Medicine and Evolution, Part 4: Physicians seduced by “intelligent design” creationism

I’ve been meaning to write about this topic for a long time.

In fact, ever since our illustrious Senate Majority Leader Bill Frist, who also happens to be a Harvard-educated cardiac surgeon, came out in favor of teaching “intelligent design” creationism alongside evolution in public school science classes back in August, I’ve been meaning to write a bit about a tendency that, as both a surgeon and a scientist, I find disturbing. That tendency is for physicians to be far more susceptible than one would think they should be to the siren call of the pseudoscience known as “intelligent design.” Far more often than should be the case, physicians are vocal proponents of ID and are presented as authorities by creationists. I’ve touched on this topic before obliquely, but this time, impelled by PZ‘s and Tara‘s mention a couple of months ago of an article that appeared in Science explaining the importance of the theory of evolution to modern medicine, I’d like to take it on a bit more directly, particularly because it fits in perfectly with my Medicine and Evolution series.

You would think that physicians, trained in biology, human physiology, biochemistry, genetics, and science, would be pretty resistant to the blandishments of ID proponents, but sadly such is not the case. Indeed, as a reader pointed out to me in the comments of the introduction to this series, physicians supporting ID are used as “authorities” by ID advocate. For example, Doug Moran stated on William Dembski’s blog:

I know quite a few medical doctors. Some are researchers, some limit themselves to private practice, and some do both. These are men and women of all ages and specializations. Not thousands or even hundreds of them – but maybe 30 or 40. Mind you, this is only one data point from a small sampling of physicians, but it is a good one: not one of these fine people believes in Darwinian Evolution. One told me that “Any physician who doesn’t see intelligent design in even his most troubled patient is either blind or stupid or just not paying attention.”

(Of course, I’d counter that there are so many examples of seemingly poor design in the human body, that I consider them to be evidence that any “intelligent designer” needs to be a better bioengineer, but we’ll leave that aside for perhaps another entry in this series in the future.)

Sadly, Moran’s post is not entirely empty. There is evidence to back up his claim. For example, at least one poll shows that a significant fraction of physicians accept ID as being more valid than evolution, and a majority of Protestant physicians accept ID as valid science:

A national survey of 1,472 physicians indicates more than half — 63 percent — believe the theory of evolution over that of intelligent design.

The responses were analyzed according to religious affiliation.

When asked whether they agree more with intelligent design or evolution, 88 percent of Jewish doctors and 60 percent of Roman Catholic physicians said they agree more with evolution, while 54 percent of Protestant doctors agreed more with intelligent design.

When asked whether intelligent design has legitimacy as science, 83 percent of Jewish doctors and 51 percent of Catholic doctors said they believe intelligent design is simply “a religiously inspired pseudo-science rather than a legitimate scientific speculation.” But 63 percent of Protestant doctors said intelligent design is a “legitimate scientific speculation.”

Worse, 15% of physicians believe that states should be required to teach ID and 50% believe that states should be permitted to teach it. In other words, 65% of physicians are in favor of or neutral to teaching ID in the science classroom. (For full results of the poll, go here.) True, this poll was conducted almost a year ago, before the Kitzmiller v. Dover decision, but there’s little reason to believe that the resounding defeat suffered by ID advocates in December would change all that many minds, particularly among doctors.

In fact, it’s even worse than that. Believe it or not, there are budding doctors out there who are young earth creationists. Indeed, I’ve come across at least one blogging medical student named Alice out there who is a self-described young earth creationist, and, like many young earth creationists, she parrots Answers in Genesis misinformation claiming that microevolution occurs (as in antibiotic resistance) but that we have never observed macro evolution (i.e., speciation). Don’t believe me?

Look here at what Alice says, and remember that this is a soon-to-be physician:

Has anyone ever documented a plateful of Strep pneumo mutating into E coli? Or even into Strep pyogenes? I didn’t think so. They mutate, and they exchange information. But they remain separate species, with their own unique characteristics. Staph aureus remains unique in possession of the coagulase enzyme; E coli remains identifiable by its lactose metabolism. They are all separate species and geni; and they definitely are not progressing into amoebae or protozoans.

Macro-evolution, then, is the belief that one kind of life can change into another kind; that by an almost unimaginable series and accumulation of mutations, some random process could turn an amoeba into a plant, and then into a primitive fish, then into an amphibian, and so eventually into “the miraculous race that we are” (to quote G.K. Chesterton’s poem). Macro-evolution is the idea that a species of fish mutated, and turned into a land-walking amphibian. It’s the idea that an ape mutated, and became an intelligent, (occasionally) rational, artistic, human. To me, this sounds like some of the wilder science fiction plots.

So: I believe that God created the world in six 24-hour days, out of nothing. He made every animal kind himself. Part of the natural order that he set up included the ability for DNA to mutate. BUT: When DNA mutates, it generally loses information. The mutation that makes Strep pneumo resistant to penicillins is the loss of a protein (called, in the usual utilitarian manner, penicillin-binding-protein). Dogs are another good example of this. Many of the different breeds we have today resulted from breeding for specific characteristics. Some of these are so extreme that they can’t even breed with each other any more (eg, Great Danes and chihuahuas). But the breeding didn’t add any information; it took it away. The chihuahua lost the ability to grow large; the labradors lost the ability to grow curly hair; and so on. These species and subspecies did not add anything; they lost it.

Thus, it is quite reasonable to believe in the fact of micro-evolution, since it can be seen on a regular basis in the world around us. It can be measured in the lab, and witnessed, and reproduced. This does not in any way necessitate a belief in the theory of macro-evolution, that life originated from non-life, or even that God made the bacteria and then let everything get along from there. Macro-evolution is definitely a theory, since it has not been witnessed or verified by any scientific standard (meaning the standards that applied before scientists got carried away with trying to make a philosophical explanation for the origin of the universe).

It’s a bit scary to me that this third year medical student will soon be a physician, as her understanding of biology is clearly very flawed, particularly her understanding of mutations and genetics. In addition, she is parrotting one of the oldest creationist canards there is by claiming that evolution can be observed within species but that speciation (i.e., macroevolution) has never been observed. She is, of course, incorrect about this. Also, despite the evidence regarding its importance, Alice does not believe that the recent discovery of fossils of a transitional organism constitutes support for evolutionary theory. Even despite this, she will probably do OK as a physician as long as she stays away from specialties involving genomic medicine (which, these days, include more and more specialties as time goes on) or out of research that involves an understanding of genomics and evolutionary principles. She’ll probably even be able to use the findings of genomic medicine, but her young earth creationist beliefs will almost certainly make it necessary for her to ignore or deny the evolutionary foundation upon which much of the new genomic medicine rests. What I find disturbing, though, is how someone soon to enter my profession is able to accept the mass of pseudoscience, dubious arguments, and logical fallacies that one has to accept in order to accept not even ID but young earth creationism as a valid alternative to evolution and make arguments that depend upon a misunderstanding of molecular biology, mutation, and basic biology.

Biologists and other strong opponents of ID often express puzzlement or disbelief that so many doctors could be so ambivalent about ID or even downright sympathetic to it. To them the fact that so many physicians have such a poor understanding of evolutionary biology is hard to swallow. Perhaps this is where I can help the science-minded out there who read my blog. Even though I straddle two worlds, the world of the clinical surgeon and the world of the practicing physician, sometimes I don’t udnerstand how so many physicians can be so easily seduced by this pseudoscience. Nonetheless, I’ll give it a shot at explaining some of the reasons why this may be so.

One important reason that physicians as a group are susceptible to the fallacies of ID is the same reason I mentioned when I first started this series: the lack of formal training in evolution the vast majority of physicians suffer from, as described by Nesse et al:

Although anatomy, physiology, biochemistry, and embryology are recognized as basic sciences for medicine, evolutionary biology is not. Future clinicians are generally not taught evolutionary explanations for why our bodies are vulnerable to certain kinds of failure. The narrowness of the birth canal, the existence of wisdom teeth, and the persistence of genes that cause bipolar disease and senescence all have their origins in our evolutionary history.

And, as I put it:

Twenty years ago, when I was studying anatomy, physiology, histology, and medical biochemistry in medical school, evolution was rarely mentioned, and then usually only in trite and simplistic examples. As far as I can ascertain, at my medical school at least, the situation is no better today.

Also, most doctors are not like me in that they are not actively involved in research. Rather, they use the results of others’ research and apply it to the best care of their patients. Indeed, physicians must provide at least the “standard of care.” True, they have to keep up with the latest research in order to update treatments to match the ever–excuse the term–evolving standard of care, but this standard is seldom “cutting edge.” What this means, though is that in standard medical practice, as long as a physician practices this ‘standard of care,” he or she can be a creationist and utterly deny Darwin and still provide competent care to patients. Advances in genomic medicine will likely make such a disconnect less easy to pull off, but for now it is not that difficult in most specialties. Even among those who are involved in research the majority do not do basic or translational research, but rather clinical research, the bulk of which involves testing one drug or treatment versus another or versus a placebo. Thus, even among academic physicians, only a relatively small proportion are involved in basic biological research, and, as I pointed out before, even among those who do basic research, all too little thought is given to evolutionary thinking in medicine.

Another aspect of being a physician that basic scientists often forget is the very motivation why people become physicians in the first place. Although there can be overlap, there’s a big difference between the primary motivations for going into science and medicine. Basic scientists tend to be motivated by a profound curiosity, a desire to understand nature, and a profound satisfaction that one derives from satisfying that curiosity and fulfilling that desire. In other words, it is the thrill we as scientists get from discovering something new, from deepening our understanding. To a scientist, there’s no greater rush than discovering a new and important gene, for example, or coming up with a hypothesis and seeing it validated by experimentation. All scientists seek that rush, and it is their curiosity that drives them. In contrast, what motivates most physicians to enter medicine is not curiosity; at least that is not the primary reason. Rather, as corny as it sounds, it is the desire to help people and the satisfaction we get from curing disease and easing suffering. Some of us have the motivations of a scientist, but there has to be a strong element of wanting to help others to go through the pain of medical school. Clearly this is the case with Alice, but along with that strong desire to help, she brings the baggage of a fundamentalist literalist interpretation of the Bible, including creationism and a desire to proselytize Muslim medical students sharing her present rotation.

In marked contrast to the secularism of many scientists, because of this desire to help people directly, for a significant number of physicians, the wellspring behind their choice of a profession is their religion. Because all of the major religions preach as part of their doctrine service to the less fortunate, many physicians see their calling as a professional who cares for the sick to be the highest form of service to God and their fellow humans. Indeed, there is even evidence that physicians as a group are more religious than the general population:

King isn’t alone among today’s doctors, according to a first-of-its-kind survey led this year by University of Chicago researcher Dr. Farr Curlin, an assistant professor of internal medicine.

Curlin and his fellow researchers surveyed 1,260 practicing physicians in the United States. They found that 76 percent of the doctors believe in God, and 59 percent believe in some sort of afterlife. The researchers also found that 90 percent of the doctors attend religious services at least occasionally, compared to 81 percent of adults in the general population. And 55 percent said their religious beliefs influence how they practice medicine.

The findings surprised Curlin, who assumed patients would be more religious than their doctors. “Our study challenges that conventional wisdom,” said Curlin, whose study was published in the Journal of General Internal Medicine.

Curlin’s team also found that different medical specialists varied in their practice of and attitudes about religion. Family practice doctors and pediatricians were more likely to carry their beliefs into other aspects of their lives. Radiologists and psychiatrists were the least likely to do so.

I don’t know if Curlin is correct, but it has certainly been my experience that physicians as a group are at the very least not less religious than the general population. One neurosurgeon whom I trained under was a devout Catholic who went to mass every day that he was not operating and served on a medical advisory group of some sort under Pope John Paul II. Of the seven of us in our group, at least four of us are highly involved with a church (or, in one case, synagogue), and one even offered to pray for me during a time of difficulty (something that has always made me uncomfortable, even when I was a weekly churchgoer). As far as I can tell, their religion does not unduly affect their views on medicine or science or how they practice medicine, certainly not to the point of accepting a religiously-inspired pseudoscience over sound science. Even so, it is not too far-fetched to suggest that such religiosity might make at least a significant minority of physicians sympathetic to the concept that there is a divine creator guiding evolution and uncomfortable with the concept of natural selection. Couple that with the fact that as physicians we see the fascinating complexity of human anatomy and physiology every day, it’s not surprising that some of us would combine our belief in a God with our awe at the incredible complexity of the human organism and conclude that there must have been some element of design. It’s not much of a leap from being able to “repair” malfunctions in the human organism to starting to look at ourselves in a way similar to repairmen. And what do repairmen repair? Designed machines, of course.

Finally, although this is less so than decades ago, physicians still hold a very privileged place in society. Indeed, in many rural communities, the revered family physician who is viewed as a pillar of the community still exists, as a surgeon who graduated the same year found out when he took a private practice position in a small rural Ohio town. At a meeting several years ago, his wife expressed wonder at the fact that she no longer felt as though she could go shopping wearing sweatpants; because of her stature in the community, people would notice and talk. Living on the East Coast in a suburban area where physicians are a dime a dozen, fortunately, I suffer no such inhibition, but in large areas of the country there is still a considerable mystique associated with being a doctor. We are viewed, rightly or wrongly, as authorities on a variety of topics outside of medicine, particularly if those topics are related to biology. Consequently, when debates such as the political debate over ID crop up, physicians are often among the first consulted for opinions. Similarly, when pro-ID doctors write letters to the editor asking for “academic freedom” regarding evolution while parroting creationist talking points, they are probably more likely to be published by editors and taken seriously by readers. Most lay people reading such editorials don’t realize that most physicians don’t know what they’re talking about when it comes to evolution. Indeed, all too often we physicians forget that most of us don’t know what the heck we’re talking about when it comes to evolutionary biology and, given our natures, will happily pontificate about the issue. And, not surprisingly, ID proponents are more than happy to cite such physicians spouting off about a topic that in reality they know little about as “authorities” supporting their position.

In contrast, physicians who do support science and understand what a sham ID and young earth creationism are often inhibited from speaking out. Another thing that scientists don’t always understand is that we as physicians are trained to place a high premium on being nonjudgmental of our patients, because being judgmental severely intereferes with the doctor-patient relationship, makes the delivery of optimal care less likely because patients will be less likely to tell us relevant information, and may even prevent some patients from seeking care at all. Consequently, knowing that many of our patients support ID or even creationism, we physicians as a group tend to be reluctant to speak out against it, for fear of seeming judgmental or critical of our patients’ religious beliefs, particularly since there are far more people out there who are believers than not. Alternatively, we will adopt a neutral stance, in essence accepting the concept of “teaching the controversy.” Indeed, even when we do speak out for science and evolution, as Dr. Robert Schwartz tried to do when he criticized ID as pseudoscience in the pages of The New England Journal of Medicine last fall, we tend to pull our punches, even to the point of qualifying our criticisms by saying something as ridiculous as what Dr. Schwartz said while attacking ID, “Phillip Johnson, Professor Emeritus of Law at the University of California, Berkeley, and one of the founders and financial backers of the intelligent design movement, can accurately pinpoint many problems that the theory of evolution has not come close to solving. His criticisms have merit, and his focus on precisely those things that we do not yet know blocks any rational dialogue.” (As some may recall, I almost choked when I read that sentence, given that Johnson misrepresents evolutionary theory and uses the same bad science and mangled logic that nearly all ID advocates do–not to mention his prominent role among HIV/AIDS “dissidents.”)

So what’s the solution? Certainly it won’t be easy and it won’t be fast, but education is the key, particularly in medical school to show future physicians that a solid understanding of evolution is not only relevant but critical to understanding human disease. As Ness et al put it:

What actions would bring the full power of evolutionary biology to bear on human disease? We suggest three. First, include questions about evolution in medical licensing examinations; this will motivate curriculum committees to incorporate relevant basic science education. Second, ensure evolutionary expertise in agencies that fund biomedical research. Third, incorporate evolution into every relevant high school, undergraduate, and graduate course. These three changes will help clinicians and biomedical researchers understand that both the human body and its pathogens are not perfectly designed machines but evolving biological systems shaped by selection under the constraints of tradeoffs that produce specific compromises and vulnerabilities. Powerful insights from evolutionary biology generate new questions whose answers will help improve human health.

I agree, although such a solution will take many years to produce a new generation of physicians with an understanding of how evolution influences human disease and can provide unique insights into the the understanding and treatment of human disease. An additional salutory effect of improving the education of physicians in evolutionary biology would be to dramatically decrease our use by politically minded proponents of ID, who see them as useful tools to persuade a public unknowledgeable about science that ID is more than a religiously-inspired pseudoscience.