3 years ago I wrote an article critical of “evolutionary medicine” as it was presented in a new book. Recently a correspondent asked me if I thought another book, Why We Get Sick: The New Science of Darwinian Medicine, by Randolph M. Nesse, MD and George C. Williams, PhD, was a more reasonable approach to the subject. It was published in 1994 and got good reviews from respected scientists like Richard Dawkins (“Buy two copies and give one to your doctor.”) and E.O. Wilson (“bringing the evolutionary vision systematically into one of the last unconquered provinces…”). I was able to obtain a copy through interlibrary loan.
The book was interesting and gave me some things to think about, but it didn’t convince me that “Darwinian medicine” is a new science, that its existence as a separate discipline is justified, or that its unique approach offers any real practical benefits for improving medical care.
Why do we get sick? A simplistic view of evolution holds that it systematically eliminates any factors that decrease fitness for survival. So why does disease persist? Why didn’t we evolve to be “fit” enough to never get sick? Because evolution is not a straightforward process.
I don’t know how I’ve missed this, given that it’s been in existence now for a month and a half, but I have. Regular readers (and even fairly recent readers, given that I write about this topic relatively frequently) know that I’m not a big fan of the National Center for Complementary and Alternative Medicine (NCCAM). (Come to think of it, neither is anyone else writing for this blog.) Just search this blog for “NCCAM” if you don’t believe me. I’ve explained the reasons many times, but the CliffsNotes version is that NCCAM is an enormous waste of taxpayer money, dedicated as it is to the study of modalities that are at best highly implausible and at worst break well-established laws of physics (i.e., “energy healing”). I do concede that, since the latest NCCAM director (Dr. Josephine Briggs) took over, there has been a noticeable attempt to bring more scientific rigor to NCCAM, and to some extent Dr. Briggs has succeeded. At the very least she is a legitimate scientist with an impressive pre-NCCAM track record, and I do fear who will succeed her when she moves on or retires given that there is enormous pressure from the CAM community to appoint one of their own as director.
Unfortunately, as rigorous a scientist as Dr. Briggs was in her former life, since coming to NCCAM she has gradually been assimilated into the culture of the place. Indeed, although it is good that NCCAM has backed away from studying woo like homeopathy and distance healing, the co-optation of science-based modalities such as exercise, diet, and natural products pharmacology has continued apace. Worse, the recently released five year strategic plan for NCCAM admitted that the science funded by NCCAM in the past was crap and, in essence, promised to do some real science for a change. That’s why on occasion I’ve jokingly said that we should take off and nuke NCCAM from orbit. It’s the only way to be sure. On the other hand, no doubt someone would think I seriously mean that we should nuke NCCAM. Of course, I’d never advocate that! NCCAM is located right smack dab in the middle of the NIH campus. The collateral damage would be unacceptable.
I keed. I keed. I’m not kidding, though, when I echo the questioning of why NCCAM still exists.