Darwinian Medicine

[TTSD]

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Does anyone here follow Darwinian medicine to some degree? Such as believing that the fever has a purpose and you don't treat it with medicine unless necessary?

As for that matter, the Red Queen Hypothesis. Do you guys think we splash and squander antibiotics around too much AND too little? (meaning we use them a lot but don't use them properly)

 

[SaltySqueegee]

Originally posted by TTSD
Does anyone here follow Darwinian medicine to some degree? Such as believing that the fever has a purpose and you don't treat it with medicine unless necessary?

As for that matter, the Red Queen Hypothesis. Do you guys think we splash and squander antibiotics around too much AND too little? (meaning we use them a lot but don't use them properly)

I saw the title of this post and thought it was going to be about survival of the fittest medical student or premed... 😀

 

[BioMedResearch]

Hmm sounds like a Cornellian who took BioNB221.

 

[mattorama]

I was hoping to read something about not treating people medically. If someone gets sick and can't get over it naturally, they have bad genes which should be taken out of the gene pool. Let nature do its thing. Survival baby!

 

[acab]

My apartment mate never takes any medicine. He believes his body is better off fighting the infection or flu, stregthening its immune system. I've known him for over 12 years, and he rarely gets sick.

I try to follow his philosophy to the extent that I can withstand the pain. Beyond a threshold, I'll take any medicine necessary. In other words, when I get a headache, I'll wait about a half hour and if it doesn't go away, I'll just take an extra-strength tylenol!

 

[Heal&Teach]

For some of the folks out there who haven't followed DM (like me), a little background:
http://www.people.virginia.edu/~rjh9u/darwmed.html

 

[felipe5]

uhhhhhhhh, isn't that like an oxymoron? If the idea is to let nature take its course and let the disease/maladie/whatever run its course without any intervention, than what the hell is the 'medicine' aspect of it???

 

[DD214_DOC]

Do you even know how antibiotics really work?

 

[TRUE]

Originally posted by JKDMed
Do you even know how antibiotics really work?

What's this quesiton referring to? The original post has some interesting aspects to discuss on antibiotics. They're used a whole lot, but when people start feeling better, they stop taking them and that creates resistent bacteria. It's a very large problem in medicine...

 

[nrosigh]

Of course fevers have a purpose or else your immune system wouldn't make them! Bacteria and virally infected cells have a much harder time reproducing when it's hot.

 

[tugbug]

I think Darwinian medicine is very interesting and an area with more promise than is widely understood. Im in the grad program at U of Louisville and the dept has made a big push in this area bringing in Paul Ewald and setting up a center for DM research.

I think some of the posters above are mistakenly thinking that DM=no treatment. It doesnt as far as I know. It just provides another perspective to consider. For example:

The fever/cough associated with a cold you guys mentioned. DM points out that it is the body's way of fighting off the infection... so, we should be careful about sabotaging our defenses.

Morning sickness. Classic Medical defin. would say its a byproduct of the crazy hormones of pregnancy... Evol med wonders if its not an adaptation to help mothers avoid certain chemicals during a period of the pregnancy where the fetus is susceptable... Once this perspective was considered research showed that mothers with MS had lower rates of miscarriage. So DM says if you treat MS, take care not to expose moms to the chemicals the sickness would have helped them avoid.

There is also tons of DM research into infectious causes for diseases like schizophrenia, heart disease, cancer, etc.

Its also very helpful for epidemiology. For example, when projecting the virulence of a strain of a disease that will likely spread through a population and coming up with a strategy for preventing spread.

Lots of neat DM stuff going on, IMO.

 

[tugbug]

Im not sure the Red Queen hypothesis specifically relates to the overuse of antibiotics. It is the idea that all things must continue to evolve just to maintain their place... because all of their competitors are constantly evolving. So, in one sense, organisms are evolving constantly... but in another, they are no better adapted to their environment because it is evolving at a constant rate. In the Evol. class I just finished it dealt specifically with extinction rates... namely that the length of time a species had been in existence said nothing about how likely it was to go extinct.

But yeah, I think the Hypothesis and the effect of overuse of antibiotics are both interesting and important to understand.

 

[TTSD]

Originally posted by tugbug
Im not sure the Red Queen hypothesis specifically relates to the overuse of antibiotics. It is the idea that all things must continue to evolve just to maintain their place... because all of their competitors are constantly evolving. So, in one sense, organisms are evolving constantly... but in another, they are no better adapted to their environment because it is evolving at a constant rate. In the Evol. class I just finished it dealt specifically with extinction rates... namely that the length of time a species had been in existence said nothing about how likely it was to go extinct.

But yeah, I think the Hypothesis and the effect of overuse of antibiotics are both interesting and important to understand.

Yes, I was brining up the point of the Red Queen, that sexy lady, in regards to the continual delicate balance that we walk in our evolutionary arms race.. with all the implications of evolution and the attempts at wiping out disase.

The beauty of the Red Queen is that it can be applied to almost anything in it's form, "It takes all your running to remain in one place." And thus is the case with antibiotics. We he-***** slapped bacteria a few decades ago, but that balance is equilibrating itself again and God knows when we'll be able to pull off another sucker punch or whether disease will sucker punch us first.

It's similar to an arms race and a nuclear deterrance. We make bigger guns, they make even bigger guns and so on and so on.

 

[skypilot]

Originally posted by mattorama
I was hoping to read something about not treating people medically. If someone gets sick and can't get over it naturally, they have bad genes which should be taken out of the gene pool.

If I have a cold or the flu I probably would like a doctor like you. But if I ever get spinal meningitis I hope I don't get you. It used to be a death sentence before antibiotics.

How about giving me a vasectomy instead of refusing to treat me?!

🙂

 

[lessismoe]

I think DM is particularly interesting on the subject of pain. I mean, think of it, what is pain? Something our minds made up to get us to stop biting our tongues (or to avoid that guy that likes to poke us with the pointy stick). How the pain-sensory system evolved, and how it goes off track sometimes with chronic pain diseases is super-interesting.

 

[Chrisobean]

i think the most interesting part of DM is SEX.... ;-)

guys do their thing much faster than girls to ensure they get their little sperm up there to reproduce and get their genes passed on... and girls take alot longer to keep the guy around so he's not out screwing other girls so his resources are all for her.
that definitely was my favorite chapter of the book "why we get sick"

the antibiotic thing, we definitely do use them too much and incorrectly. its the patients fault, b/c every time they get the sniffles they go to the doc and expect medicine even tho its just viral. if the doctor refuses to prescribe, they will go to someone else. people seem to think cures are always medicine. have some faith in your own body people!!

 

[TTSD]

Originally posted by Chrisobean
i think the most interesting part of DM is SEX.... ;-)

guys do their thing much faster than girls to ensure they get their little sperm up there to reproduce and get their genes passed on... and girls take alot longer to keep the guy around so he's not out screwing other girls so his resources are all for her.

Is that DM or simply evolutionary behavior? Screwing around is a basis of cost in reproduction. Guys are evolved to put their 'mighty fire-hoses' in as many 'love-gloves' as possible because:

a) It increases chances of genetic survivability
b) The actual cost of reproduction is only limited by who we can get to bed, and how long it takes to "charge up" with the ensuing resources needed.

Girls on the other hand, while they may have the ability to have multiple orgasms and keep on going and screw an army, girls are limited by the relatively long time it takes to reproduce and the costs inherent in that (also a good reason why girls shouldn't be dropping babies when they reach a certain age). Also, is the need to form attachments to protect that reproductive cost (why girls are so clingy), and how they choose their mates (why girls keep score cards on the type of credit card you use).

So unless you're talking about how orgasming can increase white blood cell count and how it relates to sex, what you're talking about is pure evolutionary-basis as opposed to DM.

 

[TTSD]

Originally posted by lessismoe
I think DM is particularly interesting on the subject of pain. I mean, think of it, what is pain? Something our minds made up to get us to stop biting our tongues (or to avoid that guy that likes to poke us with the pointy stick). How the pain-sensory system evolved, and how it goes off track sometimes with chronic pain diseases is super-interesting.

Yes indeed, if it wasn't for our sense of mechanical stress, we would be in a WORLD of trouble. Even the basic "shifting-around" on bed, or standing alleviates trouble and friction that can prove fatal.

 

[Chrisobean]

Originally posted by TTSD
So unless you're talking about how orgasming can increase white blood cell count and how it relates to sex, what you're talking about is pure evolutionary-basis as opposed to DM.

youre right... but i learned about it in my darwinian class, so there you go 🙂

but i remember learning some stuff relating to sex and mother/baby interactions as pertaining to health and medicine... although i cant recall, brain fart!

 

[Zweihander]

I'm not sure I understand the purpose of this hypothesis. Of course the body has natural defence mechanisms. We don't understand these entirely, so sometimes the medicine we take interferes with them. But clearly modern medicine has had an overall positive effect. Many of the diseases that ran rampant among us when we didn't have medical technology and were "letting nature take its course" are now gone or diminished.

The proof is in the pudding.

 

[lessismoe]

no one is saying that we shouldn't use medicine when it is needed. The issue DM raises with medicines is whether or not we are over-using them sometimes. For instance, some studies suggest that taking fever-reducers during the course of a standard flu/infection/whatever in which the fever itself isn't actually posing a threat to the patient can actually increase the duration of the illness. The DM hypothesis is that the fever is a tool your body uses to inhibit viral/bacterial reproduction, and that the fever reducers throw that off track.

I don't think anyone here (when we're all docs) would hesitate to prescribe antibiotics when it's a warranted situation. DM in these cases is just about trying to hone in on which cases are actually hindered by some medications.

 

[PublicHealth]

Anyone interested in Darwinian Medicine should read "Why We Get Sick" by Randy Nesse and George Williams (http://www.amazon.com/exec/obidos/t...f=sr_1_1/103-0797763-0606235?v=glance&s=books)

Some more links:

http://darwinianmedicine.org/

http://www-personal.umich.edu/~nesse/publications.htm

Someone mentioned that "modern medicine has an overall positive effect." Where's your data? Much of modern medicine provides nothing more than symptom relief. Pain meds do nothing more than block the brain from receiving pain signals. They do not remove the source of the pain. Perhaps pain is adaptive? Sure, people are living longer today, but a significant proportion have chronic diseases. When you look at various health indicators, public health measures, as opposed to medicine, are responsible for improvements in health outcomes over the past 100 years.

The following article provides a comprehensive and detailed summary regarding evolutionary health promotion. PM me if you want the full article.


Evolutionary health promotion.

Eaton SB, Strassman BI, Nesse RM, Neel JV, Ewald PW, Williams GC, Weder AB, Eaton SB 3rd, Lindeberg S, Konner MJ, Mysterud I, Cordain L.

Department of Anthropology, Emory University, 2887 Howell Mill Road NW, Atlanta, GA 30327, USA. [email protected]

Health promotion's promise is enormous, but its potential is, as yet, unmatched by accomplishment. Life expectancy increases track more closely with economic prosperity and sanitary engineering than with strictly medical advances. Notable achievements in the past century--the decreased incidences of epidemic infections, dental caries, and stomach cancer--are owed to virologists, dentists, and (probably) refrigeration more than to physicians. Prevention speaks against tobacco abuse with a single voice, but in many other areas contradictory research findings have generated skepticism and even indifference among the general public for whom recommendations are targeted. Health promotion's shortcomings may reflect lack of an overall conceptual framework, a deficiency that might be corrected by adopting evolutionary premises: (1) The human genome was selected in past environments far different from those of the present. (2) Cultural evolution now proceeds too rapidly for genetic accommodation--resulting in dissociation between our genes and our lives. (3) This mismatch between biology and lifestyle fosters development of degenerative diseases. These principles could inform a research agenda and, ultimately, public policy: (1) Better characterize differences between ancient and modern life patterns. (2) Identify which of these affect the development of disease. (3) Integrate epidemiological, mechanistic, and genetic data with evolutionary principles to create an overarching formulation upon which to base persuasive, consistent, and effective recommendations. Copyright 2001 American Health Foundation and Elsevier Science (USA).

 

[Chrisobean]

that book was the one i read for my class at Stony Brook... Williams was from stony brook... we also read the coming plague which was about outbreaks from the past to present and the cdc disease cowboys...
both very cool books

 

[PublicHealth]

George Williams is really nice. I met him at a Human Behavior and Evolution Society (HBES) meeting a couple years ago. Check out www.hbes.com for more info on HBES.

"Plague Time" by Paul Ewald is also a good read.

 

[HollyJ]

Originally posted by nrosigh
Of course fevers have a purpose or else your immune system wouldn't make them! Bacteria and virally infected cells have a much harder time reproducing when it's hot.

Sorry Charlie. Humans don't get fevers high enough to kill or inhibit many of the bacteria that infects us. Heck, I use a 40 C incubator to encourage staph to reproduce, which is like a 104 degree fever. There is a hypothesis currently being floated that fevers may interfere with viral reproduction, but it's largely untested.

I think DM is really interesting, but I think that there is a fundamental problem with the notion that all of our immune responses are good. Try telling that to someone with lupus.

 

[TTSD]

Originally posted by PublicHealth
... <lots of stuff> ...

Dang man (or are you a woman), that was beautiful. A lot of the research I do, pertains indirectly to the idea that modern culture and conveniences is really fudging us up. While humans as a whole are extremely adaptive to the environment they move to, when you take them out of a natural environment and put them into the environment we created, our bodies are having a hard time coping with it.

For instance, melatonin, serotonin, and the almight lightbulb. How long do you stay up in the night?

Our diet.

Stress.

 

[Zweihander]

Originally posted by PublicHealth
Someone mentioned that "modern medicine has an overall positive effect." Where's your data?

I said it, and as I said in my post, the truth behind the statement is self-evident. We're living longer now, we no longer suffer from small pox, the first world has practically eradicated polio, the list goes on.

See again my post: I don't disagree that we sometimes interfere with our bodies' defence processes. I detest antibacterial soap, and I will happily share food and drink from the same straw and so on with other people, 'cause I don't give a crap about "passing germs." I think we're supposed to get sick so we can stay healthy in the long run. But I think I had misinterpreted the degree to which DM is supposed to be taken, and lessismoe explained that, so I'm good now.

😉

 

[PublicHealth]

Originally posted by Zweihander
I said it, and as I said in my post, the truth behind the statement is self-evident. We're living longer now, we no longer suffer from small pox, the first world has practically eradicated polio, the list goes on.

See again my post: I don't disagree that we sometimes interfere with our bodies' defence processes. I detest antibacterial soap, and I will happily share food and drink from the same straw and so on with other people, 'cause I don't give a crap about "passing germs." I think we're supposed to get sick so we can stay healthy in the long run. But I think I had misinterpreted the degree to which DM is supposed to be taken, and lessismoe explained that, so I'm good now.

😉

Huh?

 

[evines]

I never take medicine, although I would if I ever got deathly ill. Fevers, snotty nose don't bother me much, and I rarely get sick. Maybe it's coincidence?
Also, I think we feed our bodies to much crap. We weren't put together to withstand all the processed preserved foods that we eat. Even strawberries from the grocery store are manipulated beyond anything natural. We "engineered" them to be sweeter, and lost much of the nutrition along the way. Same goes with many other agricultural products. Blueberries, oranges, carrots, corn, you name it. Seems like technology is advancing faster than our bodies can adapt to the changes in our diet/environment. This is all hypothesis, of course, but I wonder how healthy we could be if we went back to a natural diet, but still enjoyed modern medical care?
Or better yet, how healthy could we be if we spent the same time, money and energy creating healthy foods that we do now creating sweet, processed foods?

 

[Zweihander]

Originally posted by evines
This is all hypothesis, of course, but I wonder how healthy we could be if we went back to a natural diet, but still enjoyed modern medical care?
Or better yet, how healthy could we be if we spent the same time, money and energy creating healthy foods that we do now creating sweet, processed foods?

The advent of agriculture was actually a disaster in terms of human health. Hunter-gatherers were healthier by far than we have been for much of our history -- only in the twentieth century first world and with the use of modern medicine have we begun to make up for what we lost when we left behind the lifestyle that we evolved into. It isn't just your hypothesis, and the skeletal records support this idea very strongly.🙂

 

[Zweihander]

Originally posted by PublicHealth
Huh?

I respond to your confusion with further confusion. Why are you confused?😕


😛

 

[lessismoe]

Zweihander, did you get that info on hunter-gatherers vs. first agricultural societies from Jared Diamond's "Guns, Germs and Steel"? It's funny, I'm literally reading that chapter as I read your post.

 

[TTSD]

Originally posted by Zweihander
I respond to your confusion with further confusion. Why are you confused?😕


😛

Look at it this way Zweihander. Think of it as a fight between two equally matched opponents: The Human Race versus Disease as a whole.

Now, just for reference take in the Red Queen Hypothesis: "It takes all your running to stay in one place," or that of an arms race.

What you have is essentially a cold war with casualties. While the old disease may have been eradicated or subdued, disease comes out with doozies that we cannot fight yet. And once we begin to fight those, they'll evolve as well.. nature's funny like that.

And even so, while we can learn to cope with certain disease, they're still around and prevalent as ever. Such as the common cold. So yes, while I agree as a whole humanity is resting more comfortably, it's also a temporary position at best. The fluke that was antibiotics is slowly waning out.. so when does the next big miracle happen?

 

[Zweihander]

Originally posted by lessismoe
Zweihander, did you get that info on hunter-gatherers vs. first agricultural societies from Jared Diamond's "Guns, Germs and Steel"? It's funny, I'm literally reading that chapter as I read your post.

Read Diamond's The Third Chimpanzee as well. It's a fascinating book.

 

[Zweihander]

Originally posted by TTSD
The fluke that was antibiotics is slowly waning out.. so when does the next big miracle happen?

I agree that they are not as dependable as they once were, but I'm not sure I believe that they are on the road to becoming totally useless. I do find the whole idea of the biological arms race to be very interesting, though I myself haven't studied the issues much. Hopefully I'll learn a thing or two about microbial disease in med school...
😀

 

[TTSD]

Originally posted by Zweihander
I agree that they are not as dependable as they once were, but I'm not sure I believe that they are on the road to becoming totally useless. I do find the whole idea of the biological arms race to be very interesting, though I myself haven't studied the issues much. Hopefully I'll learn a thing or two about microbial disease in med school...
😀

No, of course not. But we can be certain that with the amount of application and less than complete irradication, the ability for disease to mutate quickly will bring us back to a somewhat equalized state as we were before.

Not to mean that people will die off more because of infection during surgical procedures. But wouldn't it be scary if there was a form of meningitis we couldn't cope with? Those infectious bugs at the hospital getting in to open wounds during surgeries that you can't beat? Or during childbirth? Those are frightening propositions.

Now, this is the way SDN should be.. good cerebral debates as opposed to the constant, "omg! Will I get in?!" whining.

 

[tugbug]

Interesting thread. Just wanted to say again that IMO the big benefit of DM (and of evolutionary thinking in general) is that it gives an additional perspective... It's not in competition with modern medicine.

Using evolutionary thinking to take on all kinds of diseases in NEW ways is the benefit.