Slinking away in shame over my profession yet again (another surgeon behaving badly over evolution)

You know, I'm really tired of this.

I'm tired of my fellow physicians with a penchant for spouting scientifically ignorant "attacks" on or "doubts" about evolution. It embarrasses the hell out of me around ScienceBlogs, and I really wish they would stop it. Sadly, it seems to be an increasingly long list. Although I first noticed it when former Senate Majority Leader Bill Frist (who is a cardiac surgeon) voiced support for "intelligent design" back in 2005, this tendency among my fellow physicians to pontificate on their distaste for evolution didn't start to irritate me really seriously until last spring, when I first encountered a medical student who is a young earth creationist who does not accept the theory of evolution. At the time, I lamented that she would soon be a physician. Next, I was made aware of a a fellow general surgeon, Dr. Henry Jordan, who made our young earth creationist medical student look like a Professor of Evolutionary Biology in comparison, as he spouted truly idiotic canards about evolution hither and yon as he ran for Lieutenant Governor of South Carolina last year. Dr. Jordan was the first to make me truly ashamed for my profession's general lack of scientific knowledge about evolution. Then, to add insult to the proverbial injury, I soon learned of Physicians and Surgeons for Scientific Integrity, a group that produced an insipid and vague "dissent from Darwin"-like statement that is in essence meaningless scientifically and exceedingly disingenuous in the conclusion to its statement, which says, "This does not imply the endorsement of any alternative theory."

Yeah, right. (And don't even get me started on Dr. Deepak Chopra's antievolution woo.)

More recently, I was forced either to hang my head in shame or consider putting the proverbial paper bag over my head again when last month I became aware of Dr. Geoffrey Simmons and his anti-evolution book Billions of Missing Links and his previous history of spewing yet more anti-evolution pseudoscience. Then, a mere few days later, I became aware of an orthopedic surgeon, Dr. David Cook, who, at the behest of Behe's minions at Uncommon Descent, liked to tout his credentials before launching into the usual bunch of creationist canards. The only thing interesting about him was that he apparently believes in panspermia and that he showed up in the comments section of my post all wounded because I had tweaked him for his listing his Boards scores and parroting of long-debunked creationist misinformation about evolution. You, my readers, also had quite the field day with the hapless and clueless (about evolution, anyway) Dr. Cook in the comments, as well.

After all that, I was hoping that I could let this topic rest a while. I was wrong. Thanks to an effort by the Discovery Institute's pushing of its "Dissent from Darwin" list (which, by the way, contains a "whopping" 700 scientists who are "skeptical" of evolution, none of whom appear to be evolutionary biologists), I became aware of yet another physician who "doubts" Darwin and has signed on to the list. Indeed, this is the most prestigious physician yet that I'm aware of who has attacked evolution, and his name is Dr. Michael Egnor, a Professor of Neurosurgery and Pediatrics at SUNY Stonybrook. I had been thinking about just ignoring him, but then wouldn't you know it? Pat Hayes and PZ would have to go and rub my face in his blather. They didn't tweak me intentionally, of course, but not surprisingly my name came up in the comments, making me feel obliged to comment on Dr. Egnor. Even then, I might have ignored Dr. Egnor, but he just couldn't resist digging himself in deeper and making his ignorance of evolution even more apparent for all to see. And, you see, he's a brain surgeon, obviouslymuch more studly than me, a mere general and oncologic surgeon! So his statements attacking evolution must carry a lot of weight, right?


It all started with a mention of Dr. Egnor in Michael D. Lemonick's Eye on Science blog. I really love how Lemonick said in a couple of sentences what it took me a couple of paragraphs to say, namely that physicians like Dr. Egnor (and Dr. Cook) are intentionally using their credentials to imply to the public that their word about evolution actually holds some weight:

Talk about an attempt to divert your attention. Yes, he actually is a brain surgeon, and yes, SUNY is a reputable place. Which is very important if you need your brain operated on, but which says nothing whatever about your sophistication about biological theory or about evolution. Discovery counts on your awe of brain surgery and your awe of magazine "best" lists to keep you from thinking about the fact that there's nothing here establishing Dr. Egnor's expertise on the topic at hand.

Exactly. In just the same way that the Discovery Institute encouraged Dr. Cook to tout all of his credentials, including even his Board scores, to impress people who have no idea that being a physician does not necessarily imply a decent understanding of evolutionary biology that Dr. Cook "must really know what he is talking about," Dr. Egnor trades on the awe that his being a neurosurgeon provokes in most people to give his words scientific authority that they most definitely don't deserve. What he learned in neurosurgery residency was the anatomy and function of the brain and nervous system and how to operate on them to repair damage or abnormalities, not evolutionary biology, and sadly, he probably didn't learn much evolutionary biology in medical school either, despite its increasing importance in understanding many human diseases. Indeed, poor Dr. Egnor then validated Mr. Lemonick's criticism in a most spectacular fashion by showing up in the comments and asking:

I ask this question as a scientific question, not a theological or philosophical question. The only codes or languages we observe in the natural world, aside from biology, are codes generated by minds. In 150 years, Darwinists have failed to provide even rudimentary evidence that significant new information, such as a code or language, can emerge without intelligent agency.

I am asking a simple question: show me the evidence (journal, date, page) that new information, measured in bits or any appropriate units, can emerge from random variation and natural selection, without intelligent agency.

PZ didn't break a sweat to point him in the direction of many examples, and a simple writer (as he put it), Pat Hayes, pointed out how Dr. Egnor could have very easily used the ubiquitous tool that is Google to find answers to his "challenge":

Do we have to lead this eminent brain surgeon by the hand? Is he incapable of doing a PubMed search? Do we have to stack the evidence up before him like the evidence for evolution of the immune system was stacked up before Michael Behe at the Dover trial?

Finding the evidence for evolution is really quite simple. It isn't rocket science, it isn't even brain surgery. All it requires is simple intellectual curiosity. You will find it in your local library. Bookstores will have a section on evolution. Since you are on a SUNY campus, there will be a biology department with scientists who will be able to steer you in the right direction.

Sadly, medical school actually does, unfortunately, sometimes train physicians to be used to being spoon-fed the information they need by giving them the material in lectures laid out to tell them exactly what they need to know, and perhaps that is what is going on with Dr. Egnor. Or perhaps Dr. Egner simply doesn't want to risk coming across information that would demolish his beliefs about evolution. Either way, there appears to be a distinct lack of intellectual curiosity at work here. Dr. Egnor hasn't even bothered to investigate his own claims more closely from the primary scientific literature. That's the first thing a scientist does when investigating a phenomenon: Find out what has been published about it by others.

Naturally, the Discovery Institute views Lemonick's criticism as an attack on an eminent neurosurgeon by a mere journalist and quickly sent its attack poodle to opine:

The whole point of the [Dissent from Darwin] list was to refute the claim in PBS' 2001 Evolution series that no scientists doubted Darwin. (Then it was 'no credible scientists'; which became 'well, not very many scientists'; and so on.) Still. Time magazine journalist Michael Lemonick got himself all in a huff over the list. So much so he even attacked the doctor we quoted in the release about the list. Lemonick attacks Dr. Michael Egnor --professor of Neurosurgery at State University of New York-- for not knowing enough about biology, for not having a degree in the field, for only being a brain surgeon. That's rich coming from a guy who writes for a weekly news tabloid.

How about if the criticism comes from a guy who is a surgical oncologist, has a PhD, and runs an NIH-funded laboratory? What would the Discovery Institute say about that? And I agree with Lemonick. Dr. Egnor is using his credentials to give his brain farts about evolution way more respectability than they deserve, when in reality, as I have explained many times medical school does not give physicians a good background in evolutionary biology. No doubt the rejoinder to me would be that, as a physician, I have no more inherent expertise in evolution than Dr. Egnor. That might indeed be true if my knowledge and training in evolution were my medical education, but since then I have made it my business to educate myself about evolutionary biology and how it applies to human disease, as I've discussed at length before, and that includes looking at the "counterevidence" (if you can call it that) published by pro-ID organs such as the Discovery Institute.Moreover, although my work is not directly related to evolution, one of my projects involves the study of homeobox genes, important developmental regulators, for their role in cancer. If Dr. Egnor's comments in Mr. Lemonick's blog are any indication, he hasn't bothered to do anywhere near the same. For example:

The Darwinists' reply to irreducible complexity (a concept first proposed by Darwin himself): they have hypothesized (not demonstrated) a few exaptations that they propose might explain the Darwinian evolution of a couple of steps (eg: that the bacterial flagellum evolved from a type 3 secretory organ). Darwinists offer a couple of hypothetical explanations for a couple of steps, out of millions.

You say that 'several claims of IC have been falsified'. Translated into non-Darwinian English, you mean 'Darwinists have no answer to the vast majority (many millions) of IC predictions'. I note also that no actual experimental evidence refutes even one IC prediction. They're all stories: 'This is how it might have happened'. Darwinian refutations of IC are literature, more than science.

When I read his comments, I was hoping that Dr. Egnor would be so kind as to enlighten me and list a few (or even one) of these "millions" of examples of testable predictions that IC makes. But, no, he didn't, and I was disappointed. In addition, Dr. Egnor seems to be completely unaware of experimental research into three of Michael Behe's favorite examples of "irreducible complexity," the bacterial flagellum, the clotting cascade, and the production of antibodies are not irreducibly complex. For one thing, one of the requirements of IC is that you can't remove a single part of the "molecular machine" and still have function. That has been shown not to be true for the bacterial flagellum, and, worse for IC, a subset of the proteins in the the bacterial flagellar complex, known as the type III secretory apparatus, can function quite nicely doing something else, (Remember, by definition, IC requires that no subset of the proteins in an IC structure can function, nor can the IC structure function if any component of it is removed.) The bacterial flagellum is not irreducibly complex. Neither is the blood clotting cascade. Even Behe himself now admits that the clotting cascade is not IC. In fact, none of the examples that ID proponents represent as IC, when examined more closely, truly turn out to be IC.

Digging himself in even deeper, Dr. Egnor even pulled out the hoariest antievolution canard of all, one that ol' Chucky Darwin himself had to deal with:

No one has described the evolution of the eye on a molecular level, or even offered a remotely plausible hypothesis of how it could have happened.

Dr. Egnor, meet Dr. Ivan Schwab. Dr. Schwab, meet Dr. Egnor. As for molecular mechanisms, apparently Dr. Egnor has never heard of the Pax genes (particularly Pax6). Sorry, Dr. Egnor, but arguments from your own personal incredulity and ignorance of the scientific literature just don't cut it. I truly hope for his patients' sakes that Dr. Egnor shows a better understanding of the neurosurgical literature than he does of the scientific literature in molecular biology and evolution.

I've speculated before about why physicians seem to be so prone to falling for the pseudoscience of "intelligent design" creationism. I'm beginning to wonder whether, among physicians, surgeons are more prone to falling for this pseudoscience than other specialties. First, there's medical school, where the teaching of evolution, if it is taught at all, is rudimentary, superficial, and strictly practical. For instance, it's used to explain the evolution of bacterial resistance to antibiotics, for example, and why it is important for a patient to complete a course of antibiotics and resist the temptation to stop the antibiotics after they feel better, because prematurely terminating treatment can result in surviving resistant bacteria growing out. Next, in many specialties (key exceptions being infectious disease and oncology), it is possible to practice quite happily without an understanding of evolutionary biology. Then, couple that with the lack of any real teaching of the scientific method in most medical schools an residencies (I guess they're too busy making room in the curriculum for antiscientific woo), and many physicians are woefully undertrained in scientific thinking. Finally, couple that with the well-known arrogance (or as we in the biz would call it, "self-confidence") of physicians, and you can see how the temptation for physicians to assume that their training gives them more insights into such matters than it in fact does might manifest itself as a susceptibility to pseudoscience like "intelligent design." Also, ask yourself: Of all medical specialties, which are known the most for their "self-confidence"? Oh, yeah, it's us surgeons, and probably deservedly so. It takes cojones to cut people open and rearrange their anatomy for therapeutic effect, you know; so self-confidence is basically a job requirement. And, of course, among surgical specialties, neurosurgeons operate on the human brain, fer cryin' out loud! That takes serious cojones. So it's not surprising that neurosurgeons might be prone to thinking themselves better judges of biological science outside of their area of expertise than they actually are (which probably describes Dr. Egnor to a T, given his pontificating in the comments of Mr. Lemonick's blog). Finally, as surgeons, although we are physicians, one large component of what we do is to "repair" the human body by getting our hands dirty (metaphorically speaking) getting "under the hood." It's not hard to see how some of us might fall into the trap of viewing the body as designed. After all, what do repairmen repair? Machines? And aren't machines "designed"? If you don't think a little more deeply about the biology, it's quite possible to wonder how evolution could have produced the marvelous complexity that we see in the human body every time we operate.

It's starting to look again as if I'm going to need something more durable than a paper bag to cover my head in shame. Fortunately, the Dr. Cooks and Dr. Egnors of the world are counterbalanced by Dr. Ivan Schwab (an ophthalmologist) and Dr. Sid Schwab (a retired general surgeon, no relation to Ivan that I'm aware of), both of whom recognize the pseudoscience of creationism for what it is. They're keeping me from a more permanent solution to my embarrassment than a paper bag over my head--like a metal mask, shades of Doctor Doom.

ADDENDUM: Since I published this, Ed Brayton has also weighed in, shredding Dr. Egnor's lame parroting of creationist appeals to information theory.


More like this

I love the hanging my head in shame series!! Thanks for this latest entry.

Dr. Jordan practices General Surgery in Anderson, South Carolina. Dr. Henry Jordan, a male, graduated from the Emory University School Med with a MD and has been in the profession for 36 years.

From the Council on American Islamic relations: CAIR is calling on the governor of South Carolina to ask for the resignation of a state official following a second incident of anti-Muslim bias. The official, South Carolina Board of Education member Dr. Henry Jordan, was quoted earlier this year as saying, "Screw the Buddhists and kill the Muslims." The remarks were made during a board discussion of whether the Ten Commandments should be posted in public buildings. At that time, he was also quoted as saying the religion of Islam is a "cult" that worships "Lucifer."

From THE STATE newspaper: And it's hard to imagine that a guy would worry about, say, being misquoted when he's best known for having said, as a member of the state school board, "Screw the Buddhists and kill the Muslims. And put that in the minutes."
Seriously. I think he was talking about the Ten Commandments at the time.

You'd think the State Medical Board would discipline physicians who violate their Oath and demean and endanger the public. If a physician says screw the Buddists and kill the Muslims he can serve either Buddists or Muslims and is a disgrace to the profession of Medicine.....oh, yeah, forgot it's South Carolina. Let's see a physician say this in New York or California and not get disciplined for being a danger to the public.

If a physician says screw the Buddists and kill the Muslims he can serve NEITHER Buddists or Muslims and is a disgrace to the profession of Medicine.....oh, yeah, forgot it's South Carolina. Let's see a physician say this in New York or California and not get disciplined for being a danger to the public.

Sorry, NEITHER not either.

Orac, you have my profoundest sympathy. I've been embarassed for some time by members of my profession -- engineering -- trying to sound authoritative about evolution. Even worse, I'm a software engineer, so I share that title with Sal Cordova, DaveScot and several other IDiots at Uncommon Descent. Ah well.

I came up with Dr. Doom on that survey, but I'll cede the metal mask to you. I'm thinking of something more like this for myself.

I tend to believe in evolution but I'm not as certain as some seem to be. I still remember respected professors telling us how estrogen prevented heart attacks and that ulcers were caused by smoking. As for violating the Hippocratic oath, all surgeons do, as the original version forbids physicians to operate or perform abortions. If you ever prescribed Vioxx you broke that part about not using deadly medicines. And if you've never done some harm in your career youre either a liar or Jesus returned..

By Frank Drackman (not verified) on 19 Feb 2007 #permalink

Orac, with regard to physician behavior you might take a look at the post "Evidence-Based Medicine Backlash" by Robin Hanson, stimulated perhaps by my comment on the post "Bias Toward Certainty" by Arnold Kling over on their blog "Overcoming Bias".

Don't take it too hard, Orac. It's good for poor science-challenged humanities types like Red State Rabble when the Dr. Egnors of this world show us that brain surgeons ain't all they're cracked up to be. Now if only we can find some poor Bible-addled rocket scientist to come out for intelligent design...

Frank, regarding your statement:

"I tend to believe in evolution but I'm not as certain as some seem to be. I still remember respected professors telling us how estrogen prevented heart attacks and that ulcers were caused by smoking."

I say this respectfully and kindly, but your analogy is terrible. The supporting evidence for the examples you gave, both in volume and diversity, was orders of magnitude from that for evolution...they simply aren't comparable, the epitome of apples-and-oranges.

But your comment raises an important point: Most people lack sufficient understanding of evolution to understand how such a comparison is flawed, and many indeed think as you do because of that ignorance. To them, all scientific theories and hypotheses are more or less the same, and biologists, chemists and doctors are nearly indistinguishable. Thus evolution is "just another scientific theory, and we know how reliable those can be, eh?" A roughly analogous statement would be to blur the distinction between all self-propelled vehicles ever made, and hold the entire category suspect in response to the most spectacularly bad examples. Which makes perfect sense if you don't know much about that context, how can you know to trust one over the other? Nero Wolfe might not have been so phobic if he'd been a mechanic.

That's why we keep coming back to advocacy for improved science education in schools. As odds are you're unable to pursue such formal education conveniently, I recommend you do some self-education. There are some excellent books that will give you a thorough introduction to evolutionary biology, and many of them are an enjoyable read. I can throw together a reading list if you're interested, although PZ Myers maintains a far better list over at Pharyngula. You can also get good information online, especially over at TalkOrigins, although its main focus is on refuting specific false claims about evolution and creationism.

I hope it's clear that my comment is neither hostile nor condescending. I apologize if I've misunderstood you, but I think I understand your position, and if so, then it's merely a result of ignorance. Not the ignorance of the insulting usage ("your village is missing its idiot") but rather the technical usage ("I only took Physics 101, can't really explain quantum mechanics to you.")

I, like Art, am an engineer (though electrical rather than computer systems, as BU called it), and I share the embarrassment of having members of your well-respected profession speak out on something they have no qualifications to discuss.

I think the reason both engineering and medicine have this problem comes down to Orac's statement: "Sadly, medical school actually does, unfortunately, sometimes train physicians to be used to being spoon-fed the information they need by giving them the material in lectures laid out to tell them exactly what they need to know, and perhaps that is what is going on with Dr. Egnor."

It's hard to fault the schools, because after all engineering and medicine are professions, and the purpose of professional education is to transfer the knowledge required to practise that profession and to communicate effectively with other members of the profession. Both fields, in daily practice, essentially require a specialised set of problem-solving skills, enough theoretical grounding to understand cutting-edge literature, and... well, that's about it. A strong background in scientific thinking isn't actually required to be a very successful practicing engineer or doctor, as long as one knows the lingo well enough to follow the output of the researchers who actually do have a science background.

It's unfortunate that this is the case, but I don't see things changing in either profession any time soon.

It's easy for very smart people to get intellectually sloppy, and one of the common ways this manifests itself is in overestimating how much one can become an expert in a field merely by thinking about it. It takes some getting used to the fact, as one ages, that people who have lesser IQs may nonetheless have spent sufficient time with the requisite rigour to have knowledge of a subject far superior to one's own.

When we are six the smartest kid is right about everything, because at that point IQ is all that matters. It's a different world at 60, but some smart people seem to never make the transition. Thus we get Hoyle on evolution, Shockey (the inventor of the transistor) on racial superiority, Newton on alchemy, the super-genius bar bouncer on the unification theory, and of course the good doctors and engineers with their screwy opinions on evolution.

I've heard anecdotally that physicians are particularly attractive targets for con artists, perhaps because their experience of saving lives can lead to the misapprehension that their expertise carries over into other realms of experience. It was certainly true of my father, a fine neurosurgeon who never met a scam he didn't like.

As somebody who teaches in medical school, I know that MD students get little if any training in evolutionary theory, and that what they may actually know about the subject derives more from independent study and their undergraduate education than their medical training. Of course, I'd love to teach them more about evolution, but while evolution is critical for biological research, it is not all that crucial for the practice of clinical medicine, and they are already loaded down with so much clinical information to master that they simply have no time to spend learning about evolution.

Joshua pegs it:

A strong background in scientific thinking isn't actually required to be a very successful practicing engineer or doctor.

While both medicine and engineering make significant use of the knowledge generated by science, and though some practitioners of both also have a scientific bent or work as researchers, these are practices, and the vast majority of practitioners in both fields are not scientists. That is no slur on them. It's just the nature of the fields.

Hmmmm, I notice that virtually all of the MDs mentioned are surgeons.

Instead of focusing on the similarities between med school and engineering school, perhaps a better question would be to look at how surgery and engineering are both the "procedural" arms of their respective professions. Perhaps there is something specific about the skill sets that make good engineers and good surgeons (being able to see how parts of a system fit together) that predisposes some persons to see everything as if it were a designed system.

You have no idea how hard it was not to sneak in a "that's-why-it's-not-called-'cognitive'-medicine" joke in this comment.

Oh, don't get too cocky yet.

Go to the Physicians and Surgeons for Scientific Integrity site and look at the list of signatories to the "dissent from Darwin" statement there. There are plenty of non-surgeons there. In fact, non-surgeons far outnumber surgeons.

It could just be that surgeons are bigger loudmouths and more vocal about their "dissent." ;-)

You know, I was just thinking to myself this morning, "You know what Orac's place needs? More Nero Wolfe references!"

rrt's comment is particularly apropos here, because Wolfe would have nothing but contempt for the kind of person who can't be bothered to pick up a reference book before they sign a "dissent from Darwin" petition. He'd also have a pithy comment about someone who claims to dissent from a long-dead scientist, whose work no modern scientist champions without drastic modification.

Related groups of animals change over time; the ones that don't change fast enough or in the right direction die out. Denying directly observable facts doesn't make anyone, no matter how impeccably degreed, a courageous dissenter--they make him an idiot.

By Robert M. (not verified) on 20 Feb 2007 #permalink

When I read his comments, I was hoping that Dr. Egnor would be so kind as to enlighten me and list a few (or even one) of these "millions" of examples of testable predictions that IC makes. But, no, he didn't, and I was disappointed.

Here they are: Predictions of Intelligent Design. They seem to be a few short of millions.

Natural structures will be found that contain many parts arranged in intricate patterns that perform a specific function (e.g. complex and specified information).

Yawn. Behe redux.

In general, vestigial organs (sic) will yield some function for the organism. See design, law, and chance for more on this.

That seems an appropriate question for a surgeon.

Because of the processes inherent to designing, the concept of ID will have to be explored before the actualized design can be explored.

No, that didn't make sense to me either. Thanks for asking though.

By ivy privy (not verified) on 21 Feb 2007 #permalink

Here they are: Predictions of Intelligent Design. They seem to be a few short of millions.

And pretty anemic. Almost all of them are also predictions of evolutionary theory, for example,

In general, vestigial organs (sic) will yield some function for the organism.

"In general?" What does that mean? Evolutionary theory predicts that most organs will yield some function for the animal, because an organ without function is subject to being lost by drift or by pre-emption for some other function. But why under ID should there be any vestigial organs.

Much so-called "junk DNA" will turn out to perform valuable functions.

Evolutionary theory certainly predicts that some noncoding DNA will provide valuable functions. Is it much? Well that depends upon how much is "much"? 10%? 20%? 80%? And why under ID should there be any DNA without function? A salmon has enormously more DNA than a blowfish. Is ID willing to predict that more than 50% of that excess DNA will have a valuable function?

Intelligent Design?!?!? Look at the prostate gland...of course maybe the designer has a sense of humor

By Frank Drackman (not verified) on 25 Feb 2007 #permalink

And why under ID should there be any DNA without function?

Let alone functionless DNA shared between closely related species. Smoking gun to any sane person.

Orac - Out of a sense of science blogger solidarity, and a bit of self-indulgence, I chimed in on this topic also.

Regarding junk DNA - it isn't that we just don't know what much of it does and therefore assume it's junk, much of it is demonstrably bits of viral DNA that got inserted into the genome. Further, related species shared these bits of useless mutated viral DNA - in a nice evolutionary pattern. There is NO non-evolutionary scientific explanation for this.

I took a look at Ivy Privy's link.

Almost the first thing that caught my eye was this piece of wording at the beginning about the various ID "ideas":

Please note: These predictions are theoretical proposals for brainstorming research ideas. These are highly speculative and have not gone through any research or testing yet.

You don't say? I wonder why that is?

Cynical, moi? Whatever gave you that idea? :)

By David Edwards (not verified) on 24 Apr 2007 #permalink