Signaling and Coronary Candidacy

Recently, Dr. Tom Nolen of the Biology Department at SUNY New Paltz gave an EvoS seminar talk on the communication, aggression, and behavior of crickets. Whilst this talk may have little implications to human health on the surface, one recurring theme in his talk was how crickets communicate via signals, notably, honest and deceitful signals.  Something that comes to mind is how people can send “signals” regarding the mortality and morbidity of their diseases.

A discussion of the social sciences in medicine would be incomplete without including the topic of coronary candidacy.  Coronary candidacy is an example of lay epidemiology, a concept coined by Blaxter in the ’70’s and 80’s.  Lay epidemiology seeks to explain the causes of disease as the “laity” understand them as opposed to how the medical model would explain the cause of a disease.  At the heart of coronary candidacy is something called the “prevention paradox,” that is, one’s apparent ability to prevent heart disease through beliefs about what makes one a candidate for heart disease.

I am sure that you heard someone say, s/he is the “last person” they would expect to have a heart attack.  This formulation of a “candidate” for a heart attack is an example of a layperson describing “signals” or “cues” for someone who would or would not have a heart attack.  Another prevailing theme in coronary candidacy is the justification of behaviors.  For example, if someone has a family history of heart disease, but good eating habits, but does little exercise, but has good cholesterol medicine, but has moderate stress, etc., that person is evaluating their disease risk not by using a scientifically validated medical risk assessment, but rather formulating a “candidacy” for heart disease based on a cohort of lay beliefs.  The point here is that people send signals to others regarding their coronary candidacy, even if these signals are unintentional cues.

The handicap principle, although not without its problems, applies here too.  If someone were to be at high risk of a heart attack due to excessive weight, if s/he were to suddenly lose weight, s/he may send the signal that s/he is healthy, but this dishonest signal comes at an enormous cost of sudden weight loss, which is a severe trauma on the body.  It is clear that we send enormous amounts of information about our health through signals and cues, regardless of the honesty of the signal.


About Darwinius Cantabrigiensis

Darwinius is a cardiovascular epidemiologist who has trained in the United States, the United Kingdom, and Japan. He is an alumnus of the evolutionary studies program.
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