You are not reading carefully. (1) I pointedly said that many of the problems addressed by surgery were not heritable, and not part of the issue I raised. Precisely the "notched ear" issue. (2) I did not suggest that this problem would be universal, and I already noted that medical care is substandard in many places. You repeat this. (3) I made no assumptions about the future. If our history as a species goes back more than 400,000 years, then most of our history has taken place in the absence of surgery. A better question would be, why would anyone assume it's here to stay?