Human beings are perfectly designed to choke

elderly woman Choking a water drink after take  medicine ,isolated on white background.

Pandemonium has broken out on my Facebook page because I dared to point out that rape is both natural and evolutionarily successful in some settings. Natural childbirth advocates and lactivists are so blinded by their kindergarten level view of evolution — everything natural must be good — that they are reeling in indignation.

The responses have ranged the tiny gamut from nonsensical to truly absurd. The nonsensical responses insist that since everything natural must be good and rape is bad, rape can’t possibly be natural. The absurd responses assert that rape doesn’t exist in the animal kingdom or among human beings prior to the development of advanced civilizations.

Pointing out that choking is natural does not make me a “choking apologist.” Similarly pointing out that rape is natural does not mean I think rape is good.

But rape is hardly the only ugly, harmful thing that occurs in nature. Human beings are perfectly designed to choke.

Direct connections between the mouth, esophagus, and stomach put the lungs at risk for aspiration during swallowing and regurgitation, and excess gas can be swallowed. The pharynx and mouth are used in common for eating, vomiting, and breathing, and food and liquids entering the mouth must be diverted away from the lungs by the epiglottis to avoid flow into the lungs. Major and minor episodes of aspiration contribute to the terminal stages of many diseases, and aspiration appears to play a role in a variety of chronic disorders, such as cough, bronchial asthma, bronchiectasis, and pulmonary fibrosis…

It is a very poor design from an evolutionary point of view.

…[T]he crossing of the respiratory and digestive tracts in the human throat can cause death from choking on food. It would be better design — much safer in terms of survival — if our air and food passages were completely separate.

But evolution can only work with what exists:

…[A]ll vertebrates … from fishes to mammals on the phylogenetic tree … have crossing respiratory and digestive tracts… The crossing of passages is a historical legacy … Not in itself an adaptation, it is a by-product of selection’s having molded [current anatomy] from what came before.

Evolution does NOT produce perfection; working with existing structures and behaviors, it only produces “good enough.”

Just as crossing respiratory and digestive tracts are “good enough” to ensure the survival of the species, childbirth that has a high instrinsic mortality rates is also “good enough.” Similarly, breastfeeding that has a high rate of insufficient breastmilk is also “good enough.” Evolution does not lead to “perfect design”; it leads to imperfect design that is better than other possible adaptations given the constraints of existing design and the existing environment.

The erroneous view that evolution produces perfection was criticized by biologist Stephen J. Gould as the Panglossian paradigm. The paradigm references Pangloss, a character in Voltaire’s Candide who believes that “all is for the best in this best of all worlds.” In the context of evolution the Panglossian paradigm imagines that everything that exists in nature today is the product of intense natural selection and represents the perfect solution to a particular evolutionary problem.

The propensity for human beings to rape and murder each other is not a perfect solution or even a good solution to the problem of survival of the individual or the species. But it isn’t a bad solution, either, because evolutionary traits are neither good nor bad.

That’s why my pointing out that choking is natural does not mean that I am a “choking apologist” or think choking is a good thing. Similarly pointing out that rape is natural does not mean that that I am a rape apologist or that I think rape is good. The entire point of my piece is that whether or not something is natural tells us NOTHING about whether or not it is perfect or even good.

That’s why natural isn’t always good and technology is often better. Rape is natural and even evolutionarily beneficial in some circumstances. But technology allows us to catch and punish rapists severely. Unmedicated vaginal birth is natural and even evolutionarily beneficial in some circumstances. But technology like interventions and C-section allows us to dramatically lower both the neonatal and maternal mortality rates. Interventions and C-sections are often better than unmedicated vaginal birth. Breastfeeding is natural and even evolutionarily beneficial in some circumstances. But formula allows us to dramatically lower the infant mortality rate and in many circumstances is better than breastfeeding.

The bottom line is simple — so simple that even those with a kindergarten level understanding of evolution could understand: Just because something occurs in nature doesn’t make it good. Unmedicated vaginal birth and breastfeeding are natural, but so are rape and choking.

  • A1Supreme

    When I seen this I was like “what” this is funny I’m gonna love this.

  • PeggySue

    Marginally OT: a friend posted something this AM on FB–an article from NPR, which at one point was a reputable news source, with a terrifying headline about how “diet-related health problems” were the major current source of death worldwide, or something like that. I am annoyed. The article included heart disease, diabetes, etc. Apparently the word “multifactorial” was not part of the article writer’s vocabulary, and who knows if the study referenced was any good. Grr. I mean, really, how are “plant-based milks” sustainable?

    • demodocus

      Because nut juice sounds rude and water is boring. Besides, I prefer my water steeped with Camellia senensis

  • Cat

    Completely OT: my daughter had a playdate the other week and I was startled when the other kid’s mum left her sleeping baby outdoors in a very secure, shady place to nap. Not startled in a bad way: the baby had a lovely nap in the fresh air and the bigger kids had a great time, undisturbed by a screaming baby angry at having been woken up and taken out of the pram. I think I’d just forgotten that the attachment parenting bubble isn’t the real world. People might spend hours arguing on parenting sites about whether it’s OK to leave your baby while you take a five minute shower, or advising against leaving your baby with its father for an hour because “read up on attachment disorders, hun”, or interpreting the safe sleep guidelines in true Mumsnet style to mean that, if you need a pee, you have to lug your sleeping baby to the toilet in a Moses basket to avoid breaking the rule about room-sharing for the first six months. But that isn’t how most people live their lives (thank goodness).

    • mabelcruet

      I’m child-free, but my sister was totally into home birth and all that attachment parenting stuff-she had hers at home with NCT midwives, and was scarily complacent that it was perfectly safe because I was going to be there (I’m a pathologist) and her husband is a nurse (psychiatric nursing)-we were hardly the dream team for an obstetric emergency. Anyhoo, she ended up with three babies under 3 at the end. The day she discovered that the utility room was the best place for the babies to sleep revolutionised her sleeping-the regular noise of the washing machine and tumble drier soothed them more than anything else. She put them in there, and they all slept within minutes. But then she had to lie to her mother and baby group, because shutting them in the utility room probably counts as child cruelty and abandonment!

      • Cat

        Oh lord. I’ve read a lot of your comments about your work on here and I have the highest respect for what you do, but I still wouldn’t think “hey, mabelcruet can deliver my baby in an emergency – a pathologist will definitely have the right skill-set” !

        • mabelcruet

          Luckily she was one of those mothers that everything went perfectly for-she got the pregnancy glow with perfect hair and skin, sailed through to term, delivered them all within 4 hours using nothing but a mini TENS machine for pain relief. I told her I was happy to look after the others, but the only way I was going to get involved at the business end was phoning an ambulance if needed. We delivered babies as students, but under a lot of supervision, and I was a student a very long time ago!

          • Cat

            Yup – I did a little criminal law as a student but that doesn’t mean I want to defend anyone on murder charges anytime soon!

          • mabelcruet

            Nonsense! Deep down in your bones, you KNOW how to do this. It’s instinctive, primeval, you’re programmed to do this, its what the universe wants you to be. Your body is designed to do this: you have your special ways of knowing, your intuition, you don’t need to read books to know how to do this, the spirit of the earth mother will strengthen you and you’ll join with your sisters and you’ll be PERFECT at it-you’ll be a warrior…

            Sorry, that’s not lawyers, is it? That’s attachment parenting moms.

          • Cat

            Yup – if you do lawyering like AP moms do momming, your firm’s professional indemnity insurance premiums are going to go through the roof.

  • Cat

    I’ve had the hardcore Baby Led Weaning brigade tell me that babies are perfectly designed so they CAN’T choke.

    (I’ve nothing against BLW. Just don’t give me any shit about healthy babies not choking).

    • AnnaPDE

      Yeah, sure. And that’s why we need to cut grapes for them for a while, not give them blobs of peanut butter that are big enough to get stuck, and have a whole song and dance about small parts in toys. Because it’s all in our heads and no accidents ever happened that involved choking.

      My son is the poster boy for how some kids would literally just starve on BLW because they can’t not gag on bits of food for a long, long time.

      • Cat

        I think that, for some of the real hardcore lactivist cranks, the fact that their specific babies would starve on BLW is a pro rather than a con, because they see all solids as “junk food” and want to preserve the milky purity of their babies’ tummies for as long as possible. When I was researching weaning, I saw some women on the La Leche League boards telling each other that babies are designed to have nothing but breastmilk until their molars come in. Your sixteen month-old has never done more than suck on a bit of carrot and throw it on the floor? Well done, mama, your breastmilk is really good stuff and you’re giving your baby the best possible start in life!

        (I have an undeveloped germ of a theory that there’s a relationship between, on the one hand, the fact that society trains girls and women to have food issues and, on the other hand, the extreme fetishization of breastmilk. You grow up in a culture that teaches you that food is a necessary poison that will make you fat and disgusting, and that you have to control what goes into your mouth obsessively. Then you have your perfect little baby and you’re responsible for feeding them. It’s not surprising that some women fixate on breastmilk as the one pure thing that can be allowed to cross their baby’s lips).

        • Cat

          Obviously that’s not a comment on either exclusive breastfeeding or BLW in general, just the kind of mothers who think that any deviation from either will “ruin” their baby!

      • demodocus

        Both mine were hungry for solids long before they had the coordination to put enough food into their stomachs to please them. Being uncoordinated doesn’t help, either, lol.

  • Mel

    Human gallbladders seem designed to fill with stones, get infected and oh yeah, cut of their own blood supply.

    That’s two technological innovations involving surgery and antibiotics that’s saved me from an early grave in two years.

    • mabelcruet

      If evolution was doing its job properly, it would have got rid of the vermiform appendix entirely, rather than just leave a little vestigal remnant that regularly turns gangrenous and explodes. And evolution did a generally crappy job of the knees and the lower back. And the feet-they need a good look at too. Given that humans are such an evolutionary bodge-job all round, I think that’s quite good evidence of a Designer, but a designer who was working from an instruction manual translated from Korean by someone who only spoke Portuguese and who had never seen a human before. Or maybe it was the youth opportunities apprentice designer’s Friday afternoon project. Honestly, we’re a bit of a mess.

      • PeggySue

        The sacroiliac is the enemy of the people.

        • mabelcruet

          Definitely-we really shouldn’t have bothered coming down from the trees, the other great apes don’t get that sort of low back pain. On a bad day, I sometimes think I’d trade sentience for the ability to be painfree and effortlessly bendy.

          • AnnaPDE

            Things went wrong earlier than that.
            Consider how wrong we got this whole procreation thing in comparison to kangaroos. They are a clear example to how to do this upright position thing well, too.

          • StephanieJR

            I do sometimes feel that I need a tail that acts like a limb…

          • mabelcruet

            I quite like the idea of a trunk-they look useful.

        • FormerPhysicist

          It’s my enemy this week. 🙁

          • PeggySue

            Rats. I’m sorry to hear it.

  • mabelcruet

    At least lactivists are entirely predictable in their behavioural pattern. They are so stereotypical it’s very easy to predict their reaction. Hannah Dahlen’s behaviour in trying to get you banned is entirely to be expected-her colleagues and supporters (like Milli Hill, Byrom) always do this juvenile ‘I’m going to tell on you’ step. They routinely copy in people’s employer or institution when arguing, they demand to know who is a journalist’s editor, they’ve even copied the UK health minister into tweets when arguing with an obstetrician about home birth in the UK. What’s causing them problems with SOB is that you don’t have an employer or professional body-I’ve no doubt that had you still been working your employer and your medical board would have received mountains of abuse and spurious complaints about you. Instead, they are running to the ‘authority’ of Facebook to punish you.

    I don’t know if they are taught to do this-they have certainly never been taught debate, or critical thinking, or how to assess the validity of scientific research. Instead they rely on gut instinct, their mysterious ways of intuition and secret knowledge. And when something jars with them, they react emotionally and instinctively, without an iota of critical thought. Midwifery in the UK is incredibly hierarchical with lots of levels so running to supervisor with a complaint or whinge is normal. They are also renowned for filling in datix forms (datix is an incident reporting system for reporting issues that could potentially have resulted in patient harm). ‘I’m going to datix you’ is used as a threat and a form of bullying, and certainly in the hospital where I worked before semi-retirement, this was a big concern because so many trivialities were being reported by midwives with a grudge and there was a lot of management input to try and deal with it. Running and telling on someone is typical behaviour for HD, SB and their fangirls.

  • RudyTooty

    I just want to make swallowing mantras now – just like the silly hypno-birth mantras.

    “I am relaxing and opening my esophagus.”

    “My esophagus knows perfectly how to swallow this bolus.”

    “I relax and let peristalsis happen.”

    “This bolus of cheeseburger is the perfect size for my pharynx.”

    “The knowledge of how to swallow is deep within me.”

    • kilda

      trust swallowing.

      • The Bofa on the Sofa

        Look, humans have evolved to swallow. If we couldn’t swallow right, we would have never survived as a species.

      • KQ Not Signed In

        OH MY GOD I AM HOLDING BACK SO MANY FILTHY JOKES RIGHT NOW.

        I’m trying to hold back, but I might just accidentally spit one out.

        • mabelcruet

          There was a theory a few years ago that “swallowing” was protective against pre-eclampsia with the hypothesis that it was something to do with immunomodulation. I don’t recall if they looked at differences between spitting or swallowing…

          The original paper did the usual ‘we need to do a bigger trial’ conclusion but I don’t know if anything ever came of it.

    • rational thinker

      “your food knows how to be swallowed”

  • storkdoc

    AHHHH, the natural is better conversation. I have had this conversation with many patients who believe natural is better. I point out that it is natural to have a heart attack and die, but not good. It’s natural for tornados to destroy your house ( I live in tornado country), but it’s not good.

    I then ask if they live in a house, drove to the office and wore clothes. All not natural but good,

    I tell them nature is neither good nor bad, nature is indifferent to your survival

  • alongpursuit

    Beautifully laid-out argument! Well done, Dr. Amy!

    This reminds me of a comment I received from an ICBLC at my hospital.

    My baby was not getting enough milk from me and by day 4 she had lost more than 10% of her birth weight, was increasingly jaundiced, sleepy, had urate crystals and was starting to look dehydrated. So I supplemented her with formula and continued to do so while trying to increase my milk supply and sort out latching problems (latching got better as she got older, but my supply never increased beyond ~2 ounces/day).

    At an appointment with the ICBLC I said “Thank goodness for formula, I don’t know what we would have done without it”. The annoyed IBCLC replied “Well, you would have breastfed!”. Yeah, and my baby probably would have died.

    • rational thinker

      The most important thing a newborn needs after birth is calories and lots of them. I dont know why people dont want to acknowledge this. Maybe its because our society has demonized calories so much for adults that they have forgotten it is exactly what growing babies and children need. You absolutely did the right thing supplementing and a lactation consultant that would say that to a new mom maybe should not be a lactation consultant cause those kind of comments are putting babies at risk.

      • Mel

        I enjoy giggling with other moms of preemie or medically complicated kiddos about responding to the humblebrag of parents who are feeding their kids all natural fruits and veggies with “Cool. Cool. Do you have any good recipes for cookie-and-ice-cream sandwiches? Doctor’s orders for kiddo to gain weight!”

        • fiftyfifty1

          LOL, I like that! It reminds me of the phrase “empty calories” that they use with such a derogatory sniff. But empty calories is an oxymoron. Calories are the opposite of empty, they are a measure of how full of fuel something is.

        • demodocus

          I’ll have to remember that line, just in case it ever becomes an issue, lol. Boybard and Girlbard are right on target, despite their passion for goldfish crackers, and dislike for nearly all vegetables. Fortunately, they both eat raw carrots and if I put a handful of frozen chopped greens in the rice or pasta, they’ll still eat it. I figure we lucked out there, lol. (Not spinach though. Spinach is apparently the devil.)

          • Mel

            My newest veggie trick is giving Spawn pieces of a vegetable stromboli with the bread face up and the spinach side down. He likes bread. He likes cheese. He’s excited enough by those two things that he misses the spinach stuffed between the bread and cheese.

          • demodocus

            Cool. Don’t think that’ll work with Boybard, though. He’s been refusing spinach since his first taste at 4 months old but at least he’ll eat other greens in small doses.

    • AirPlant

      So pet peeve for the lactation consultant: she says that without formula you would have breastfed, but you demonstrably did breastfeed. You breastfed her two ounces per day and you also fed her formula. The idea that it is only breastfeeding if it is exclusive is bizarre and absurd.