Challenging the “one size fits all”
approach in modern medicine
Anne MacGregor, MD
Specialist in Headache
and Women’s Health,
Barts Health NHS Trust
London, UK
Alec Mian, PhD
CEO Curelator Inc.
Cambridge, MA
We can easily recogn ize the face of someone we know
from thousands, if not millions, of other humans.
However, it turns out that individual differences in
physical appearance are dwarfed by the biochemical
differences within us. In the middle of the last century,
Roger J. Williams, PhD, a distinguished American
scientist specializing in nutrition at University of Texas,
argued eloquently that clinically speaking, the “average
man” simply does not exist. 1,2 Indeed, he said the very
hallmark of being human is the high degree of individual
variation our species exhibits.
The variability that Dr. Williams referred to went
beyond the obvious differences or even the presence or
absence of a single genetic change that can alter drug
response. Dr. Williams wrote: “If normal facial features
varied as much as gastric juices do, some of our noses
would be about the size of navy beans while others would
be the size of twenty-pound watermelons.”
Beneath this witty statement lies something less obvious
and very intriguing. What Dr. Williams may be alluding
to is the fact that in human evolution, millions of years
of sexual selection and the desire to have mates that
don’t look odd, may have acted to greatly normalize our
physical appearance. Beneath our physical appearance
however, our internal anatomy and biochemical
machinery were never subject to such a normalizing
selection pressure. Therefore, we may be greatly
underestimating the anatomical and biochemical diversity
that lies beneath our skin.
Today only one of his books remains in print, but at
the time Dr. Williams’ studies were widely published and
the importance of his work was embraced by some of
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