Mouse genetics and transgenics: a practical approach

A medical student approached me after a lecture I had given saying that he had only heard the word evolution mentioned twice in his four years of medical studies; and that both occasions were in the previous hour. My lecture had been a general one on dermatology and I had used arguments about our biological history to hopefully illuminate two topics; why we scratch and why skin colour varies in peoples living in dierent parts of the world. The pleasure of standing on the shoulders of giants is that it often allows one to make up interesting stories for undergraduates rather than fall foul of the ubiquitous `name this rash' or `this is psoriasis, this is eczema', etc. How else can we think about how maladaptive scratching seems in the context of atopic eczema? How else can we wonder why pale skin is allowed to be so susceptible to the eects of that most ubiquitous carcinogen, ultraviolet radiation? Even given my own special interests, it seems that such approaches oer so much in thinking about the `hows' and `whys' of disease. I therefore looked forward to reading this book. Instead, with one or two chapters that stand out as exceptions, such as the one by Nesse, I ended up frustrated and disappointed. The problems start, as does the book, with the Foreword. Here we discover that one of the themes is to attack orthodox medicine and biomedicine. Much of the book seems to want to berate `orthodox' medicine for the failure to take on Darwin's great re-engineering of biology in the mid-nineteenth century. I am not at all surprised. Medicine has never been big on theory and lives at the applied end of the scienti®c spectrum; in general, theory counts for little if medicine can ®nd a quick and dirty solution for one of its pressing problems. Medicine is, and remains, technology-driven, obsessed with short-term practical consequences. The intellectual landscape is often determined by, rather than being just a consequence of, practical considerations. Tuberculosis provides an obvious example. Tuberculosis can be considered a genetic disease or an infectious disease Ð it all depends on what you want to achieve and what provides the most insight at a particular time. In the nineteenth century insight and therapy followed the idea of an external infectious cause for TB resulting in the development of chemotherapy in the middle of the twentieth century. Conversely, today, interest in genetic susceptibility has recapitulated earlier data on familial in ̄uence on TB incidence and may yet provide practical insights. Rather than chapters on the immunogenetics of malaria or TB, or the evolution of skin colour, the book hosts several poorly disguised and familiar diatribes against the technology that is modern medicine as well as repeated ex cathedra statements that prevention is ideologically preferable to therapy, and worst of all, that doctors need more protocols. Indeed, I wondered whether many of the chapters had been intended for a belated festschrift for Ivan Illich. Many of the contributors seem obsessed with the status of their own disciplines, quick, it seems, to self-reference themselves and other evolutionary medicine theorists, all apparently in an attempt to avoid discussion of empirical data. 1 Much falls within that tired old `social science model' writ big, and, as usual, failing. It may continue to fool the academic judges, but I hope it still counts for little outside the ivory tower. Perhaps with so many academic dollars in medicine one must feel some sympathy for those who, previously excluded, now feel it appropriate to apply for the ever larger `welfare for academics schemes', usually know as research grants or RAE fodder. For me this little inbred strain of theorists urgently needs some hybrid vigour, before it faces the full rigours of whatever the environment can throw at it. On the other hand, perhaps the latter happening sooner rather than later would be kinder. What saddensmost, however, is that there really is somuch to say on the subject of evolution andmedicine, and good reason to remain excited. Yet, this will only happen if we forget the manifesto statements about membership of the evolutionary medicine club and get to gripswith the data and themechanics of the various physiological systems on oer Ð con®dence limits included. So rather than rely on this volume for inspiration, I would favour looking at Jared Diamond's wonderful, broad brushstrokes to remindoneof the historical context of all human disease and then head straight to the lab or clinic.