Medicine and evolution: time for a new paradigm?

The theory of Evolution is being invoked frequently in medicine to account for counter-intuitive findings such as programmed cell death in congestive heart failure and the fact that fever can prove both blessing or curse, depending on the circumstances. These and other examples of what might be called maladaptive adaptations are discussed, and it is suggested that human development may have reached a stage where the roles of mutation and selection are drastically changed. By creating an environment both mutagenic and protective, we have altered the balance between the two great driving forces of evolution, increasing the frequency of mutations and reducing the need for adaptation. As a result, new diseases have arisen and the whole evolutionary process seems to have lost some of its benevolence, no longer insuring the survival of the fittest. We must entertain the possibility that Darwin's theory cannot explain the last few millennia of human evolution and is now useful chiefly as an approximation applicable to very long periods of time.