Just what Dr. Egnor wanted for Christmas: Some not-so-Respectful Insolence!

It’s Christmas Eve.

I know, I know, it’s all supposed to be Peace On Earth, Good Will Towards Men (and Women), and all that jazz. Really, that’s exactly what I had intended for today and tomorrow. Indeed, my plan was to do nothing more than a quickie post today and a maybe a couple of brief (and hopefully amusing) Christmas-related posts this afternoon and tomorrow. Really, I had.

Then it came, and it came from a direction that I least expected. Yes, yet another “old friend” of the blog had to go and and not just ask but beg for a heapin’ helpin’ of not-so-Respectful Insolence. My readers know that I seldom turn down such heartfelt requests. I may be cranky, arrogant, and cantankerous, but I’m a benevolent box of blinking lights, and it is Christmas Eve. That creationist neurosurgeon with a love of pseudoscience and logical fallacies, that surgeon who embarrasses me with his frequent fusillades of misinformation about evolution, so much so that I have joked about wearing either a paper bag or a Doctor Doom mask to hide my face, that man with a knack for perseverating about the same misinformation over and over and over again no matter how many times he is corrected, Dr. Egnor, has gone off the deep end again, launching a direct frontal assault against me and fellow skeptical and science-based physician Dr. Steve Novella. My Christmas present to him is to give him the not-so-Respectful Insolence that he’s clearly asking for.

Now, you’d probably expect that, as usual, Dr. Egnor’s broadside would be about evolution (replete with his repetitive perseveration that the “only contribution” that “Darwinism” has ever made to medicine is eugenics) or about dualism and his belief that the physical brain and central nervous system are insufficient to explain the mind. Most recently, he was going on and on about how he has taught medical students for decades and how his experience as a physician and in clinical practice allows him to “recognize B.S.” when he sees it, in this case the claim that evolutionary biology contributes to medical advances. My words at the time (a mere two weeks ago) now seem prescient:

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.

Sometimes I amaze even myself. I came so close to hitting on what Dr. Egnor would do next that I scare even myself. So, let’s see. We’ve seen Dr. Egnor deny evolutionary theory using pseudoscience and logical fallacies. We’ve seen him go through all sorts of logical contortions and twisting of evidence to argue that the brain is not sufficient to account for the mind. So what’s next?

That’s right: The full court press attack on scientific medicine and medical “arrogance.” Witness his post at the house organ for pseudoscientific evolution denial, Evolution News & Views entitled Advice to an Arrogant Medical Priesthood: Wash Your Hands.

True to Dr. Egnor’s form, it’s the single longest non sequitur I’ve ever seen. Despite Dr. Egnor’s denials that he supports “alternative medicine” or antivaccinationism, it’s also chock full of attacks on scientific medicine and the “arrogant medical and scientific priestcraft” that would not be out of place on Whale.to, NaturalNews.com, Mercola.com, or even Age of Autism. Get a load of it:

There is an internet cottage industry of physicians and scientists who regularly excoriate alternative medicine and other non-traditional or even fringe approaches to health or to scientific understanding. Steven Novella, Orac, and a host of other faux “defenders of science” decry the danger to the public from vaccine “denial,” homeopathy, acupuncture, chiropractic, among others.

Now, I’m more than proud to be part of this “cottage industry,” along with Steve Novella, Dr. R.W., PalMD, Mark Crislip, Harriet Hall, and other skeptical physicians. Occasionally, I get e-mails from people thanking me for helping them turn away from woo or for supplying them with ammunition to argue against woo with a family member or friend. These occasional e-mails are reward enough for what I do. If I can lead just one person to see the light and avoid falling into the clutches of quacks, the last four years of blogging will have been worth it.

Interestingly (to me, at least), I can’t help but notice that Dr. Egnor chooses to use the word “industry,” as though we’re all in this to make money. Doesn’t it have the connotation of a certain industry, big pharma, perhaps? Maybe I’m being a bit paranoid, but it sure sounds like an insinuation that we’re in “industry’s” pocket or that we’re somehow making money off of our efforts. Or maybe I’m giving Dr. Egnor credit for too much subtlety. In any case, to clarify, of all the skeptical physicians who blog, the only ones I know of who make any money at all for their efforts are PalMD and I, and, trust me, it’s not exactly a lot. Because we blog for ScienceBlogs, we are paid a small amount based on our traffic. It doesn’t matter; if ScienceBlogs didn’t exist or never invited me to join the collective, I’d still be doing this, either on my old (and currently mothballed) Blogger blog or on a different platform.

In any case, after insisting that he is not a “supporter of ‘alternative medicine,'” Dr. Egnor launches into a huge hunk o’ burnin’ stupid in the form of the silliest non sequitur I’ve ever seen. Really, there are lots of things Steve and I or the science-based medicine we routinely defend might be criticized for, but what Dr. Egnor latches on to is about as silly as it gets. Logic? Who cares? Science? Who cares? Dr. Egnor, desperate to brand Steve and me “hypocrites,” decides to fixate on…washing hands:

Yet there is an irony in the efforts of “defenders of science” to protect the public from treatments and theories that are outside of the mainstream of medical practice. The greatest iatrogenic danger to patients isn’t chiropractors or homeopaths or vaccine “deniers.” It’s the doctors, nurses, and other medical personnel working in the traditional medical paradigm.

The data is uncontestable. Each year in the United States, errors of traditional science-based medical practice kill at least a hundred thousand people, probably substantially more. These errors include medication errors, surgical errors and unnecessary surgery, preventable bedsores, infections caused by poor technique and the failure of medical personnel to practice good hygiene such as hand washing, and many others. Note that none of these deaths are caused by homeopaths, vaccine “deniers,” etc.

The harm done by traditional practitioners of medicine is one of the leading causes of death in the United States. Where is the introspection by “skeptics” and “science defenders” like Drs. Novella and Orac about the enormous harm done to patients by themselves — traditional medical practitioners? What hypocrites.

What a moron.

I’ve tried. Really, I’ve tried not to call Dr. Egnor a moron or to insult him. I’ve told him he’s wrong. I’ve pointed out his logical fallacies and statements that are simply not correct. Unfortunately, he now leaves me no choice. He calls me an arrogant hypocrite based on a huge logical fallacy? I’ll return the favor by calling him a moron, and an obtuse moron at that! Yes, he’s a neurosurgeon, and he possesses knowledge and skills that I don’t have and will never have. No doubt he is highly intelligent in some ways and skillful at what he does; unfortunately, aside from his surgical knowledge and skill, elsewhere his intelligence has apparently been placed in the service of his ideology and religion. In contrast, I’m a scientist and a cancer surgeon. I possess knowledge and skills that Dr. Egnor does not and will never possess, the most important of which are an understanding of the scientific method and a skeptical mind. That’s why, after Dr. Egnor’s ignorant broadside, I now feel justified in saying that, when it comes to science, Dr. Egnor is a moron.

Dr. Egnor gets it all wrong anyway. No one’s saying that doctors can’t be arrogant and lazy. They are human beings, after all, and human beings with power at that. Besides, it’s not science or science-based medicine that’s leading doctors not to wash their hands enough between patients. Indeed, science, and science-based medicine tell us that we should, that it decreases the chances of spreading pathogenic microbes from one patient to another. It’s a message that begins right in medical school. The problem isn’t that doctors don’t accept that washing their hands is important for infection control; they do. Ask any physician if it’s a bad idea not to wash his hands between patients, and virtually every single one will agree that it is. The problem is that physicians are human, and human nature makes it easy for them to forget to do it–even leading them sometimes to misremember doing it when an objective observer can see that they did not–especially when they are rushing busily about on rounds. That’s one reason why hospitals have tried to make it easier for physicians and other health care personnel to remember. These days, in most hospitals, there are dispensers of alcohol-based antibacterial lotion or foam outside of every patients’ room. Just a quick spritz between patients is all that’s needed, and it works.

Dr. Egnor also doesn’t earn much in the way of scientific style points for linking to a post from Mercola.com called Death By Medicine to make his point against Steve and me. The damned article is even co-written by über-quack, HIV/AIDS denialist, coffee enema maven, and antivaccinationist Gary Null! Really, Dr. Egnor should look into his sources a bit more closely before citing them. He couldn’t have chosen less credible or less reliable sources if he had tried (well, maybe if he had also included Mike Adams of NaturalNews.com). Besides, this article was thoroughly taken apart by Harriet Hall not too long ago, and Peter Lipson has also discussed the exaggerated claim that iatrogenic causes are among the top causes of death in the U.S. Finally, it should be pointed out that, besides being science-based, one area in which science-based medicine distinguishes itself from “alternative” medicine is in a rigorous, ongoing attempt to reduce medical errors, as Peter also discussed here and as I’ve discussed when I lamented the Office for Human Research Protections putting the kibosh on a test of a checklist for placing central lines.

In any case, just when I thought Dr. Egnor couldn’t sink any lower, he then pulls out the favorite of apologists for “alternative medicine” everywhere. That’s right. He likens defenders of science-based medicine to an “arrogant priesthood”:

Arrogance of scientists and physicians is an old scourge. Alfred Russel Wallace, who helped develop the theory of evolution in the 19th century and who confronted the scientific arrogance of his own day, famously commented on medical arrogance in a different context (i.e. eugenics), calling it

… an arrogant scientific priestcraft. (1)

Of course. Dr. Egnor can’t discuss medicine without invoking eugenics. He seems utterly incapable of not bringing up eugenics any time he discusses medicine. It seems to be in his DNA. I am, however, surprised that he did not bring up Ignaz Semmelweis, the physician who discovered 150 years ago that simple hand washing could prevent the spread of puerperal fever among women giving birth. I suppose I should be thankful for small favors. Or maybe Dr. Egnor isn’t familiar with Dr. Semmelweis. Suffice it to say that his results were not as controversial as quack apologists like to claim, and he brought some of the abuse he received on himself. Whatever the case, what comes next is painful to read, not because it cuts me to the quick or anything like that, but by how embarrassing it is to me as a fellow surgeon:

Far more damage is done to patients by doctors and other mainstream health care providers than is done by vaccine “deniers,” acupuncturists, homeopaths, etc. Fatal disease is much more likely to be spread by a doctor’s unwashed hands than by some (mostly misguided) parents who fear that a vaccine may harm their child. I’ve never known a patient to be harmed by a chiropractor. Tens of thousands of patients each year are harmed in preventable ways by their (usually well-intentioned) surgeons.

Dr. Egnor labors under the delusion that we who advocate science- and evidence-based medicine either aren’t aware, don’t care about, or don’t pay attention to the shortcomings of modern medicine. Nothing could be further from the truth. We do, as I pointed out above. Our patients demand no less. Science demands no less. I emphasize again to him that the very data about the dangers of physicians not washing their hands comes not from creationist neurosurgeons like Dr. Egnor or supporters of quackery like Gary Null or Joseph Mercola. Rather, they come from physicians doing scientific studies. They come from science- and evidence-based medicine. They come from the application of science to the question of identifying shortcomings in current medical practice and identifying ways to remedy them.

How unlike “intelligent design” creationism, for example!

I have to wonder: For all his protestations that he does not support “alternative medicine” or antivaccine fear mongering, does Dr. Egnor realize that the comparison of scientists and science-based physicians to a “priesthood” and of science-based medicine to a “religion” is straight out of the playbook of quacks? Dr. Egnor assures us in his post again and again that he does not support the quackery that is most of “alternative medicine,” but he seems blissfully unaware that he is using exactly the same rhetorical techniques that quacks and apologists for quacks like to use. There is, of course, a reason for that. The same rhetorical techniques are what Dr. Egnor routinely uses when attacking evolution and “materialist” neuroscience, and it’s probably very easy for him to slip into using them in this new context. Still, I’m guessing that Dr. Egnor doesn’t know that he’s echoing the rhetoric of the pro-quackery underground, but he is, especially with his next comment:

My advice to Dr. Novella, Orac, and other arrogant medical clergy: go easy on the parents concerned about autism from vaccines, even though the evidence suggests that their fears are unfounded. They’re not idiots, and they shouldn’t be treated with scorn. A little humility on the part of doctors, and some respect for the right of people to hold other views (even if those views are wrong), and to act on those views, would be a good thing. Respectful discourse with patients who disagree with our advice, not scornful excoriation, is much needed.

What Dr. Egnor is blissfully ignorant of is that none of us–and I mean none of us–attack typical parents who are fearful of vaccines, at least not the vast majority of these parents. Rather, we excoriate a small subset of these parents who not only believe that vaccines cause autism, but have taken it to the level of becoming leaders and activists in the antivaccine movement. I mean parents like Jenny McCarthy or J.B. Handley, not Joe and Jane Sixpack, who hear Jenny McCarthy’s idiocy or come across the Generation Rescue website and, without a scientific background and not knowing any better, wonder if there might actually be something to the hysterical claims that vaccines cause autism. I can’t speak for anyone else, but my contempt is not reserved for parents; it is reserved for the leaders and opinion shapers of the antivaccine movement, be they parents of autistic children (like Jenny McCarthy) or opportunists (like David Kirby and Robert F. Kennedy, Jr.). They are the ones who foment resistance to vaccination based on pseudoscience, not the parents these leaders scare. These frightened parents need evidence-based explanations of why Jenny McCarthy and her ilk are wrong. In essence, Dr. Egnor might as well be Robert F. Kennedy, Jr. ranting that those of us who oppose antivaccine pseudoscience hate mothers.

Dr. Egnor can’t resist finishing:

Doctors should be less arrogant with our advice and we should denounce faux “skeptics” like Dr. Novella and Orac who exhibit no skepticism about their own dogma and behavior and are coarsening this discourse because of their own ideological commitments rather than for any rational commitment to public health.

My irony meter just exploded, leaving nothing but a quivering, molten pile of circuitry, capable of releasing only the occasional whimper.

Ideological commitments? Faux skeptics? It was an ideological commitment to his religion over science that led Dr. Egnor to reject the science of evolution. It was Dr. Egnor’s lack of skepticism towards his own dogma and behavior that has led him to become the attack poodle of the Discovery Institute, which exists not for science but to push an ideology! If anyone’s “arrogant,” it’s Dr. Egnor. He has the arrogance of ignorance, at least about evolution. He seems to think that his “clinical experience” inoculates him from “B.S.” and that his education as a neurosurgeon provides him with sufficient knowledge and understanding to make pronouncements about evolution. Indeed, he is the most “faux” of faux skeptics in that his “skepticism” is nothing more than opposition that no amount of evidence can sway. I realize that Dr. Egnor will never believe me when I say this, but if, for example, well-designed scientific and epidemiological studies started to show a clear link between vaccines and autism, I would rethink my position. I really would. Ditto if good studies came out clearly supporting the efficacy of various alternative medicines above that of a placebo. In contrast, I’d ask Dr. Egnor the question: Is there any evidence that could ever make you change your mind about evolution or neuroscience? If so, what is it?

I think we all know the answer to that question.

Depressingly (for me, at least), Dr. Egnor appears to be branching out. No longer satisfied with just denying evolution and blaming Darwin for eugenics and the Holocaust, or even with espousing dualism when it comes to the mind, apparently Dr. Egnor wants to start defending antivaccinationists, homeopaths, and other quacks against justified attacks based on science. Worse, he does it not because he actually believes in the quackery but rather because such attacks are nothing more than a convenient tool for him to attack those who call him on his pseudoscience.

And, lest I forget: Merry Christmas, Dr. Egnor! Consider this loving application of not-so-Respectful Insolence a Christmas present from Orac to you. Clearly, judging by your post, it’s just what you wanted for Christmas. How else to explain a broadside against me and Steve a mere two days before?