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?


  1. #1 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.

  2. #2 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.

  3. #3 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.

  4. #4 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.

  5. #5 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”?

  6. #6 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.

  7. #7 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.


    how would you determine the characteristics for culling?

    and shouldn’t we experiment with the lawyers first?

  8. #8 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?

  9. #9 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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