Pharyngula

What’s the matter with M.D.s?

Take a look at this interesting discussion of a recent PLoS article in which publications in medical journals are reluctant to use the word “evolution”:

According to a report released last week in PLoS Biology, when medical journals publish studies about things like antibiotic resistance, they avoid using the “E-word.” Instead, antimicrobial resistance is (euphemistically, I suppose) said to “emerge,” “arise,” or “spread” rather than “evolve.”

This decision has consequences, too—popular press descriptions of the work then tend to avoid using the word “evolution”, too. This is exactly the kind of run-around that allows kooks like Phil Skell to claim that modern biology doesn’t actually need evolution (although, truth be told, Skell is so looney that he claims papers on evolutionary biology that use observations of fossils or gene frequencies don’t really need evolutionary theory).

Of course, what this is all about is really just to have an opportunity to tweak the noses of the good doctors here at Scienceblogs, like Orac and Revere and Charles and Craig—what’s wrong with these M.D.s? Are they poorly educated, cowardly, or do the granting agencies or journal publishers actually pressure them to avoid ‘controversial’ words?

There is some degree of seriousness to the question. This habit has effects; what can we do to correct it?

Comments

  1. #1 Stogoe
    February 21, 2007

    Well what do you expect with mandatory CAM courses in med school?

  2. #2 llewelly
    February 21, 2007
  3. #3 carlman23
    February 21, 2007

    This is really sad… Some of my fellow grad students and I have been playing around with the idea of peer-reviewed popular-press journals about science. Articles would of course be reviews in format. Something to combat the ‘spin’ of the media and get people thinking about real science and how it actually works. It may not count for professional credit, but I’m sure a lot of scientists are dying to communicate with the public (hint, hint šŸ˜‰ )

    Mind you, if the actual journals/agencies themselves are employing some form of censorship, then that would be terrible. Perhaps this is cause for pressure towards an investigation? How, I’m not sure.

  4. #4 Brian
    February 21, 2007

    As a biomedical student, I’d have to say that the reason is that the organism that we are primarily interested in is now evolving so slowly (due to the ever-increasing size of the gene pool for the average person) that we really consider evolution to be something that happened in the past. Additionally, biomedical people are used to thinking of evolution in terms of model organisms vs humans, where the evolutionary divergence is on average about 80 million years ago.

    It may not be right, but when we hear the term “evolve,” we think of what the creationIDsts are trying to say when they say “macroevolution.”

  5. #5 Saint Gasoline
    February 21, 2007

    There’s only one thing we can do…

    We have to make the medical environment unsuitable for these pansies, so that the invisible hand of natural selection may remove them from the meme pool.

  6. #6 drcharles
    February 21, 2007

    just saw this post before heading home for the night. i can think of three reasons: the first logical, the second conspiratorial, and the third nonsensical.

    “Instead, antimicrobial resistance is (euphemistically, I suppose) said to “emerge,” “arise,” or “spread” rather than “evolve.””

    this vocabulary seems to stem from the epidemiologists and infectious disease types, who study “emerging” patterns of antimicrobial resistance, “emerging” threats like Ebola and mutating H5N1 that can be almost visualized on a map of expanding red circles of doom. They are supposed to focus on real time trends and short-horizon patterns of resistance as they relate practically to public health rather than the long run biology.

    conspiracy theory:
    “evolving” has a built-in negative connotation with selective pressures driven by lazy/fearful/defensive doctors who prescribe zithromax for every viral URI they see so as to please security moms and avoid missing pneumonia. but we do admit as a profession to over-prescribing antibiotics and try to reinforce their judicious use, so a conspiracy to suppress a “mea culpa” by using the term “evolve” seems not right either. now that i’m thinking out loud, maybe the use of the terms “emerge,” “arise,” or “spread” actually blames us more for our overuse (and agricultural overuse in livestock) than the seemingly natural/detached term “evolve.”

    Hyperconspiracy theory : the only hope we ever have of caps on pain and suffering awards that are killing us in medmal are republican measures introduced into congress, and you know santorum didn’t like the word evolution. but this is absolutely not the reason, just for fun that i include it.

  7. #7 Brian
    February 21, 2007

    I’d have to disagree, drcharles. I think that ‘evolve’ implies change in response to a selective pressure (like docs overprescribing antibiotics). Arise/emerge sounds more like something that just happens on its own.

  8. #8 Dianne
    February 21, 2007

    Sticking the keyword “evolve” into medline gets 476 pages of hits and “evolution” gets 9521 (20 articles/page), if that makes anyone feel better.

  9. #9 Don Monroe
    February 21, 2007

    One nonconspiratorial explanation would be that bacteria have many mechanisms for expanding their genetic repertoire, beyond the mutations that drive most evolution at our level. In fact, much resistance does indeed spread, by lateral gene transfer, transposons, plasmids, naked DNA, etc. In this case the resistance does not evolve, but moves between individual bacteria and between species. It might be reasonable to say that the bacteria are evolving, but the whole question of the nature of bacterial species is somewhat flexible as it is because of the horizontal transfer.

    Or maybe they’re just being wimpy.

  10. #10 Maria
    February 21, 2007

    I don’t know what the best way to phrase it would be, but I find that both “evolve” and “emerge” give the wrong impression to a layman. It makes it seem like antibiotics *cause* bacteria to develop a resistance, as opposed to natural variation meaning some bacteria are already resistant, and antibiotics kill the others.

  11. #11 Orac
    February 21, 2007

    Orac has an excellent post on this.

    I’m–sniff, sniff–devastated the PZ doesn’t read each and every pearl that I post to my own blog.

    šŸ˜‰

  12. #12 Jonathan Badger
    February 21, 2007

    Well, as people have somewhat already alluded to, evolving antibiotic resistance sort of implies a random mutation conferring resistance that is selected for. That’s not the only (or even most common) way bacteria gain antibiotic resistance. Of course, some would argue that’s because since the New Synthesis the selectionists have monopolized the term “evolution”.

  13. #13 Chris Clarke
    February 21, 2007

    I like Don Monroe’s idea sitting here with my editor hat on, though I don’t know that it would account for more than a minority of the usage examples.

  14. #14 'As You Know' Bob
    February 21, 2007

    It’s possible that they don’t mention “evolution” at every opportunity any more than they feel they have to mention the local value of g at every instance. I don’t know if avoiding the term is a real problem or not in the medical literature, but the wingnuts are everywhere, and they are always vigilent against Satan’s Special Word.

    A co-worker of mine is a Reservist. He went to some mandatory training or other, and the instructor starts out innocuously enough:

    “We’re going to talk about the evolution of the NCO’s job.”

    Instantly, a wingnut reflexively objects:
    “But there is no such thing as ‘evolution’!”

    I mean, really: how does a society cope with omnipresent wingnuttery? (Other than outright mockery, I mean.)

  15. #15 Tony Popple
    February 21, 2007

    I suppose on some level, it is very ironic that doctors have an aversion to evolution. If humans were designed and build by an engineer instead of being cobbled together through evolution, doctors might not have much to do.

    Instead, my doctor and I are looking at my family history and discussing all the things that are going to fall apart before I am done using them.

  16. #16 quitter
    February 21, 2007

    It’s just a numbers issue.

    Med schools are graduating thousands and thousands of doctors each year. Something like 30-40k doctors are licensed in any given year, and training in medschool is a lot of memorization of facts that is rarely tied to the basic science that took decades to uncover the medical treatments and understanding of physiology. Med students simply don’t have the time to learn everything about everything and the history of how muscarinic receptors were discovered, or how basic science led to the discovery of proton pump inhibitors.

    I’d say it would be worthwhile to try and teach them, but it would never work, they just don’t have time.

    So any asshole with good grades who can incorporate buckets of information at a rapid pace will succeed in medschool, there is very little need for scientific thinking (until you get to the wards, then I think it’s quite useful if infrequently used). For the most part, it’s a job based on apprenticeship and memorization. The mistake is thinking that an MD degree is a degree that confers expertise in the sciences. It really is not, although those with a scientific proclivity can do a great deal with the degree.

    Now, MD/PhD’s on the other hand…

  17. #17 John Emerson
    February 21, 2007

    I worked in a medical school / research university for 25 years. The PhD-track people I knew didn’t have a lot of respect for the MD-track people (with individual exceptions).

    MD-track people can be a) primarily religiously motivated b) primarily materialistically motivated c) totally lacking in imagination and curiosity (compartmentalizers) or d) all three of the above.

    The best MDs are terribly admirable people, but the median MDs aren’t necessarily so. I think that the character of the field has actually been improving lately, as people have figured out that medicine isn’t as relatively lucrative as it used to be (compared,for example, to finance or management).

  18. #18 Glen Davidson
    February 21, 2007

    It would probably be better if they tied recent findings more closely to evolution, however it’s likely as others have said, that words like “emerge” seem to carry around fewer pre- and wrongful conceptions. In addition, “seeing it happen” seems less theoretical, and perhaps more evocative of the various physical processes which nearly everyone agrees occur. As such, emergence might seem more “natural”, and if properly tied to evolution, less off-putting than terms against which people stupidly react.

    It ought to be noted that Darwin also avoided the term “evolution” at the earlier stage, partly because many people thought then (like many do now) that it is some kind of unfolding of inevitable events. I don’t know if Darwin’s example speaks to us today, but perhaps it does suggest that using terms other than “evolution” need not necessarily hamper the message of biological sciences.

    Glen D
    http://tinyurl.com/35s39o

  19. #19 Scott Hatfield
    February 22, 2007

    On a related note, I’d like to pose a question for our friends in the medical profession. I had a conversation with an ID-friendly M.D. who claimed it was a slur to say that doctors are not ‘scientists’; to hear this guy tell it, pretty much all doctors do scientific research, all the time.

    I was skeptical. Most medical people I see aren’t doing research, they are doing applied science, albeit with impressive skill in most cases. I’d like to hear what medical professionals on this blog have to say as to how they distinguish the practice of medicine from science, and have them hazard a guess as to the percentage of their peers who would actually qualify under their criteria.

  20. #20 Ichthyic
    February 22, 2007

    I’d have to disagree, drcharles. I think that ‘evolve’ implies change in response to a selective pressure (like docs overprescribing antibiotics). Arise/emerge sounds more like something that just happens on its own.

    then that’s a pretty horrid understanding of evolution.

    here, try this:

    does it make sense to say in the case of microbial resistance that a mutation without selection would cause something of any notice to “arise”?

    hardly. without the selective pressure of the antibiotic to begin with, a random mutation that causes “resistance” wouldn’t be noticed to even identify something as “emerged” or “arisen” to begin with.

    ergo, your description simply can’t be how the term is being used, and it really does seem that the terms under debate here (emerge/arise) are being used in place of the proper terminology.

    nope, Orac and PZ hit the nosie on this one. something is back assward here, and needs fixing.

  21. #21 Ichthyic
    February 22, 2007

    to hear this guy tell it, pretty much all doctors do scientific research, all the time.

    perhaps the good doctor was just trying to give you a false impression to make you think better of doctors in general?

    surely you know for a fact that this is not the case, even without having to ask.

  22. #22 Dustin
    February 22, 2007

    Scott, I won’t argue over which kinds of M.D.’s are scientists and which ones aren’t since I know very little about medicine. But I do know enough to give a helpful criterion: An I.D. friendly M.D. is not a scientist.

    As for the topic in question, I think the students up at the top have probably summed it up. I doubt that the medical journals are deliberately trying to squelch the E-word, since something like 45% of American M.D.’s are agnostics or atheists (at least according to the Associated Press, which makes that figure every bit as reliable as the astrological talisman I had drawn up for myself this morning).

  23. #23 Dustin
    February 22, 2007

    And while the AP says one thing, the Journal of General Internal Medicine did one suggesting that 24% are agnostics or atheists (this, curiously, was also reported in the AP). That was a mail-in questionnaire survey, so it might or might not mean anything. If that survey does mean something, it’s probably cause for concern since 55% of the respondents also said that their religious beliefs factored into the way they practiced medicine. If that’s the case, there might really be a religiously motivated flight from the word EVOLUTION.

  24. #24 Doc Bill
    February 22, 2007

    You know, according to the AMA’s own stats, doctor’s screw ups kill well over 100,000 a year…more Americans than died in the whole Vietnam war. This is not counting all the people paralyzed, blinded, and stroked out from their failures.

    If the good Docs would spend more time on their work and less time on sites like this that use science as a front for political and relgious rants, it might be better.

  25. #25 afdave
    February 22, 2007

    “This is exactly the kind of run-around that allows kooks like Phil Skell to claim that modern biology doesn’t actually need evolution”

    *********************************************

    Evolution isn’t needed … in fact it is often a hindrance …

    Francis Crick, What Mad Pursuit: A Personal View of Scientific Discovery, Basic Books, 1988
    pp. 138-139
    Biologists must constantly keep in mind that what they see was not designed, but rather evolved. It might be thought, therefore, that evolutionary arguments would play a large part in guiding biological research, but this is far from the case. It is difficult enough to study what is happening now. To try to figure out exactly what happened in evolution is even more difficult. Thus evolutionary arguments can usefully be used as hints to suggest possible lines of research, but it is highly dangerous to trust them too much. It is all too easy to make mistaken inferences unless the process involved is already very well understood.

    and

    Ehrlich, Paul and L.C. Birch (1967), “Evolutionary History and Population Biology,” Nature, 214:349-352, April 22.
    p. 349
    Some biologists claim that an understanding of the evolutionary history of organisms is a prerequisite to any comprehension of ecology. We believe that this notion is having the effect of sheltering large areas of population biology from the benefits of rigorous thought. [Sounds like DI talking here.] It is clear that the phylogenetic origins of an organism, structure, or process may be of great interest, and that the elucidation of such origins is a legitimate subject for investigation and or speculation. We contend, however, that such investigation or speculation is not required for many studies of ecology and taxonomy. Indeed, since the level of speculation (rather than investigation) is inevitably high in phylogenetics of any kind, a preoccupation with the largely unknown past can be shown to be a positive hindrance to progress.

  26. #26 bones
    February 22, 2007

    If the good Docs would spend more time on their work and less time on sites like this that use science as a front for political and relgious rants, it might be better.
    Posted by: Doc Bill | February 22, 2007 04:35 AM

    Perhaps “Doc Bill” would be better served going to church at 4:35 in the morning or praying or helping the sick in hospital by attending at their bedsides as they get up in the morning than spouting stupid ignorant crap on sites like this….

  27. #27 Jud
    February 22, 2007

    afdave quoted a 1967 Nature article saying: “Indeed, since the level of speculation (rather than investigation) is inevitably high in phylogenetics of any kind, a preoccupation with the largely unknown past can be shown to be a positive hindrance to progress.”

    Worth noting that phylogenetics is a lot less speculative 40 years later.

  28. #28 Orac
    February 22, 2007

    Perhaps “Doc Bill” would be better served going to church at 4:35 in the morning or praying or helping the sick in hospital by attending at their bedsides as they get up in the morning than spouting stupid ignorant crap on sites like this….

    “Doc Bill” showed up on my blog too, posting the identical rant to an unrelated post.

    In any case, I’m having a hard time not getting a little miffed at some of the comments here, but I’ll restrain myself. I said pretty much everything I meant to say about this “study” here. Quite frankly, it’s a “well, duh!” study, a veritable tempest in a teapot that means very little. Of course, evolutionary biologists publishing in evolution journals are going to use the term “evolution” more than biomedical researchers publishing in medical journals! I’d be shocked if they didn’t!

    For another thing, the study found that the use of the word “evolution” in titles of papers and abstracts in the biomedical literature is increasing, and, contrary to PZ’s implication, the study itself provided ammunition to suggest that granting agencies aren’t blackballing evolution-related research out of fear of controversy.

    Finally, as I said in my post:

    Looking at it another way, it’s the difference in how the emergence (excuse me, evolution) of microbial resistance to antibiotics appears “in the trenches.” And when you’re in the trenches, “emerge” is what resistance appears to do (actually “emerge” and “spread”). What we as physicians dedicated to infection control then want to know is: How do we prevent the emergence of antibiotic resistance and, once it has appeared, how do we slow down its growth?

    Really, guys, this study isn’t that big a deal. It’s the difference between those who have to try to find practical ways to stop antibiotic resistant organisms from emerging/evolving and spreading and those who are more concerned with basic evolutionary principles.

  29. #29 Orac
    February 22, 2007

    I doubt that the medical journals are deliberately trying to squelch the E-word, since something like 45% of American M.D.’s are agnostics or atheists (at least according to the Associated Press, which makes that figure every bit as reliable as the astrological talisman I had drawn up for myself this morning).

    Actually, there is fairly good data out there to suggest that physicians are as religious or possibly even more religious than the general population.

  30. #30 windy
    February 22, 2007

    Well, as people have somewhat already alluded to, evolving antibiotic resistance sort of implies a random mutation conferring resistance that is selected for. That’s not the only (or even most common) way bacteria gain antibiotic resistance. Of course, some would argue that’s because since the New Synthesis the selectionists have monopolized the term “evolution”.

    What are these other ways that enable antibiotic resistance to “spread” significantly and don’t involve selection?

  31. #31 Scrapefoot
    February 22, 2007

    I have something to say in the defense of (some) doctors. Doctors focused more on practicing medicine rather than research can’t afford to be outspoken about evolution. As an example, my mother is a doctor and has actually used the “e-word” while explaining to a patient how her particular problem came into existence. The patient quickly snapped at her, “You don’t really believe that, do you!?” There was nothing my mom could do other than refuse to answer because patients have major problems seeing doctors that do not have the same religious beliefs in my area of Texas. Furthermore, if her patients knew she was an atheist, not only would there be less of them, but it would significantly increase her risk of being sued for malpractice for no good/ phony reason. It’s just not safe.

  32. #32 Flex
    February 22, 2007

    Tony Popple wrote, “If humans were designed and build by an engineer instead of being cobbled together through evolution, doctors might not have much to do.”

    As an automotive engineer, I beg to differ. No matter how well we design things, we still need mechanics.

    Even assuming that a divine all-knowing engineer would design a body without all the clear problems we currently have, some turkey would invariably drive his body into a ditch someplace and the doctors would have to patch him up.

    On the other hand, medical school might be easier…

    “Now, to replace the artery in the lower leg, turn off the valve in the groin, unzip the lower thigh, and remove the damaged part using the quick-disconnects above the ankle and below the knee….”

  33. #33 Louise Johnson
    February 22, 2007

    As an author on this paper, it’s great to see it discussed here (I’m a regular reader, and comment pseudonymously).

    Orac, I take your point that the existence of a difference is not surprising, but I think the magnitude of that difference is surprising, and problematic.

    When medics describe the increase in frequency of antibiotic resistant genotypes over time – that is, when what they mean is ‘evolution’ – they say something else 97% of the time. We gave the benefit of the doubt if, say, “emerge” might have referred to the initial mutation rather than its increase in frequency.

    The papers read as if someone’s done a Find and Replace, and public understanding suffers as a result.

  34. #34 Orac
    February 22, 2007

    Orac, I take your point that the existence of a difference is not surprising, but I think the magnitude of that difference is surprising, and problematic.

    […]

    The papers read as if someone’s done a Find and Replace, and public understanding suffers as a result.

    I don’t deny that there is a difference, but I suspect it reflects a difference in primary concern more than anything else.

    I’ve actually railed against the ignorance of evolution prevalent in my profession time and time again (see my Medicine and Evolution series (search the term “Medicine and Evolution” on my blog) or my recent takedowns of the idiotic statements of two truly obnoxious pro-ID physicians, Dr. David Cook and Dr. Michael Egnor, if you don’t believe me). Indeed, I’ll put my passionate defense of evolution and dismay at how little shrift evolution is given in my professoin against that of any other physician or surgeon any day. So it’s not as though I’m dismissing or minimizing the ignorance of the medical profession when it comes to evolution. It’s just that this particular observation struck me as neither particularly surprising or necessarily all that alarming. I agree that it would be helpful if physicians used the proper terms when evolution is relevant to their field, but such a sea change needs to start in medical school in the education of doctors-to-be.

  35. #35 PZ Myers
    February 22, 2007

    Orac, I know that you are one of the good guys, and are on the side of goodness and light and beauty. But I disagree when you suggest that this observation is not alarming. MDs have far more respect and cultural clout than mere PhDs (we aren’t real doctors, you know), so when I see that doctors are minimizing the relevance of evolution, something that teachers are also doing, it is grounds for serious concern. That’s a strike at the root of good science education in our country.

    I think also the problem doesn’t start in med schools — it’s much earlier. Med school (and college) is too late.

    If you’re looking for more MDs to bash, though, take a look at William Harris, the Kansas surgeon who teams up with John Calvert to give a false aura of scientific legitimacy to ID. He was interviewed in Flock of Dodos and comes across as an amiable idiot.

  36. #36 Dianne
    February 22, 2007

    I agree that it would be helpful if physicians used the proper terms when evolution is relevant to their field, but such a sea change needs to start in medical school in the education of doctors-to-be.

    That strikes me as kind of late. I think the change needs to start in high school or maybe middle school in the education of doctors-to-be and lay-public-to-be. It would be harder to fool the public if everyone or most everyone understood evolution because they’d learned the basic concepts in their early eduction and it would seem more natural to doctors to use the proper terms if they were familiar with them from early on. (Yeah, and I’d like a pony too, thank you.)

  37. #37 DrBadger
    February 22, 2007

    To the people who are saying MDs shouldn’t be considered as scientists, I would like to say that it may be true for many MDs, but I consider most MDs who write in medical journal as scientists. They’re performing controlled experiments (many basic science in nature) and probably have some sort of training in research (obviously not as rigourous as a PhD, but it’s definately more than just the memorization that’s done in med school.
    Another thing to keep in mind is that most of the authors in medical journals are PhDs. So we can’t fault MDs only for this (we could fault the editors).

  38. #38 John Emerson
    February 22, 2007

    There are a significant number of religious med students and MDs, and many are creationists or IDers. They’re more aggressive than the evolutionist medical people, and I imagine that journals cater to them just to avoid bother. By saying “develop”, they can sneak their idea into compartamentalized medical minds which would otherwise be resistant.

  39. #39 Jonathan Badger
    February 22, 2007

    windy:

    What are these other ways that enable antibiotic resistance to “spread” significantly and don’t involve selection?

    Many plasmids encode genes that promote their own transfer to other bacteria. If the plasmid contains antibiotic resistance, this is passed along as well. But plasmids containing no genes of use to their host are *also* transferred, which can’t very well be explained by selection acting on the host. (yes, the transfer genes of course increase the fitness of the plasmid as a selfish element, but we are talking about selection on the host)

    This feature of plasmids is important for practical reasons. If the antibiotic resistance plasmids were maintained for the selective advantage of their hosts, one would expect that stopping use of an antibiotic would cause antibiotic resistance to be lost. But as people like Abigail Salyers have shown, this seems not to happen — one gained, antibiotic resistance is kept with or without selective pressure.

  40. #40 joeski
    February 22, 2007

    I am an obstetrician and have encountered resistance to the explanatory power of evolution among my medical peers. This I believe is due to its nihilism. For example, babies will continue to get bigger at birth simply because they can. Before C-sections (about 150 years ago) big babies and/or a small maternal pelvis was a death sentence for baby and possibly mom. These phenotypic extremes, which have been shown to be heritable, had been trimmed from the gene pool. Since the advent of C-sections, selection against these extremes has been eliminated in developed countries. The C-section rate will continue to increase at least in part because pelvis size and birth weight will spread out in their distribution, and at least with the case of birth weight, there is unlimited upside. The same applies to preterm births: since neonatal ICU care has been able to rescue babies that would have died from prematurity, and since prematurity is heritable, the rate of prematurity is going up. The very notion that treating certain diseases or abnormalities may increase their incidence in the population is counterintuitive. These notions frustrate physicians who want to have controllable variables in disease processes. I think this may be the reason for evolution denial.

  41. #41 Ford
    February 22, 2007

    On the other hand, the article does show increasing use of “evolution” in research grants and the scientific literature. I found such an increase even relative to a neutral scientific term, “photosynthesis” (see my blog, This Week in Evolution). The question is whether increasing reluctance to use the word “evolution” is masking an even bigger increase in the evolutionary focus of modern biological research.

  42. #42 Chinchillazilla
    February 22, 2007

    That thing afdave quoted:

    It is clear that the phylogenetic origins of an organism, structure, or process may be of great interest, and that the elucidation of such origins is a legitimate subject for investigation and or speculation. We contend, however, that such investigation or speculation is not required for many studies of ecology and taxonomy.

    Uh, now, I admit I’m only in high school, but isn’t taxonomy kind of dependent on evolution? I mean, if you’re not grouping things by how closely related they are, there’s not going to be any order to the groupings. You might as well put us in with squid and call us cephalopods.

  43. #43 RavenT
    February 22, 2007

    I mean, if you’re not grouping things by how closely related they are, there’s not going to be any order to the groupings. You might as well put us in with squid and call us cephalopods.

    Yes, afdave is falling back on some of the finest 18th- and 19th-century taxonomical thought there, though I doubt he even realizes it.

  44. #44 Russ
    February 22, 2007

    In post #37 DrBadger said, “To the people who are saying MDs shouldn’t be considered as scientists, I would like to say that it may be true for many MDs, but I consider most MDs who write in medical journal as scientists.”

    It might be the case that “most” MD’s writing for journals are scientists, but from my long experience with research MD’s, “most” seems to me a bit too overreaching. I lean toward “a few.”
    ——————
    I am a freelance statistician who has worked with many research MD’s at the University of Michigan and Michigan State among others over the course of three decades. From the principle investigators(PI) I’ve been personally involved with, I can think of none who had a clear understanding of experimental process. Over the years many PI’s have simply told me, “I want to prove that this drug/therapy/suture/machine/technique/catheter/pump/whatever does this.” That’s what they got the grant to prove, so that’s what they are going to prove.

    Many of those “writing” in medical journals have no part in getting the article into publishable form. They didn’t find or write the grant; they have grant writers to do that. They didn’t research the literature; that’s delegated. They didn’t do the protocol design; they have grad students or consultants to do that. They didn’t conduct the research; again, lesser mortals are conscripted. They didn’t do the analysis; once more, they have underlings and outsourcers for that. They didn’t research the journals where it could be published; that’s staff work. They didn’t write the article; they have technical writers for that. They didn’t submit it for publication; secretary. They didn’t revise from reviews. But, they DID sign off galleys as first author and principle investigator.

    Many have direct ties to pharmaceutical companies – stock and retainers for consulting for instance -and are essentially doing work for that company using university resources. Many are using university facilities to do R and D for their own companies. Many live out some kind of “I’m an MD” fantasy and have no concept for just how ignorant they truly are of natural science, in general, and specifically, the process of developing evidence which is related to the hypothesis at hand. Most can’t tell you what would support the hypothesis, but frankly most don’t care. MD fantasies don’t concern themselves with specifics.

    I work under non-disclosure agreements, so I can’t provide details about specific articles, but I have witnessed data being manufactured as lab managers worked backward from an unfavorable result. In other cases, the published articles reported data distinct from what I know to have been generated. If one loosens the criteria whereby they judge outliers – you know, like those numbers give the wrong result – “proving” ones point gets much easier. That’s not what the grant said to prove, so that’s not what we’re going to report.

    That said, there are a few who have astounding intellectual capacities, including all the science and all the statistical tools for doing research from square one to writing the result for publication, and the integrity to report honest results. Some possess monumental minds. Unfortunately, every last one of them thinks he does.

  45. #45 windy
    February 22, 2007

    If the antibiotic resistance plasmids were maintained for the selective advantage of their hosts, one would expect that stopping use of an antibiotic would cause antibiotic resistance to be lost. But as people like Abigail Salyers have shown, this seems not to happen — one gained, antibiotic resistance is kept with or without selective pressure.

    Why is retaining a neutral trait surprising? But these cases where the trait is already present in the population do not fit the terms “emerge”, “arise”, or “spread” any better.

    And selection for those bacteria which have received an antibiotic resistance plasmid is just as much “evolution” as selection for a de novo antibiotic resistance mutation.

  46. #46 SEF
    February 22, 2007

    We’ve had this discussion before of course.

    Medical doctors generally aren’t scientists and they can also generally avoid noticing evolution via the sort of comparative anatomy vets have to study. They are very much the weakest link in those respects. Engineers are in much the same category for what they learn versus what they avoid.

    Additionally, the self-selection and system-selection for medical doctors includes many negatives (eg desire for power, prestige and money) and emphasises memory over thinking, self-pride and in-group loyalty over honesty. Indeed dishonesty is actively prized in many ways! Eg over concealing information from patients or relatives – even before any issues of malpractice law-suits arise.

  47. #47 DrBadger
    February 22, 2007

    Russ, I guess I can’t say much against what you say (I don’t have the inside information that you do… though there are also plenty of PhDs that get pharmaceutical money or use a university as their R and D for a company they own).
    I still fault the editors for this trend. As a related example, the Feb 2, 2007 issue of the American Journal of Health-System Pharmacy published a letter from a student claiming that access to emergency contraceptives should be limited because of rediculously unlikely things like pedophiles may purchase them and force minors to take it before raping them, and cited ProLifeBlogs.com as evidence that emergency contraceptives increase the risk of STDs (there’s plenty of real evidence that they don’t). I don’t fault an idiot writing his unfounded opinions, but when an editor decides that this letter is worthy of being published there’s something seriously wrong with medical journals (btw, I e-mailed the editor and he found nothing wrong with ProLifeBlogs.com being used as a source – in fact, he called it “literature”).

  48. #48 Jonathan Badger
    February 22, 2007

    windy:

    Why is retaining a neutral trait surprising?

    It isn’t. But many mechanisms of antibiotic resistance are far from neutral — they make the bacteria “sick”. For instance, rif-resistant bacteria have screwed up transcription — but screwed up transcription is better than no transcription, which is what the rif-sensitive bacteria have in the presence of rif.

    But these cases where the trait is already present in the population do not fit the terms “emerge”, “arise”, or “spread” any better.

    I disagree. Consider the following analogy: There’s a virus which makes people sick but which happens by accident to make people resistant to arsenic poisoning. Would you say that that the infected people evolved arsenic resistance? Or that the virus spread? That’s what a plasmid is — a selfish element similar to a virus — it doesn’t “want” to help its host — if it does that’s just a coincidence — it “wants” just to make copies of itself and spread.

  49. #49 windy
    February 22, 2007

    Consider the following analogy: There’s a virus which makes people sick but which happens by accident to make people resistant to arsenic poisoning. Would you say that that the infected people evolved arsenic resistance?

    If the virus is, say, incorporated in human DNA and passed down to subsequent generations as plasmids are, and the environment happens to be arsenic-rich and the mortality of people not carrying the virus is much higher, in some way resistance does evolve.

    Alternatively, there may be variation in the viruses or plasmids in that only some of them confer resistance, and those genetic elements that keep their host alive are selected for. Presumably a lot of the medical literature is concerned with cases where resistance, whether plasmid or gene derived, really is selected for. It doesn’t look like bacteria just “happen to be” multiresistent in a way that is unrelated to antibiotic use.

    That’s what a plasmid is — a selfish element similar to a virus — it doesn’t “want” to help its host — if it does that’s just a coincidence — it “wants” just to make copies of itself and spread.

    This isn’t necessarily that different from any other types of genes.

  50. #50 Ron Chusid
    February 22, 2007

    Personally I check on a person’s views about evolution as part of every medical history. If they don’t believe in evolution I stick with older, less expensive antibiotics like ampicillin and don’t both them with issues such as antibiotic resistance. I also give these patients one influenza vaccine and tell them that, according to their belief system, it should work for the flu in future years and there is no need to repeat it every year.

    Ok, I’m just joking here. I’d try to stick up for my profession but unfortunately I realize that any defense of the medical profession could be refuted with just two words: Deepak Chopra.

  51. #51 John Emerson
    February 22, 2007

    I have heard stories like Russ’s above (about researchers who fudge the statistics and don’t understand the scientific method at all) from three different sources in two different schools. Psychology researchers are the worst; for them, the tiniest significant correlation is good enough to write up.

    At best, statistics are a powerful tool, but they can be misused. And very few have even as much statistic savvy as I do (very little indeed), so statistical presentations can be used to confuse people.

  52. #52 Ichthyic
    February 22, 2007

    no, the issue is why invent a terminology that implies something that isn’t, as YOU JUST DID by writing emerging/evolving as if they meant the same thing.

    IOW, by maintaining this, all this accomplishes is confusing what the real issues are.

    If what you are really trying to say is that when a medical paper uses “emerge” they really mean “evolve”, then why on earth use the term “emerge” to begin with??

    the point is that the medical profession has not invented a new theory of variation and heritability, so why are they inventing new terms to describe already existing theory?

    there are only three possible explanations, none of which sound very appealing:

    1. gross ignorance.

    2. they think they DO have an alternative explanation.

    3. there is political pressure NOT to use the appropriate terminology.

    so which is it?

    I guess i didn’t read far enough into your take on it in the post on your blog, because I’m not certain now what your answer really is.

  53. #53 Ichthyic
    February 22, 2007

    btw, the last post was missing the quote from Orac, and it was entirely directed at his first response in this thread.

  54. #54 Jonathan Badger
    February 22, 2007

    If the virus is, say, incorporated in human DNA and passed down to subsequent generations as plasmids are

    Neither is generally true of plasmids. Most plasmids remain as independent genetic elements with their own origin of replication (if they integrate into the genome, they are no longer really plasmids). They *can* be transmitted vertically, but there’s no guarantee of that either — when bacteria divide, often low copy number plasmids fail to make it into one of the new cells.

    Presumably a lot of the medical literature is concerned with cases where resistance, whether plasmid or gene derived, really is selected for. It doesn’t look like bacteria just “happen to be” multiresistent in a way that is unrelated to antibiotic use.

    Obviously you can apply selective pressure for antibiotic resistance by using the antibiotic; this happens in both medical treatment and is a common technique in molecular biology experiments (put the gene you want to be expressed on a plasmid together with an antibiotic resistance gene, let the plasmid spread, and treat with the antibiotic to kill the cells without the plasmid).

    The point is that even in the absence of selection the plasmids still spread for their own reasons even to the detriment of the hosts. This *is* important to medical research, because as I’ve mentioned, it means that the naive idea to eliminate resistance by retiring an antibiotic for a while is not possible.

  55. #55 Caledonian
    February 22, 2007

    The unfortunate truth is that the only things you need to be a servicable doctor is a good memory and a willingness to work very hard while you’re in school. That’s it. Intelligence, wisdom, concern for other human beings, awareness of your own limits – none of that is necessary, or even all that common.

    Doctors do what they were taught to do, and by and large they don’t deviate from what they learned in medical school, which is why changes in the way things are thought about are only generally adopted as doctors are replaced.

    Part of the problem is that doctors are part of a guild system. Rather like university faculty, actually…

  56. #56 Ichthyic
    February 22, 2007

    The point is that even in the absence of selection the plasmids still spread for their own reasons even to the detriment of the hosts.

    curious. what reasons would those be? care to elaborate?

    what would cause the noticeable concentration of a particular plasmid mutation within a given population?

    neutral mutations?

    if so, how would that be called a “reason”?

  57. #57 Ichthyic
    February 22, 2007

    Doctors do what they were taught to do, and by and large they don’t deviate from what they learned in medical school, which is why changes in the way things are thought about are only generally adopted as doctors are replaced.

    so their usage of terms like ‘arise’ and ’emerge’ boil down to gross ignorance of actual theory then?

    yeah, i lean towards that answer too.

    However, it still doesn’t make it acceptable in my mind if they plan to publish papers on the subject.

    It would be much like an engineer publishing a paper on “stress thingies” in a physics journal.

    which suggests a ready way of dealing with this:

    Journal standards. reviewers of articles for publication in medical journals SHOULD THEMSELVES at least, be aware of the proper terminology and usage when a paper is submitted for publication, and suggest appropriate corrections to the authors before acceptance.

  58. #58 Caledonian
    February 22, 2007

    But I think the reviewers for medical journals are also MDs, so the problem is somewhat circular.

    I still maintain that the best solution is a carefully-orchestrated culling of the doctor population. Not many are up for that, though.

  59. #59 Ichthyic
    February 22, 2007

    But I think the reviewers for medical journals are also MDs, so the problem is somewhat circular.

    well, at least SOME of them could learn something and then become qualified reviewers, no?

    I still maintain that the best solution is a carefully-orchestrated culling of the doctor population. Not many are up for that, though.

    Intruiging…

    how would you determine the characteristics for culling?

    and shouldn’t we experiment with the lawyers first?

  60. #60 Jonathan Badger
    February 22, 2007

    curious. what reasons would those be? care to elaborate?

    Well, I didn’t use the scare quotes that time, as I did earlier around “want”, but the point is plasmids are selected on their ability to get their hosts to transfer them even if that doesn’t increase host fitness. There doesn’t need to be any selective pressure on the host.

    what would cause the noticeable concentration of a particular plasmid mutation within a given population?

    Not sure I understand your question, but if a mutation in a plasmid, say increased efficiency of transfer, that mutant plasmid would presumably increase its relative frequency in the host population. That *would* be a good case of evolution by natural selection — but of the plasmid, not the bacteria.

    neutral mutations?

    I’d expect neutral mutations in plasmids would either become fixed or lost in the population of plasmids much in same way that neutral mutations are in any population.

  61. #61 Ichthyic
    February 22, 2007

    but the point is plasmids are selected on their ability to get their hosts to transfer them even if that doesn’t increase host fitness. There doesn’t need to be any selective pressure on the host.

    *whew*, that’s what I was hoping you would clarify your statement to. I might quibble over what cases would qualify as selection on plasmids that are completely unlinked from the host, but that’s a fine point. like comparing with selection on an obligate parasite.

    I’d expect neutral mutations in plasmids would either become fixed or lost in the population of plasmids much in same way that neutral mutations are in any population.

    yup. that’s what i would expect as well.

    sorry for giving the appearance of doubting you (I really didn’t – I’ve seen your site), but my point was that the use of correct terminology IS important, and I think you just supported my point with your more thoughtful response.

    have you considered becoming a reviewer for a medical journal?

  62. #62 Vertebrat
    February 23, 2007

    If I understand correctly, Jonathan Badger says the antibiotic resistance is really a change in the plasmid infection rate. So if there’s an evolutionary change in the bacteria (which there might not be), it’s in their susceptibility to plasmids. Has anyone tested whether the antibiotic-resistant bacteria acquire or keep plasmids more readily than their nonresistant relatives? (What’s a good search term for this? I tried variations on “plasmid resistance” but those get mostly articles about antibiotic resistance, of course.)

    If there is a change in susceptibility, this suggests an indirect attack against antibiotic resistance: expose the potential pathogens to harmful plasmids. If these preferentially infect the same bacteria that would most easily become antibiotic-resistant, they’ll select for plasmid-resistant bacteria. That should slow the spread of antibiotic resistance (if there’s a difference in acquisition of plasmids) or accelerate its loss (if there’s a difference in plasmid retention). I’m not sure how one could apply this in practice, but it ought to be straightforward to test. It seems to me the hardest part of the experiment would be coming up with suitable plasmids (and a test organism that isn’t a public health hazard).

    I feel silly contrasting plasmids to “real” genetic changes. A bit arbitrary, isn’t it?

  63. #63 windy
    February 23, 2007

    Neither is generally true of plasmids. Most plasmids remain as independent genetic elements with their own origin of replication (if they integrate into the genome, they are no longer really plasmids).

    Sorry, I wrote unclearly – obviously plasmids aren’t usually incorporated to the genome. I was saying that for your example to be comparable to the plasmids, the viruses would have to be passed down to subsequent generations at least sometimes.

    I feel silly contrasting plasmids to “real” genetic changes. A bit arbitrary, isn’t it?

    Yes. Do mitochondria evolve separately from humans since they retain their own origin of replication?

  64. #64 Orac
    February 23, 2007

    If what you are really trying to say is that when a medical paper uses “emerge” they really mean “evolve”, then why on earth use the term “emerge” to begin with??

    the point is that the medical profession has not invented a new theory of variation and heritability, so why are they inventing new terms to describe already existing theory?

    Emerge is not a new term; it’s been around at least as long as since I started medical school (over 20 years) and, I’m guessing considerably longer. No “new terms” are being “invented”

  65. #65 Orac
    February 23, 2007

    The point is that even in the absence of selection the plasmids still spread for their own reasons even to the detriment of the hosts. This *is* important to medical research, because as I’ve mentioned, it means that the naive idea to eliminate resistance by retiring an antibiotic for a while is not possible.

    Also, some antibiotic-resistant bacteria are actually less virulent than the sensitive bacteria, again implying a cost to the host for holding on to the plasmid. These resistant bacteria are often crowded out by the normal bacterial flora of the body. However, if the body is exposed to antibiotic, the sensitive bacteria die off, and the resistant bacteria are able to grow out and express their virulence.

    Antibiotic resistance is certainly a matter of natural selection, but it’s more than just that. For example, all it takes in an ICU to have an outbreak of certain resistant strains is for one inoculum to be brought in. That inoculum will spread and its resistance plasmids will be exchanged with the non-resistant bacteria (and, dare I say, “emerge:”). Granted, if there is a selective pressure (the use of the antibiotic to which the resistant bacteria is resistant), that spread will happen a lot faster, but it will still happen to some extent even without the selection. Also, even a small number of bacteria retaining a resistance plasmid can remain as a reservoir to spread the resistance, meaning that, as was stated before, just retiring an antibiotic for a while will not result in loss of resistant bacteria. If that were the case, dealing with bacterial resistance would be far easier.

    As for our freelance statistician friend who has apparently seen so much mendacity among physician researchers, all I have to say is: Wow. How do I get me some of that action? I mean, with paylines for NIH grants dropping faster than George Bush’s approval rating, I’d really love to have writers writing my grants and papers for me, big pharma money coming in to fund my lab, and minions of workers grinding out data and papers for me. That’d be really cool. Sadly, I’m stuck writing almost every word of every grant that I submit, and, because of my other responsibilities, I have about three manuscripts worth of data that need to be written up, with my postdoc producing more all the time. Now don’t get me wrong; that’s a good problem to have, but unfortunately I don’t have anyone who’s capable of writing this stuff up to do it for me, not even as a first draft. My postdoc’s English is pretty crappy, and the times I’ve tried to have him write up sections of papers I’ve ended up spending more time correcting his writing than I would have spent just writing it up myself.

    According to our statistician friend, I must be a real fool, slaving away like this and living on the knife edge of having my R01 renewal rejected the next cycle. Why on earth am I doing this, when, according to him I could be riding the big pharma gravy train, having underlings write grants and papers for me, and generally living high off the hog, scientifically speaking.

    The reason, my friends, is that it’s not that easy to get drug company funding, nor is it that easy to get into a situation where you have lots of underlings working for you.

  66. #66 evo_is_our_friend
    February 26, 2007

    I think this also occasionally happens with some Ph.Ds at major research medical centers. I think it is not just a reluctance to get involved in the “ID wars”

    At least part of the problem at large biomedical research universities is a prejudice toward reductionism and an almost contempt for evolution, ecology, or related “soft” integrative issues not directly focused on molecular details of their system or disease focus of their research interest.

    Further, when evolution is invoked, it is often sort of a naive “just so” stories that bear no resemblance to a modern understanding of evolution and allied fields.

    The reductionism that was invoked in the initial study of genome sequence analysis, also, often seemed to me to actually impede that analysis. A subset of several significant thought leaders in the human genome program needed a number of years before they more frequently invoked the “E” word as a core component in a robust analysis of the sequence products of the genome project. You would have thought that BLAST was just comparing protein structure/function alone to hear a few surprisingly prominent people talk in the earliest years of the genome project.

    At least part of the issues that underlie this might be a lack of central focus on real evolution and population genetics in many undergraduate curriculum. MDs have to have many years of science as undergrads, yet if you ask many MD/Ph.Ds their knowledge and training in even the most basic issues of evolution and population genetics it is often very poor.

    How can you be trained as a biologist and not have heard of the “Modern Synthesis” and related theories. I would bet that more than 4/5ths of the MDs and Ph.Ds at major medical centers have not a clue about that period or subsequent but related issues in the history of biological thought that first brought together genetics, evolution, and related thinking.

    As specific example, look at almost any timeline associated with genome research issues–even the last time I looked at a timeline from NIH human genome research institute–and you can find lots of details on molecular events in the history, but no mention of events critical to advances in thinking about genomes, such as publication of “Hardy-Weinberg”, the publication of the “Genetical Theory of Natural Selection,” or key events in basic publications of molecular evolution.

  67. #67 Ian MacLeod
    May 26, 2007

    This is simply cowardice of the first water! When scientists cease using proper terminology to appease fanatics, the fanatics have won far too much. In a discussion with my brother some years ago (we’re both middle-aged), I mentioned how in an anvironment that’s changing, mutations play a vital role in adaptation, and he said, “Why bring mutation into it? The “force of evolution” will take care of it.” He didn’t realize that mutation was part of evolution, as though there was a mysterious “force”, something like electromagnetism, that altered animals so that they could adapt over time! He even thought It had a goal in mind, and he is not religious at all!

    This kind of foolishness opens the door to misunderstanding and LACK of understanding, not to mention a return to a Cotton Mather theocracy. We must combat this now before we find we’ve lost already, war over and done.

    Ian

  68. #68 Ichthyic
    May 26, 2007

    since this thread has been resurrected…

    I thought Orac was getting the gist of the argument here, but when I saw:

    Emerge is not a new term; it’s been around at least as long as since I started medical school (over 20 years) and, I’m guessing considerably longer. No “new terms” are being “invented”

    not only do i see he still doesn’t get it, but fails to realize that if emergence is 20 years old, that still makes it baby terminology considering what it is attempting to co-opt.

    IOW, Oracs’s point here does NOTHING to invalidate the arguments against using the terminology.

    Ian, in resurrecting the thread, at least shows he understands what the actual argument is.

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