Jack Krebs posted Entry 3105 on May 3, 2007 07:58 PM.
Trackback URL: http://www.pandasthumb.org/cgi-bin/mt/mt-tb.fcgi/3095

Lately there has been a lot of posts in the blogoshere about whether doctors need to know anything about evolutionary science. Today I got drawn into this discussion over on Uncommon Descent: I posted on a thread for another reason (see Ed Brayton’s post Sal Cordova’s Rank Dishonesty for that story), and a commenter there replied to me:

You are on record as being pro Darwinist and active in promoting Darwinism. Why don’t you take a crack at supporting Darwinism here for students in general and medical students in particular. And in the process enlighten us.

Well, I spend some time responding to this person here, and in doing so told a story that I’d been thinking about writing up for the Panda’s Thumb.

So I’m going to duplicate-post my comment there as a post here. Here’s what I wrote at Uncommon Descent:

This is off the topic of my point, and the thread really, but I find that in general when ID advocates talk about “Darwinism” they are really talking about the philosophy of materialism rather than just modern evolutionary science. I support mainstream evolutionary science, and am active in promoting it, but I am not “pro-materialist” nor active in supporting materialism as a philosophy. On the contrary, I am pro-religion, and active in promoting an understanding of the nature of religion and an appreciation for the diversity of religious perspectives.

So I encourage people to keep these differences in mind.

Now to the larger question.

I am a public high school teacher. Right now I teach only calculus because I mainly have other administrative duties. Every year I explain to my students that one thing they will get from my class will be an understanding of some big ideas that will broaden their perspective on how the world works, so that even if they never do a calculus problem after they leave high school, they will benefit from having taken my course.

On the other hand, I tell them, it may turn out that some of them, or maybe just one every few years, will take what I teach them and run with it - moving on to a field where calculus is an essential tool every day for figuring out important things about the world.

And I explain that most of them will fall in between - they will be better at math and a little broader as a human being, but they will probably never use calculus outside of my calculus class.

And finally I explain that I have no way of knowing which of them might fall in these various categories, and neither do they. Teaching is somewhat like casting your bread upon the waters - I act towards all that they might be the one who will grow because of grasping a big idea, or by using the tools I give them for great good at some later time, but I have no idea about when, how and to whom the fruits of my teaching might come.

The same applies to teaching evolutionary theory to those who are studying medicine. Understanding the basics of evolutionary science broadens one’s understanding of the nature of life, and of the human beings that they will be helping. While many may not use specific aspects of evolutionary science on a daily basis, there will be others for whom the evolutionary perspective will play an important role at some point in their medical work.

Let me tell a story to illustrate.

I have a son with some difficult mental health issues, and at one time they thought he was bipolar, although now we don’t think that is true. He has never had regular sleep habits, and he also has a chronic viral infection which gets worse in the winter and better in the summer.

Therefore, I was interested in a recent article published in the Proceedings of the National Academy of Sciences, by Joseph Coyle, entitled “What can a clock mutation in mice tell us about bipolar disorder?” Coyle is a member of the Department of Psychiatry at the Harvard Medical School.

The summary of the article here says,

Bipolar disorder, also known as manic-depressive illness, is characterized by episodes of mania and episodes of depression usually interspersed with periods of relatively normal mood (1). During the manic phase, affected individuals exhibit elevated mood, irritability, increased activity, reduced sleep, hypersexuality, and increased goal-directed activities. Bipolar disorder in its various forms affects >3% of the population and is associated with a high risk for suicide, substance abuse, and vocational disability (2). Although several animal models for major depressive disorder have been developed, there are no plausible models for bipolar disorder (3). In this issue of PNAS, Roybal et al. (4) describe the results of a systematic analysis of the behavior of a mouse with a deletion of exon 19 in the Clock gene, which shows remarkable parallels to the symptoms observed in individuals in an episode of mania (1). The Clock mutant mice exhibit hyperactivity, decreased sleep, reduced anxiety, and increased response to cocaine, sucrose, and medial forebrain bundle stimulation. Furthermore, many of these behaviors can be reversed by transfection of the ventral tegmental area (VTA) dopaminergic neurons with WT Clock gene or by treatment with therapeutic doses of lithium (Li+), a commonly prescribed mood stabilizer.

Considerable evidence accumulated over the last 30 years supports the notion that bipolar disorder involves a fundamental disruption in circadian rhythms (5). The episodes of mania and depression in bipolar disorder generally develop a regular periodicity, often linked to the seasons of the year (6, 7). Within an episode, disrupted circadian rhythms including sleep–wake cycle, hormonal secretions, and diurnal variation in mood are evident (8–10). Current treatments to prevent the recurrence of episodes of mania/depression emphasize maintaining a stable diurnal pattern of activity

Well, here is a place where it is a good thing that someone in the field of medicine knows something about evolutionary science.

From the beginning, organisms have been evolving in a world which has both daily and yearly rhythms, and thus many behaviors and processes flow with those rhythms. People like my son seem to have faulty regulation of some of these processes, and that takes it toll.

Studying the genetic basis of these circadian rhythms in simpler organisms in order to perhaps some day better treat people with circadian rhythm disorders seems valuable to me.

The longer summary of the study (not online, unfortunately) is full of references to evolutionary science. Here’s an example:

The circadian clock has been shown by genetic analysis in Drosophila and mammals to consist of a time-delayed transcription–translation feedback loop (12). In mammals, a heteromeric dimer of the transcriptional activators, CLOCK and BMAL1, induces the expression of several genes by interacting with the enhancer elements of their promoters known as the E-box. These genes include Per1 (Period), Per2, Cr y1 (Cr yptochrome), and Cr y2, the protein products of which translocate to the nucleus to inhibit the activ it y of the CLOCK–BMAL1 complex, thereby repressing their own expression. Recent studies have identified a polymorphism in the 3f lanking region of Clock that is associated with more frequent episodes of mood disturbances and reduced need for sleep in bipolar subjects (13, 14). Nievergelt et al . (15) have reported a suggestive association of t wo other circadian genes, Per3 and ARNTL (BmaL1), with bipolar disorder. Mansour et al . (16) replicated the association of BmaL1 with bipolar disorder and also found an association with Timeless. Thus, clock genes are implicated as potential risk genes in this disorder of complex (non-Mendelian) genetics.

Note well that all the genes and biological pathways mentioned have first been identified and studied in simple organisms, by scientists who accept that our genetic relationship through common descent to these simpler organisms is central to this work, as well as are some of the principles of how genes mutate and the actual histories of how those mutations and their effects have been passed on through the eons.

So, as with my calculus students, students going into medicine need to learn evolutionary science. For many this will just be background knowledge that is not part of their daily practice. But for others - a critical set of others even though they may only be a few - their understanding of evolutionary science may prove to be a essential part of research or treatment that winds up making a tremendous difference.

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Comment #173426

Posted by Reed A. Cartwright on May 3, 2007 8:46 PM (e)

Don’t forget that evolution has conclusively exonerated the Tripoli Six.

Comment #173434

Posted by paul on May 3, 2007 9:53 PM (e)

Good post Jack.

Most physicians don’t know a gram stain from a graham cracker, and they still prescribe antibiotics too much. A little evolutionary knowledge helps, and I think a lot of MDs are getting better, but I think that more evolution education is needed to stop over-prescribing antibiotics.

Of course, this isn’t a particularly compelling argument to creationists because it is merely “microevolution”.

Reed, what was the fate of Tripoli Six?

Comment #173438

Posted by Ed Darrell on May 3, 2007 11:23 PM (e)

Tripoli Six? Verdict expected in about a week. Go see here: http://www.globalvoicesonline.org/2006/12/18/lib…

Declan Butler has been one of the chief reporters, if not the chief reporter. The article whose link I posted says:

Declan Butler reports that the U.S. Department of State refuses to give a straight answer on its position regarding “the death penalty trial in Libya of 5 Bulgarian nurses, and a Palestinian doctor, accused of injecting over 400 children with HIV, even though the verdict is expected next Tuesday.” Also, Butler links to videos of a Geneva press conference on the Libya HIV trial.

Comment #173439

Posted by Ed Darrell on May 3, 2007 11:25 PM (e)

Nope, oops – verdict was due last month.

Comment #173467

Posted by Dan Gaston on May 4, 2007 5:59 AM (e)

Ed Darrell The verdict was last month I believe, and they were found guilty despite the overwhelming scientific evidence in their favour.

As for the post, excellent one. Unfortunately the Creationists will plug their fingers in their ear and shout things like “it’s Genetics not Evolution” or its microevolution, etc.

Comment #173479

Posted by Ric on May 4, 2007 8:10 AM (e)

I got sidetracked when I read this over at UD:

Jerry said:

“If most of us thought that, I and a whole lot of others would be out of here in a second. This blog would fall apart as it would loose all respectability.”

Uncommon Descent would lose all respectability? Ahahahahahaha… snort…. chortle. Yeah, because it has so much respectability now. So these people have any idea how they are seen by the world at large?

Comment #173480

Posted by harold on May 4, 2007 8:36 AM (e)

Paul -

“Most physicians don’t know a gram stain from a graham cracker, and they still prescribe antibiotics too much. A little evolutionary knowledge helps, and I think a lot of MDs are getting better, but I think that more evolution education is needed to stop over-prescribing antibiotics.”

I am a physician (no longer practicing) and a strong advocate of including evolution in medical education (my undergraduate degree was a legitimate biology degree from a mainstream university, so I entered medical school with a good background in evolution. Nevertheless, the continued biomedical science I received in medical school - one of the few places where one gets to study everything from neuroanatomy to microbiology in the same semester - probably refined my understanding and appreciation of evolution. Jack Krebs provides an extremely elegant and articulate individual example, but all of medical science makes sense only in the context of evolution. Egnor manages to combine technical competence with evolution denial only by employing semantic hypocrisy (for example, he can describe the mechanisms of antibiotic resistance correctly but denies the obvious fact that this is an example of evolution).

Now that I have established that we agree on that basic issue, let me say that your comment is, in my view, unfair and, without wishing to seem harsh, ill-informed. The Gram stain has been a fundamental of the medical school curriculum since the days of the horse and buggy.

Some doctors probably overprescribe antibiotics - although recently trained physicians are strongly biased against doing so - but this issue is more complex than you seem to realize…
1) “Underprescribing” antibiotics - waiting too long - can lead to such outcomes as death, blindness, deafness, mental retardation (apologies to those who object to this still-standard term; I don’t consider it derogatory), amputation of a body part, or merely a prolonged and expensive hospital stay. You can’t always wait for “proof” that an infection is bacterial, or precise identification of the microbe’s susceptibilities.
2) Viral infections are often complicated by mild, opportunistic bacterial super-infections. Antibiotics do sometimes make patients with mild viral infections feel better, for this reason. This doesn’t justify their use in this context, but it puts doctors under pressure.

Incidentally, in last night’s Republican debate, the candidates were asked if they “believed in evolution” - a question not asked at the Democrat debate. Four candidates answered. Three said no, and McCain, to his credit, said “yes”, but only after comical hesitation.

Any comments on this? Why was that question asked at a political debate between Republicans? Would three Democratic presidential candidates answer “no” to that question?

Comment #173491

Posted by Ed Hensley on May 4, 2007 9:51 AM (e)

DNA mutation hikes heart attack risk
Our friends at UD need to read the following recent article from MSNBC.com.
url href=http://www.msnbc.msn.com/id/18472655/
Anyone who can read this and then claim that Doctor’s should not know about evolution has their head in the sand.
“This is the single most important discovery made to date about a new finding of what genetic variations can lead to heart attack,” said cardiologist Dr. Christopher Granger of the Duke University Medical Center, Durham, N.C.
“I think this is a stunner,” Dr. Francis Collins, director of the National Human Genome Research Institute, told reporters. “It seems like this one place carries all of that weight for two very common and very dangerous diseases.”

Comment #173492

Posted by jasonmitchell on May 4, 2007 9:56 AM (e)

well I know who I WON’T be voting for: Huckabee, Tancredo or Brownback

source: http://www.nytimes.com/2007/05/04/us/politics/04…

“There were revealing moments that went past the well-rehearsed lines by all the candidates. Three of the candidates — Mr. Huckabee, Senator Sam Brownback of Kansas and Representative Tom Tancredo of Colorado — raised their hands to signal that they did not believe in evolution.”

McCain (even though he caved to the conservative “base” in the past on evolution education) came out looking the most sane of the bunch:

“Mr. McCain, looking at Mrs. Reagan in the audience, split from most of his rivals in stating unequivocally that he would support the use of federal funding to expand stem cell research.”

and
“Three of the better-known candidates — Mr. Romney, Mr. Giuliani and Mr. McCain, saying he was speaking with the benefit of hindsight — said Congress made a mistake in interceding in the legal question of whether to maintain life support for Terri Schiavo, a brain-damaged Florida woman.”

McCain’s also on record as having a rational view of global warming (some right wing groups acuse him of being biased)

source http://www.cnsnews.com/ViewNation.asp?Page=%5CNa…

Patrick J. Michaels is the author of a new book “Meltdown: The Predictable Distortion of Global Warming by Scientists, Politicians, and the Media.” He is an environmental sciences professor at the University of Virginia who believes that claims of human-caused “global warming” are scientifically unfounded.

Michaels spoke with CNSNews.com Thursday following a panel discussion sponsored by the libertarian Cato Institute in Washington, D.C., where Michaels also serves as a senior fellow in environmental studies.

“John McCain, a Republican, has probably held the most biased hearing of all,” Michaels said. McCain is a big proponent of limiting greenhouse gas emissions, which he believes are causing “global warming.” The Arizona senator also “is trying to define himself as an environmental Republican, which he is going to use to differentiate himself from his rivals for the (presidential) nomination in 2008,” according to Michaels

- combined w/ my (cynical?) opinion that neither current democrat front-runner is electable (BECAUSE one is an African-American and one is a woman) in this relatively unenlightened country - McCain in ‘08 may be the only viable choice…

Comment #173496

Posted by Doug S on May 4, 2007 10:25 AM (e)

Nice post!

People’s attitude towards science seems to be moving in the direction of “what have you done for me lately,” which is terribly unfortunate, since science in and of itself makes life richer and more meaningful, even if it isn’t applied directly to anything, or most people don’t use it after learning about it. Thanks for reminding us of that, even if that wasn’t the main point of your post!

Science should first be about understanding the world that we live in, and only second be about using that knowledge to improve our world (improving anything without understanding it fully is a dangerous proposition).

I’m glad to say I still get to use calculus in my job.

Doug

Comment #173517

Posted by Glen Davidson on May 4, 2007 12:33 PM (e)

On the other side, though, creationist physicians understand the value of animal models and probably do recognize how phylogenetic analyses are legitimate. It’s a piecemeal understanding, without the coherence and meaningfulness of an overall evolutionary understanding of biology, however I think that many can get by without fully comprehending biology.

What I’m saying, basically, is that I don’t know how much evolution physicians going into practice need to learn in med school. Ideally, they’ll have learned enough about evolution at the undergrad level to be able comprehend biology above the piecemeal level (which, at best, is not ideal), and whether a student coming from a good college needs to be taught evolutionary theory itself, I don’t know.

What occurs to me is that evolutionary theory might be most useful to physicians keeping office hours would be in explaining various practices, and the relevance of phylogenetic and animal tests, to their patients. Physicians (and not just oncologists) should know that, and how, cancers evolve. Doctors ought to have a good understanding of theory as well as practice, not to lecture patients on evolutionary matters, but to be able to tie the various threads together with repect to specific medical situations.

I think of my creationist physician father and wonder how he would think to explain how tests on mice and macaques would be relevant to human health. I’m sure he said that it’s been “shown to work” or some such thing, but how would any creationist/IDist know (especially in the past) that some entirely different systems don’t exist in mice and monkeys? Even evolution causes surprises sometimes, but with ID lacking any predictive power at all (since ID doesn’t even claim that organisms evolved, let alone according to evolutionary mechanisms (it’s bizarre to claim that we evolved but not by evolutionary mechanisms), only leaving the option open), ID would give no guidance about the meaning of an animal experiment involving something that hasn’t already been shown to be similar in humans and animals.

Let’s put it this way—the evolutionist physician has learned to abide by the constraints of science, and ought not to suppose that something entirely different exists in humans rather than animals. Where ID is faulty, extremely faulty in a way that could affect a physician’s judgment, is in the belief that the “human mind” is a miraculous production unrelated to animal “minds”. While casting out demons will probably not be the usual advice of creationist physicians, why ought the latter to use animal models for understanding what goes on in normal psych. or abnormal psych.? I know my Dad had a model of mind that I would never approve, and which probably affected his practice somewhat.

The creationist can believe that the mind is miraculous, has a “free will” not explained by physics, and one which is affected by random or evil spirits. Most will be affected by the scientific temper of our age and be constrained that way, however they will not themselves have the proper view of mental phenomena to best serve their patients. This is less likely to affect specialists who deal primarily with bits and pieces of patients, yet it will affect family physicians who really ought to understand that we have primate minds.

Glen D
http://tinyurl.com/35s39o

Comment #173523

Posted by harold on May 4, 2007 12:55 PM (e)

Troll (you know who you are) -

A minute ago Jack Krebs was a “liar” for noticing that you post under multiple identities.

“Thou Shalt Not Bear False Witness” - that’s one part of the Bible that creationists don’t interpret literally!

Comment #173537

Posted by harold on May 4, 2007 2:06 PM (e)

Give it up.

Plenty of Christians post here without being “attacked”.

Being shown to be wrong on a web site is not being “attacked”.

Plenty of pro-science Christians post here.

The major basic theme of this web site is protecting valid science education. Something most people of any religion can support.

Jack Krebs doesn’t “pretend to be above the fray”. He’s an active contributor here, and a member of an organization specifically dedicated to protecting valid science education in Kansas. I don’t know or care what his religion is.

Comment #173539

Posted by paul on May 4, 2007 2:20 PM (e)

Harold-

I know how complex the issue is. My undergrad and grad training is in biology/microbiology. In grad school I studied resistant Staph that infected hip transplants. I am an eye doctor (OD) now, and I prescribe antibiotics every day (I hope not too much!)

Over-prescribing is still a problem, as evidenced by the resistant strains that continually arise. My point remains “more evolution education is needed” especially at the high school level, where it is most lacking. But you are right, the Gram stain comment was unfair, it was a dumb try at rhetoric, sorry.

I know you like discussing politics, but I have no interest in discussing the Republican debate with you! I like to stay somewhat on topic.. : )

Comment #173544

Posted by harold on May 4, 2007 2:37 PM (e)

Clarification -

You can probably delete my last two posts at any rate, but…

When I wrote…

“Plenty of Christians post here without being ‘attacked’”

“Being shown to be wrong on a web site is not being ‘attacked’”

Those are independent statements.

I’m not suggesting that Christians have been “shown to be wrong” to be Christian. Some may feel that way, but that’s not my opinion.

Comment #173546

Posted by harold on May 4, 2007 2:45 PM (e)

Paul -

I’ll gladly agree that the Republican convention incident isn’t the topic of this thread and leave it at that then.

I personally think that it might deserve a thread, but I’ll wait for that…:-)

Comment #173560

Posted by Gerard Harbison on May 4, 2007 4:04 PM (e)

harold wrote:

Incidentally, in last night’s Republican debate, the candidates were asked if they “believed in evolution” - a question not asked at the Democrat debate. Four candidates answered. Three said no, and McCain, to his credit, said “yes”, but only after comical hesitation.

Any comments on this? Why was that question asked at a political debate between Republicans? Would three Democratic presidential candidates answer “no” to that question?

I, too would be interested in that question. I have a feeling that, if they were forced to answer in one word, the answer would be ‘yes’, but I’d be interested to hear how much, in a longer answer, they waffled, McCain style, to try to capture the legendary ‘non-conservative evangelical’ vote.

Comment #173578

Posted by harold on May 4, 2007 5:25 PM (e)

Gerard Harbison -

I think your assessment of how Democrats would answer the question is almost fair. Any “yes” answers would be heavily qualified by declarations of religious faith. There would probably not be a bold, assertive defense of mainstream science in that particular context.

I’m not sure it’s fair to say that McCain “waffled” (he hesitated, and yes, I did find his hesitation comical, but once he spoke, he wasn’t ambiguous).

Comment #173749

Posted by the pro from dover on May 5, 2007 6:22 PM (e)

I have practiced internal medicine for 30 years in the Denver metro area. The theory of evolution certainly doesn’t impact my practice to the extent of those in infectious diseases, public health or medical genetics. Yet patients have always been seemingly receptive to my use of evolutionary theory to explain the whys of the problems they bring to me. Structures well designed for quadrupeds are not always foolproof for upright position: intervertebral discs, knees, and plantar fascia. Vestigial structures gone bad: appedixes, paranasal sinuses, congenital anomalies of many gill arch remnants. Structures and functions once imperative now no longer necessary but vulnerable to disease anyway: gall bladder, much of the large intestine, spleen (all can be removed with no immediate shortening of life) and fight-or-flight reactions. Some patients are even becoming receptive to the no antibiotics thing!!! (this was unheard of 30 years ago). Perhaps the context of blaming natural processes rather than an angry god lets me get away with saying things to people that they wouldn’t like if the situation was different. Internal Medicine is definitely primarily a patient-education-oriented specialty and that’s why I like it.

Comment #173888

Posted by Martin LaBar on May 6, 2007 7:42 PM (e)

That’s a great post. Thanks!

Comment #174339

Posted by Pumpkinhead on May 9, 2007 1:05 AM (e)

Our aspiring physicians have already been force fed enough Darwinian horse manure in their high school and undergraduate days. In light of the GPA requirements to get into medical school, you know they’ve digested it. Why should they be forced to endure more propaganda about monkeys gave birth to humans or how the bonds of matrimony should consecrate the act of buggery.