Train wreck, thy name is Egnor!

It figures.

After my having written repeated debunkings of various physicians who are creationists (mostly of the "intelligent design" variety), in retrospect I should have seen this one coming. I should have seen that the Discovery Institute, eager to use anyone they can find whom they can represent to the public as having scientific credentials (never mind whether those credentials have anything to do with evolutionary biology) and thus dupe the public into seeing them as having authority when they start laying down ignorant brain farts about how they "doubt Darwinism," would settle on physicians. After all, as I have pointed out before, until recently medical schools taught little about evolutionary biology (that is, if they taught anything at all about it), and as a result all too many physicians, particularly the ones whose undergraduate majors were not biology, tend to be no more knowledgeable about evolution than your average lawyer--you know, like Phillip Johnson--or your average mathematician--you know, like William Dembski.

I should have further seen that, sooner or later, one physician would emerge from the pack of evolution-ignorant physicians willing to sign the Discover Institutes's eminently mockable "Physicians and Surgeons' Statement of Dissent from Darwinism," the vast majority of whom are in private practice, are not scientists, and do no research of any kind, to become the most prominent "Darwin-doubting" physician that the DI could trot out to impress the rubes as he or she parrots pseudoscientific and antiscientific "objections" to "Darwinism" cribbed straight from the DI's talking points. At first, I thought that it might be Dr. Geoffrey Simmons, who's a fellow at the DI, has written two anti-evolution books, and is even now showing up on bastion of paranormal conspiracy-mongering founded by Art Bell, Coast to Coast AM, to promote his antievolution propaganda. However, Dr. Simmons is in private practice; so, his science cred, while adequate for the DI's purposes, is not as good as it could be. Then I thought that it might be Dr. David Cook, an orthopedic surgeon who got a taste of Respectful Insolence a couple of months back and promptly retreated back to the warm and cozy confines of the home forBill Dembski's sycophants over at Uncommon Descent. And then the DI hit what they must think to be the jackpot. Then, the DI found a willing lackey who also happens to be an academic physician with the title of Professor at a reputable medical school.

Then, the DI found SUNY Stony Brook Professor of Neurosurgery Dr. Michael Egnor.

Not only does Dr. Egnor have an impressive academic title and, to the lay person, an even more impressive profession, but the DI must love the fact that he's like the Energizer Bunny of ID creationism; he just keeps going and going and going and going, all the while trading on his status as Professor of Neurosurgery to give the false impression that he actually has any knowledge or understanding of evolution and in the process bringing more shame upon his (and my) profession. Although I've joked (well, only half-joked) that Dr. Egnor is making it so that I have to wear a paper bag over my head to hide my face in embarrassment over the disgrace he is bringing upon our shared profession, in fact Dr. Egnor's writings and podcasts are like a slow motion train wreck or like the aftermath of a bad multicar collision on the freeway, in which not all the bodies have been extricated yet. I don't want to look, because I know it will be horrible to behold, but I can't help myself.

You may recall that recently I plugged an essay contest for high school students being sponsored by the Alliance for Science, for which the topic is Why would I want my doctor to have studied evolution? Not surprisingly, the DI was not at all amused by this particular contest. In fact, they enlisted Dr. Egnor to write a response. Sadly, it is a clarion call to high school students to remain scientifically ignorant, a plea for them not to bother with all that nasty science, because, according to Dr. Egnor, real doctors don't need all that nasty "Darwinism":

Really, it's a funny question. Think about it. Would anyone sponsor an essay contest on 'Why I would want my doctor to study anatomy' or 'Why I would want my doctor to study physiology'? Of course not, because we all know that these kinds of science are important to medicine. Is evolutionary biology important? If it is, why do they have to ask the question?

Doctors don't study evolution. Doctors never study it in medical school, and they never use evolutionary biology in their practice. There are no courses in medical school on evolution. There are no 'professors of evolution' in medical schools. There are no departments of evolutionary biology in medical schools.

If you needed treatment for a brain tumor, your medical team would include a physicist (who designed the MRI that diagnosed your tumor), a chemist and a pharmacologist (who made the medicine to treat you), an engineer and an anesthesiologist (who designed and used the machine that give you anesthesia), a neurosurgeon (who did the surgery to remove your tumor), a pathologist (who studied the tumor under a microscope and determined what type of tumor it was), and nurses and oncologists (who help you recover and help make sure the tumor doesn't come back). There would be no evolutionary biologists on your team.

I am a professor of neurosurgery, I work and teach at a medical school, I do brain research, and in 20 years I've performed over 4000 brain operations. I never use evolutionary biology in my work.

Because so many have weighed in, including fellow ScienceBloggers PZ, Afarensis, Joan Bushwell, and John Lynch, not to mention other science bloggers Tyler DiPietro, ERV, and Christopher O'Brien, not to mention the coup de grace, the most excellent and detailed evisceration of Dr. Egnor's nonsense, a post that truly I would have been proud to have authored if I had gotten around to authoring it first, Dr. Burt Humburg's response, you might think that there's nothing left for me. You'd be wrong. I just have to take a slightly different tact and try to synthesize a lot of the demolition into a nice, neat package.

But first I can't resist a little fisking, because that first salvo from Dr. Egnor is just too fat and tempting a target to ignore. It just cries out for the Respectful Insolence⢠that Orac is known (and either loved or hated) for, and, as you know, Orac seldom refuses such cries. The reason that a contest with such a topic was thought to be a good idea, I'd guess, is because evolution-ignorant creationists like Dr. Egnor are constantly attacking evolution in a manner that you don't see other of the basic sciences that form the basis of medicine ever being attacked. His argument about there not being "any evolutionary biologists on your team" taking care of you if you had a brain tumor is a nonsequitur, and such a ludicrously risible one at that that I wonder how Dr. Egnor can write it with a straight face. (Obviously debating is not one of his better skills.) Let's look at the basic sciences that Dr. Egnor apparently does consider important. I have news for him. There wouldn't be any physiologists or molecular biologists taking care of you either, but does that mean that the basic sciences of physiology and molecular biology would be unimportant to your care? Of course not! molecular biology is at the heart of today's targeted chemotherapeutic agents, and physiology is at the heart of modern anaesthesia and ICU care. Also, you would probably get chemotherapy, but no, contrary to what Dr. Egnor says, no pharmacologists or biochemists of the kind who discovered the chemotherapies being used would be taking care of you, either (although pharmacists, who take the practical fruits of the effort of pharmacologists and biochemists and apply the knowledge practically, would be). Does that mean that pharmacology and biochemistry are not important to your care? Of course not! It's also tempting to point out that most targeted drug design these days involves evolutionary and genetic principles, often adapted from the study of simpler organisms, and, because the targeted proteins are often highly conserved through many species, the results end up being applicable to humans. In other words, evolutionary biology is becoming increasingly important to basic pharmacology. I could go on, but I'll finish with this one: There would almost certainly be no neurobiologists involved in your care, either. Does that mean that neurobiology and neuroanatomy aren't important in the care of brain cancer patients? I think you know the answer to that one by now. Would Dr. Egnor himself know where to cut and and what losses of neurological function could be expected if he cuts wrong if neurobiologists and neuroanatomists (some of whom were surgeons) hadn't studied the nerve transmission pathways of the brain and mapped them in such exquisite detail in animals and humans over the course of many decades?.

I wouldn't want to bet my life on on it--or the aneurysm that is developing in my brain every time I see one of Dr. Egnor's idiotic statements like this:

Would I be a better surgeon if I assumed that the brain arose by random events? Of course not. Doctors are detectives. We look for patterns, and in the human body, patterns look very much like they were designed. Doctors know that, from the intricate structure of the human brain to the genetic code, our bodies show astonishing evidence of design. That's why most doctors--nearly two-thirds according to national polls--don't believe that human beings arose merely by chance and natural selection. Most doctors don't accept evolutionary biology as an adequate explanation for life. Doctors see, first-hand, the design of life.

I do use many kinds of science related to changes in organisms over time. Genetics is very important, as are population biology and microbiology. But evolutionary biology itself, as distinct from these scientific fields, contributes nothing to modern medicine.

No, as so many others have pointed out, Dr. Egnor does use evolution, or at least the results of the study of evolution, in his work whether he wants to admit it or not, even if he chooses to label it as "genetics" or "population biology." He simply doesn't understand or refuses to remain willfully ignorant that all of these fields are linked. All of them intertwine, and it's almost impossible to define where one ends and another begins. Besides, if he uses antibiotics according to currently accepted guidelines (in other words, does not use more powerful antibiotics than the infection being treated calls for and does not use them longer than necessary), he is using the fruits of the study of evolution. If his radiation oncologist uses small fractions of radiation therapy to treat brain tumors, he is using differences in mutation rates and DNA repair ability to design a therapy that will maximize damage to tumor, minimize damage to surrounding normal tissue, and minimize the chances of resistance developing. Similarly, the entire study of chemotherapy is based on evolutionary principles applied at the cellular level. Dr. Egnor may dismiss all of this as not being due to evolution as a "distinct field," but in doing so reveals himself to be that stereotype of surgeons that drives me crazy, that of the pure technician who doesn't understand the science behind what he is doing. Particularly galling is that Dr. Egnor doesn't seem to realize that he is not, as he seems to think, being "bold" or" creative" by spouting truly astonishing antievolution nonsense that only reveals the limitations of his own understanding.

Because so many have lambasted Dr. Egnor for his ignorance on these issues, in the last section of this post, I am not going to go into detail as to why his further assertions are incorrect. For example, Joan brilliantly (and succinctly) demolishes Dr. Egnor's claiming that, because lots of discoveries were made before Darwin and without invoking evolutionary theory that evolution is irrelevant to medicine. Burt and Afarensis completely toast his claims that medical schools don't have scientists studying or teachers teaching evolutionary biology Burt points out that the AAMC considers evolution to be important enough to be covered on the medical school admission examination MCAT, as there is this list of evolutionary medicine courses being offered at medical schools, including Stanford and my alma mater, the University of Michigan to contend with. (This goes somewhat to make up for its recent pitching of woo to its medical students.) And Burt and ERV demolish his claim that no Nobel Prizes have been awarded for evolutionary biology, as do many of the commenters at Panda's Thumb. Finally, Christopher O'Brien and I have both utterly trashed Dr. Egnor's specious claims that "Darwinism" led directly to eugenics (a.k.a. the "Darwin led to Hitler" argumentum ad naziium).

What I want to discuss here briefly is just how much in error Dr. Egnor is about evolution and its effect on medicine using my area of expertise, cancer, as an example. Nearly a year ago, I wrote about how a measure of diversity used in the study of the evolution of populations of organisms, the Shannon index, had been applied to the problem of determining which patients with a condition known as Barrett's esophagus, in which the risk of developing esophageal cancer is elevated considerably above that of the general population, are most likely to go on to develop esophageal cancer. It was an elegant study that correlated the Shannon index to multiple biopsy specimens (these patients undergo periodic upper endoscopy to assess the state of their Barrett's esophagus) to their risk, and proposed that their method might be useful to determine which patients should be offered esophagectomy for cancer prevention. More recently, in the context of refuting some of Dr. Egnor's more silly pontifications, I discussed a review article in the very latest Nature Reviews Cancer discussing how evolutionary principles are beginning to have profound implications in our understanding of cancer itself and why people are susceptible to it.

One article that I didn't mention had been published a mere three months earlier in the very same journal, and it was entitled Cancer as an evolutionary and ecological process. This article, written by Lauren Merlo, John Pepper, Brian Reed, and Carol Maley, presents an even more detailed overview of how evolution is necessary for the understanding of cancer, both at the organismal level (cancer susceptibility and who does and does not get cancer and why) and at the cellular level, in which the tumor is viewed as an ecosystem of competing clones competing and cooperating with each other and other cells in their microenvironment. In addition, although scientists have mostly thought of the role of artificial selection (i.e., chemotherapy and other anticancer therapies that select for resistant tumor cells), it turns out that genetic drift, as well as models of parasitism, commensalism, and mutualism can be applied to tumors, specifically different clones of cells within the tumor. Similarly, the development, growth, and spread of tumors can be viewed in terms of natural selection for clones able to proliferate, spread, and metastasize, as well as dispersal and colonization.

More interestingly, evolutionary biology suggests how we might alter our chemotherapeutic regimens to be more effective. Right now, most chemotherapy is designed to kill as many tumor cells as possible without killing the patient. A large dose is given, near what is known as the maximum tolerated dose. This kills as many tumor cells as the drug can kill, but also exacts a high toll on the body, killing off white blood cell and platelet precursors in the bone marrow. Consequently, a break is needed to allow the bone marrow (and the rest of the body) to recover, at which point another dose is given. The rationale for this is to hit the tumor hard and leave as few surviving cells as possible. However, the disadvantage is that the prolonged break between cycles can allow resistant clones to proliferate, making it more likely that by the next round of chemotherapy there will be enough even more resistant clones to survive. Based on evolutionary principles, scientists and oncologists are now developing strategies to overcome this problem:

There are several possible evolutionary approaches to cancer therapy and prevention that could address the problem of therapeutic resistance. These include multi-drug therapies76, therapies that work to alter competition between cancerous and non-cancerous cells by boosting the fitness of benign cells, selection for chemosensitivity10, selection for genetic stability and the induction of crippling bottlenecks. Of these strategies, only multi-drug therapies have been explored experimentally and/or clinically. The way a therapy is applied might also affect the evolutionary dynamics in a neoplasm. Evolutionary experiments show that the application of selective pressures in pulse versus continuous treatment can alter the outcome of competition. Traditional chemotherapies are applied in large pulsed doses, but evolutionary theory, and evidence from antiangiogenic therapy, suggests that lower, continuous doses might work better. Neoplastic cell populations that expand between doses might generate new resistance mutations. In addition, under pulses of a therapy, the fitness of a neoplastic cell is the average of its fitness during therapy and its fitness between doses, weighted by the duration of those conditions. This is likely to be higher than the fitness under a lower but continuous dose, although pulses of extremely high doses have also been shown to be efficacious in some cases.

The population bottleneck caused by cancer therapy might be able to cripple a neoplasm. Following therapy, many patients with leukaemia show minimal residual disease, in which a very small population of leukaemic cells remain as a stable subpopulation, and do not grow exponentially as would be characteristic of cancer. One hypothesis for the population stability is that the characteristics selected by chemotherapy might also interfere with proliferation. For example, if a cancer drug only kills proliferating cells, then quiescent cells might survive the treatment and remain quiescent thereafter. Alternatively, if the bottleneck is small enough, cells with fitness disadvantages can become fixed in the neoplasm by genetic drift. Because the rate of evolution is very slow in small populations, it might take a very long time before a leukaemic clone acquires mutations that enable it to expand again.

Whether Dr. Egnor likes it or not, the principles of evolution are becoming increasingly important in designing cancer therapies. Indeed, another example was published last year, in which the authors applied the techniques of evolution to study specific sequences in the BRCA1 gene (a gene that is responsible for a form of hereditary breast cancer) to determine which sequences were important and which sequences were selected for. An even more ambitious review article than the two I've mentioned before was also published, in which it is hypothesized that forms of antagonistic coevolution have produced strong links between positive selection at the molecular level and increased cancer risk. I've meant to blog on this one for a while now, and perhaps I should do so in the near future.

Finally, let'sbring it on home to Dr. Egnor's own specialty. Neurosurgery, one of the major journals about (of course) neurosurgery has drawn Dr. Egnor's wrath in the not-too-distant past by publishing an article by Dr. John J. Oró of the Division of Neurosurgery at the University of Missouri-Columbia, entitled Evolution of the brain: From behavior to consciousness in 3.4 billion years. Apparently members of Egnor's own specialty, including someone whose credentials are more impressive than those of Dr. Egnor's (see Dr. Oró's CV) are coming to appreciate that the evolution of the brain matters in what they do. What's remarkable about this article is that it's a review article that's purely about evolution and it appeared in one of the premiere journals of neurosurgery. Not surprisingly, Dr. Egnor was not pleased at this development, not pleased at all. He even wrote to the journal a few months later, just going to show that he's been embarrassing himself over evolution for at least two years now. I think it's worth publishing the exchange, to see Dr. Egnor getting himself slapped down (if this is too long for you, feel free to skip to the end). Also, people commenting on Panda's Thumb were wondering about it:

Dr. Oro's article (6) is a fine review of the development of the brain from the perspective of Darwin's theory of evolution. That is its weakness. Darwin's theory that life can be explained by the purely materialistic mechanism of natural selection acting on variation is increasingly under assault for substantive reasons by scientists (1, 4, 5) and philosophers (4, 8). The Darwinian explanation for consciousness is particularly problematic.

Dr. Oro asserts that we are conscious because we have evolved brains that are computers made of meat and that parallel processing of complex sensations led to consciousness. However, if our consciousness evolved because of natural selection, natural selection would only hone conscious activities that favor procreation. Other conscious activities, such as pondering theories of evolution, would be selectively neutral or even selected against (skimming the Journal of Human Evolution is not notably procreative). Our scientific opinions would bear no necessary relation to the truth, because the discernment of truth is not selected; procreation is selected. In the evolutionary paradigm, all conscious activity that evolved by natural selection is directed to procreation, including the thinking that produced the theory itself. If our consciousness evolved, we have no claim on the ability to discern scientific truth. Evolved consciousness is a tool for mating rather than a tool for science.

The materialistic aspects of Darwinism are dubious as well. The assertion that consciousness is the result of "adaptive representational networks" that are "individualized circuitries that generate behavioral solutions that precisely fit the specific environmental conditions, bioenergetic needs, personal experiences, and unique life history of the individual" (6, p 1294) is so vague that it is even difficult to ascertain how it could be proven right or wrong. What experiments could be done to test its predictions? What are its predictions? What is the scientific basis for asserting that complexity of "circuitries" is sufficient for consciousness? Can consciousness even be defined in material terms? A professor is smarter than a schoolboy, but is he more conscious? A person with normal vision and normal hearing certainly processes more complex sensory information than a person who is born blind and deaf, but is he or she more conscious than the disabled person? Does consciousness correlate with intelligence quotient? Are adults more conscious than children? Is a computer running Windows 2000 closer to consciousness than a computer running Windows 98? Where is there even a shred of evidence that brain complexity causes consciousness rather than mediates it?

The fundamental weakness of Darwinism is that it restricts itself to materialistic explanations for life, including materialistic causes for consciousness and for what most of us would call the "soul." An alternative explanation for life and consciousness, of course, is that it was designed by a higher intelligence. During the past decade, several biochemists and mathematicians have suggested that it is possible to identify intelligent design (ID) in biological processes. Perhaps the most cogent recent evidence for ID has been the recognition of irreducible complexity (1). Irreducible complexity is the characteristic of many molecular systems, such as metabolic pathways and bacterial flagella, in which it seems necessary that all of the individual components be in place before the system as a whole can function. These molecular systems are too complex to have arisen fully formed by a single mutation; thousands or even millions of individual mutations would be necessary to create them from nonfunctional precursors. Evolutionary theory requires that each minute intermediate mutation must have conferred procreative advantage by itself; yet, the irreducibly complex system does not work until all the mutations have occurred and all the components are in place. It is difficult to ascertain how undirected evolutionary mechanisms could have assembled intricate molecular systems of such complexity and specificity without functional intermediates. How did such systems evolve by natural selection?

Among modern theories in physical science, Darwinism is unique for the paucity of quantitative evidence to support its fundamental hypothesis--the hypothesis that the extraordinary specified complexity of living organisms is the result of the undirected process of natural selection acting on random variation without intervention by an intelligent agent. Recently, investigators have applied the mathematics of information theory to biological complexity. Mathematician William Dembski (4, p 166), using Emile Borel's probability method to detect design (3), has proposed that any contingent system that contains more than 500 bits of information has sufficient complexity and specificity that it is almost certainly intelligently designed. The chance that a system with more than 500 bits of information arose without an intelligent agency would be less than 10 150, which is no chance. A single e strand of human deoxyribonucleic acid encodes information that is many orders of magnitude greater than that threshold for detection of design; in any other branch of science except evolutionary biology, the genetic code would be recognized as an artifact of ID. The hypothesis that some of the complexity of living systems is the result of ID has been excluded from biology for philosophical rather than scientific reasons. Scientific materialism is the secular religion of modern biology.

The detection of ID is common in other fields of science. It forms the basis for forensic science, cryptography, and archaeology. The a priori exclusion of the possibility of ID as an explanation for biological complexity leads to absurdities. If an archaeological site were unearthed and found to contain a man's corpse with a primitive ax wedged in the man's skull, an archaeologist would affirm that the ax was designed, a forensic scientist would conclude that the man's death was intentional, and an evolutionary biologist would conclude that the man was an accident.

The ethical implications of Darwinism are gaining credibility at the same time that the scientific implications are losing credibility. If consciousness is what makes us human, and consciousness is the result of material complexity of the brain, it is inevitable that the conclusion will be drawn that smart people are more human than simple people. Newborn babies and some neurologically handicapped people demonstrate less behavioral complexity than many animals do. Are they less conscious than animals? Are they less than human? Princeton University's Peter Singer, the world's preeminent ethicist, has suggested that newborns and some people with severe cognitive handicaps ought to have fewer legal rights than some animals and that it is ethical for their parents or caretakers to kill them if they wish (7).

The emergence of such ethics is not surprising. Philosopher Benjamin Wilker (8, p 27) has pointed out that every philosophy of science necessarily includes a worldview; there are no separate magesteria in which scientific theories do not have philosophical and ethical implications. In the 20th century, the worldview of Darwinism had a profound impact on humanity. Social Darwinism, the application of Darwinism to the social sciences, served as the basis for a vast program of eugenics and involuntary sterilization in the United States (2). It fell into disrepute in the 1930s when "survival of the fittest" emerged as a philosophy of government in Europe. The worldview engendered by Darwinism has since taken more subtle but perhaps more pervasive forms. During the past half-century, abortion, infanticide, genetic screening, the prospect of therapeutic and reproductive human cloning, the use of fetal tissue for experimentation, and voluntary and even involuntary euthanasia, all of which benefit the fit at the expense of the less fit, have been gaining acceptance.

Neurosurgeons practice an applied science; we care for many people who are not particularly "fit," and we have a special responsibility to understand the ethical implications of scientific theories published in our journals. Dr. Oro's review of the evolutionary development of the human brain is a retelling of a dubious scientific theory with a disturbing ethical pedigree. Evolutionary theories are collections of stories, some quite fanciful, such as the assertion that "we started to eat meat, got smarter, and thought of cleverer ways to obtain more meat . . ." (6, p 1293) or "tools and increasing cognition allowed procurement of a richer diet that led to a smaller gut, thus freeing more energy for brain expansion" (6, p 1287). Although there is no other area of modern physical science in which such tales would be accepted as meaningful theories, the ethical implications of Darwinism have been taken quite seriously and seem to be gaining currency again. Philosopher Daniel Dennett has called Darwinism a "universal acid" that gradually transforms any culture in which it gains ascendance (8). The corrosive ethics of Darwinism are proving far more durable than the science (6).

There it is, on display, pretty much every fallacy about evolution that Dr. Egnor has been parroting for the DI recently ("Darwinism=materialism/atheism," "evolution is not supported by the evidence," consciousness can't be explained by evolution or a strictly biological mechanism), all two years ago and with a twist. Specifically, he's taking advantage of the controversies over the development of consciousness and how we study it, in essence claiming that, because we don't yet have good tools to study consciousness and how it evolved, then evolution must be bogus. (paging Dr. Chopra). And, not surprisingly, at the end, Dr. Egnor trots out his tired old "Darwinism leads to eugenics, abortion, infanticide, and euthanasia (although why evolutionary theory would lead to such things he does a preetty poor job of explaining.) I'm surprised that he didn't add that Darwinsim leads to halitosis and flatulence as well. Fortunately, Dr. Oró is up to dismantling Dr. Egnor's mendacity, for the most part, although he does drift into some religious arguments at the end. At least he knows enough to see Dr. Egnor's letter for what it is, an attack on evolution and a proposal of "intelligent design" in its place:

I appreciate Dr. Egnor's comments on my article (20). It is unclear whether he opposes the theory of the evolution of life or just of the evolution of human life and consciousness. [Orac note: No it isn't. Dr. Egnor clearly opposes the theory of evolution of life; Dr. Oró is being kind.] However, it is clear that he advocates ID. A brief review of the ID movement may benefit readers new to the subject.

In 1987, the Supreme Court in Edwards v. Aguillard ruled that creation science was not science but religion. In his 1993 book, Darwin on Trial, University of California law professor Philip Johnson (10) suggested the use of "intelligent design" as an alternative. In 1996, he established the Center for Science and Culture at the Discovery Institute in Seattle (28, p 3) and subsequently published The Wedge of Truth: Splitting the Foundations of Naturalism (11). In her book, Creationism's Trojan Horse: The Wedge of Intelligent Design, Barbara Forrest notes that Johnson's book is part of a "wedge strategy" designed to
get intelligent design "theory" into the public schools (7). (We should credit Johnson for revealing his bias that ". . . scientific evidence is not really needed to prove the theory true any more than scientific evidence is needed to prove that two plus two equals four" [10, p 45].)

Among the leading advocates of ID is biochemist Michael J. Behe. His central argument, which Dr. Egnor views as "perhaps the most cogent recent evidence for intelligent design," is presented in the book Darwin's Black Box: The Biochemical Challenge to Evolution (3). Behe argues that the presence of biological "irreducibly complex" structures (by definition, a structure that would not work after the loss of one of its component parts) indicates that they were designed and could not have evolved. He uses the analogy of the common mousetrap: take away the hammer, spring, or pin, and the trap will not work. Behe believes that several biological structures or systems are irreducibly complex, among which are the flagellum, blood clotting, and the immune system. The argument, a modern version of the 19th century notion that the eye could not have evolved, is flawed. As biologist Kenneth Miller states: "Multiple parts of complex, interlocking biological systems do not evolve as individual parts, despite Behe's claim that they must. They evolve together, as systems that are gradually expanded, enlarged, and adapted to new purposes" (18).

The mechanisms of evolution are more robust and dynamic than Dr. Egnor suggests. Exaptation, the use an adaptive structure for a different function than that for which it was initially developed, plays an important role in the development of complex structures. Instead of being irreducibly complex, homeostasis is being demonstrated to have rapidly evolved in vertebrates (1). These studies further reveal the "power and versatility of gene duplications and exon shuffling." Computer modeling indicates that the number of mutations needed to generate some complex functions can be startlingly small and that initially deleterious mutations can serve "as stepping-stones to the evolution of complex features" (14). Furthermore, recent studies of the genome's silent areas have uncovered a hidden function: regulating the development of complex structures (15). As the mechanisms of biological complexity are revealed and the evolution of homeostasis, the flagellum (6, 19), and the immune system (9) are defined, the complexity argument fades. Even Behe's analogy of an irreducibly complex mousetrap has lost its vigor (16).

Mathematician William Dembski (5) proposes the concept of specified complexity. A suitable pattern, which he calls specification, combined with complexity (measured by probability and pattern) indicates ID. He developed an explanatory filter to determine whether an event is caused by necessity (natural law) chance, or design. An event of high probability is a result of law, and one of low probability is a result of chance or design depending on the presence of a suitable pattern meeting the condition detachability. Detachability, crucial in Dembski's scheme for differentiating chance from design, seems to be subjective (21, p 25). Furthermore, the outcome of the filter depends on how tightly its probability limits are set. The management of change is also problematic. Does an event such as a cometary impact, highly probable during Earth's period of heavy bombardment and now highly improbable, change from law to a chance? Finally, the definition of design itself is unclear because Dembski suggests design without a designer in some cases (21, pp 21-22). Although one ID advocate described Dembski as "the Isaac Newton of information theory" (21, p 20), other reviewers are not convinced (21, 28).

A new "carefully nuanced" (8, p 314) argument is moving to center stage. In their book, Rare Earth: Why Complex Life Is Uncommon in the Universe, paleontologist Peter Ward and astronomer Donald Brownlee discuss various observations suggesting that Earth-like planets are rare (27). ID advocates Guillermo Gonzalez, an astronomer/physicist, and Jay W. Richards, a philosopher/theologist and vice president of the Discovery Institute, have expanded on this theme in their book, The Privileged Planet: How Our Place in the Cosmos Is Designed for Discovery. Gonzalez and Richards argue that because the "Earth's conditions allow for a stunning diversity of measurements" (8, p xiii), which render it "optimal for making scientific discoveries" (8, p xv), and because our planet is habitable, we must have been designed. This "correlation between habitability and measurability" is their "compelling discovery" (8, p 332). Given that we would not be here if Earth were not habitable, the debate centers on our possible uniqueness. The thrust of my article, that conscious life appeared on this habitable terrestrial planet after billions of years of evolution altered by a series of catastrophic events, suggests that human life and consciousness may indeed be unique.

Gonzalez and Richards suggest what they mean by design: it does not have to be perfect, moral, or efficient (8, p 330). Because the authors do not debate evolution, support the history of catastrophic impacts, and are likely to agree that asteroidal collisions are caused by law or chance and not by design, let's briefly review our planet's history. The Earth is created by accretion and then by heavy bombardment of comets and asteroids. A proto-moon of just the right size hits the Earth in just the right direction so that it avoids destruction yet is able to capture much of the material to create the Moon, which stabilizes Earth's orbit and limits extreme fluctuations in climate. Once life begins and is well established, a huge asteroid slams into the Earth, destroying 90% of marine life and 70% of terrestrial life. Vertebrates make it through this "bottleneck" and evolve into mammals and dinosaurs. The huge reptiles dominate the Earth for 100 million years, whereas mammals remain "small creatures confined to the nooks and crannies of a dinosaur's world" (13). Another catastrophic impact destroys the dinosaurs and finally allows mammals to flourish and evolve into conscious beings. Is this history, dependent on what Dembski's filter would detect as law or chance events (the impacts) (5), the result of design? When considered from this wider perspective, defining the options as law, chance, and design is not revealing. I suggest that the mystery lies deeper.

Consciousness is likely latent in all creation and becomes apparent in organisms with highly complex brains. The limited self-awareness in chimpanzees (12, 24) and the partial consciousness of extinct Homo neanderthalensis (able to shape stone tools and bone awls, occasionally bury the dead, and possibly stitch crude clothing [2]) suggest an evolved emergence. In humans, the neural correlates of consciousness are being defined by functional brain imaging (12, 22, 25, 26). Whether adaptive representational networks or other theory enriches our understanding of consciousness, it is a wonder we live in this age of discovery.

The remainder of Dr. Egnor's critique seems to be based on the view that science requires the philosophy of materialism. It does not. Forty percent of scientists reject materialism and accept an active and personal God (13), which is a figure similar to that in the general population. In Finding Darwin's God, biologist Kenneth Miller (17) writes: "Darwin lifted the curtain that allowed us to see the world as it really is" and "ultimately brought us closer to an understanding of God."

The wedge strategy is unnecessary. A millennia-old Aramaic translation of Genesis reads: "And God saw all that had been done and behold it was a unified order" (23). Darwin (4) revealed the unified order of life and concluded in the last line of On the Origin of Species: "There is grandeur in this view of life, with its several powers, having been originally breathed by the Creator into a few forms or into one; and that, whilst this planet has gone cycling on according to the fixed law of gravity, from so simple a beginning endless forms most beautiful and most wonderful have been, and are being evolved."

I'm not entirely sure that Dr. Oró is correct that 40% of scientists believe in a personal God, although it is almost certainly true that physicians and surgeons are at least as religious as the general population. Indeed, I've written about the religiosity of physicians before and how there are a disturbing number of creationists (even young earth creationists) among our ranks. One thing that irritates me about Dr. Egnor is that it's blindingly obvious that his objections to evolution are based on his personal religion, which is Roman Catholicism (apparently he's never heard that the Catholic Church reconciled itself with the theory of evolution over 50 years ago, a point that was reiterated by the late Pope John Paul II about a decade ago, something the wingnuts have never forgiven him for). Nonetheless, Dr. Egnor insists on claiming that his objections are scientific in nature, showing how his religion has distorted his science and critical thinking. Looking at the exchange above, I think it's becoming more clear to me why Dr. Egnor has joined the Discovery Institute. His antievolution views are, thankfully, becoming more and more marginalized in medicine, even in his own specialty of neurosurgery. My guess is that Dr. Egnor was coming to be viewed more and more as a crank by his colleagues. In contrast, at the Discovery Institute, he has been able to find a number of like-minded pseudoscientists, and they're willing to fawn over him because of his academic title and his enthusiastic willingness to spread their propaganda far and wide while dazzling lay people with his credentials as a genuine Professor of Neurosurgery. At the DI, he's a bigshot. The sad thing is, by all accounts Dr. Egnor appears to be an excellent neurosurgeon otherwise. Why he needs the sycophancy of the Discovery Institute, I'll never know. If I were him, the gratitude of my patients would be more than enough.

On a final note, I'm happy to report that Dr. Egnor will have yet another opportunity to humiliate himself in front of his peers. Clearly under the influence of those evil Darwinists wanting to "destroy those who dissent from Darwinism," Neurosurgery has published another review of the evolutionary biology of the brain in its March issue, hot off the presses, entitled Evolution of the human brain: Changing brain size and the fossil record.

I can hardly wait to see what Dr. Egnor's response is.