Posted by Burt Humburg on March 9, 2007 08:44 PM

Those who haven’t had the experience of reading Dr. Egnor’s contributions to the creation/evolution conflict will not know that he is a neurosurgeon at Stony Brook who has trumpeted his support for intelligent design and against evolution. Dr. Egnor has recently written an essay at the Ministry of Media Complaints of the Discovery Institute. Ever on-message, Dr. Egnor seems to think that doctors don’t need to know evolution because he objects to the Alliance for Science’s essay challenge. (Alliance for Science asked high schoolers to write an essay entitled and organized around the thesis, “Why would I want my doctor to have studied evolution.”)

Dr. Egnor has been the subject of multiple fiskings recently and this is a curiosity itself. I’m personally acquainted with at least four attending-level physicians who were creationists at the University of Kansas School of Medicine. Up at Minnesota, a chief resident in the department of surgery was a creationist. And now at Penn State, there’s at least one creationist. The Discovery Institute, fresh off their defeat from Dover, put a lot of effort into developing a five-page list of physicians who think evolution isn’t such a big deal - so why is Egnor getting all the infamy for his incredulity? I don’t have a good answer for that: maybe he’s just the DI “Flavor of the Month” or the only physician willing to write essays. What I can answer are Dr. Egnor’s claims that evolution is not needed in medical school.

And I’ll do it on the flipside.

Egnor’s Argument in Summary
For those who can’t stomach Egnor’s essay, permit me to summarize:

Isn’t it “a funny question” whether we would want physicians to know evolution? There are basic sciences that are taught in medical school that must be “important to medicine” like anatomy and physiology. Doctors don’t “study evolution in medical school”, “there are no courses in medical school on evolution,” “there are no professors of evolution” in medical schools,” and “there are no departments of evolutionary biology in medical schools,” and “no evolutionary biologists” would provide useful information to a medical team in hospital. Therefore, evolution just isn’t important to the practice of medicine. I call upon my “20 years [of performing] over 4000 brain operations” to attest that I have never once used evolutionary biology in my work. How could I since evolution is random and doctors look for patterns, patterns that lie far afield from the randomness that is evolution? “I do use many” understandings provided by basic science in my work, such as population biology, “[but] evolutionary biology itself, as distinct from these scientific fields, contributes nothing to modern medicine.” “No Nobel prize in medicine has ever been awarded for work in evolutionary biology.” So I wouldn’t want my doctor to have studied evolution; that answer wouldn’t win the “Alliance for Science” prize, but it would be the truth.

Man, there’s a lot of work fisking all that. I’ll leave the simple stuff (selection ain’t random and that’s why it’s called selection, dude) for others. Let me concentrate on the medical stuff, which I’ll deal with in separate sections.

Section 1: Evolution is a Vital Basic Science for Medicine
I’ll start off my fisking by criticizing an aspect of medical practice and, to make sense of it, those who aren’t physicians need to know that there’s a great divide in the practice of medicine between the physicians who practice to simply the “standard of care,” (the kind of practice you’re expected to know for quizzes, tests, and boards and the level of care you need to meet to not get sued) and the physicians who know the basic science behind why the standards of care are what they are.

For example, when someone is having a heart attack (and daily after they have one), they need to be on aspirin because of the pathophysiology of heart attacks. (I review much of it that pathophysiology here.) Briefly, the aspirin irreversibly inhibits the platelet enzyme involved with forming clots. But you don’t have to know about the irreversible acetylation of cyclooxygenase that occurs in the presence of acetylsalycylic acid in platelets; all you have to do is give people aspirins after heart attacks. The “divide” I refer to is between the physicians who know the biochemistry behind that reaction and the doctors who are content to know only that they should give aspirins after heart attacks. Make no mistake: one can be a great doctor and simply practice to the standard of care knowing not a whit of the basic science that provides that standard’s underpinnings. But if you can know the reasons why the standard of care is the way it is, why on Earth would you limit yourself by choosing to not know it?

The example I’ve given here is limited to a single therapeutic regimen in cardiology, but ideally there’s basic science that undergirds everything we do in medicine. There’s a reason why it’s no big deal if you’re not wearing lead in the radiology suite (thanks to the inverse-square law, as long as you’re three or four feet away from the radiation source, the dose you get is negligible). There’s a reason why diazepam - a drug we use to treat seizures - can cause seizures (much of the brain’s neurons are inhibitory and their suppression leads to increased seizure activity). There’s a reason why two different rheumatological diseases can require separate therapies (diseases involving deposition of immune complexes wouldn’t likely be amenable to an exchange of antibiodies as much as they would be to suppression of the immune system overall). Again, there are doctors who know or want to know the reasons behind the practice and there are doctors who don’t know and/or don’t want to know those reasons.

Doctor Egnor seems to like being in that latter category. More than that, he seems to recommend not knowing the basic science that undergirds the practice of medicine, to the extent that he perceives evolution might have had a hand in developing the state of the art. I see his perspectives as nothing more than ignorance advocacy for the basic sciences, writ large and not limited whatsoever to evolution.

Sure, he writes

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.

as if to suggest that he has some interest in basic science, but I don’t buy it for a second. First, how is it possible to separate evolutionary biology from genetics and population biology? Post-Darwin, pre-Mendelian evolution, Egnor might have made a weak case that they might be separable fields. However, the entire modern synthesis of evolutionary biology dealt in its essence with merging genetics and selection. Today, they are so fused as to render Egnor’s phrase meaningless: the entity of population biology without evolution does not exist any more than water without wet exists.

Second (and this may be a bit snarky), Egnor quibbles at evolution being immaterial to the practice of medicine, but he says that he uses population biology. Man, don’t I know it. I just can’t get the vitals on patients referring to Hardy-Weinberg and Kimura at least once or twice per patient. Egnor knows as well as I do that if he isn’t going to find evolution in his daily rounds, he’s not going to find population biology, which leads me to suspect that his endorsement of it was a facile claim intended to stave off accusations that he’s an advocate of ignorance.

Well, I think he is an advocate of ignorance, despite the rhetoric he wrote about population biology and genetics.

Let’s move on to Egnor’s claims about evolution in medical school. First, he mentions anatomy and physiology - courses offered in the first two, or “pre-clinical,” years of medical school - and cites them as being important. But “Doctors never study [evolution] in medical school” so it’s therefore not important. I should also point out that calculus is also not studied in medical school. Neither was statistics. Neither was inorganic or organic chemistry, physics - hang on a second while I fish out my college transcript - composition and grammar, or biophysical chemistry. Med schools aren’t going to teach medical students how to write essays or how to add two and two. They also aren’t going to teach elementary chemistry or evolution. They’re going to assume that entering medical students have the barebones literacy to know certain things before they even get an offer to interview, let alone get enrolled.

Hmmm. Egnor might have a point though because that’s a pretty big assumption. I wonder if there were a way to tell whether a future physician would likely have the requisite understandings to succeed in medical school. If only there were a test, some sort of standardized test that admission committees could use evaluate how well medical school applicants had prepared for their medical careers! Can anyone think of such a test?

Of course I’m being facetious. Go here and do an in-PDF search for evolution. Dr. Egnor well knows that the MCAT is required to get into medical school and, according to the people who make the test, the MCAT in part tests one’s comprehension of evolution. And, unsurpringly, pre-medical committees across the nation have strongly recommended to kids that they know evolution. (There’s just something about a low med-school acceptance rates from pervasive failures to prepare students for the MCAT that makes a college or university unpalatable to parents.)

I tried to find something specific from the AAMC about evolution advocacy. Look what I found. (PZ may not have made much of Collins’ book, but the AAMC is an organization of medical schools to whom premed advisors and medical school hopefuls look for advice regarding career preparation for their students, and this interview of Collins appears on their website. I consider this a significant statement and wish they would be even more explicit about the “Look, guys, you need to know evolution” hint that they just haven’t brought themselves to say forthrightly.)

And I want to be the first to ruin the day of creationists when I say that you don’t stop having to know evolution once you get in. For those who don’t know, Step 1 (more formally known as the United States Medical Licensing Exam Step 1) is an exam you have to take after the second year of medical school in order to progress. And I can attest that, during my exam, a question that tested my ability to apply the central theory of population genetics - the Hardy-Weinberg Equilibrium - was asked, as was my knowledge of whence cometh the mitochondrion into eukaryotes.

That’s just getting into medical school. What about making sense of things once you are there? In the cardiovascular physiology block, we learned about the sympathetic and parasympathetic nervous systems. Whereas previous generations had to perform labs on dogs not intended to survive, we were spared this (so were the dogs) and instead watched a videodisk (it really was - this was before DVD-RW, I guess) of a dog being given various agents and seeing what affect it had on the blood pressure, heart rate, etc. I can’t imagine the befuddlement Dr. Egnor must have had, had he my experience in my medical school labs, when he perfectly understood what happened to the dog, but couldn’t allow himself to generalize the dog’s experience to the human.

Or consider my anatomy lab. So we’re learning the muscles of the back and having a dickens of a time trying to memorize their innervation. No problem, says my anatomy professor, and walks to the chalkboard. He draws a circle and puts in two perpendicular intersecting lines like crosshairs. Picking up the red chalk, he drew the musculature of the shark and with the yellow chalk he drew the nerves that innervate those muscles. Pretty primitive anatomy, really. Then he explained how, through phylogeny, the shark shape gets filleted down the middle, with the two inferior bits being the most lateral and the posterior being the medial, and there you’ve got the mammalian innervation. And the anatomy of it made perfect sense. There was no longer any memorization (past the damned names, that is); there was a theory that explained it all. And I can see Egnor refusing to admit the ease an evolutionary perspective of anatomy affords students, maybe to the point he would have refused the easy way of learning that material. His anatomy lessons must have been harsh, memorizing every muscle, compartment, bone and nerve, never once allowing himself to grasp the overall organizing patterns because he just knew that evolution was wrong.

Egnor reprised that theme often in his essay so let me make something clear here. Anytime you see comparative medicine, or comparative biochemistry, or comparative pharmacology, or anything comparative, that is evolutionary theory. We test drugs in rats and it’s not because we think rat pharmaceuticals are a lucrative industry. (Since 1938, non-toxicity must be demonstrated in animal models before a drug can come to market.) We don’t practice our surgical techniques on animals because we hate pigs. (Residents at SUNY Upstate have access to an animal surgery lab, in which they can hone their techniques on animals before they operate on humans.) Whenever you see stuff practiced or tested or homogenized or whatever on animals with the intention of applying those conclusions to humans or other species, that is evolution being used in practice. Without evolution, animal testing is just making drugs for rats and patting yourself on the back at the sheer (reproducible) dumb luck that the drug you’ve designed for the rat would likely do a decent job in humans as well. (Just a bit of intellectual integrity is needed to make the leap.)

Egnor thinks can say that evolution is unimportant to medicine when he points out that no course entitled “evolution” is generally to be found in medical school curricula. As I’ve shown, he’s dead wrong, and no medical school hopeful would be well served by avoiding an understanding of evolution. Word of advice to premed students: take the hint (which really ought not be a hint, ahem) from the AAMC and learn it if you want to do well.

What about making sense of things after you finish medical school? Has Dr. Egnor never obtained ATLS certification? I certainly don’t want to be the unfortunate patient needing a chest tube on whom Dr. Egnor discovers to my cost that a large amount of pressure but not too much is needed to introduce a trochar through the parietal pleura of the lung. I’d just as soon it be an anesthetized pig, like the one I learned on back in Wichita, KS.

In summary, evolution is indeed important to get into medical school, it is important to succeed during it, and it is important after you leave. Egnor’s perspectives are completely wrong.

Section 2: Professors of Evolution Do Teach in Medical Schools

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.

This one is a simple claim to fisk. Andrea Bottaro, contributor to the Thumb is an associate professor of medicine at a medical school who has published explicitly evolutionary articles. Thanks for playing, Dr. Egnor.

But let’s run with this a bit because it’s so easy. Hans Thewissen, the dude who discovered Ambulocetus natans, is employed in the anatomy department of the Northeastern Ohio Universities Colleges of Medicine and Pharmacy. He appears to have a dual appointment, both to anatomy and also as the football program’s head coach. (Note to self: I am so getting one of these t-shirts.)

But he isn’t the only one. Nationwide (probably worldwide), there’s a push in medical schools to include specialists from non-medical disciplines in the basic sciences. It’s for this reason that Thewissen, a palentologist, teaches anatomy at a medical school.

Egnor teaches at SUNY Medical Center, right? Well, just check out their medical school’s website and look at their department faculty. Anatomy looks promising. Okay, we see that Sussman is interested in the “comparative morphology” of humans and apes, Stern is interested in “The evolution of postcranial adaptations in primates,” Rubin works on bones in animals and humans, … Those were just the last three - you guys look up the rest.

Want to be a graduate student at SUNY and get your doctorate in anatomy?

The program is concerned with the analysis and interpretation of gross vertebrate structure in relation to adaptation and systematics. Training and research focus on (a) an evolutionary perspective in the analysis of morphology, including the influences of function, structure, and phylogenetic history, and (b) the structural adaptations of bone as load-bearing tissue, including the physiologic mechanisms of osteogenesis and osteolysis.

And that’s just the anatomy department. And that’s just at SUNY.

The University of Chicago’s Department of Ecology and Evolution is part of an interdisciplinary medical program, the “Biological Sciences Division.” The dean of medical affairs is the dean of the division. Best still, they call their interdepartmental evolution program “Darwinian Sciences.”

For more examples, read Cammarata’s “The Anatomy Professor that Ate New York: Some Dinosaurs are Teachers,
and Some Teach About Dinosaurs.”
Read Baker’s “Darwin in Medical School.” And go here to see Nesse’s list of medical scientists/professionals involved or interested in evolution.

No professors of evolution in medical schools? By any non-trivial parsing of that phrase, Egnor is dead wrong. Professors with evolution training and active research involving evolution are commonplace in medical schools and you’ll probably see more of that, not less, as time goes on because these people make the material so freaking easy.

Section 3: Nobel Prizes in Medicine Have Been Awarded for Work in Evolutionary Biology

No Nobel prize in medicine has ever been awarded for work in evolutionary biology.

Creationists evolve, rolling out new arguments and angles like automobile prototypes at a trade convention. The argument that no one has ever won a Nobel prize for work in evolution was apparently first trotted out by Steve Fuller at none other than the Kitzmiller trial:

And in a sense, one way you can see this is that, if you look at the Nobel prizes that have been awarded for physiology in medicine, which is the field, the biological field, essentially, you don’t find anyone ever getting the prize specifically for evolution.

Ideally, I could simply turn to the cross examination portion of the transcript, but Steve Fuller was scoring so many own-goals with his testimony that our lawyers let him off the hook without much of a fight. Yay for the Kizmiller trial, but now I have to do the work.

Briefly:

  1. Insulin was first isolated in dogs and the research was subsequently applied to humans; Macleod and Banting won the Nobel Prize for their discovery in 1923.
  2. Neurophysiology was elucidated by studying squid, whose giant axons were large enough to pierce with the instruments of that day and the research was subsequently applied to humans; Hodgkin and Huxley won the Nobel Prize for it in 1963.
  3. Using an animal model of sea slugs, Eric Kandel deomnstrated how changes of synaptic function are central for learning and memory; in 2000, he won the Nobel prize for his work.
  4. The mechanism for olfaction and the genes giving rise to it were found; Axel and Buck won the 2004 Nobel Prize for their discovery and their seminal paper described the evolution of the genes over lower vertebrates and invertebrates. (See this article for a great writeup on it.)

I’m certain there are others (and living Nobel laureates should please not feel slighted by my not listing their work here). Feel free to include any examples you can think of in the comments. By way of summary, Egnor is, again, completely wrong.

Conclusion

In fact, I think it’s safe to say that the only contribution evolution has made to modern medicine is to take it down the horrific road of eugenics, which brought forced sterilization and bodily harm to many thousands of Americans in the early 1900s. That’s a contribution which has brought shame—not advance—to the medical field.

So ‘Why would I want my doctor to have studied evolution?’ I wouldn’t. Evolutionary biology isn’t important to modern medicine. That answer won’t win the ‘Alliance for Science’ prize. It’s just the truth.

Dr. Egnor knows that he would be required to use glucocorticoids to prevent seizures in many situations in neurosurgery, but they were first tested in humans in 1948 - well after the FDA would have required the drugs to be proven non-toxic in animal models. Unless he isn’t giving medicines approved after the 1930s - and one doesn’t often find homeopathic surgeons - then he’s using evolution, even if he refuses to recognize it.

But that’s what his post is primarily about. It’s not that evolution is useless to medicine; on the contrary, it is a non-controversial component of essential medical education and one needs to know it certainly to get into medical school these days, to say nothing of staying in and doing well afterwards, to say nothing of having any prayer of a chance of making sense of the science that others use to generate the “standards of care”.

What’s going on here is that Egnor dislikes evolution and is hoping to de-emphasize its importance. Why? It is possible that he earnestly and sincerely believes that evolution has not contributed to his art. It is possible that he earnestly and sincerely believes that recognizing the validity of evolution would render his life meaningless or without value. It is possible he is a cynical liar and he wants no readers of the Discovery Institute Ministry of Media Complaints who credit his perspectives to enter or do well in medical school. (Hey, if true, he wouldn’t be the first surgeon who knew better about evolution but still advocated for ID only to make a buck, gain a little influence, or exhibit some sort of other ulterior motive.) Whatever his motivations may be, readers should not credit his testimony: he is at least dead wrong.

Further, his perspectives are very difficult to distinguish from ignorance advocacy. Egnor first came to attention when a blogger at Time magazine criticized him for not being an expert in evolution. He has stated that he does not use evolution, but this is more an admission of a willful disregard for the evolution he does use and upon which his art is based. Taken together, along with his assurance that the only contribution evolution has made to medicine was eugenics*, his writings bespeak the dangerous combination of ignorance and arrogance, traits altogether common with creationists, but that shine in Dr. Egnor to such an extent that a neologism should bear his namesake.

Egnorance. (n) The egotistical combination of ignorance and arrogance.

BCH

*Recall please that Egnor endorsed population biology. I’m informed by my pal Reed Cartwright that the people to blame for eugenics were the early population geneticists. (D’oh!)