What About Antibiotic Resistance Doesn't Egnor Understand?

Well,

I don't know about the medical students in the US, but over here in Germany we do take biology courses which contain evolution as a basis for most of the microbiology and embryology as well.
There are also course about developed resistance to antibiotics.

I somehow doubt they don't teach that to American students.

Still many officials here ignore the issue as well or to downplay the problematic.

The are no courses the teach evolution specifically in medical school. That is, if you look at the course catalog, you do not see any courses with the word "evolution" in them. But that does not mean it is not covered. In fact, it is mentioned probably every day.

Plus, when I was in residency, we had a series of lectures devoted specifically to the topic. Not every residency program is directed by Randy Nesse, but mine was.

You can't study medicine without studying embryology, comparative anatomy, and the like. You can't learn about surgery of the head and neck, without learning how the gill slits affected the development of that area. You can't understand microbiology AT ALL without understanding evolution. You can't study medicine without learning genetics, and you can't understand genetics unless you understand evolution.

Evolutionary theory may not be an everyday issue in medial practice, but you can't be a decent doctor without understanding the basic science that underlies everything you do. And you can't understand such things without a set of organizing principles. Evolution is one of those principles.

I don't blame you for jumping all over his case.

Mike, you've nailed exactly what pisses me off so much about Egnor. Right now, we're talking about something that's become deeply personal to me.

Since January, my father has been paralyzed from the waist down. The cause of it is MRSA. He had a long-delayed circulation problem resulting from cancer surgery a decade ago, which led to having two toes amputated. But that didn't get rid of the infection. So he had to have his entire leg amputated, followed by a six week course of IV antibiotics. And still that wasn't enough - one week after the antibiotics were stopped, the infection got into his spine.

The beginning of this whole disaster was really unavoidable - we knew the circulation in his leg was a wreck, and that it would probably eventually come back and bite him.

But 20 years ago, he would have been forced to have the amputation - most likely of the leg - and that would have been the end of it. Even 10 years ago, a 6 week course of IV antibiotics would almost certainly have wiped out any infection.

But now - he's got a multiple-antibiotic resistant strain of staph. It is, for all practical purposes, completely immune to anything from the penicillin family; to 1st-3rd gen cephalosporins. It's even partially resistant to vancomycin! This is not a bug that existed 20 or 30 years ago. It's something new - and signficantly different from "traditional" staph strains.

And a fucking *surgeon*, who should god-damned well *know* about bugs like this - who *needs* to know about stuff like this in order to properly take care of his patients - this shitbag is going around telling people that surgeons don't need to know about evolution. That things like the dramatic rise in resistant bugs, the dramatic differences in the basic biology of some of these bugs - that these things don't matter to surgeons.

Mark C-C-
My condolences on the situation your father is in. And people wonder why I was so freakin' strict about anyone who came into my room last year when I was inn after a surgery washing their hands (for more than a count of ten) in front of me.
The move towards nosocomial infection rate reporting in public forums for hospitals is a baby step in the right direction (knowledge is power - but only if you take advantage of that knowledge), but the real problem is people like Egnor.
I can't speak for everyone here, but I deal with microbial/viral evolution every day, and the first person to say to my face that HIV resistance is due to some fairy tale deity creating it should expect to get smacked back to the dark ages from whence they came. Sometimes it is too hard to count to ten before responding, esp when these people are ultimately trying to effect what gets taught to the microbiologists of the future who are in training today.

Mark,

with CC, I share my condolencences. It's why I do what I do for a living (and I would be thrilled if I lost my job because the problem went away). The ignorance is so murderous.

Mike & Joseph -

A point you almost make, but don't quite come out and say: In the US, one is expected to do undergraduate work before medical school. Medical schools generally require a significant amount of biology before they will let you in, and those undergrad courses cover evolution. Medical school students are expected to understand evolution before they get in the door. Evolution is so fundamental to biology and medicine that saying evolution is unimportant to MD's because medical schools don't have a course called evolution seems kind of like saying basic addition and subtraction is unimportant to mathematics because math grad schools don't have a course called basic arithmatic.

Edward I am afraid to say that many undergrad programs especially the biophysics and biochemistry ones tend to underdiscuss evolution. Some of the students have realized this upon going to graduate school where it was expected they were to know about evolution and couldn't answer basic questions on evolution during their qualifying exams. These programs focus to much time on in vitro work and do not do a good job at integrating it with the in vivo work that has been done.

I appreciate what has been said so far and mostly agree. I would add one thing about Dr Egnor's comment:

A physician is (to a large extent) trained as a technician who applies the technologies of medical science, but doesn't necessarily generate them. While I agree wholeheartedly that ignorance of, and the deliberate attempt to discredit one of the foundational underpinnigs of medical science is abhorrent and inexcusable, it is not surprising to me that you'd find a tenacious subset of evolution deniers who are MDs. EVO denier MDs tend to be kind of like auto mechanics who can't necessarily give you a detailed history and evolution of the technologies they work with, but they can still tune up your car.

Anyway, the generation of medical technology and even the delivery of health care involves a vast, variagated, interdisciplinary system that is so much bigger than the surgeon and his/her specific expertise. Dr Egnor claims that because medical students do not take an entire class on evolutionary biology and medicine, that evolutionary biology is irrelevant to medical science.

He equates all of medical science to the training of a physician!!! If it isn't grilled into students in medical school, it isn't relevant to medical science?!? That is a slap in the face to every non-physician involved in medical science and the medical profession. He is essentially saying that the only relevant person in the development and delivery of health care is the physician. Focused arrogance like this can truly make a smart person say stupid things.