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Long before there were effective treatments, physicians dispensed prognoses, hope, and, above all, meaning. When something terrible happens-and serious disease is always terrible-people want to know why. In a pantheistic world, the explanation was simple-one god had caused the problem, another could cure it. In the time since people have been trying to get along with only one God, explaining disease and evil has become more difficult. Generations of theologians have wrestled with the problem of theodicy-how can a good God allow such bad things to happen to good people? Darwinian medicine can't offer a substitute for such explanations. It can't provide a universe in which events are part of a divine plan, much less one in which individual illness reflects individual sins. It can only show us why we are the way we are, why we are vulnerable to certain diseases. A Darwinian view of medicine simultaneously makes disease less and more meaningful. Diseases do not result from random or malevolent forces, they arise ultimately from past natural selection. Paradoxically, the same capacities that make us vulnerable to disease often confer benefits. The capacity for suffering is a useful defense. Autoimmune disease is a price of our remarkable ability to attack invaders. Cancer is the price of tissues that can repair themselves. Menopause may protect the interests of our genes in existing children. Even senescence and death are not random, but compromises struck by natural selection as it inexorably shaped out bodies to maximize the transmission of our genes. In such paradoxical benefits, some may find a gentle satisfaction, even a bit of meaning-at least the sort of meaning Dobzhansky recognized. After all, nothing in medicine makes sense except in the light of evolution.

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Does her hearing come back? It’s entirely possible; if the khui can keep Harlow’s brain tumor in check, it could also repair the cilia in Lila’s ears that affect the transmission of sound. Of course, this is problematic - ‘fixing’ her hearing assumes that she’s flawed. Like Rokan says, she’s perfect just as she is. So will she get her hearing back? I haven’t decided, and she doesn’t need it one way or another. She’s strong enough either way and I hope I’ve portrayed her so.

The Model T was introduced on October 1, 1908. Its purchase price was $825. Breaking all records, the Model T sold over ten thousand copies in that first year. It had several distinctive features, like having the steering wheel on the left, which every other company soon copied. The entire engine and transmission were enclosed; there were four cylinders cast in a solid block, and two semi-elliptic springs were used for the suspension. Best of all, the car was easy to drive, simple to learn, and inexpensive to repair.

Of course, the word machine here is being used in its broadest definition, i.e., as the systematic organization of designs for the transmission of power. And since power can be social as well as mechanical it is important to remember that machines can be institutional in addition to being material. For this reason, we speak of political machines as well as the mechanics of government as comfortably as we discuss how many speakers our stereo contains or how many words per minute we can type. But when the persons who design, implement, and repair these machines, social and mechanical, are thought of as social types, this broader definition of machine often vanishes. Somehow the common usage of the word machine in its many modes does not extend into a consideration of the humans behind the machines. Instead, these persons are sequestered into diverse occupational categories: engineer, economist, radiologist, technician or political scientist. Yet, historically there is a sense in which a segment of this diverse collection of experts attained a uniformity of thought and action sufficient to justify a more unified categorization. And, indeed, it is the intention of this work to demonstrate that there were experts who had in common, from the beginning of the American machine age, the desire to sell society on their expertise by providing plans for systematically organized devices for the transmission of power in production and in politics.

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Historian Michael Rothberg has coined the term “implicated subjects” for those who are neither perpetrators nor victims but should not simply be considered “passive bystanders” because they benefit, knowingly or not, from the oppression of others, and their actions, or failure to act, help to perpetuate the social structures of inequality. Implicated subjects, in Rothberg’s view, can be part of a “transmission belt of domination.” Even if ignorant of the violent crimes and the methods of coercive control that perpetuate the rules of tyranny, they are morally compromised because they enjoy privileges derived indirectly from the subordination of others. Therefore, even if not directly involved as witnesses, they share in the social responsibility for making things right. “‘Modes of implication’—entanglements in historical and present-day injustices—are complex, multifaceted, and sometimes contradictory,” he writes, “but are nonetheless essential to confront in the pursuit of justice.