 A more telling criticism of naturalism is that although its advocates claim to rely exclusively on biological science to generate their definitions of health and disease, these rely implicitly on an equation of statistical and theoretical normality (or the “natural state” of the organism), at least in Boorse’s formulation (Ereshefsky 2009). But biology does not give us these norms directly, nor is there anything absolutely standard in “species design” (as many philosophers of biology have argued) despite Boorse’s claims. No particular genes are the “natural” ones for a given population, even if we take a subgroup according to age or gender (Sober 1980). Nor does standard physiology provide these norms (Ereshefsky 2009), not in the least part because physiological accounts typically provide idealized and simplified descriptions of organs and their functions, but not of their natural states (Wachbroit 1994). Rachel Cooper (2002) compellingly argues that coming up with an acceptable conception of normal function (and in turn dysfunction) is the major problem with Boorsian-style accounts, arguing that his analysis should focus on disposition to malfunction instead. This argument utilizes counterexamples such as activities that interfere with normal functioning such as taking contraceptive pills that are not diseases, as well as examples of persons with chronic diseases controlled by drugs who function normally as a result. Elselijn Kingma (2007, 2010) has critiqued Boorse’s appeal to reference classes as objectively discoverable, arguing that these cannot be established without reference to normative judgments. A further issue often noted with regard to naturalistic accounts of disease (for example, that of Lennox 1995) is the underlying assumption that biological fitness (survival and reproduction) is the goal of human life, and along with this that medicine is only considered to be interested in biological fitness, rather than other human goals and values, some of which might indeed run contrary to or make no difference in terms of the goal of biological fitness, such as relief of pain.