Medical Philosophy

We have all inherited a genetic immune system from our evolutionary past that is our first line of defence from infection and disease. With the growth of cultural ideas it is only to be expected that cultural medical ideas would arise to enhance and supplement this genetic system. The first ideas, passed down through generations orally, could be called traditional or folk medicine. Our first attempts were more often magic than logic.

African witchdoctors knew something of traditional medicine but a good part of their practice was pretence and exploitation. The use of fetishes and divinations as protection from disease could have had no real value. But not all was ineffective and there was a “bush craft” intertwined with their practice that recognised many plants for their medicinal properties. The witchdoctor could be capable of cures in some cases.

Other folk cures have been successful and incorporated into modern medicine and include the chewing of willow bark to relieve headaches of which the effective ingredient (aspirin) was later produced artificially in large quantities. The bark of the South American cinchona tree was used by the local Indians against malaria. Scientists later reproduced the active alkaloid (quinine) artificially and its use allowed the extensive colonisation of Africa and South America. Today, many traditional medicines have been investigated and the active components extracted and reproduced artificially.

Early European medicine also had its problems. Without microscopes bacteria were unknown and operations were performed with little attempt at cleanliness. Blood circulation was unknown so cupping and the use of leeches to remove “local” diseased blood killed many people. Mental disease was often associated with devils entering the mind, with exorcisms given as a cure. Early medicine was mixed with both mythical and factual components.

The Chinese, in a more systematic approach, developed many weird and wonderful concoctions for various illnesses. A lot of these cures took advantage of the wide variety of chemicals in plants. Cures were found largely by trial and error. Here people would notice that a herb had a particular effect. Later two herbs would be mixed to produce a greater effect and so on. Mixtures of plants and their methods of application would improve over time. Just as a bird can fly without understanding the mathematics of airflow, herbal medicines often worked without the practitioner knowing the chemistry of their method. Experiencing the results was sufficient proof of their effectiveness.

One of the most successful cultural medical ideas was that of vaccination which started with the use of cowpox as a vaccination against smallpox. Vaccinations are now the mainstay for fighting a wide range of diseases. Another successful idea was the use of anti-bacterial compounds produced by the penicillium fungus. Many new anti-bacterial compounds have now been produced. Other ideas, such as chemotherapy, evolved from the mustard gas of the First World War. Some soldiers exposed to the gas had their cancers arrested. All medical ideas are cultural ideas that address the genetic desire for good health.

But not all medicines are beneficial. In our modern society there is a lot of false advertising and trickery. People hope the medicine works. Examples could be the countless creams to reverse the aging of the skin or magnets that cure arthritis. Faith healing with prayer is also popular. In other cases doctors prescribe medicines that are pushed by manufacturing companies and have little understanding of a medicine’s real effectiveness. Side effects are often not disclosed or downplayed. Other medicines are simply fake and produced in countries that don’t have adequate legal structures. Some people’s lives have been ruined by the medical advice and medicines they have received. People believe this advice because, for many, genetic hope is stronger than cultural logic.

Despite these flaws, new medical ideas, along with improved nutrition and sanitation, have led to the average lifespan almost doubling in many parts of the world. The important point here from the brief description of medicine above is that cultural ideas can contain both factual and mythical parts. Sometimes the factual and mythical components can vary between people because they are genetically different (as per bell curve mentioned earlier). For example, one person may be saved from an infection by penicillin while another may die from an allergic reaction to the same penicillin. What is fact for one can be myth for another. A person is best off in terms of happiness utilising factual ideas and avoiding the mythical. People should look at their genetic inheritance to discover whether the cultural ideas to which they are exposed adequately address these genetic ideas. The complexity of many modern medicines can make this analysis difficult.

One example could be the use of contraceptives. In earlier times, sexual intercourse led to pregnancy and of the many children born, a proportion died. Offspring survived differentially as per the evolution process. Today, new cultural ideas include a range of contraceptives that can prevent fertilisation. Here cultural ideas have allowed more frequent mating, often with different partners, resulting in increased pleasure and so possibly increased happiness. Children are avoided or reduced in number. Through the use of contraceptives, a person gains the genetic reward (sexual pleasure) without the genetic consequence (children). The person is still opting for maximum happiness by addressing genetic ideas but in this case sexual happiness and reproduction no longer go hand in hand. From an evolutionary point of view this is quite an unusual situation. The original purpose of the brain was to allow cultural ideas to be accumulated so that the chance of reproduction was increased not reduced. Here people are actively deciding to limit the number of their children even though they may well have the resources to raise considerably more children. They may even decide to have none at all yet still enjoy sexual union. In this case, cultural ideas have turned against the genes. The genes have been deceived by cultural ideas. This is a variation of the idea of suicide mentioned earlier in the main text. If a person decides to have no children, then it is a type of reproductive suicide, if only for the next generation.

If people with low genetic nurturing desire are less likely to contribute to the next generation, then there must be some affect on the human genome. Today, many couples in western societies are opting for fewer children. They have discovered new cultural ways of addressing old genetic ideas that produce greater happiness than the traditional large family. They are putting travel, lifestyle and career first in a more hedonistic approach to life. There appears to be some volume of ideas necessary before this way of living can be taken. That is, limiting children is a sophisticated idea compared with traditional reproduction.

Another example could be pelvis size. Today, if a mother’s birth is becoming difficult, a doctor may decide to give the child a caesarean birth. There were certainly many deaths in earlier times caused by complications during birth and a caesarean birth today may allow some mothers to survive where they would have otherwise died. If the mother has new genes for a small pelvis that preclude her from a natural birth then the survival of these women and their children will allow these new genetic ideas to spread in the population. Current research shows evidence for a decreasing pelvis size in western women. It might be that in the future (with the future being hundreds of generations), caesarean births will become the norm rather than the exception. Some increase in this operation might be because there is a reluctance to accept the pain of childbirth but another part might be small pelvis genes. The point here is that a cultural medical practice can influence the direction of genetic evolution.

Children born today might have genetic errors that are compensated for by cultural medical intervention. Examples could be debilitating medical conditions such as diabetes and asthma. Where diseases have a genetic component, and where these genes are continued through successful reproduction after medical intervention, any genetic errors will increase in frequency. Over time, such genetic errors could be commonplace rather than rare. The result will be an acceleration of medical treatments for offspring suffering the same or similar conditions to the parents. The net effect over time will be a transfer of the major responsibility for health from the genetic to the cultural. If we become more and more reliant on cultural medical ideas then the medical services industry could outgrow every other industry and eventually consume most of human endeavour. This seems to be happening already.

There has been a minor recognition of this danger with some attempt to stop the proliferation of genetic errors. For example, some genes that cause breast cancer, Down syndrome, haemophilia, and so on, are now known and an early test of the foetus in the womb has led to some pregnancies being terminated. That is, differential survival is being re-introduced in a small but rising number of cases. It seems then that human cultural ideas can influence the direction of human genetic evolution.