Hunter Gatherer Notes

Heather would often get strep throat and then developed laryngitis as an adult. She gave this presentation via text to her students:

The medical profession’s response to my frequent laryngitis is that I really ought to take some pharmaceuticals, and then some more to counteract the side-effects of the first ones. Why those pharmaceuticals? Because in some cases they reduce some instances of the inflammation that can cause laryngitis. What are the shared symptoms between those cases and mine? The medical professionals don’t know. Furthermore, they don’t seem to care. Just take the drugs, they advise.

I don’t do as they ask.

The treatment of the vast majority of medical complaints with drugs, rather than with actual diagnosis, weakens the ability of the medical system even to do diagnosis. It also pollutes the data stream: who knows who is sick with what, and from what origin, if so many people are on pharmaceuticals with unknown side-effects.

When I show up on the doorstep of the medical establishment with laryngitis again, they ask me, “Are you on our drugs?” When I tell them no, they abdicate all responsibility? If I won’t just follow directions, how can they help me?

Following directions when the people giving them seem to have no idea what they’re doing, or why, is neither honorable nor smart. The medical system has been reluctant to take up evolutionary thinking, opting instead for pharmaceutical fixes that too often create new problems, and mask rather than cure the old ones. Anything with a simple biochemical switch would almost certainly have been “solved” by selection by now, if it were possible without triggering unacceptable trade-offs, and if the “problem” being solved were really a problem.

Against Reductionism

The modern approach to medicine (practically reductionist), reveals itself clearly in scientism. Friedrich Hayek observed that, too often, the methods and language of science are imitated by institutions and systems not engaged in science, such that the resulting efforts are generally not scientific at all. Not only do we see words like theory and analysis wrapped around distinctly untheoretical and unanalyzed (and often unanalyzable) ideas, but—worse—we see the rise of a kind of fake numeracy, in which anything that can be counted is, and once you have measurement, you tend to forgo all further analysis.

Once we have a proxy for something, we think we know it. This is particularly true if the proxy is quantifiable, no matter how flawed those numbers might be. Furthermore, once we have a category, we often stop looking outside of the categories for meaning, as our formal system of carrots and sticks exists solely within the categories.

This is the engineer’s approach to what humans are, and it vastly underappreciates how complex and variable we are. Everyone is susceptible to this error: We look for metrics, and once we find one that is both measurable and relevant to the system we are trying to affect, we mistake it for the relevant metric. Calories, psych drugs, etc. We also forget that our bodies are variable and that as long as a system works (blood vessels traveling different paths to the same place) it doesn’t matter. 

Considering the Risks of Reductionism as We Choose What to Put in Our Bodies

We often mistake an effect (e.g., of an action, a treatment, a molecule) for our understanding of the effect. What a thing does, and what we think (or know) that it does, are not the same thing. An example is believing vanillin is the same as vanilla or that THC or CBD is the same as marijuana. The parts are different to the whole.

From fluoridated drinking water to shelf-stable foods with unintended consequences, from the myriad issues with sun exposure, to whether GMOs are safe—we are constantly seduced by reductionist thinking, led astray by the fantasy of simplicity where the truth is complex. Reductionism, particularly with respect to our bodies and minds, is harming us. 

Early in the 20th century, fluoride was discovered to be correlated with fewer cavities. So fluoride was put in many municipal water supplies to decrease tooth decay. The fluoride in drinking water is a by-product of industrial processes, though, not a molecular form that appears in nature or has ever been part of our diet. Furthermore, we find neurotoxicity in children who are exposed to fluoridated drinking water; a correlation between hypothyroidism and fluoridated water; and, in salmon, a loss of the ability to navigate back to their home stream after swimming in fluoridated water. The quest for magic bullets, for simple answers that are universally applicable to all humans in all conditions, is misguided. If it were that easy, selection would almost certainly have found a way. Look for the hidden costs.

• Propionic acid (PPA) inhibits mold growth, and is a prominent additive to processed foods for that reason, but its presence in utero affects fetal brain cells and is linked to an increase in diagnoses of autism spectrum disorder of children thus affected. 
• Similarly, people who live near the poles, or who rarely go outside, can come to suffer from short stature, and weak and curved bones (rickets). Vitamin D was identified as the missing molecule for such people, and as we moderns seem to like our pills, we are provided vitamin D as a stand-alone product, or as an additive to milk. Vikings, unlike other northern Europeans, did not succumb to rickets. This turned out to be due to a diet rich in cod. 
• The historical evidence suggests that most of us could go out in the sun for a bit every day, or eat cod, or do some combination of both, but pills are easier, and they reek of scientism, which is easily mistaken for science and for “taking control of your health.”
• Reduce your exposure to the sun, the logic goes, and skin cancer rates fall. Guess what goes up when sun exposure goes down, though: blood pressure. And as blood pressure climbs, so do rates of heart disease and stroke. People who avoid the sun have higher overall mortality rates than do people who seek it. A research study on Swedish women reported this remarkable result: “Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking.”

Are some GMOs safe? Almost certainly. Are all GMOs safe? Almost certainly not. How will we know which are which, and can we rely on those who have created them to be vigilant on our behalf? Until we know the answer to those last questions, the Precautionary principle suggests steering clear.

Surgery, antibiotics, and vaccines—are firmly rooted in a reductionist tradition and have saved millions of lives. The problem we are highlighting is the overapplication of a reductionist approach. The germ theory of disease—in its simplest formulation, the recognition that pathogens cause much disease—led to the discovery and formulation of antibiotics, a huge health boon for humanity. Then we overgeneralized, and imagined that all microbes are bad for us.

Just as people are falling ill from lacking healthy microbiomes due to over-prescription of antibiotics, so too are our livestock. Furthermore, there are unintended side effects of many antibiotics, such as Heather’s personal experience of receiving a ruptured Achilles tendon. It is now understood that tendon and ligament injury is one side effect of Cipro (and all of the antibiotics in that class, the fluoroquinolones), which Heather took in quantity in the 1990s to ward off GI bugs while conducting research in the tropics.

From fluoridated drinking water to antifungals in shelf-stable food, from sunscreen to the overuse of antibiotics—over and over we make the same kinds of mistakes. Combine reductionism with a tendency to overgeneralize, in a hyper-novel world where quick but expensive and potentially dangerous fixes are common, and we have explained some of the major errors of modern health and medicine.

Bringing Evolution Back to Medicine

Ernst Mayr, one of the 20th century’s great evolutionary biologists, formalized the distinction between proximate and ultimate levels of explanation. In attempting to tease apart cause and effect in biology, he distinguishes two branches within biology, which many scientists themselves may not be aware of.

• Functional biology, Mayr argues, is concerned with how questions: How does an organ function, or a gene, or a wing? The answers to these are proximate levels of explanation.
• Evolutionary biology is concerned with why questions: Why does an organ persist, why is a gene in this organism but not that one, why is the swallow’s wing shaped the way that it is? The answers to these are ultimate levels of explanation.

How questions—that is, proximate levels of analysis, questions of mechanism—are more easily pointed to, observed, and quantified than the underlying question of why, mechanism has become most of what is studied in science and medicine. How questions also tend to be what are reported, in breathless sound bites, by the media. Too often, these proximate questions are imagined to be the level at which the scientific conversation needs to be had. This serves nobody—not those who are interested in the study of why, nor those who are interested in the study of how.

Combine a tendency to engage only proximate questions, with a bias toward reductionism, and you end up with medicine that has blinders on. Even the great victories of Western medicine—surgery, antibiotics, and vaccines—have been over-extrapolated, applied in many cases where they shouldn’t be. 

Those who break bones often get them put in a cast. This immobilizes it and causes the muscle to atrophy. For some situations a splint is all you need. The recovery process happens much quicker and the pain subsides quicker without the blunting of excessive pain medication. The pain, heat, and swelling of an injury is communication about your progress. As long as you don’t die of infection or by being eaten by carnivores (our ancestors’ typical problems), your bones should heal. If you need surgical intervention to fix the break, that’s advisable. Just don’t expect a reductionist approach to solve the whole issue. Modern medicine can be lifesaving. That doesn’t mean it can completely replace the body’s healing response.

Whom to Believe in the Era of Reductionism and Hyper-Novelty

Relying on cultural rules and reductionist thinking instead of consciousness is much more energy efficient. However, in this time of hyper-novelty we are required to be more flexible to avoid being led around. Many people’s faith in authority has been shook after recent events, due to their wavering demands.

We need a less reductionist approach, while still being able to take advantage of what incredible solutions we have engineered in the past. We need to use the hammer when a nail is the problem, rather than be forced to use a hammer for all situations.

The Corrective Lens

• Listen to your body, remembering that pain evolved to protect you. Pain is information about the environment, and how your body is responding to it. Some injuries require professional treatment, but some can be monitored without intervention. Pain is both unpleasant and adaptive; think twice before shutting down its message.
• Move your body every day. Take walks. Mix it up—don’t do the same thing all the time, and don’t move your body in the same way whenever you move it. And, at least sometimes, move intensely, and move outside, where the stakes are higher.
• Spend time in nature, the less constructed and controlled the better. This has many benefits, among them the dawning recognition that you cannot control everything in your life, and that experiencing discomfort—even the slight discomforts of a too-warm day, or rain for which you are unprepared—calibrates your appreciation for other aspects of your life.
• Be barefoot as often as possible. Calluses are nature’s shoes, and they do a far better job of transmitting tactile information to your brain than do shoes.
• Resist pharmaceutical solutions for medical problems if you can. While antidepressants, antianxiety meds, and more improve some people’s lives, they are often not the best solution. Usually, there are alternatives available; many mood disorders, such as depression, are beginning to be understood by Western medicine to be treatable with diet, ample sleep, and regular activity.
• Look out for mismatch diseases, such as adult-onset diabetes, atherosclerosis, and gout. These are diseases that reflect an inconsistency between (one of) your Environments of Evolutionary Adaptedness and your current life. They also tend to reflect affluence, compared to your evolutionary past. For at least some of these, bringing your modern behavior closer to that seen in an older EEA could help mitigate the damage.
• Consider this informal test to assess certain types of ailments, and whether a modern “fix” is called for: In environments similar to the one I am living in, did people suffer from this ailment prior to modern medicine? If yes, a novel solution is warranted. If no, look to history for the solution. Take rickets as an example, for someone of European heritage living in the Pacific Northwest. Did people suffer from rickets in such northern latitudes in the past? One type of answer is that evidence suggests that at least some populations of northern Europeans did not suffer from this condition. Seek answers there (remember the Vikings and their cod). A second type of answer is that native people in the Pacific Northwest did not suffer from rickets. What worked for them might not work for someone who is not of native heritage, but it well might. Look to geographically local history for solutions.