of explanation in exploring the causes of disease. It begs the question, though, whether evolutionary explanations of disease can really be regarded, as they suggest, as 'ultimate'. To do so, in denial of supernatural explanations in terms of God, redemption and hope, pre-supposes the absence of anything beyond the physical world in a way that is neither explicitly stated nor evidence based.
If diagnosed with a devastating disease, a patient may well ask the question, 'why me?'. Answers to this are provided at every level of scientific endeavour, from molecular biochemistry through altered physiology and epidemiological risk-factors to evolutionary trade-offs.
Though each explanation may prove satisfying, is any complete? Questions remain about meaning, purpose and the future. It may be that the scientific explanations do provide the final word; that disease is simple a 'brute fact' we have to deal with. But to state this firmly is to defend the philosophical position of atheism, and not a defend a scientific theory. In answering these questions for ourselves, we must recognise that because the questions posed are philosophical, in answering them we all become philosophers. What have I done to deserve this? What happens when I die? Is this profound experience I am encountering nothing more than a matter of biological accident?
On these ultimate questions, evolution, along with all of science, is silent. It points directly neither to atheism nor to theism. Attempts to use science to discount supernatural explanations confuse two crucial explanatory categories: mechanism and meaning. An understanding of the mechanism of a disease does not constitute an explanation or denial of its supernatural significance.
One 'ultimate' answer to the question, 'why me?' - is that there is neither rhyme nor reason to why a person has a disease, beyond various scientific explanations, and that the disease is simply an accident to be accepted. A second answer is that somewhere in God's purposes this was allowed to happen - but that through the resurrection of his son Jesus, a better world without disease or suffering has begun to appear.
Each of us will take our pick of ultimate answers. But in doing so, whilst we are perhaps being rational, we are not being scientific.
Competing interests: No competing interests
Re: Evolutionary biology within medicine: a perspective of growing value
The authors suggest that evolutionary biology as they see it has a significant contribution to make to the education of doctors and to clinical practice.
Are they able to offer any specific examples where a clinician or researcher who fully accepted Darwinian theory could design or read a clinical trial, make a diagnosis or manage a patient better than an equivalent doctor who (like the late Terry Hamblin) accepted the Biblical creation account? Dr Hamblin managed to do world leading science in the field of chronic lymphocytic leukemia unhampered by his young earth creationist beliefs.
The issue of antibiotic resistance is a red herring: it is a mere matter of differential survival and change in gene frequency which no creationist has any problem with.
The undergraduate curriculum is busy enough. The pseudoscience of evolutionary medicine would be an unwelcome and entirely pointless addition to it.
Competing interests: Author of 'Three Men in a Hut and Other Essays' (Amazon Kindle) a book of Christian apologetics containing severe criticism of Darwinism.