Respectful Insolence

I’ve been meaning to write about this topic for a long time.

In fact, ever since our illustrious Senate Majority Leader Bill Frist, who also happens to be a Harvard-educated cardiac surgeon, came out in favor of teaching “intelligent design” creationism alongside evolution in public school science classes back in August, I’ve been meaning to write a bit about a tendency that, as both a surgeon and a scientist, I find disturbing. That tendency is for physicians to be far more susceptible than one would think they should be to the siren call of the pseudoscience known as “intelligent design.” Far more often than should be the case, physicians are vocal proponents of ID and are presented as authorities by creationists. I’ve touched on this topic before obliquely, but this time, impelled by PZ‘s and Tara‘s mention a couple of months ago of an article that appeared in Science explaining the importance of the theory of evolution to modern medicine, I’d like to take it on a bit more directly, particularly because it fits in perfectly with my Medicine and Evolution series.

You would think that physicians, trained in biology, human physiology, biochemistry, genetics, and science, would be pretty resistant to the blandishments of ID proponents, but sadly such is not the case. Indeed, as a reader pointed out to me in the comments of the introduction to this series, physicians supporting ID are used as “authorities” by ID advocate. For example, Doug Moran stated on William Dembski’s blog:

I know quite a few medical doctors. Some are researchers, some limit themselves to private practice, and some do both. These are men and women of all ages and specializations. Not thousands or even hundreds of them – but maybe 30 or 40. Mind you, this is only one data point from a small sampling of physicians, but it is a good one: not one of these fine people believes in Darwinian Evolution. One told me that “Any physician who doesn’t see intelligent design in even his most troubled patient is either blind or stupid or just not paying attention.”

(Of course, I’d counter that there are so many examples of seemingly poor design in the human body, that I consider them to be evidence that any “intelligent designer” needs to be a better bioengineer, but we’ll leave that aside for perhaps another entry in this series in the future.)

Sadly, Moran’s post is not entirely empty. There is evidence to back up his claim. For example, at least one poll shows that a significant fraction of physicians accept ID as being more valid than evolution, and a majority of Protestant physicians accept ID as valid science:

A national survey of 1,472 physicians indicates more than half — 63 percent — believe the theory of evolution over that of intelligent design.

The responses were analyzed according to religious affiliation.

When asked whether they agree more with intelligent design or evolution, 88 percent of Jewish doctors and 60 percent of Roman Catholic physicians said they agree more with evolution, while 54 percent of Protestant doctors agreed more with intelligent design.

When asked whether intelligent design has legitimacy as science, 83 percent of Jewish doctors and 51 percent of Catholic doctors said they believe intelligent design is simply “a religiously inspired pseudo-science rather than a legitimate scientific speculation.” But 63 percent of Protestant doctors said intelligent design is a “legitimate scientific speculation.”

Worse, 15% of physicians believe that states should be required to teach ID and 50% believe that states should be permitted to teach it. In other words, 65% of physicians are in favor of or neutral to teaching ID in the science classroom. (For full results of the poll, go here.) True, this poll was conducted almost a year ago, before the Kitzmiller v. Dover decision, but there’s little reason to believe that the resounding defeat suffered by ID advocates in December would change all that many minds, particularly among doctors.

In fact, it’s even worse than that. Believe it or not, there are budding doctors out there who are young earth creationists. Indeed, I’ve come across at least one blogging medical student named Alice out there who is a self-described young earth creationist, and, like many young earth creationists, she parrots Answers in Genesis misinformation claiming that microevolution occurs (as in antibiotic resistance) but that we have never observed macro evolution (i.e., speciation). Don’t believe me?

Look here at what Alice says, and remember that this is a soon-to-be physician:

Has anyone ever documented a plateful of Strep pneumo mutating into E coli? Or even into Strep pyogenes? I didn’t think so. They mutate, and they exchange information. But they remain separate species, with their own unique characteristics. Staph aureus remains unique in possession of the coagulase enzyme; E coli remains identifiable by its lactose metabolism. They are all separate species and geni; and they definitely are not progressing into amoebae or protozoans.

Macro-evolution, then, is the belief that one kind of life can change into another kind; that by an almost unimaginable series and accumulation of mutations, some random process could turn an amoeba into a plant, and then into a primitive fish, then into an amphibian, and so eventually into “the miraculous race that we are” (to quote G.K. Chesterton’s poem). Macro-evolution is the idea that a species of fish mutated, and turned into a land-walking amphibian. It’s the idea that an ape mutated, and became an intelligent, (occasionally) rational, artistic, human. To me, this sounds like some of the wilder science fiction plots.

So: I believe that God created the world in six 24-hour days, out of nothing. He made every animal kind himself. Part of the natural order that he set up included the ability for DNA to mutate. BUT: When DNA mutates, it generally loses information. The mutation that makes Strep pneumo resistant to penicillins is the loss of a protein (called, in the usual utilitarian manner, penicillin-binding-protein). Dogs are another good example of this. Many of the different breeds we have today resulted from breeding for specific characteristics. Some of these are so extreme that they can’t even breed with each other any more (eg, Great Danes and chihuahuas). But the breeding didn’t add any information; it took it away. The chihuahua lost the ability to grow large; the labradors lost the ability to grow curly hair; and so on. These species and subspecies did not add anything; they lost it.

Thus, it is quite reasonable to believe in the fact of micro-evolution, since it can be seen on a regular basis in the world around us. It can be measured in the lab, and witnessed, and reproduced. This does not in any way necessitate a belief in the theory of macro-evolution, that life originated from non-life, or even that God made the bacteria and then let everything get along from there. Macro-evolution is definitely a theory, since it has not been witnessed or verified by any scientific standard (meaning the standards that applied before scientists got carried away with trying to make a philosophical explanation for the origin of the universe).

It’s a bit scary to me that this third year medical student will soon be a physician, as her understanding of biology is clearly very flawed, particularly her understanding of mutations and genetics. In addition, she is parrotting one of the oldest creationist canards there is by claiming that evolution can be observed within species but that speciation (i.e., macroevolution) has never been observed. She is, of course, incorrect about this. Also, despite the evidence regarding its importance, Alice does not believe that the recent discovery of fossils of a transitional organism constitutes support for evolutionary theory. Even despite this, she will probably do OK as a physician as long as she stays away from specialties involving genomic medicine (which, these days, include more and more specialties as time goes on) or out of research that involves an understanding of genomics and evolutionary principles. She’ll probably even be able to use the findings of genomic medicine, but her young earth creationist beliefs will almost certainly make it necessary for her to ignore or deny the evolutionary foundation upon which much of the new genomic medicine rests. What I find disturbing, though, is how someone soon to enter my profession is able to accept the mass of pseudoscience, dubious arguments, and logical fallacies that one has to accept in order to accept not even ID but young earth creationism as a valid alternative to evolution and make arguments that depend upon a misunderstanding of molecular biology, mutation, and basic biology.

Biologists and other strong opponents of ID often express puzzlement or disbelief that so many doctors could be so ambivalent about ID or even downright sympathetic to it. To them the fact that so many physicians have such a poor understanding of evolutionary biology is hard to swallow. Perhaps this is where I can help the science-minded out there who read my blog. Even though I straddle two worlds, the world of the clinical surgeon and the world of the practicing physician, sometimes I don’t udnerstand how so many physicians can be so easily seduced by this pseudoscience. Nonetheless, I’ll give it a shot at explaining some of the reasons why this may be so.

One important reason that physicians as a group are susceptible to the fallacies of ID is the same reason I mentioned when I first started this series: the lack of formal training in evolution the vast majority of physicians suffer from, as described by Nesse et al:

Although anatomy, physiology, biochemistry, and embryology are recognized as basic sciences for medicine, evolutionary biology is not. Future clinicians are generally not taught evolutionary explanations for why our bodies are vulnerable to certain kinds of failure. The narrowness of the birth canal, the existence of wisdom teeth, and the persistence of genes that cause bipolar disease and senescence all have their origins in our evolutionary history.

And, as I put it:

Twenty years ago, when I was studying anatomy, physiology, histology, and medical biochemistry in medical school, evolution was rarely mentioned, and then usually only in trite and simplistic examples. As far as I can ascertain, at my medical school at least, the situation is no better today.

Also, most doctors are not like me in that they are not actively involved in research. Rather, they use the results of others’ research and apply it to the best care of their patients. Indeed, physicians must provide at least the “standard of care.” True, they have to keep up with the latest research in order to update treatments to match the ever–excuse the term–evolving standard of care, but this standard is seldom “cutting edge.” What this means, though is that in standard medical practice, as long as a physician practices this ‘standard of care,” he or she can be a creationist and utterly deny Darwin and still provide competent care to patients. Advances in genomic medicine will likely make such a disconnect less easy to pull off, but for now it is not that difficult in most specialties. Even among those who are involved in research the majority do not do basic or translational research, but rather clinical research, the bulk of which involves testing one drug or treatment versus another or versus a placebo. Thus, even among academic physicians, only a relatively small proportion are involved in basic biological research, and, as I pointed out before, even among those who do basic research, all too little thought is given to evolutionary thinking in medicine.

Another aspect of being a physician that basic scientists often forget is the very motivation why people become physicians in the first place. Although there can be overlap, there’s a big difference between the primary motivations for going into science and medicine. Basic scientists tend to be motivated by a profound curiosity, a desire to understand nature, and a profound satisfaction that one derives from satisfying that curiosity and fulfilling that desire. In other words, it is the thrill we as scientists get from discovering something new, from deepening our understanding. To a scientist, there’s no greater rush than discovering a new and important gene, for example, or coming up with a hypothesis and seeing it validated by experimentation. All scientists seek that rush, and it is their curiosity that drives them. In contrast, what motivates most physicians to enter medicine is not curiosity; at least that is not the primary reason. Rather, as corny as it sounds, it is the desire to help people and the satisfaction we get from curing disease and easing suffering. Some of us have the motivations of a scientist, but there has to be a strong element of wanting to help others to go through the pain of medical school. Clearly this is the case with Alice, but along with that strong desire to help, she brings the baggage of a fundamentalist literalist interpretation of the Bible, including creationism and a desire to proselytize Muslim medical students sharing her present rotation.

In marked contrast to the secularism of many scientists, because of this desire to help people directly, for a significant number of physicians, the wellspring behind their choice of a profession is their religion. Because all of the major religions preach as part of their doctrine service to the less fortunate, many physicians see their calling as a professional who cares for the sick to be the highest form of service to God and their fellow humans. Indeed, there is even evidence that physicians as a group are more religious than the general population:

King isn’t alone among today’s doctors, according to a first-of-its-kind survey led this year by University of Chicago researcher Dr. Farr Curlin, an assistant professor of internal medicine.

Curlin and his fellow researchers surveyed 1,260 practicing physicians in the United States. They found that 76 percent of the doctors believe in God, and 59 percent believe in some sort of afterlife. The researchers also found that 90 percent of the doctors attend religious services at least occasionally, compared to 81 percent of adults in the general population. And 55 percent said their religious beliefs influence how they practice medicine.

The findings surprised Curlin, who assumed patients would be more religious than their doctors. “Our study challenges that conventional wisdom,” said Curlin, whose study was published in the Journal of General Internal Medicine.

Curlin’s team also found that different medical specialists varied in their practice of and attitudes about religion. Family practice doctors and pediatricians were more likely to carry their beliefs into other aspects of their lives. Radiologists and psychiatrists were the least likely to do so.

I don’t know if Curlin is correct, but it has certainly been my experience that physicians as a group are at the very least not less religious than the general population. One neurosurgeon whom I trained under was a devout Catholic who went to mass every day that he was not operating and served on a medical advisory group of some sort under Pope John Paul II. Of the seven of us in our group, at least four of us are highly involved with a church (or, in one case, synagogue), and one even offered to pray for me during a time of difficulty (something that has always made me uncomfortable, even when I was a weekly churchgoer). As far as I can tell, their religion does not unduly affect their views on medicine or science or how they practice medicine, certainly not to the point of accepting a religiously-inspired pseudoscience over sound science. Even so, it is not too far-fetched to suggest that such religiosity might make at least a significant minority of physicians sympathetic to the concept that there is a divine creator guiding evolution and uncomfortable with the concept of natural selection. Couple that with the fact that as physicians we see the fascinating complexity of human anatomy and physiology every day, it’s not surprising that some of us would combine our belief in a God with our awe at the incredible complexity of the human organism and conclude that there must have been some element of design. It’s not much of a leap from being able to “repair” malfunctions in the human organism to starting to look at ourselves in a way similar to repairmen. And what do repairmen repair? Designed machines, of course.

Finally, although this is less so than decades ago, physicians still hold a very privileged place in society. Indeed, in many rural communities, the revered family physician who is viewed as a pillar of the community still exists, as a surgeon who graduated the same year found out when he took a private practice position in a small rural Ohio town. At a meeting several years ago, his wife expressed wonder at the fact that she no longer felt as though she could go shopping wearing sweatpants; because of her stature in the community, people would notice and talk. Living on the East Coast in a suburban area where physicians are a dime a dozen, fortunately, I suffer no such inhibition, but in large areas of the country there is still a considerable mystique associated with being a doctor. We are viewed, rightly or wrongly, as authorities on a variety of topics outside of medicine, particularly if those topics are related to biology. Consequently, when debates such as the political debate over ID crop up, physicians are often among the first consulted for opinions. Similarly, when pro-ID doctors write letters to the editor asking for “academic freedom” regarding evolution while parroting creationist talking points, they are probably more likely to be published by editors and taken seriously by readers. Most lay people reading such editorials don’t realize that most physicians don’t know what they’re talking about when it comes to evolution. Indeed, all too often we physicians forget that most of us don’t know what the heck we’re talking about when it comes to evolutionary biology and, given our natures, will happily pontificate about the issue. And, not surprisingly, ID proponents are more than happy to cite such physicians spouting off about a topic that in reality they know little about as “authorities” supporting their position.

In contrast, physicians who do support science and understand what a sham ID and young earth creationism are often inhibited from speaking out. Another thing that scientists don’t always understand is that we as physicians are trained to place a high premium on being nonjudgmental of our patients, because being judgmental severely intereferes with the doctor-patient relationship, makes the delivery of optimal care less likely because patients will be less likely to tell us relevant information, and may even prevent some patients from seeking care at all. Consequently, knowing that many of our patients support ID or even creationism, we physicians as a group tend to be reluctant to speak out against it, for fear of seeming judgmental or critical of our patients’ religious beliefs, particularly since there are far more people out there who are believers than not. Alternatively, we will adopt a neutral stance, in essence accepting the concept of “teaching the controversy.” Indeed, even when we do speak out for science and evolution, as Dr. Robert Schwartz tried to do when he criticized ID as pseudoscience in the pages of The New England Journal of Medicine last fall, we tend to pull our punches, even to the point of qualifying our criticisms by saying something as ridiculous as what Dr. Schwartz said while attacking ID, “Phillip Johnson, Professor Emeritus of Law at the University of California, Berkeley, and one of the founders and financial backers of the intelligent design movement, can accurately pinpoint many problems that the theory of evolution has not come close to solving. His criticisms have merit, and his focus on precisely those things that we do not yet know blocks any rational dialogue.” (As some may recall, I almost choked when I read that sentence, given that Johnson misrepresents evolutionary theory and uses the same bad science and mangled logic that nearly all ID advocates do–not to mention his prominent role among HIV/AIDS “dissidents.”)

So what’s the solution? Certainly it won’t be easy and it won’t be fast, but education is the key, particularly in medical school to show future physicians that a solid understanding of evolution is not only relevant but critical to understanding human disease. As Ness et al put it:

What actions would bring the full power of evolutionary biology to bear on human disease? We suggest three. First, include questions about evolution in medical licensing examinations; this will motivate curriculum committees to incorporate relevant basic science education. Second, ensure evolutionary expertise in agencies that fund biomedical research. Third, incorporate evolution into every relevant high school, undergraduate, and graduate course. These three changes will help clinicians and biomedical researchers understand that both the human body and its pathogens are not perfectly designed machines but evolving biological systems shaped by selection under the constraints of tradeoffs that produce specific compromises and vulnerabilities. Powerful insights from evolutionary biology generate new questions whose answers will help improve human health.

I agree, although such a solution will take many years to produce a new generation of physicians with an understanding of how evolution influences human disease and can provide unique insights into the the understanding and treatment of human disease. An additional salutory effect of improving the education of physicians in evolutionary biology would be to dramatically decrease our use by politically minded proponents of ID, who see them as useful tools to persuade a public unknowledgeable about science that ID is more than a religiously-inspired pseudoscience.

PREVIOUS ENTRIES IN MEDICINE AND EVOLUTION:

Comments

  1. #1 Big Al
    April 19, 2006

    I am so old, hardly anything surprises me. Is there any data on other cultures/nations. I wonder if Darwin had been an american, he would have received more acceptance.

  2. #2 JK
    April 19, 2006

    Excellent post. Keep fighting the good fight.

  3. #3 RPM
    April 19, 2006

    Will teaching evolution do much to convince the creationists? In the two universities in which I have seen evolution taught at an introductory level (as an undergrad and grad student) neither curriculum seemed all that capable of swaying a creationist. To really understand evolution requires immersing yourself in the enormous body of evidence (either primary/secondary literature or text books), and I don’t see many premeds being interested in that material.

    Secondly, don’t most premeds engage in some research as undergrads? It was my impression that the competitive nature of med school application requires a resume with some research experience. Given that most research at an undergraduate institution is not of the clinical variety, shouldn’t they at least have some understanding of how basic research is done?

  4. #4 Karl
    April 19, 2006

    Very nice article. Thank you.
    Comments:
    Regarding: “In addition, she is parrotting one of the oldest creationist canards there is by claiming that evolution can be observed within species but that speciation has never been observed. She is, of course, incorrect about this.”
    I read the article that you linked to. I don’t think that anything in there would change her mind. Fruit flies remain fruit flies, etc.
    The problem is that the IDers are thinking “Kinds” not species. And “Kinds” seem, to me, to be more equivalent to genera than species. So, as rare as it is to observe creation of new species, it is that much rarer to observe creation of new genera.
    A second difficulty with any discussion about species is, as was pointed out in the reference article, the definition of species. For example, dogs: (“dogs” are a “kind”). Unless “species” is redefined from a DNA point-of-view, not all dogs belong to the same species – Can a chihuahua actually, physically mate with a Saint Bernard? Ergo, they are separate species.
    There is also the question of Ring Species – which incidentally, applies to the dog situation. The question is: is “same species” a transitive relation? And Ring Species demonstrate that the answer is no. I would hold that that means that the concept is not well-defined.
    The point of this is that it is pointless to tell IDers about examples of speciation when the concept is poorly defined, and , more importantly, when that is not what they’re thinking about anyway.

  5. #5 Alice
    April 19, 2006

    Karl is quite correct. The variations in the article Orac posted did not create new kinds of animals. The one sort-of-new plant I saw, the raddish-cabbage cross, was rather infertile, and useless. Not exactly an evolutionary advancement.

    Also, evolution is supposed to be random. Almost all the instances in that article were of scientists, obviously intelligent, designing experiments and circumstances that could produce new arrangements of genetic material.

    But to me the more important question is not whether scientists are able to produce some novel arrangements of already-existing DNA. The real question is, where did all of this come from? Where did DNA come from? Orac has explained to me before :) that intelligent design/origin of the universe is not the same thing as evolution of life that already exists. So: you can explain how one fruit fly turned into another fruit fly all you like, but that doesn’t explain how the miraculous code of DNA came into existence, or how this planet happened, with such a perfect climate and environment for life, or how a series of random, purposeless events produced rational humans. I would suggest that the fervor evolutionists show in denying Creation is equally religious, and is equally addressed to the philosophical question of the meaning and origin of life. That’s why neither of us will persuade the other, short of divine intervention.

  6. #6 Davis
    April 19, 2006

    The variations in the article Orac posted did not create new kinds of animals.

    I can’t help but ask, but what is the actual definition of a kind? Things that look kinda alike? It always seems to be some arbitrary category that can be expanded at will in order to make the argument that “evolution can only change within kinds.”

    Not exactly an evolutionary advancement.

    Evolution is not about “advancement,” and understanding this fact goes a long way toward understanding evolution.

    I would suggest that the fervor evolutionists show in denying Creation is equally religious…

    That depends — do you consider following the evidence where it leads to be a religious pursuit?

  7. #7 JM
    April 19, 2006

    I have given this a bit of thought. Part of the problem is that we don’t teach the process of science well. Normally we teach the facts and principles, and not how those were developed. As a result, people can take many science courses (as doctors do), or even become scientists, without being able to distinguish between a scientific theory (evolution) and a philosophical notion (ID).

    There is a further problem with ID. Put the right way, it sounds good and some people who know better can be seduced. There is a wicked-smart (as my niece would say) astronomer on my local NPR station whose weekly commentary, one day last August, spoke glowingly of life appearing intelligently designed. I contacted him and told him that ID is creationism. He responded to me immediately, and retracted his words the following week. He said he was just in awe of the complexity of life; not advocating a creator. A couple months later, he spoke against ID creationism yet again.

    Teaching more about evolution would certainly help, teaching more about the nature of science would help a lot more. The astronomer knew the basics of science, and immediately recognized the problem with ID when it was pointed out to him.

  8. #8 BronzeDog
    April 19, 2006

    Alice, here’s some homework for you.

    Almost all the instances in that article were of scientists, obviously intelligent, designing experiments and circumstances that could produce new arrangements of genetic material.

    If I’m reading your implication correctly, you’re moving the goalposts. Do you have evidence our environment was designed?

    …but that doesn’t explain how the miraculous code of DNA came into existence, or how this planet happened, with such a perfect climate and environment for life, or how a series of random, purposeless events produced rational humans.

    1. Abiogenesis.

    2. You’re working backwards. Shuffle a deck of cards, and draw five. The odds of you getting that particular hand are very small. That doesn’t mean God stacked the deck for you so that you could get that exact hand.

    3.This ball of rock was one of probably many lucky lotto winners out of a pool of countless illions others, to have a stable orbit, liquid water, and a few other traits. Combined with the apparent ease that scientists have replicated some simple abiogenesis events, life was probably inevitable.

    4. Argument from personal incredulity. Just because you don’t see how everything adds up doesn’t mean that it can’t add up.

  9. #9 The Brummell
    April 19, 2006

    “Also, evolution is supposed to be random.”

    NO, it’s not. This is perhaps the single biggest dumb myth about Evolutionary Theory.

    Evolution: change in allele frequencies through time.

    Does the word “random” appear there? How about “chance”, or “probability”?

    There are four factors that we know can change allele frequencies – in other words, cause evolution.
    1. Selection
    2. Drift
    3. Mutation
    4. Migration

    Selection is the one most people are perhaps most familiar with. Selection IS NOT RANDOM. It’s a departure, a deviation from random. It’s all about correllations between genes and survival, genes and reproduction, genes and tomorrow’s population. Selection is the opposite of random – which is NOT design or planning or any sort of foresight.

    Drift – genetic drift – is almost random. It’s actually stochastic, which is slightly different, but the distinction between stochastic and random is pretty fine. Drift is a sampling process that changes allele frequencies in a manner not correllated with specific genotypes.

    Mutation – urgh. I’m not going to get into the details here, I’ll just point out that a) there are a range of possible mutations that could occur in a given DNA molucule, not just deletions or substitutions, b) beneficial mutations have been observed, in natural populations, repeatedly. Search the Web of Science with the keywords “mutation” and “beneficial”.

    Migration – trivially obvious, really. If an individual with alleles not found here immigrates, the local allele frequency has changed. I’ve never seen any argument around this.

    Finally, I agree with what BronzeDog said. Especially point 4. I’m supposed to be swayed by your arguments that you lack the intelligence and imagination to create testable hypotheses? Being humble is one thing. Proclaiming oneself to be stupid is a useless rhetorical technique.

  10. #10 Alice
    April 19, 2006

    That’s a very nice website. I’ll return the favor: go read a few pages from Answers in Genesis. I don’t have the time to argue with everything on your page. But to take abiogenesis: this is the starting point that evolution has to have. If life can’t arise from non-life, you have to acknowledge some kind of creator, whether God or some aliens. The “simple abiogenesis” experiments involved carefully controlled environments with external input. The scientists put the specific chemicals that they knew would be conducive, they chose the temperature, and provided the electrical stimulation (I believe it was). That’s not random.

    Both evolution and creation are religious beliefs. Is there a Higher Power who created you, to whom you owe your existence, and to whom you are responsible? Or is your life the result of random chance occurrences, leaving you unobligated to any authority external to your own moral preferences?

    (Which is why I doubt that any amount of education could make me an evolutionist. I have been taught some phylogenetics, and fossil arrangements, and so on. The college biology textbooks I used were written by evolutionists, and the classes were taught by professors who had PhDs from evolutionary programs. It’s not feasible to teach the average doctor more about evolution than I’ve already heard. It’s a matter of presuppositions.)

  11. #11 Russell
    April 19, 2006

    Alice writes, “Also, evolution is supposed to be random.”

    Um, no. That’s as mistaken as saying that Newton’s law of gravity requires everything to fall in the same direction, or that photosynthesis violates the second law of thermodynamics. Mutation might be random, or somewhat random. Even that is not required by evolution, but only that there is variability. Evolution as a whole definitely is not random, and does not produce a random result.

    For myriad other examples of non-random processes involving some random elements, you might look at the many probabilistic algorithms in computer science. Throwing the dice speeds up many kinds of search and resolution and design space exploration, which gives software engineers the frequent desire to throw dice. Or at least, pseudo-dice.

  12. #12 Stanton
    April 19, 2006

    Evolution is not a religious belief.
    Exactly how does devising the ecological behavior of trilobites constitute a religious myth?
    Who is a recognized “priest” of evolution?
    I strongly doubt that Alice could tell the difference between Opabinia, Calymene, or Homarus if her deluded life depended on it.

  13. #13 Stanton
    April 19, 2006

    Furthermore, only blind, gibbering fools think that the purpose of fruit fly experiments were to produce a new kind of insect: the purpose of the original fruit fly experiments was to map out their genomes. On the other hand, people have been able to produce new kinds of fly, like the way scientists have been able to breed a new kind of short-stalk-eyed flies by barring the females from breeding with the long-stalked males they normally prefer to breed with. Further tests show that the newer generations of females will actively select for males with short eye-stalks and ignore normal males with long eye-stalks.

  14. #14 KeithB
    April 19, 2006

    Alice:
    Do you believe that the fossil record was laid down during a flood some tens of thousands of years ago, or that God created the fossils in situ?

    Most of us *have* read AIG, now it is your turn to read talk.origins, especially the index to creationist claims.

  15. #15 Flex
    April 19, 2006

    Both evolution and creation are religious beliefs.

    Not really. Creation is a religious belief because it states that a creator in the religious sense exists.

    Evolution does not address religion in any fashion directly. It does, however, suggest that certain claims made by various religions are incorrect. This does not make it a religious belief. It is impartial to religion.

    Evolution does suggest that a literal interpetation of genesis is incorrect. Evolution also suggests that the ancient Greek or Norse creation myths are incorrect. And that the endless cycle of Vishnu is incorrect. Or that the Mayan multi-cyclical mythos is incorrect. These religions may not have as much weight in your eyes as Christianity, but you should recognize that many human beings have held these beliefs to be true as fervantly as you hold your own religious beliefs.

    Evolution is impartial to religion, it is a statement of the best level of our understanding of how the diverse lifeforms found on our planet developed to their present day forms. Evolution is backed by mountains of physical evidence, and continually being re-affirmed by additional discoveries in a myriad of scientific fields.

    As a seperate example, Newtonian mechanics suggests that, in direct opposition of what is reported in the bible, the sun couldn’t have stood still. Does this mean that Newtonian mechanics are a religious belief? No. It suggests that that particular story may be better viewed as an allegory or poetic license.

    Good luck in your chosen profession, I wish I had the determination necessary to become a physician. I took the easy way out and became an engineer.

    -Flex

  16. #16 Kristjan Wager
    April 19, 2006

    But to take abiogenesis: this is the starting point that evolution has to have. If life can’t arise from non-life, you have to acknowledge some kind of creator, whether God or some aliens.

    Please educate yourself on what you are debating. No, abiogenesis is not a necessary starting point for evolution. Life is a necessary starting point for evolution.

    If life cannot rise from non-life (which it can, as have been proven by several experiments), it doesn’t mean we have to acknowledge some kind of creator, instead it could mean that we have to acknowledge an enternal life circle, which at some point has reached Earth. If we think of God or aliens, then the natural question would be, what did these beings come from, since life can’t rise from non-life?

    The “simple abiogenesis” experiments involved carefully controlled environments with external input.

    The environments were carefully controlled to be as close to the condition when life started on Earth as possible. Yes, there was external input, like there is on Earth (you know, the sun does give a lot of input to our world), but none of the external input was life – in other words, life came from non-life. Did life rise the way the experiment showed they could (sans humans)? We don’t know, which is why there is still being done research on the subject.

    Both evolution and creation are religious beliefs. Is there a Higher Power who created you, to whom you owe your existence, and to whom you are responsible?

    At some stage it was official Church doctrine that the world was flat, though learned people knew better, that the Sun circled the world, though observed data showed great problems with this, and a number of other things. People pointed out that this simply couldn’t be true (and some times got burned or exiled for their efforts). Was a spheric view of the world or a heliocentric view of our solar system also just religious beliefs? Well, they were in the same way as evolution is today. They were theories that fit with the observable data.
    This is what science is, another religious doctrine….

    Or is your life the result of random chance occurrences, leaving you unobligated to any authority external to your own moral preferences?

    My life is the result of two people having sex, as is your most probably. It was pretty much by chance that my father travelled half-way around the world and stuck around long time enough to meet my mother, so I am in that sense a result of chance. However, if you are speaking of the process of evolution of a process of chance, then you have little understanding of what natural selection is. Species mutate, which happens by chance, and the harsh realities of natural selection takes care of those that doesn’t mutate in a benifician way. That is by no means a process of chance.

    I am by no means unobligated to other beings. My participation in society demands that I do certain things (pay taxes, behave in ways considered contructive by society), and my craving for social contact makes even more demands upon me, since certain sorts of behaviour will make it impossible for me to interact socially with other people, even if I keep within the formal bounds of my obligations to society.
    Personally I find it rather sad that people have to believe in God to feel that they have obligations towards others, and I am quite happy that not all religious people feel that way.

    Which is why I doubt that any amount of education could make me an evolutionist.

    You know, they are called biologists, perhaps even scientists. ‘Evolutionist’ is a Creationist word.

    It’s not feasible to teach the average doctor more about evolution than I’ve already heard. It’s a matter of presuppositions

    It’s quite likely it’s not feasible to teach the average doctor more about evolution than what you’ve heard, but I would certainly hope that they learn more about evolution than you have.

  17. #17 chuko
    April 19, 2006

    The whole point of natural selection is that it is a sifting process for random mutations. In organisms, most mutations are neutral, some are negative, even fewer are positive.

    I don’t think the idea of evolution is complicated at all. (Although the products of the process and how it works in the real world are.) I wrote an evolutionary algorithm based in the principle when I was ten. Once you have reproduction, a genetic code, and mutation, it’s hard to see how darwinian evolution could not occur.

  18. #18 compass
    April 19, 2006

    I deeply appreciate a coherent, unemotional approach to your writing.

    ANd a commentor made the astute observation that ID is actually better suited to the philosophy classroom rather than the science classroom (given science’s near-exclusive reliance upon empirical data).

    But I would be interested to hear your response to Alice’s comment:

    Both evolution and creation are religious beliefs. Is there a Higher Power who created you, to whom you owe your existence, and to whom you are responsible?

  19. #19 Kristjan Wager
    April 19, 2006

    Compass, what does evolution have to do with religion? Can one have a belief in a higher power, and still be a sound scientist, or does one have to become a creationist? And the million dollar question, why do you keep focusing on religion?

  20. #20 BronzeDog
    April 19, 2006

    On the morality nonsense that shows that Alice didn’t pay attention to the talkorigins index:

    I’ve said a pretty good bit a while back.

    On the philosophy class issue: My brother with a philosophy degree is really opposed to that: ID is nothing more than an argument from ignorance and other logical fallacies. It only belongs in theology classes, not philosophy.

    Both evolution and creation are religious beliefs.

    Dead wrong. Look at the evidence and how readily evolution changes with new evidence.

    Is there a Higher Power who created you, to whom you owe your existence, and to whom you are responsible?

    There’s no evidence of one.

  21. #21 Lixivium
    April 19, 2006

    Alice wrote:

    If life can’t arise from non-life, you have to acknowledge some kind of creator, whether God or some aliens.

    Alice, I’m going to assume that you obviously don’t accept the concept of the Big Bang. Here’s my question: do you then disregard ALL OF PHYSICS? Do you reject Newton’s mechanics, Maxwell’s electromagnetics, Einstein’s relativity, all quantum principles, etc., because you reject the Big Bang?

    You might ask why I expect you to do so. The reason is that all that we know from physics indicates that the universe is very old and is currently expanding. Extrapolate back through time and you have to conclude that it started out as a very small particle – the Big Bang. If you don’t accept this then there must be something wrong with physics as we know it.

    If your answer is that YES, you do not accept physics, then we have nothing further to discuss.

    If your answer is NO, then please explain why we should throw out all we know from evolutionary biology because it cannot account for abiogenesis. It’s the same scenario: all we know from evolutionary biology indicates that different species today share common ancestors, and that simpler organisms appear older than more complex organisms. Extrapolate that back and you have to conclude that living organisms today share a common ancestor that was probably very simple – abiogenesis.

    As to where this first ancestral organism came from, we can no more answer that than we can say where the Big Bang came from. But I don’t see this as a reason to reject all of evolution, and I’d like to hear you explain why you do.

    Both evolution and creation are religious beliefs. Is there a Higher Power who created you, to whom you owe your existence, and to whom you are responsible? Or is your life the result of random chance occurrences, leaving you unobligated to any authority external to your own moral preferences?

    This is a false dichotomy, because the bolded portion you wrote does not match any definition of evolution I’ve ever heard.

  22. #22 Buridan
    April 19, 2006

    Alice demonstrates very well how embracing the fundamentals that underlie modern medicine is not a prerequisite to practicing modern medicine. In fact, this is probably more true today than in the past. Physicians do not need to believe in the underlying science behind their craft in order to practice it. Having said that, how sad it is that one can become certified to practice in a field so reliant on science and the scientific method and yet be successful in that same endeavor while denying its very core. It’s the proverbial biting the hand that feeds you. They used call such practitioners quacks. Today we give them diplomas.

  23. #23 BronzeDog
    April 19, 2006

    The bolded part is also a non-sequitur. Even if our origins are “random” (whatever that word means after all the Creationist verbal legerdemain), it doesn’t entail anything about morality or obligations. Even if we were created by some sort of higher power, I don’t see how that would entail anything about morality or obligations.

  24. #24 Ahistoricality
    April 19, 2006

    I’m reminded of the old joke:

    What do you call someone who graduates at the bottom of the class in medical school?

    Doctor.

  25. #25 Flex
    April 19, 2006

    They used call such practitioners quacks.

    I prefer to call them technicians. Meaning no offense to technicians who do rely on critical thinking skills to perform their jobs, the general distinction between a technician and an engineer is between understanding the underlying concepts of a profession and simply manipulating already developed tools to achieve a result.

    The difference between the two is that the technicians can perform the functions they are trained to do, and even apply those operations to things they were not trained on. The engineers are the ones who can tell if the function is appropriate to reach the desired result.

    A great number of physicians seem to be technicians. There are a number of treatment options available for any particular medical condition, and the physician selects the treatment option which makes to most sense to them. There are other physicians who are researchers attempting to determine if the treatment option is proper for the medical condition.

    Both professions are necessary, important, even critical for our society to function. The technicians maintain the current status of the technological development of our society and the researchers work toward improved technological development.

    While it may be a shame that some technicians refuse to understand the underlying knowledge which makes their work effective, this does not mean that the technician’s treatments are ineffective.

    I reserve the term ‘quack’ for those who not only disregard the underlying principles of a profession, but also substitute known ineffective treatments in place of known effective ones. Alice can still be a very effective physician without knowing the underlying principles which generated the medical knowledge she is using. This does not make her a ‘quack’.

    Of course, not understanding the underlying principles of a profession is a gateway to ‘quack’ beliefs. Like electronics technicians falling for ‘vacuum-state’ free energy machines (and I’ve known a couple), not clearly understanding the underlying principles behind a profession prevents a person from spotting claims which violate those underlying principles. That is an open invitation to ‘quack’ ideas.

    -Cheers,

    -Flex

  26. #26 compass
    April 19, 2006

    Can one have a belief in a higher power, and still be a sound scientist, My answer to this is a resounding YES!!!!

    Is this true for you as well? If so, then we have no argument.

  27. #27 compass
    April 19, 2006

    Buridan:

    . . .while denying its very core.

    What IS that very core?

  28. #28 Nymphalidae
    April 19, 2006

    Creationism is science just like evolution, which is a religious belief just like Creationism.

    Just….stop. Please.

  29. #29 Sid Schwab
    April 19, 2006

    I’m a surgeon. Here’s what I said about evolution in my newly published book (available in the usual places, online and others) “Cutting Remarks; insights and recollections of a surgeon.” And no, I’m neither a creationist nor an evolution-denier:

    “Darwin might have been wrong:
    when you see the body’s response to massive trauma, you have
    to figure that evolution bailed out early. If you get yourself into
    that kind of mess, it said, you’re gonna die. Up to a point, shock is
    a reasonable response to injury. First of all, it makes you lie down,
    if you’re not smart enough to do it yourself. Then it shuts off the
    blood going to unimportant places–your arms and legs and belly,
    for example–and sends it where it’s most needed: your brain and
    heart. But since you’d like to have your kidneys, your liver, and
    your bowels back at some point, you’ll want to return circulation
    to those places before too long. For small injuries (maybe the things
    evolution was dealing with) it works out fine–lie down, have a
    bowl of mastodon soup. But for major modern trauma, body
    response can become disease, with treatment making it worse.
    Injury releases various bad substances into the bloodstream which
    can make capillaries leaky (the smallest and most diffuse and metabolically
    active blood vessels). So when you give the huge amounts
    of fluids needed to overcome deep shock, it seeps out everywhere.
    The body becomes one of those party-favor sponges that quadruple
    in size when you add water, turning itself into an unrecognizable
    shiny-skinned blob; worse, the lungs fill up with fluids. Patients
    need ventilators, using higher and higher pressures to hammer
    air through the soup in their chest. Then the high pressure and
    high oxygen levels themselves cause more problems: perforated
    lungs, oxygen toxicity. Or this: injury makes blood more likely to
    clot, which makes good sense. But it can go crazily wrong, making
    little clots form throughout the bloodstream, which eats up
    all the protein factors needed for blood to clot, which then causes
    uncontrollable bleeding everywhere. These conditions–ARDS
    (acute respiratory distress syndrome) and DIC (disseminated
    intravascular coagulation)–end in death for many badly injured
    patients. Dr. Blaisdell, and Trunkey and
    others after him, made several important
    contributions to their treatment.
    At the County we were witness to, and
    participants in, the occasional save of
    the previously unsalvageable; and after
    doing it for days on end, some of it
    sinks in.”

  30. #30 Nymphalidae
    April 19, 2006

    Here’s a thought – maybe Creationists don’t want to go to a doctor who is an Evilutionist, but I sure as fuck wouldn’t go to a doctor who is a Creationist. For example, you can tell the difference between a computer scientist and the guy down at the computer shop. Computer scientists understand the mathematics and the theory behind their work, and thus does a superb job with my computer. The guy downtown at the shop knows the basic stuff and probably does an adequate job, but I’m never going to trust him with something of any importance to me, like my data.

  31. #31 Joshua
    April 19, 2006

    I’m not sure how much room there is in the med school curriculum for classes of evolutionary theory (at least, being a med student facing final exams right now, I find it hard to believe there’d be room). But there shouldn’t have to be – evolution is something to be learned in the undergraduate biology classes are prerequisites for med school. Maybe the people who write the MCAT could put a couple more questions on evolution in the test? Or admissions committees could pry a little into what applicants think of evolution?

    There’s no one in my class as outspoken as Alice on evolution or ID, but I suspect there’s a couple creationists lurking about. Luckily, there are enough of us who do realize ID is bullshit, and we’re both vocal and non-collegial enough to make fun of creationists. So y’all can take relief in the fact that creationists are a mocked minority in at least some med schools.

  32. #32 Jeff
    April 19, 2006

    The chihuahua lost the ability to grow large…

    And apparently, the Saint Bernard lost the ability to remain a reasonable size.

  33. #33 tgibbs
    April 19, 2006

    The days when physicians received a broad scientific training are long gone. Medicine is technology, not science. As somebody who teaches in medical school, we teach the minimum amount of basic science required to understand the material. Med students have all that they can handle just trying to master the practical aspects of their art–they simply don’t have the time to spend contemplating things like evolution, and they get very impatient if we ask them to do so.

    What an MD knows about evolution he probably learned as an undergraduate.

  34. #34 compass
    April 19, 2006

    CAn anyone respond to Sid Schwab intelligently?

  35. #35 reboho
    April 19, 2006

    Creationism is science just like evolution, which is a religious belief just like Creationism.

    Just….stop. Please.

    Logic circuits overloading, must resist, must resist…….
    Make it stop! …………

    Make it stop!!!!!!!!

    Whew! Just reread the part about sinners being cast into the lake of fire and I feel much better now.

    (humor off, couldn’t resist) You can go back to your lives now, Citizens.

  36. #36 Rosie
    April 19, 2006

    RPM, you said:

    “Secondly, don’t most premeds engage in some research as undergrads? It was my impression that the competitive nature of med school application requires a resume with some research experience.”

    In some countries, like the UK, most medical courses *are* undergraduate courses (some postgraduate medical courses do exist now).

    Alice: The correct plural of “genus” is “genera”.

  37. #37 KeithB
    April 19, 2006

    I am not a doctor – Orac is probably the best qualified to reply to Dr. Schwab, but I will give it a stab.

    Anything that puts you in the hospital these days, is probably something that Evolution cannot select for. After all, at that point the patient will die without treatment anyway, and not pass on his genes.

    Evolution *can* select for improvements to smaller injuries: fairly heavy bleeding, broken bones and such that cause death in a timescale to allow for the body to respond.

    It is like the sickle-cell mutation. The single gene is so beneficial to the population as a whole that losing a few folks to sickle-cell still has positive selection pressure.

    The current blod-clotting regime works best to help animals with *common* (eg, a predator missing the mark) injuries survive to breed, while others (the predator drops dead in the middle of the meal with the meal still alive) are rarer and not selected for.

  38. #38 Peter Barber
    April 19, 2006

    The “simple abiogenesis” experiments involved carefully controlled environments with external input. The scientists put the specific chemicals that they knew would be conducive, they chose the temperature, and provided the electrical stimulation (I believe it was). That’s not random.

    Alice, doctor-to-be or not, you must learn to cite your references better than that. Try this¹.

    If you had read the paper to which you’re referring, you might realise that Miller and Urey were attempting to reproduce the chemical conditions on the early Earth, not those “that they knew would be conducive”. Of course that’s “not random” – it’s called experimental design. Next time you’re doing an experiment involving random chemicals and high voltage discharges, please warn the emergency services first, mmkay?

    1. Miller S, Urey H. Organic compound synthesis on the primitive earth. Science 1959; 130: 245-251

  39. #39 Rosie
    April 19, 2006

    Keith, I see what you’re saying but I think your meaning has got a little tangled up in the words.

    Maybe a better way to express it is that:

    There is an injury, X, which is very, very likely to kill the organism which gets the injury, regardless of its phenotype. Some organisms will still be somewhat better at coping with the injury due to genetic variation, but the chance that any individual will die from the injury is so high that the relative difference in survival between well-adapted and less well adapted individuals is very low.

    (If the death rate is 100%, there is no difference in chance of survival between well-adapted and less well adapted individuals)

    If there is a chance that the individual can recover from the injury, then natural selection can operate on the variation that confers more/less resistance to the injury – but it will probably take longer for any significant evolution (as in change in allele frequency in the population) to occur than it would for an injury for which being better or less well adapted to recover from that injury has more impact on your overall chance of survival.

    As in: you might have alleles that make your spinal cord less vulnerable to injury, but if you’re under the guillotine your chance of survival is pretty much as low as that of the person next to you in line with an extra-easily-injured spinal cord… so you would not expect alleles conferring spinal cord injury resistance to increase significantly in frequency in the population **as a result of the selection pressure of the guillotine**.

    But the spinal cord resistance would also decrease your chance of dying from other injuries with lower fatality rates, so that could cause the resistant alleles to increase in frequency in the population over time.

    I hope I have made some sense here :-S

  40. #40 Peter Barber
    April 19, 2006

    Compass,

    The only point Sid seems to be making is that the body’s compensation mechanisms (clotting, vasoconstriction, capillary permeability etc.) can only do so much, and that in any case they’re not optimal responses to trauma, as ARDS and DIC show. I’m not quite sure what “sinks in” after several days, or how his post is relevant to a discussion of creationism in medicine. Maybe he’s trying to say that we’re simply “not meant” to survive severe trauma for some reason known only to a creator, but if so why? and if not, it hardly smacks of good “design” either.

  41. #41 Rosie
    April 19, 2006

    “Maybe he’s trying to say that we’re simply “not meant” to survive severe trauma for some reason known only to a creator, but if so why?”

    Duh, so God can kill you when he feels like it.

    Question: Could an omnipotent Creator make an organism too good at surviving for the Creator to kill?

  42. #42 KeithB
    April 19, 2006

    Rosie:
    Thank you, your explanation does seem a bit clearer.

    Peter:
    Exactly, he seems to be saying that because the various healing mechanisms fight each other in the case of severe trauma, we were obviously designed.

    As you said, this seems to be turning the typical ID argument on its head – but they usually like to have their cake and eat it, too.

  43. #43 Neil
    April 19, 2006

    I am 4th year med student in University College Cork, I have been reading these evolution blogs for sometime now and I have been fascinated by them all.
    I started looking them up, to argue for evolution and debate some of my creationist (mostly muslim) classmates.
    I just want to say I really have an issue with creationists in medicine, I believe medics should understand the principles of science the central notion of evidence based practice… if God says evolution is wrong and you believe it, what happens when religion conflicts with evidence of medical best practice do you ignore that too…
    I think people should be allowed believe what they want, but faith is not what medicine should be based on.

  44. #44 Sid Schwab
    April 19, 2006

    Wow! I was absolutely NOT making an argument for ID of any sort. I was making a factual statement of how under some circumstances, body responses are bad for you. The Darwin comment was for humor, making a point but not actually arguing that Darwin was, in fact, wrong. It’s true, as someone pointed out, that part of the point is that evolution can’t be at play when discussing certain modern facts: the response to injury as evolved was satisfactory (as I said in the mastodon soup comment) for the sorts of trauma seen a few millenia ago. Evolution — if I may speak simplistically — didn’t envision 357 magnums at close range; so the trauma responses we see are not always useful. In summary: it was an attempt at amusing writing. Including it in my post was an entirely disingenuous attempt to get a few people to buy my book. It’s about training to be a surgeon, in the days of 120 or 140 hour work-weeks. It’s not a political or religious screed. It brings the reader along for the ride, and, quite graphically, into the OR on the way… And, for the record, I can’t envision a designer. For one thing, I can’t get past the ultimate question: who designed the designer? If a designer can exist without having been created, why not the universe? But that’s another story. Just buy my book.

  45. #45 The Brummell
    April 19, 2006

    “Question: Could an omnipotent Creator make an organism too good at surviving for the Creator to kill?”

    Strangely enough, the hypothetical contender I can think of for that ability has been named a “Darwinian Demon” (or perhaps “Daemon”).

    If you take a straightforward population genetics model, something designed to study the processes of evolution, and plug in an organism that has infinite survival and infinite reproduction (ie, lives forever and produces an infinite number of offspring each time-period), you can actually get informative results (depending on the model you started with).

    Also, Alice, why did you link to AiG? The entire AiG site is completely wrong on multiple levels. Everyone here knows this already. Leaving aside the obvious, awe-inspiring ignorance of what Evolutionary Theory ACTUALLY SAYS, it’s not even self-consistent! Right away: Genesis 1 (6 days, light then earth then animals then Adam and Eve) and Genesis 2 (Adam’s lonely, God takes a rib and builds Eve) contradict each other.

    Has anyone ever seen a half-way reasonable argument to reconcile Gen 1 and Gen 2?

  46. #46 Chris
    April 19, 2006

    ID belongs in philosophy class as a test case of “what’s wrong with this argument?” analysis. Theology classes typically don’t teach or practice this type of analysis – it’s too dangerous. You don’t want your seminary students running around with baloney detection kits if you don’t know where they’re going to aim them.

    From there it can go to psychology class to answer the next question, “given that this argument has this list of flaws, why do people believe it anyway?”

    Alice attacks some abiogenesis experiments for selecting which conditions to simulate (out of all sets of chemical, temperature, light/radiation and weather conditions that applied on the prebiotic Earth).

    Well, if they were able to build a laboratory the size of the Earth and run the experiment for a billion years before expecting results, then they wouldn’t have had to pick a particular set of conditions that they thought would be most likely to yield results. But all the conditions they simulated did, in fact, occur somewhere on the prebiotic Earth (including electrical discharges – lightning.) And the results they got, while less than total, aren’t bad for one-billionth of the time taken for the original abiogenesis, in far less than one-trillionth of the space.

  47. #47 Rosie
    April 19, 2006

    Was just having a think and maybe this is clearer than what I was trying to say. Maths is not my strong point – I’ve just been having a play with some numbers. Sorry for any errors etc – please point them out! (I know you will!)

    Say you have a gene A/a, which affects your chance of surviving Injury.

    Image hosting by Photobucket

    The graph shows the survival rate of aa individuals relative to AA/Aa individuals for

    a) different phenotypes resulting from the aa genotype (i.e. how much being aa alters your chance of survival relative to AA/Aa individuals)

    b) different injuries – more or less likely to kill you.

    aa individuals have the least advantage over AA/Aa at the extremes of injury severity (which makes sense). However, the injury severity at which aa individuals have the greatest relative advantage depends heavily on how “good” the aa genotype is at tolerating the injury overall.

    I.e. if aa’s are only slightly better at tolerating a particular injury, (as for Injury A), aa’s have the biggest selective advantage when the injury is more severe than when it is milder. But if the aa’s are much better at tolerating a particular injury (as for Injury C), they have more of an advantage for milder injuries.

    I’m not sure if anyone is following me by this stage…

    Anyway, my overall point is that it is not easy to say under which circumstances one genotype will have enough of an advantage that it is likely to be selected for and lead to evolution, beyond saying that injuries with zero and 100% morality rates will not cause selection of genotypes that cope with those injuries better.

    (Even very small differences in the relative survival rates of AA/Aa and aa can lead to evolution, but it’s likely to take far longer; the variation in survival due to genetic variation will be very small compared to variation from other sources).

    I.e. there is not much point in saying “X injury is really
    bad and lots of people die of it –> why haven’t we evolved a better way to deal with X injury?”. There is not necessarily a stronger selective pressure for increased resistance to an injury just because the injury is bad – in fact, it is the opposite at high levels of injury severity.

    Sorry for length!

  48. #48 Rosie
    April 19, 2006

    Ahh! It ate my link!
    see pic and table here:
    http://i5.photobucket.com/albums/y172/crana/graph.jpg

  49. #49 Rosie
    April 19, 2006

    Really sorry to post again, I just saw the latest comment from Sid & wanted to make it clear that “there is not much point in saying…” in my post is not aimed at his earlier comments – more of a general point sparked by what he said.

  50. #50 Orac
    April 19, 2006

    But I would be interested to hear your response to Alice’s comment:

    Both evolution and creation are religious beliefs. Is there a Higher Power who created you, to whom you owe your existence, and to whom you are responsible?

    Why does it matter what my answer to the question is?

    One thing I will say is that it’s a load of crap to call evolution a religious belief. Sorry to be so blunt, but that’s one creationist “argument” that never ceases to annoy me.

  51. #51 David Canzi
    April 19, 2006

    I’m not sure, from his discussion of shock, what Dr. Schwab thinks Darwin might have been wrong about.

    A mechanism such as shock will be selected for, in spite of the fact that it kills, if it saves more individuals than it kills. If, under modern conditions, it frustrates medical intervention and kills more people than it saves, this doesn’t indicate that there is some problem with the theory of evolution.

    The adaptations we end up with are the ones that saved more individuals than they killed under the conditions our ancestors lived in, not under today’s conditions. We, and for that matter any other evolving species, are in a sense always dressed for yesterday’s weather.

  52. #52 Orac
    April 19, 2006

    I was making a factual statement of how under some circumstances, body responses are bad for you. The Darwin comment was for humor, making a point but not actually arguing that Darwin was, in fact, wrong. It’s true, as someone pointed out, that part of the point is that evolution can’t be at play when discussing certain modern facts: the response to injury as evolved was satisfactory (as I said in the mastodon soup comment) for the sorts of trauma seen a few millenia ago. Evolution — if I may speak simplistically — didn’t envision 357 magnums at close range; so the trauma responses we see are not always useful.

    I didn’t see all the comments on this post until now. Basically, I think people misunderstood, although I think you did it again with your remark about the .357.
    Being gored by a lion or other predator or falling out of a tree or other high place can do damage that evokes a response every bit as nasty as the injury caused by a .357 Magnum–worse, in fact, because it’s not nearly as localized.

    In any case, one can speculate that the adaptive responses of inflammation work well for mild to moderate injuries and infections. Fever, inflammation, macrophage and neutrophil chemotaxis, and cytokine release probably provided an advantage. However, in large scale injuries, the massive cytokine release is counterproductive, and the chance of fatality is high. Even so, it’s possible that a more vigorous cytokine response could be the difference between a 90% fatal injury and an 85% fatal injury, and that could be enough selective pressure even in severe injury.

    The bottom line is that we don’t yet know the evolutionary background behind systemic inflammatory response or sepsis, but clearly a response that is adaptive for minor to moderate injuries can be detrimental in more severe injuries.

  53. #53 Abel PharmBoy
    April 19, 2006

    I really feel like this is something for PharmGirl, MD to discuss and am trying to twist her arm to do a guest post at Terra Sigillata. Until I can, I’ll just put in my two cents from the PhD side.

    I agree with tgibbs that there is little time for the consideration of evolution in the context of didactic medical education, thereby relying on undergrad or high school preparation. But surely, critical thinking skills are implicit in clinical training as they are essential to diagnosis, evaluating the literature, and making pharmacotherapy treatment decisions (or at least contributing to decision making on your institution’s P&T committee). How can someone with 11 years of post-BSc education subscribe to evidence-based medicine yet believe that evolution is a fallacy?

    However, I’ve had several experiences giving CME presentations to docs about herbal meds/dietary supplements and then being approached by one afterward about becoming a franchisee in their supplement distributorship. Correct me if I’m wrong, but I believe that selling supplements out of one’s practice violates AMA guidelines.

    Anyway, if I bought into at least one I’ve them, I’d be wealthy enough now to actually go back to med school!

  54. #54 Barry
    April 19, 2006

    Sid’s comment is, perhaps a data point in favor of the doctor-as-technician argument. It doesn’t reflect a lot of thought. As has been pointed out above, evolutionary arguments would predict bodily responses which helped significantly in survivable situations. What happens drastically outside of those limits will not be selected for/against.

  55. #55 David canzi
    April 19, 2006

    Sid Schwab said: “I was making a factual statement of how under some circumstances, body responses are bad for you. The Darwin comment was for humor, making a point but not actually arguing that Darwin was, in fact, wrong.”

    In cyberspace, no one can hear you chuckle.

  56. #56 Sid Schwab
    April 19, 2006

    I appreciate Orac’s response. But, just to be sure it’s understood, when I made the original Darwin comment, it was just a device to lead into the discussion. I’m a firm believer in evolution (although “belief” isn’t at play with evolution any more than it is with the germ theory. I accept as fact… It’s not at all the point of my book. I try to explain certain “surgical” concepts to the reader, and that was a way to do it. I think, in the context in which it appears, it does not conjure such controversy. One might speculate, however, that if every person of reproductive age were subjected to the equivalent of the 357 magnum, we’d see evolution of different responses among the descendants of the survivors.

    And if I may: I used to be more generous to differing beliefs. But I have for years at least wondered about fellow physicians who were Bible literalists. I think that whereas physicians may not all be scientests, they surely must realize that we are among the greatest benificiaries of it. As such, willingly to compartmentalize bible literalism is a feat of such overtly contradictory mental machination that I figure they must take out one brain and leave it in a bell jar in the bathroom, popping in another to go to work.

  57. #57 Sid Schwab
    April 19, 2006

    Sid’s comment is, perhaps a data point in favor of the doctor-as-technician argument. It doesn’t reflect a lot of thought. As has been pointed out above, evolutionary arguments would predict bodily responses which helped significantly in survivable situations. What happens drastically outside of those limits will not be selected for/against.

    Which is EXACTLY, if you read it again, is the point I was making!

  58. #58 anon 903
    April 19, 2006

    http://www.post-gazette.com/pg/06095/679689-114.stm

    A link to why knowing about science, genetics and mutations may be a good thing if you are a doctor. Especially an oncologist.

    As for med schools upping scientific requirements- dream on baby!!

    Go to PBS, look up the NEW MEDICINE show, follow the links, and then count the prestigious medical centres and people involved in this bit of pseudoscience….

    They don’t just cure you- they heal you- which means it is okay to croak, because somehow it was meant to be.

    Win Win for them. Personally I would like the attack dog doctor at my side during a crisis.

  59. #59 drdefaccto
    April 20, 2006

    Alice: But to take abiogenesis: this is the starting point that evolution has to have.

    No, evolution, as a scientific pursuit, has to have as its starting point the observation of natural phenomena, unlike creationism, which takes its starting point in Genesis. A classmate of mine asked me once something like, “Don’t you believe the Bible is inerrant?” I said that I didn’t think God intended scripture as a science text. He said he didn’t think so, either. But he did, and probably still does.

    Only loosely related to this, I see a strong parallel between medical practitioners and engineers, trying to solve real-world problems using tools derived from science. The difference in mentality between a creative tool-user and rule-applier, on one hand, and an explorer of the boundaries of knowledge, on the other, is huge. One is a “good kid” and conformist; the other a rebel and rule-breaker. There’s probably a birth-order relationship here….

  60. #60 Flex
    April 20, 2006

    One final point in response to drdefaccto,

    I would be careful about labeling scientists, engineers, technicians, physicians, or any people anywhere as rebels or conformists.

    We are all, at various times, rebels and conformists, creative thinkers and rote followers, explorers at the boundries of knowledge and pundits of popular views.

    We, as social animals, also seem to respond to others expectations of us, so if our managers, co-workers and companions expect us to be conformists we are conformists. But one thing that I have learned over the years is that everyone is strange in some way. Everyone expresses themselves creatively at some time. This could be through work, hobbies, or activities. In my office I know two people who are avid military historians, several small boat sailors, a number of hunters, a plethora of guitar players, some parents who explore the world through their children’s eyes, gardeners, readers, writers, scrapbookers, perpetual students, part-time teachers, and many more. They may not all be creative at work, but they express their creativity and pleasure it brings them in other ways.

    One of the pleasures of being human is discovering the broad range of interests and knowledge that other humans have.

    Cheers,

    -Flex

  61. #61 BronzeDog
    April 20, 2006

    Quick comment for Sid: At least I understood your post. I was about to get fired up when I read the “humor line”, but the rest of the post got me to see your actual argument.

  62. #62 reboho
    April 20, 2006

    compass said:
    CAn anyone respond to Sid Schwab intelligently?

    Posted by: compass | April 19, 2006 06:33 PM

    Sid Schwad said:
    Wow! I was absolutely NOT making an argument for ID of any sort. I was making a factual statement of how under some circumstances, body responses are bad for you. The Darwin comment was for humor, making a point but not actually arguing that Darwin was, in fact, wrong.

    compass probably said:

    Ummmm…check please….

    Chrous said:

    compass?

    compass, with needle spinning, thinking:

    Ummmm…I got nothin’….

    compass replies to Chorus:

    I have an appointment to get my N/S realigned, I’ll get back to you…….

  63. #63 KeithB
    April 20, 2006

    Sid:
    Sorry to misunderstand your intentions, but as has been pointed out, it is very difficult to parody ID’ers or Creationists, since they can use arguments like that with a straight, even smug, face.

  64. #64 Sid Schwab
    April 20, 2006

    Keith: no problemmo. A lesson learned for me, as well.

  65. #65 IndianCowboy
    April 20, 2006

    Orac, great post, as a med student in a very very red state, I’ve seen a whole lot of ID supporters and yes, even young earth creationists among my number. I think you’ve mentioned nearly everything I was going to in a post I was planning on writing sometime in the vague future. Oh well.

    RPM said:

    Secondly, don’t most premeds engage in some research as undergrads? It was my impression that the competitive nature of med school application requires a resume with some research experience. Given that most research at an undergraduate institution is not of the clinical variety, shouldn’t they at least have some understanding of how basic research is done?

    ‘research’ seems to consist of pipetting. At the undergrad level at least. THe questions they’re asking/answering are simply too small, too simple, and too insignificant for it to have any real effect on the way these students think.

    Obviously present company excepted, but one thing a lot of people don’t realize about med students is that never in their educational process is critical thinking encouraged. As one of the commenters mentioned, a lot of med students/doctors basically become technicians. There’s a big difference between learning about science and learning how to do science. One thing I’m fortunate for is that I was able to get at least some training in how to do science (masters in bioanthropology) before medicine sucked me in. And the one thing that hits me day after day is that med school (at least the first two years) is like first year undergrad all over again. ‘learn this’, ‘memorize that’.

    To those who say there’s no room for more evolution education, *snort*.

    I’m almost done with my first year of med school, and it’s amazing how much of this stuff I’m told by recent graduates and long-time practitioners I will never see/use again (except for USMLE Step 1 next summer). Instead of useless classes, why not spend more time on evolution? After all, as Dhobzansky said, “nothing in biology makes sense except in the light of evolution”

    One last point, biology/evolution education at the high school and introductory undergrad level needs to be drastically revamped to something more like physics. Instead of being a massive population genetics/mathematical equations borefest, we ned to introduce people to the theory and the whole of the theory. And not only that but introduce them to the evidence. I took AP biology in HS, took at least 5 evolutionary bio courses in undergrad, and got a master’s in human evolution, and amongst all that coursework, not once did the professors treat it as their responsibility to cover why evolution is fact

  66. #66 frankis
    April 25, 2006

    One trouble with ID, Alice, is that it has little to no explanatory power as compared with a scientific theory such as evolution. The theory of evolution enables you to understand more in the future than you do already by applying the simple insights it gives you into the nature of life.

    Another thing is that a priori religious beliefs will force you into blinkers that constrain the intelligence you otherwise clearly exhibit. Think about the potential for growth of the scientist whose daily work involves her in applying the insights gained from an education as well as her own research experience in evolutionary biology. She’s still quite able to have religious faith if she likes, there’s no prohibition of that in science. But there’s a clear advantage for her when compared to the more religious individual, beholden firstly to the authority and dogma prescribed for her by others, yet who’s also attempting to research or practice in a scientific field. In science as in religion it’s open minds that gather knowledge and wisdom, things that we all love to find in others.

  67. #67 difficult patient
    April 25, 2006

    Hmmmmmm, I need to have my 14-year-old read your blog! We have been going round and round on this very issue . . .

  68. #68 Dr. Steve
    May 5, 2006

    Evolution is not religion.

    Proof: Evolution does not threaten you with eternal damnation if you don’t believe in it.

  69. #69 Tony P
    December 27, 2007

    In the past I’ve heard about hyper religious and creationist M.D.’s but thought nothing of it. Here in the northeast I doubt you’d find such a creature.

    I spent this Saturnalia/Christmas at the in-laws place in North Carolina. Eye opening indeed since religion pervades everything.

    Met a friend of the SO’s whose daughter is just starting her residency. She’s a Jesus freak so I asked the ID question. Yes, she believes it. I didn’t challenge her training as an M.D. because I didn’t have the time to do so. But it disturbed me a great deal.