Evolution based medicine (ebm) an epistemological framework for thinking of, and dealing with the so called "crisis of medicine".

A growing interest toward the evolutionary or Darwinian approaches in medicine stimulates today's debates about the future of medical knowledge and practice. A rising number of symposia, essays, and books are questioning if medicine still makes sense without evolution, arguing that an understanding of how natural selection shaped human vulnerability to disease could provide new insights into medical research and practice, and contribute to a more pertinent idea of health and disease than the ones emerging from the understanding of physiology and biochemistry. The aim of this paper is to provide an historical and epistemological perspective for an evolution based medicine (ebm). Starting from a schematic analysis of the most controversial issues debated within the literature dealing with the so called "crisis of medicine", I will guess that medical theory and philosophy of medicine find it difficult to manage the crisis because they are suffering from a historical fallacy. A schematic reconstruction of the historical advancements of medical epistemology, both at the level of theoretical thinking and of methodological strategies will then be put forward, to demonstrate the epistemological pluralism of medicine. Instead of considering medical pluralism as a demonstration that medical knowledge is socially constructed, the essay argues that it is a consequence of the fact that the living beings who become sick and those that try to understand how and why it happens are temporary endpoints of the ongoing process of biological evolution by natural selection. The main assumptions and theories which inspire "evolution based medicine" will finally be listed and analyzed in terms of their the epistemological implications, showing why and how an evolutionary and Darwinian perspective about medical knowledge and practice can improve and complete the epistemological understanding and foundation of medicine.