Darwin for Doctors
The confusion of these two different constructions of fitness –the Spencerian one of brute strength and the true Darwinian one of 'fitting the changing environment' – has had insidious effects in medicine as well. An obvious example is in people's attitudes to micro-organisms and infectious diseases. Here, we are guided by the naïve assumption that we are engaged in a winnable battle against vicious enemies, instead of needing to co-exist with a myriad of constantly evolving creatures who share our bodies in what is a generally harmonious fashion. Our conceptions of cancer, dominated by metaphors of war and victory, may be another example of such narrow and distorted thinking. In reality, a false or non-Darwinian notion of fitness pervades our thinking so much in medicine that we never even notice this. It even affects our understanding of 'fitness to practise medicine.' This is usually taken to signify a set of fixed competencies, when it might be better and more accurate to conceptualise it in terms of the ways that doctors need to adapt continually to the changing state of human knowledge and the social and political circumstances in which they work.
A subtler and more informed view of fitness could benefit medicine in many other ways as well. In a sense, every encounter with patients is an attempt to find a good 'fit' between what they are seeking and what we have to offer. This is true of each consultation. It is just as true of every small exchange of talk that takes place within every consultation. Indeed, it is possible to understand spoken language itself – not to mention body language, touch and other forms of communication – as unceasing attempts to respond to another's needs, and to adjust one's own reactions accordingly. Evolution, in other words, is not just something that happens from one generation to the next. It occurs in the momentary ways that we enhance our own survival, and the survival of those around us, by the tiniest calibration of our responses to others, and to the physical environment. It is also reflected in the physiological, cellular and molecular changes that accompany any such response.
'Being Fit' Versus Fitness
The confusion of these two different constructions of fitness –the Spencerian one of brute strength and the true Darwinian one of 'fitting the changing environment' – has had insidious effects in medicine as well. An obvious example is in people's attitudes to micro-organisms and infectious diseases. Here, we are guided by the naïve assumption that we are engaged in a winnable battle against vicious enemies, instead of needing to co-exist with a myriad of constantly evolving creatures who share our bodies in what is a generally harmonious fashion. Our conceptions of cancer, dominated by metaphors of war and victory, may be another example of such narrow and distorted thinking. In reality, a false or non-Darwinian notion of fitness pervades our thinking so much in medicine that we never even notice this. It even affects our understanding of 'fitness to practise medicine.' This is usually taken to signify a set of fixed competencies, when it might be better and more accurate to conceptualise it in terms of the ways that doctors need to adapt continually to the changing state of human knowledge and the social and political circumstances in which they work.
A subtler and more informed view of fitness could benefit medicine in many other ways as well. In a sense, every encounter with patients is an attempt to find a good 'fit' between what they are seeking and what we have to offer. This is true of each consultation. It is just as true of every small exchange of talk that takes place within every consultation. Indeed, it is possible to understand spoken language itself – not to mention body language, touch and other forms of communication – as unceasing attempts to respond to another's needs, and to adjust one's own reactions accordingly. Evolution, in other words, is not just something that happens from one generation to the next. It occurs in the momentary ways that we enhance our own survival, and the survival of those around us, by the tiniest calibration of our responses to others, and to the physical environment. It is also reflected in the physiological, cellular and molecular changes that accompany any such response.