So the Discovery Institute’s most recent addition has chosen to reply to my post about
tautologies. (Once again, I’m not linking to him; I will not willingly be a source of hits for the DI website when they’re promoting dangerous ingorance like this.) Typically, he manages to totally miss the point:
Darwinist blogger and computer scientist MarkCC (why don’t they use their real names?) called me a lot of names a couple of days ago. The most profane was that I am a ‘bastion of s***headed ignorance.’ Profanity seems to be a particular problem with the computer-math Darwinists. A dysfunctional clad, perhaps. They’re dysfunctional because, as Aristotle wrote, effective rhetoric has three characteristics: logos, ethos, and pathos. Effective rhetoric appeals to the best in reason, ethics, and emotion. When I’m called unprintable names merely for expressing my skepticism about the relevance of Darwin’s theory to the practice of medicine, I’ve already won the ‘ethos’ and ‘pathos’ skirmishes. I can concentrate on the logos.
Yes, Dr. Egnor. Let’s make sure that we focus on issues of style rather than substance. Because we both know that you have nothing to say in response to the substance of my criticism of your pigheaded ignorance.
First – I do go by my real name. As anyone who takes the most cursory glance at my
blog can see, my name is “Mark Chu-Carroll”, but since that’s a bit long, I tend to use the
abbrevation of my email address: MarkCC. Not that what name I go by has anything to do
with the points I made, but since Egnor feels that the fact that I abbreviate my name is an issue
worth commenting on, I thought it was worth pointing out what an idiotic comment it is -
particularly since it’s quite clear that it’s part of a tactic: distract the reader, by focusing on
irrelevant issues like style, in order to obscure the fact that he has nothing to say about the actual issues that were included in the post he’s allegedly responding to.
Second – I don’t consider myself a “darwinist blogger”. I consider myself a math blogger with basic literacy in science. And anyone who’s actually literate in science recognizes the reality of the process of evolution. Calling someone a darwinist is part of the ongoing campaign by the DI and their cohorts to paint anyone who recognizes scientific fact as part of some kind of fanatical pseudo-religious movement of Darwin worship.
And third – another style versus substance issue. Yes, I used profanity in my criticism of Dr. Egnor. When I watch someone who I care deeply about suffering, and someone like Dr. Egnor dismisses the cause of his suffering with a pigheadedly ignorant casual handwave, I get rather pissed off. Dr. Egnor isn’t personally responsible for my father’s illness. But people like Dr. Egnor, with their practice of casually dismissing the ongoing process that produced the bacteria that nearly killed my father, are, to a great deal, responsible for the way that
these highly resistant bacteria have developed and proliferated over the last several years.
Mark took umbrage at my podcast comment that Darwinism wasn’t indispensable to understanding antibiotic resistance in bacteria. His father seems to have had a very hard time with a resistant strain of bacteria, and he blames me and my view of Darwinism, sort of. I’ve treated thousands of people with serious infections, and I’ve dealt, in a very first-hand way, with the difficulties of bacterial resistance to antibiotics. I’m sorry about his dad’s illness. But Mark hasn’t shown any real insight into medicine or into what doctors actually need to understand in order to deal with serious infections.
Actually, Dr. Egnore is the one who isn’t showing much real insight into the science of the biology that underlies his medical practice. He wants to wave his hands around, shout “tautology, tautology” as if it actually said anything about the actual science, and pretend that the
cause of antibiotic resistance is no big deal, nothing to worry about.
And that brings us to the point that Egnor continues to either ignore or handwave his way past. 20 years ago, there were virtually no widespread strains of staphylococcus that were resistant to multiple antibiotics. 10 years ago, multiply resistant strains were becoming common – but staph infections that were resistant to methicillin and vancomycin were quite rare. Today, methicillin resistant staph is common – infection with methicillin-resistant staph is one of the most common complications from major surgery in American hospitals. How did that happen? The answer is: evolution.
Dr. Egnor wants to ignore that, by dismissing the undeniable fact of the process of change in common bacteria as a tautology: “Bacteria that don’t get killed by antibiotics don’t get killed by antibiotics”. Yes, that is a tautology. But as I pointed out in my previous post, any legitimate scientific theory can be stated as a tautology. And in this case, that tautology is the most remarkably clear statement of exactly what’s happening to common bacteria. We overuse antibiotics; the bacteria that don’t get killed by the antibiotics don’t get killed by antibiotics, and so they’re the ones that reproduce and spread. Repeat that process for a couple of decades, and you get bacterial straints like the staph strain that infected my father – a bacteria that’s resistant to all penicillin family antibiotics, to 1st, 2nd, and 3rd generation cephalosporins, to methicillin, and to vancomycin.
Dr. Egnor also wants to ignore the fact that the staph strain that infected my father is
dramatically different than the staph strains of 20 years ago. It’s got a different
cell-wall structure; it uses different enzymes for a variety of its reproductive functions.
Through his denial of the reality of evolution, Dr. Egnore further ignores the simple fact that
by careless prescription that doesn’t consider evolutionary effects, he’s helping to produce
the truly terrifying superbug: at the moment, there are two distinct mechanisms that produce dramatic multiple antibiotic resistance: glycopeptide resistance, and β-lactam resistant. At the moment, we haven’t seen single straigns of bacteria with both glycopeptide and β-lactam resistance modes. But we know the genetics – and there is nothing incompatible between the glycopeptide resistance mutation and the β-lactam resistance mutation. A staph strain with both of those would, effectively, be entirely resistant to pretty much every antibiotic
we know of. Good doctors are incredibly careful about how they use antibiotics – to make sure that they do not do anything that’s likely to help produce this terrifying new potential strain.
Do Doctors need to be aware of evolution? Does awareness of evolution have anything to do with how Doctors should respond to infections? As an answer, let me tell you a bit about what my children’s pediatrician has told us:
- As a pediatrician, she does not routinely prescribe antibiotics. For a basically healthy child, no matter what the infection, she won’t prescribe antibiotics for at least 4 days, to give the child’s immune system a chance to defeat the infection on its own.
- She does not prescribe antibiotics for any illness until there is
hard proof that it’s caused by bacteria.
- When she prescribes antibiotics, she does it in a very strict way. The first prescription
for a child without drug allergies is always penicillin.
- After the first time that they prescribe antibiotics, the practice
keeps careful track of exactly what has been prescribed to which child when; they follow
a strict rotation process with antibiotics to try to not repeatedly prescribe the same
antibiotic to a child within a six-month period.
Why such a strict process? Because bacteria are evolving resistance to antibiotics. By following a strict process like this, they minimize the quantity of antibiotics that they prescribe, and they try to prevent a chronically ill child from becoming a walking incubator of resistant bacteria. (And yes, when talking about this, she does specifically say that bacteria are evolving resistance.)
So – yes, I do blame Dr. Egnor’s way of thinking for my father’s illness. By ignoring the fact of evolution within bacteria, his mode of thinking about these problems provides
the common excuses and practices that have led to the modern crisis in antibiotic resistance.
And in response to this, Egnor basically continues to wave his hands around, denying
reality, taking refuge behind semantic games.
Mark, your dad’s illness didn’t happen because his doctor didn’t know enough about random mutation and natural selection. Our battle against bacterial resistance to antibiotics depends on the study of the intricate molecular strategies bacteria use to fight antibiotics, and our development of new antibiotics is a process of designing drugs to counter the bacterial strategies. We use molecular biology, microbiology, and pharmacology. We understand that bacteria aren’t killed by antibiotics that they’re resistant to. We understand tautologies. Darwin isn’t a big help here.
No, my father’s illness didn’t happen because his doctor didn’t know enough about
evolution. His surgeon is actually quite aware of the process by which resistant bacteria are evolving, and takes as many reasonable steps as he can to both combat resistant bacteria in his patients, and to avoid contributing to the evolution of more resistant bacteria. But his illness is the result of the actions of many doctors – doctors like Dr. Egnore who ignore reality, and don’t practice medicine with an awareness of how their actions contribute
to the evolution of the other species that surround us. It’s people like Dr. Egnor who hand out antibiotics like candy, because after all, bacteria don’t evolve, and so their prescription practices can’t possibly contribute to a process that doesn’t happen. It’s people like Dr. Egnore
who’s attitudes allow the use of third generation cephalosporins – which are restricted for use in humans – to be used in cattle feed. Because after all, evolution doesn’t happen, so what harm can it possible do to have volumes of these antibiotics floating in the
manure pools that are used to produce the fertilizer that used to grow the vegetables we eat?
No, Dr. Egnor. You do not understand tautologies. You do not understand
science. And you are a disgrace to your profession, and a danger to your patients.
Not to mention that you’re an asshole.