Introduction
The discourse around the evolution of biological understanding is vast, especially with regard to the seminal works published in the 1970s. Among these, Richard Dawkins’ The Selfish Gene and E.O. Wilson’s Sociobiology: A New Synthesis aimed to distill complex biological concepts into simpler, foundational ideas. However, as we revisit these texts fifty years later, the landscape of biology has shifted, prompting renewed discussions about their relevance.
Part the First: The Selfish Gene is 50 Years Old
The mid-1970s ushered in two significant biology books that continue to resonate. The first, E.O. Wilson’s Sociobiology: A New Synthesis (1975), focused on the biological underpinnings of social behavior. The second, Richard Dawkins’ The Selfish Gene (1976), sought to simplify the complexities of biology into fundamental units of selection—genes. Both authors aimed to provide a foundational framework that could explain the mechanisms of evolution.
As a molecular cell biologist with a deep interest in evolution, my experiences in traditional biochemistry equip me with a unique perspective on the oversimplification that can arise in academic discourse. A recent retrospective on The Selfish Gene was published in Nature, emphasizing that a narrow focus on genes is outdated. As noted in the piece, “A focus on the gene alone has become outdated. Books that capture the complexity of life deserve center stage.”
From the author, Daniel Comfort:
The essential idea behind The Selfish Gene was enchantingly simple: a living organism is a gene’s method of generating additional organisms that carry its genetic code through generations.
Initially, The Selfish Gene appeared benign. Dawkins’ theories aligned with mainstream sociobiology, resonating with many academic teachings of the time.
Yet, revisiting it now, my understanding of biological scholarship over the decades reveals a troubling dimension. The book indulges in a deterministic approach that presents genes as the sole agents of evolution while portraying organisms merely as “vehicles” or “replicators.” This perspective risks implying that complex traits, such as aggression, are inherently programmed into our DNA. Thankfully, advancements in research methodologies and interdisciplinary studies have increasingly acknowledged the nuanced realities of biology. For a contemporary understanding of life on Earth, readers would benefit from exploring literature that embraces a broader perspective.
While Dawkins later refuted this idea, the essence of his book posits genes as the primary units of evolutionary selection. Although genes are undeniably pivotal to life, they are not the sole units of evolutionary change. Scholars like Stephen Jay Gould and philosopher Mary Midgley have highlighted this fallacy, advocating for a more integrative view of biology. Fifty years later, we find that an approach embracing the complexity of biological systems yields richer insights. Biological organisms shape their environments just as much as they are shaped by them. Richard Lewontin asserts this beautifully:
A coalition of biologists, philosophers, and historians calls for an extended evolutionary synthesis, one that recognizes multiple levels of heredity. Evidence suggests that epigenetic alterations—changes to gene expression that don’t modify DNA—can be passed down through generations. Ecosystems consist of numerous life forms that influence one another, fostering stability and homeostasis, ultimately promoting resilience in the face of change. Remarkably, our bodies harbor more microbial cells than those inherited from our biological parents. Although the microbiome doesn’t directly contribute to genetic inheritance, it is vital for our survival.
Comfort recommends the recent work Eco-Evo-Devo: The Environmental Regulation of Development, Health, and Evolution by Scott F. Gilbert and David W. Pfennig. Though I haven’t read it yet, I anticipate it will have significant implications, particularly in cancer biology, given Gilbert’s contributions to developmental biology. I’ll revisit this once I delve into the text.
In summary, it is essential to remain skeptical of overly simplistic biological explanations. Such narratives often serve a more insidious purpose, occasionally linked to the ideologies of eugenics—sometimes overtly, but often veiled. This concern parallels the pitfalls of reductionist explanations in economics, though at least biology holds the merit of being a recognized science.
Part the Second: What is Wrong with Big Medicine?
Big Medicine is massive—and it tends to be as impersonal as Sue, the beloved T. rex welcoming visitors at the Field Museum in Chicago. Recently, I stumbled across this obituary for Arnold Relman, a former editor of The New England Journal of Medicine who is dearly missed.
Relman was a formidable figure in American medicine: a medical researcher, clinician, educator, and prolific commentator on health care. In 1977, he became editor of The New England Journal of Medicine, enhancing its reputation as the world’s leading medical journal. Under his guidance, it transitioned from merely presenting research findings to addressing critical ethical and policy questions within medicine.
In 1980, he published a pivotal article, “The New Medical-Industrial Complex,” warning that the American healthcare system was devolving into a profit-driven model. His concern remained predominant throughout his life: that health care in the U.S. is treated as a commodity, distributed according to the payer’s ability rather than medical necessity. This predicament leaves millions of Americans without access to adequate healthcare, despite spending approximately twice as much per capita as other advanced nations, much of which is allocated to unnecessary tests and administrative costs.
Relman argued for a dual solution: a single-payer finance system, akin to Medicare, devoid of private insurance profiteering, and a nonprofit delivery model consisting of groups of salaried doctors operating within a fixed budget. He believed that the Affordable Care Act would ultimately unravel without significant reforms, since while it increased access, it did not dismantle the profit-driven insurance model. He warned of escalating costs or inadequate benefits burdened with excessive deductibles and copayments.
This encapsulates the situation aptly. Over the past twelve years, circumstances have only deteriorated. For the past forty years, I believed that eventually, the United States would recognize the need for healthcare reform. Unfortunately, it appears that a complete systemic collapse may be the only catalyst for change. Today’s medical students are starting to grasp this reality, albeit some of them. They represent potential solutions to the crisis, and a few proactive educators strive to enlighten them before the imposing influence of Big Medicine overwhelms their enthusiasm. It is indeed a challenging struggle.
Part the Third: Alternative Medicine in the Swiss Dock
Last week, I briefly touched on Swiss medical clinics catering to affluent clients, offering treatments that often yield only placebo effects. Coincidentally, Did an Alternative Medicine Guru Accidentally Kill Patients? by D.T. Max from The New Yorker came into my view recently:
Thomas Rau, a renowned Swiss doctor specializing in alternative—or “biological”—medicine, believes that the optimal approach to healing is to enhance the body’s natural defenses rather than to target diseases directly. In his view, conventional practitioners are often too cautious and rigid. He uses dark-field microscopy on his patients’ blood samples to analyze cellular behavior over time, assessing their response to potential toxins or inflammation. Rau interprets the presence of specific formations in the blood as indicators for tailored treatment plans, typically involving dietary adjustments. His clinic, BioMed, situated in the charming town of Schwellbrunn, Switzerland, clients often stay for weeks, spending substantial sums of money.
Rau claims that virtually anyone can benefit from his treatments, especially those with what he classifies as “unclear” conditions. He estimates that around eighty percent of patients—especially those with long COVID or chronic fatigue syndrome—leave his clinic significantly improved. At a 2024 event in Brooklyn titled “The Future of Medicine,” he described himself as “the master in rebuilding cellular function.”
His methods include techniques such as colon hydrotherapy, ozone treatments, and hyperthermia therapy, which purportedly mimics fever to shrink tumors. When questioned about the lack of supportive studies for his clinic’s treatments, he responded, “I pay a lot of taxes… I pay scientists’ salaries.”
Red blood cells can indeed “stack” under various conditions, but this clumping is merely a nonspecific sign of potential imbalances. Contrary to Dr. Rau’s assertions, red blood cells are not motile. They may be displaced through Brownian motion, but true motility is exclusive to white blood cells. The validity of dark-field microscopy as a primary measure of metabolic processes in the body would surely spark debate among hematologists. If Dr. Rau truly possessed mastery over cellular function, one would expect him to be widely renowned, particularly following his presentation in Stockholm last December.
It is significant to recognize that treating patients with “unclear conditions” offers Dr. Rau a buffer against accountability, mitigating concerns regarding the efficacy of his treatments. Colon hydrotherapy is fundamentally an enema, while infusing blood with ozone poses risks without proven benefits, and infrared treatments do not reduce tumors.
Perhaps Dr. Rau’s establishment is appealing if one can afford such treatments. The ambiance is inviting, yet it differs markedly from this comparison. The article presents a lengthy examination, with its conclusions remaining ambiguous. However, I anticipate that Dr. Rau’s clinic will continue operating as long as he does, much like alternative and functional medicine practices in the U.S., although with notably better financial outcomes—at least for now.
Part the Fourth: Whither American Football?
As football season unfolds in the Land of the Free and the Home of the Brave™, the industry surrounding it is massive, with billions at stake in both professional and collegiate realms. Yet, how sustainable is this model, especially in light of recent findings regarding chronic traumatic encephalopathy (CTE) among players at the highest levels?
When I played football from grades 3-12, it was classified as a “contact sport.” I experienced two probable concussions, one from colliding with another player and another from a harsh fall. As the sport has evolved, so has the understanding that such collisions inflict significant long-term brain damage, a fact supported by accumulating evidence. A Scientific American summary notes:
American football can be perilous. While the physical impacts of hits and tackles are recognized, their effects on the brain have only recently become clearer. A substantial number of former players show signs of chronic traumatic encephalopathy (CTE), which manifests in mood swings and dementia. Diagnoses usually occur postmortem, resulting in uncertainties about the actual prevalence of CTE among active or retired athletes.
However, a recent study published in JAMA Network Open analyzed records from thousands of deceased former NFL players, revealing that approximately 75 percent of these athletes likely died with CTE.
“No other environmental or occupational exposure has been identified that increases dementia risk to this extent,” states Yorghos Tripodis, the study’s lead author.
This study scrutinized the records of 2,362 deceased former NFL players who played in the league for an average of five years. Of the nearly 400 who donated their brains, an astonishing 93.5% were diagnosed with CTE.
In contrast, fewer than 1 percent of brains from the general population indicate evidence of CTE.
While correlation does not imply causation, statistical evidence can be compelling when a mechanism exists to explain it. The underlying research published in JAMA Network Open rigorously controlled for bias.
**Main Outcomes and Measures**. This study primarily assessed the bias-adjusted prevalence of CTE and all-cause dementia among the target population, measuring both in donors. A selection ratio for brain donation based on cognitive symptoms (probability of donation given CTE versus probability of donation without CTE) was estimated using Poisson regression to adjust observed prevalence rates.
**Results**. Of the 2,362 deceased former NFL players studied (mean [SD] years played: 5.1 [3.9]; 971 [41.1%] aged ≥80 at death), 396 were brain donors and 1966 were nondonors. Of 387 donors, 362 (93.5%) exhibited CTE. The median selection ratio was 4.97 (95% CI, 4.72-5.26), revealing a bias-adjusted prevalence of CTE at death at 74.5% (95% CI, 69.6%-78.3%). Moreover, the adjusted prevalence of all-cause dementia during life stood at 27.2% (95% CI, 22.6%-31.6%).
**Conclusions and Relevance**. The results suggest that while donor-based estimates of CTE prevalence may be inflated due to selection bias, it fails to fully account for the heightened burden of CTE neuropathology in this specific population. Continued research is vital to elucidate the clinical repercussions of this disease.
The cumulative trauma suffered from repeated brain accelerations leading to powerful collisions can result in lasting damage, with dementia being a diagnosis reserved for posthumous examination. As a consequence, the NFL may choose the narrative of “died with CTE” rather than “died of CTE.” If a former player’s last years were marked by occupational dementia, what implications does that carry? Currently, we witness similar obfuscation in discussions surrounding measles. I am also curious how the NCAA will respond, especially concerning their responsibility to protect “student-athletes” from long-term risks in light of lucrative branding opportunities in college football. Yes, “student” feels like a hollow term, particularly when a college football quarterback can potentially earn $5M annually as a free agent. While I support labor rights, the inevitable dissolution of this entire structure looms on the horizon, exacerbated by the rise of legal sports betting.
Ultimately, these concerns may become moot. Anecdotally, I have yet to meet a young mother willing to see her son participate in football. My daughter has explicitly stated that she does not want me teaching my grandson the fundamentals of tackling. Part of me laments this, knowing that proper techniques have deteriorated over the past decades, yet given current knowledge, I couldn’t pass them on regardless. One of my high school coaches, who played with a prominent college team in the early 1960s, later spent five years in the NFL. When he passed away last year, his family requested donations to the CTE Research Center at Boston University. Football’s future will fade once the pipeline of players dwindles.
Now the question remains: should I watch one of the most fiercely contested college rivalry games slated for this weekend, a matchup that has been a tradition for a century? The answer feels increasingly like “no.” I must keep reminding myself of that…
Conclusion
As we reflect on the evolving narratives surrounding biology, healthcare, alternative medicine, and sports, it becomes clear that progress often necessitates grappling with our past. The call for complexity in understanding both biological systems and societal structures is paramount. The coming years will determine whether we will embrace these complexities or continue to simplify them in favor of convenience or profit. In these turbulent times, I encourage my readers to stay engaged, informed, and most importantly, to exercise their right to vote. Our democratic process, while flawed, remains a crucial platform for enacting change. Don’t forget what my father always said: “If you don’t vote, you can’t complain.”
