Facepalm, thy name is Dr. Egnor! Or: I find your excess of faith in the scientific abilities of physicians...disturbing

I have to wonder if the most famous denizen of the Discovery Institute in medical circles, Dr. Michael Egnor, is on vacation or something. For some reason, he's been especially active over at the Discovery Institute's repository of pseudoscience, Evolution News & Views, over the last couple of weeks. Neurosurgeons tend to be very busy people, more so even than a humble breast cancer surgeon like me, and few are as motivated as I am to blog. Yet, these days Dr. Egnor's been flooding EN&V with more of his blather than I've seen him do in a long time, maybe ever.

It's times like these that I can't help but ask him if he doesn't happen to have a few brains to operate on instead of embarrassing the fine profession of surgery for me among all the basic scientists with whom I have to interact. After all, everybody's favorite obtusely creationist neurosurgeon, whom I once called the "Energizer Bunny of antievolution," is arguably one of the biggest embarrassments to me as a surgeon that I have yet encountered. The man is a bottomless pit of evolution denial; worse, he is unrelenting in his perseveration of repeating the same tired old "intelligent design" creationism canards over and over again and, as Mike Dunford documents, either utterly clueless or even possibly dishonest in the way he selects what he will quote from posts by those whom he is trying to refute.

In any case, this flurry seemed to start around the time I posted this exasperated plea for a mask to cover my face because of this post by Dr. Egnor. What I had failed to notice is that Dr. Egnor actually replied to me and went off on one of his usual tangents that did nothing more than hammer home his ignorance of evolutionary theory. Oddly enough (or perhaps not surprisingly), I didn't even notice that he responded, which at least reassures me that EN&V isn't a particularly highly trafficked site if its incoming signal gets totally lost in the noise of my stats. Mike Dunford, fortunately, took up my slack and leapt into the breach to shoot down Dr. Egnor's nonsense, pointing out that, if anything, Dr. Egnor had actually unintentionally made a good argument for the validity of evolution as applied to medicine. Given that Mike did such a good job of demolishing Dr. Egnor's misinterpretation of science, I don't see a compelling need to pile on, especially not when Dr. Egnor provides such a--shall we say?--target-rich environment, for instance, this post referring to P. Z. Myers:

But, as always, Myers professes stupefaction at the topic of eugenics. Myers is shocked -- SHOCKED -- that I would presume that he was attending a conference on eugenics when he blogged about attending the symposium "Understanding evolution: the legacy of Darwin," held in an old medical lecture hall. Who would ever connect "legacy of Darwin," a medical lecture hall, and eugenics

Actually, I'm shocked, too. Eugenics was not the legacy of Charles Darwin, no matter how much Dr. Egnor wishes to make it so (sorry, with the Jean-Luc Picard picture above, I couldn't resist). It was the legacy of people who warped Darwin's theory to fit their ideology. PZ was right to call Dr. Egnor on the carpet for his nonsesne. But what caught my attention even more than that little drive-by attack on Darwin was this:

Let's take up Myers' assertion that I have an "ignorance of the mechanistic underpinnings of what medicine does." I'm a professor of neurosurgery and vice-chairman of my department. I've been teaching medical students and residents for twenty-three years, and I conduct basic science research on blood flow and cerebrospinal fluid flow in the brain. I'm not sure of Myers' medical teaching and research activities, but perhaps I could learn from his personal contributions to medical education. My own experience with medical research and education is that medical practice is a very effective check on b.s., because in medicine ideas often have immediately obvious consequences. Some of these consequences are deadly. Eugenics was the consequence of the application of the Darwinian understanding of human origins to medical practice, and is the most shameful aspect of medical practice in modern times. I love my profession, and I harbor considerable ill-will for eugenic ideology that brought so much shame and disrepute to my profession and so much harm to countless innocent patients victimized by "Darwinian medicine" 1.0.

Actually, those who have been regular readers of this blog almost certainly realize that Dr. Egnor holds far too high an opinion of the utility of medical practice as an "effective check on b.s." In fact, it is science that serves as a "very effective check on b.s.," not medical practice. Indeed, I've argued that time and time again. Yes, it's true that science is often wrong, that sometimes it takes a maddenly long time for incorrect paradigms to be overthrown by new experiments and observations, and that the process of correcting accepted scientific dogma with hypotheses that more closely fit the data and make better corrections can be incredibly messy viewed from the outside, but science is inherently self-correcting. Eventually, b.s. is cast out. Not so when it comes to pseudoscience like ID creationism and--yes, you knew I'd mention it eventually--unscientific medical practices.

After all, what is the whole concept of "complementary and alternative medicine" (CAM) but incredibly concentrated b.s.; yet medical practice seems to have no effect preventing so many physicians to believe in a variety of unscientific and ineffective treatments. Indeed, unscientific CAM has infiltrated bastions of scientific medicine, such as Yale, Beth Israel, and others. Medical practice didn't stop Dr. David Katz or Dr. Andrew Weil from falling into pseudoscientific woo. It certainly didn't stop Dr. Jay Gordon from deciding that his clinical experience leading him to believe that vaccines cause autism trumps the strong science and epidemiology that say they do not, from making brain-meltingly ridiculous claims that there are "toxins" in vaccines that cause all sorts of terrible complications, or even giving speeches to rallies organized by people and groups who are antivaccine. He even exasperates the normally mild-mannered Steve Novella.) Practicing medicine didn't stop any of these people from diving headlong into pseudoscience, even in areas directly related to their medical practice.

And it certainly didn't stop Dr. Egnor from falling headlong into the antiscience of ID creationism.

No, medical practice, if anything, makes it very easy to be deceived if a physician is not very careful and very conscientious in staying up-to-date on the latest scientific and medical literature. Do I even have to point out how many times confirmation bias, confusing correlation with causation, the placebo effect, and many other confounders have lead physcians "just practicing medicine" to believe that homeopathy is more than just water, that reiki is more than just a neo-shaman waving hands and making symbols in the air, or that acupuncture is more than just an elaborate placebo? I shouldn't. In truth, physicians are no more rational than any other human being. Indeed, if there is one complaint I have voiced time and time again over the last few years, it is how poorly grounded in science so many physicians are and how little training in the scientific method we as physicians receive in medical school. Couple that with a touch of arrogance, in which physicians have a tendency to think that their extreme expertise in medicine translates to other areas, and you have a recipe for pseudoscience. Add in fundamentalist religion, and you have a recipe for not only pseudoscience, but a refusal even to consider the possibility that you don't know what you're talking about

Dr. Egnor demonstrates that in spades in a more recent post, too, as he continues to perseverates ove rhis caricature of "Darwinism" as the root of all evil (or at least all eugenics) in medicine:

I recently pointed out that Darwinian stories about the evolution of diseases were of no tangible use to medical science. Few physicians and medical scientists and educators with genuine experience with medical education, research, and practice, and who are not ideologically committed to the materialist-atheist metaphysics for which Darwinism is the creation myth, honestly believe that evolutionary biology is important to medicine. There are many important disciplines in medicine today, such as microbiology, epidemiology, molecular and population genetics, and mathematical biology, that deal with the real science for which evolutionary biologists routinely claim credit, and these genuine medical disciplines, unlike evolutionary biology, are very important to medicine. We've done very well for more than half a century without Darwinian medicine. The recent drive to introduce Darwinian Medicine 2.0 into medical education was initiated by Darwinists. They weren't invited.

It is said that you can't reason a person out of a belief that he didn't use reason to come to believe in, and I think that's definitely the case with Dr. Egnor. It's very clear that Dr. Egnor's fundamentalist Catholic religion is what convinced him that evolution could not be true, not any science, not any defects or deficiencies he has been able to describe in the science behind evolutionary biology. Instead, his argument against applying evolutionary theory to the study of human disease and treatment boils down to the simplistic and fallacious statement that, just because medicine hasn't used evolutionary theory much until recently, evolution has nothing to offer in the study of medicine:

We haven't missed it [evolution]. For more than half a century, "evolution-free" medicine has done very nicely. Heart, kidney, and lung transplants, cardiopulmonary bypass (the heart lung machine), extraordinary advances in brain surgery, joint replacements, major advances in the treatment of heart attacks, congenital heart disease, stroke, and infectious diseases, and remarkable improvements in the survival of patients with cancer and the survival of premature babies, to name just a few, have come about very nicely without evolutionary biology in the medical school curriculum. We haven't missed the mass sterilizations, the pseudo-diagnoses of "feeble-mindedness" and the carefully planned quarantine and even exterminations of the handicapped (merely planned in the U.S. -- at the Eugenic Records Office at Cold Spring Harbor -- but actually carried out in Germany). In American medicine in the past half-century, evolutionary biology wasn't missed at all.

I suppose I could mention once again how important evolutionary principles have been to the elucidation and control of bacterial resistance to antibiotics (1, 2, 3, 4). And the use of evolutionary principles to study and predict bacterial resistance is not a new phenomenon in medicine, either. It began almost as soon as bacterial resistance started to evolve in response to ever more powerful antibiotics. Then there's the use of explicitly evolutionary principles, including population measures like the Shannon index, to esophageal cancer, in addition to the usually invoked example of how tumors evolve resistance to chemotherapy. Indeed, I have to wonder if Dr. Egnor bothered to read the two papers I referred to in a previous rebuttal of this sort of nonsense, specifically the reviews by Merlo et al and by Mel Greaves. Finally, evolutionary biology combined with systems biology holds the promise of leading to truly individualized therapies.

But let's look at Dr. Egnor's argument in a more general fashion. Go back 30 years or so. Before that, medicine did "quite nicely" without, for example, molecular biology. After all, advancements in anesthesia, many of the transplant techniques that Dr. Egnor likes to harp on, many surgical advances, advances in antibiotics, the development of treatments for diseases that couldn't be treated before, advancements in cancer care, all of them came about without molecular biology. But after scientists figured out how to sequence DNA, identify genes, isolate them, put them into plasmids, and use those plasmids to transform bacteria or mammalian cells, and suddenly all sorts of proteins could be synthesized for therapeutic use, the first of which was insulin. No more pig insulin! Add to that the ability to measure the expression of genes and to identify mutations, and suddenly we're discovering the molecular mechanisms of cancer. Add computers, so that we can survey the entire human genome on a single chip, and now we're developing gene chip tests that predict disease, tumor response to chemotherapy, and all sorts of other useful predictive markers. Molecular biology unlocked a revolution in medicine. Yet medicine "did just fine" without it for decades. Perhaps we shouldn't have applied molecular biology to medicine so heavily beginning in the 1970s and 1980s, and perhaps we shouldn't be teaching medical students the basic concepts of molecular biology now. After all, medicine used to get along quite nicely without it!

Of course, Dr. Egnor probably isn't a fan of molecular biology that much either, for the simple reason that molecular biology has unrelentinly confirmed and supported the neo-Darwinian synthesis by showing how genes evolve and at what rate. Moreover, much of molecular biology, in fact, depends on evolutionary principles. Indeed, by comparing gene sequences with other animals, we infer a gene's importance (genes that don't change very quickly in response to evolutionary pressures tend to encode more important genes, determine what parts of a protein are most important for function, trace disease susceptibilities through populations, and make predictions about disease and treatment.

The bottom line is that, for whatever reason, Dr. Egnor has become so convinced that Darwin's theory led inevitably to eugenics and then the Holocaust that he resolutely ignores the number of times he's been told, with references, that eugenics is not natural selection, that it was artificial selection, and that any science can be distorted and misused for ill. Read my two posts on Nazi science, if you don't believe me. In any case, as is his usual wont, Dr. Egnor makes a massive straw man out of the arguments of his opponents

Darwinian Medicine 2.0 retains the silly stories at the heart of eugenics, but leaves out, at least explicitly, the genocide. The problem is that the inference that care for the ill and disabled "sins" against natural selection is the logical denouement of Darwinian metaphysics. "Survival of the fittest" is the origin of the human animal. Natural selection is our creator. Human benevolence often sins against its creator. Darwin himself pointed out the problem: lamenting the life-saving effectiveness of the recently developed smallpox vaccine, he asked whether it was wise to risk the degradation of mankind by "allowing our worst animals to breed."

Ugh. Here's the old "evolution as religion" argument again, in which Dr. Egnor tries to claim that scientists worship natural selection. What a load of bollocks! Worse, Dr. Egnor quote-mines Darwin, as creationists are wont to do and just as he quote-mined Mike Dunford. Indeed, this is such a frequent misquote that it has its very own Wikipedia page. Here's what Darwin really wrote in The Descent of Man:

With savages, the weak in body or mind are soon eliminated; and those that survive commonly exhibit a vigorous state of health. We civilized men, on the other hand, do our utmost to check the process of elimination. We build asylums for the imbecile, the maimed and the sick; we institute poor-laws; and our medical men exert their utmost skill to save the life of every one to the last moment. There is reason to believe that vaccination has preserved thousands, who from a weak constitution would formerly have succumbed to small-pox. Thus the weak members of civilized societies propagate their kind. No one who has attended to the breeding of domestic animals will doubt that this must be highly injurious to the race of man. It is surprising how soon a want of care, or care wrongly directed, leads to the degeneration of a domestic race; but excepting in the case of man himself, hardly anyone is so ignorant as to allow his worst animals to breed.

The aid which we feel impelled to give to the helpless is mainly an incidental result of the instinct of sympathy, which was originally acquired as part of the social instincts, but subsequently rendered, in the manner previously indicated, more tender and more widely diffused. Nor could we check our sympathy, even at the urging of hard reason, without deterioration in the noblest part of our nature. The surgeon may harden himself whilst performing an operation, for he knows that he is acting for the good of his patient; but if we were intentionally to neglect the weak and helpless, it could only be for a contingent benefit, with an overwhelming present evil.

I trust my readers to be able to see just how huge a misrepresentation of what Darwin said Dr. Egnor's words are. Yes, Darwin is pointing out that taking care of the sick and weak may lead to the "degeneration" of humans, but he also points out that it is our noblest nature that we care for the weak and helpless. Not surprisingly, Dr. Egnor falls for the old creationist canard that Darwin advocated eugenics. He did not.

I realize I've joked--if I don't laugh I'll cry--that I need to find a paper bag or a Doctor Doom mask to hide my face in shame over Dr. Egnor's antics. I'm still as embarrassed as hell that he is a fellow surgeon, so much so that the old proverbial Internet facepalm is about the only reaction I can think of that's appropriate. He could be the greatest neurosurgeon in the world, and his antievolution screeds would still be embarrassing. The arrogance of ignorance is never pretty. That's why I hope that Dr. Egnor will take the opportunity of an event next November at his very own institution to educate himself: Darwin 2009. He could learn a lot from this roster of speakers. It's sponsored by SUNY Stony Brook's Department of Ecology & Evolution.

Of course, what's far more likely is that Dr. Egnor will either not show up and instead just complain about it or, if he shows up, make an incredible pest of himself by asking obnoxiously ignorant and loaded questions. But hope springs eternal. A surgeon can hope, can't he?