Evolution, Dysfunction, and Disease: A Reappraisal

Abstract Some ‘naturalist’ accounts of disease employ a biostatistical account of dysfunction, whilst others use a ‘selected effect’ account. Several recent authors have argued that the biostatistical account offers the best hope for a naturalist account of disease. We show that the selected effect account survives the criticisms levelled by these authors relatively unscathed, and has significant advantages over the BST. Moreover, unlike the BST, it has a strong theoretical rationale and can provide substantive reasons to decide difficult cases. This is illustrated by showing how life-history theory clarifies the status of so-called diseases of old age. The selected effect account of function deserves a more prominent place in the philosophy of medicine than it currently occupies. 1 Introduction2 Biostatistical and Selected Effect Accounts of Function3 Objections to the Selected Effect Account 3.1 Boorse 3.2 Kingma 3.3 Hausman 3.4 Murphy and Woolfolk4 Problems for the Biostatistical Account 4.1 Schwartz5 Analysis versus Explication6 Explicating Dysfunction: Life History Theory and Senescence7 Conclusion