Dr. Egnor has his own blog now. Hilarity ensues about evolution and medicine.

Remember Michael Egnor?

I bet many of you do. If you were reading this blog three or four years ago, Dr. Egnor was a fairly regular target topic of my excretions of not-so-Respectful Insolence. The reason for that was, at the time, I was quite annoyed that a fellow surgeon could so regularly lay down such incredible blasts of pseudoscientific nonsense in the defense of his “intelligent design” creationism views. Back then he did this as a semi-regular blogger for a blog that is a propaganda outlet for the crank ID propagandists at Discovery Institute in much the same way that Age of Autism is a propaganda outlet for the crank anti-vaccine propagandists over at Generation Rescue. That blog is Evolution News and Views, and Dr. Egnor regularly laid down flaming swaths of stupid that were irresistable to many skeptical bloggers because they were extremely “target-rich” environments. (It’s left as an exercise for the reader to decide which of these two blogs is the crankiest.)

Time went on, and I stopped writing nearly as much about evolution and evolution denialists (i.e., creationists), mainly because I tended to specialize more in medical issues, but more importantly because there already existed a bevy of excellent bloggers to counter the misinformation and pseudoscience promoted by the likes of Michael Behe and his ilk. I didn’t feel as though I were needed so much, or that I was nearly as good at dealing with evolution=. Besides, there was just so much quackery to deal with, and I knew how to deal with it in a way that satisfied me while amusing and educating my readers. Then, just yesterday, I happened to notice, almost completely by chance, that Dr. Egnor is apparently no longer satisfied with the occasional embarrassing gig writing for the Discovery Institute’s propaganda organ. Oh, no. He has his own blog now. It started 12 days ago, and it’s called Egnorance.

Yes, it really is called that.

I’ll give Dr. Egnor credit for co-opting the insult usually applied to his particularly brain dead brand of “reasoning” and “science” when it comes to the discussion of evolution, coupled with his even more brain dead attacks on atheism as “evil.” On the other hand, in the less than two week period since Dr. Egnor started his blog, he’s been a very, very busy creationist neurosurgeon blogger indeed, having published 38 posts as of this writing. It’s almost as though he’s trying to match P.Z. Myer’s hypercaffeinated blogging style post for post, pontificating on everything from abortion, to anthropogenic global warming denialism, to the usual tiresome and predictable attacks on atheists, to even more tiresome attacks on evolutionary medicine.

Hold on there a minute.

Looking back at Dr. Egnor’s usual stomping grounds, I see that he has a post there entitled Jerry Coyne and Darwinian medicine, which he’s apparently followed up on his own blog with a post entitled Darwinian medicine and proximate and evolutionary explanations. Both are a response to a post by Jerry Coyne entitled Evolution 2011: Darwinian medicine, which to me appears to be quite a reasonable and helpful summary of the current understanding of how evolutionary principles can be used to help us understand human health and disease. The whole post is well worth reading, but can be boiled down to six principles:

  1. Evolutionary constraints
  2. Mismatch between genes and environment
  3. Coevolution with pathogen transmission
  4. Tradeoffs
  5. Reproduction trumps health
  6. Some “disease” symptom and defenses against mortality are useful, even if costly

Coyne even cautions:

While I now think that Darwinian medicine is a useful and intriguing discipline, its practitioners must be careful not to fall into the same trap that’s snared many evolutionary psychologists: uncritical and untestable storytelling.

Given that I’ve always been fairly skeptical of many pronouncements of evolutionary psychologists, some of which struck me as untestable hypotheses, I can’t help but wholeheartedly agree with Coyne’s caveat in his support of evolutionary medicine. As a physician, I was particularly puzzled that anyone would propose that type I diabetes might provide an advantage because individuals with high levels of blood glucose (or so the story goes) were better able to avoid freezing to death. That’s highly implausible on so many levels, given that type I diabetes typically strikes in childhood or young adulthood and would have a profound negative effect on reproductive success.

Dr. Egnor’s response to Coyne’s quite reasonable and educational summary of the state of knowledge regarding the application of evolution to medicine is…well, classic Egnor. Let’s see how well you all remember Dr. Egnor’s repertoire of responses to evolution. What is the first complaint he makes whenever the topic of evolution in medicine comes up? That’s right, eugenics:

Eugenics is the original Darwinian medicine. According to Darwin’s understanding of human origins, man evolved by a long brutal process of natural selection, and man’s highest qualities were evolved by a process of millions of years of often violent struggle. As man became civilized, the weakest members of the species — the ill and infirm, the handicapped, the mentally deficient — were unnaturally preserved in the population through man’s charitable instincts. Darwinists cautioned that compassion for the weak was diluting the human species, allowing defective humans to breed and spread their deficiencies. The solution to this Darwinian crisis seemed obvious: human beings must be bred, like farm animals, to produce the strongest individuals and preserve the species.

Eugenics (Darwinian medicine 1.0) was a central principle in American medicine from 1900 through the late 1930’s. It was ‘consensus science’, opposed only by a few deniers (mostly Christians and especially the Catholic church, which strongly opposed eugenics in any form) who insisted on respect for human dignity despite illness and infirmity. Eugenics was taught in medical schools and in biology programs, and was embraced by major medical and scientific organizations in the United States. Eugenics was endorsed by the National Academy of Sciences, the American Medical Association, the Birth Control League (later renamed Planned Parenthood), and countless universities. It was mainstream consensus science. Compulsory sterilization laws were passed, and 50,000 Americans were sterilized against their will in the first half of the 20th century.

The Germans deeply admired and emulated the American eugenics program, and took Darwinian medicine a step further. In the late 1930’s the Nazis organized the T4 program, which was an explicitly Darwinian approach to cleansing the German gene pool of weak people, most of whom were handicapped.

Yawn.

I’ve lost count how many times I’ve dealt with this particular canard–and just from Dr. Egnor alone, such as when he tried the same nonsense with P.Z. Myers when he tried exactly the same nonsensical argument he made above, only four years ago, thus demonstrating that truly his cranium is impervious to science; and when he couldn’t even get his story straight while coining the term “eugenics denial” to describe those who call his nonsense about eugenics and evolution for the nonsense that it is.

Of course, the whole canard about how “Darwinism” lead inevitably to eugenics and the Holocaust sounds convincing because there’s a grain of truth in it. But just a grain. Does it really need to be said again that eugenics is basically selective breeding, which farmers have done for millennia, only applied to humans? True, “social Darwinists” did seize upon on Darwin’s theory, as did racial hygienists like Alfred Ploetz, because it was convenient to do so to justify their view of who is “superior” and “inferior” in society, but it is not Darwin’s fault that they applied his theory to areas where it was not scientifically appropriate to apply it. In essence, social Darwinists and eugenicists misused Darwin’s theory to justify pre-existing racism and bigotry, just as scientific racists before Darwin used other reasoning to justify the “superiority” of their race over another or the “culling of the herd” to “improve the stock” of their people. This is a very different process from evolution, in which the selective pressures brought to bear on organisms by the environment plus random genetic variation, not the intentional selection of traits, determine which traits propagate in subsequent generations. Darwin’s genius was to make the leap from how farmers bred animals to realize that forces other than human intellect could produce selective pressure that could result in enormous changes in organisms to the point of speciation.

Even if it were true that eugenicists used evolutionary theory to justify their vile activities in the early 20th century and the whole concept of “racial hygiene,” it would be irrelevant to the argument over whether evolution is a good theory. Just because evil people put a scientific theory to evil use does not say anything whatsoever about whether that scientific theory is a valid one or not. One might just as well condemn Einstein, Niels Bohr, and all the physicists whose work formed the basis for the construction of the atomic bomb for the use to which their work was put. If we look at Hitler’s Nazi Germany, the justification for “racial hygiene” was couched more in terms of natural law (that the strong should rule over the weak) and the sort of selective breeding that has been practiced by farmers for centuries. Once again, I suggest that Dr. Egnor read Robert Proctor’s excellent treatment of the subject, Racial Hygiene: Medicine Under the Nazis for more information.

In his second response to Coyne, Dr. Egnor next decides to try to use and abuse the concept of proximate versus evolutionary explanations of biology, using as the basis of his “arguments” (if you can call them that) an article co-authored by one of the big names in evolutionary medicine, University of Michigan Professor Randolph M. Nesse entitled Darwinian Medicine: What Evolutionary Medicine Offers to Endothelium Researchers Believe it or not, I happen to be an endothelium researcher myself; one of my major areas of research interest is tumor angiogenesis, and you can’t study tumor angiogenesis without studying vascular endothelium, the cells that line the inside of blood vessels. You also can’t study atherosclerosis (which I used to study myself, way, way back in the day, as in the early 1990s) without studying vascular endothelium, because at its simplest atherosclerosis appears to arise from a chronic inflammatory response in the endothelium brought about, most likely, by oxidized LDL. Nesse describes the evolutionary tradeoffs thusly:

One way of thinking about atherosclerosisis to view it as the result of an evolved adaptive response that protects against infection but that results in endothelial injury in modern environments. Because the consequences of the injury occur late in life, natural selection preserves those systems promoting atherosclerosisin preferenceto those suppressingthem, a clas- sic case of antagonistic pleiotropy. This is a trade-off, but not quite a classic one. Because the costs were probably minimal until the past century, and because they caused no harm until modern times, the genetic variations that increasevulnerability to atherosclerosis are not really “defects,” but are instead excellent examples of “genetic quirks” that give rise to untoward effects only when they interact with factors encountered in modern environments. These speculations about the adaptive roots of atherosclerosisgive rise to a specific prediction that individuals who have a genetic predisposition to atheroscle- rosis may be less vulnerable to infection and more susceptible to other inflammatory diseases.

Dr. Egnor, as you might imagine, has a huge problem with this sort of application of evolutionary theory to medicine. Actually, he has several of them, all based on his apparent view that only “proximate explanations” are the “only explanations useful for treatment.” This leads him to make eight statements:

1) All of the relevant pathophysiology is provided by the proximate explanations, which are the only explanations useful for treatment.

2) Evolutionary explanations are based on proximate explanations– scientists understand a disease, and then, based on the detailed proximate explanation for the disease, evolutionary biologists concoct speculations as to how the disease evolved. Evolutionary explanations are always dependent on proximate explanations, not the other way around.

Apparently, prevention never enters Dr. Egnor’s mind. If we can understand how the relevant pathophysiology evolved in how a disease like atherosclerosis develops, who is more likely to get it, and who is less likely, it will provide us with a set of rationales, molecular targets, and other potential strategies to prevent the development of the disease. As usual, Dr. Egnor’s thinking is far too black-and-white. As a fellow surgeon, I can say it’s actually rather…surgeon-like. Surgeon-like in the worst way, not the best, in that he only thinks of things he can immediately fix and doesn’t care about anything else, just like the stereotype about surgeons. As Ness and Dawkins put it, “even knowing every detail about a trait offers only one half of a complete biological explanation. The other half is pro- vided by an evolutionary explanation of how that trait came to exist in the first place.” They continue:

Physicians are increasingly being educated as if they are techni- cians’ identifying problems and applying officially approved solu- tions. This makes very poor use of medicine’s most valuable resource. We select medical students carefully because we want-or should want-doctors who think. Providing them with a deep evo- lutionary understanding of the body will foster clear thinking. Instead of viewing the body as a designed machine, they will see it as a product of natural selection with traits more exquisite than in any machine, some ofwhich nonetheless leave us vulnerable to diseases.

Dr. Egnor clearly doesn’t want doctors who think. He thinks he does, but he appears unconcerned with whether physicians in training are ever taught to think more deeply about how the body functions, including its evolutionary development and the constraints it operates under. This sort of understanding is becoming more and more important with the rise of genomic medicine, as genomics and systems biology cannot be understood properly except in the light of evolution.

3) Evolutionary explanations do not provide a substantial basis for therapy. Even in situations in which evolutionary biologists claim that an evolutionary explanation has provided therapeutic insight, actual scientific confirmation of the effect of the therapy (i.e.- the proximate explanation) is needed to actually implement the theory.

4) Evolutionary explanations by themselves are worthless to medicine. All medical treatments are based on detailed proximate explanations.

Notice how repetitive Dr. Egnor is. He’s padding his list. Complaints #1 and #2 are in essence the same complain. Complaints #3 and #4 are basically the same complaint, which is a variant of the complaint in #1 and #2.

Leaving that aside, these two have to be the most facile yet. In #3, Dr. Egnor is in essence unhappy that we actually have to test our hypotheses scientifically and in clinical trials. He seems to think that evolutionary insights into disease can result in treatments immediately, which is silly. Even understandings of proximate causes don’t instantly translate into therapy, and such therapies still need to be tested. In #4, Dr. Egnor is tearing down a massive straw man. No one says that evolutionary explanations alone can produce treatments. Rather, as Nesse and Dawkins put it:

Upon hearing about new evolutionary approaches to medicine, most journalists and many doctors ask how it can improve treat- ment in the clinic today. This is the wrong question. There are some direct clinical applications, such as hesitating before blocking a defensive response such as a raised temperature or vomiting. However, theory should not change practice directly. Instead, evolution offers established methods such as population genetics, new questions about why the body is vulnerable, strategies for answering them, and a scientific foundation for an integrative understanding of the body.

Dr. Egnor seems to view evolutionary biological approaches to disease as something that should instantly give him a simple answer to disease. One wonders if he considers a detailed understanding of neuroscience to be necessary to practice neurosurgery. In any case, properly applied, evolutionary biology can lead to new, testable hypotheses regarding disease, which can potentially lead to an understanding of how the proximate causes with which Dr. Egnor is so enamored came about and suggest unexpected ways to attack those causes. Indeed, this article even suggests a general strategy that can be used.

5) Even in areas of medicine in which evolutionary insight is claimed to be important (such as the development of antibiotic resistance in bacteria), the necessary expertise– microbiology, cell biology, molecular biology, molecular genetics, population biology, pharmacology, pathology, etc.– is already an integral part of medical education and research. Evolutionary biology has contributed nothing of substance in the past, except to point out that bacteria that are not killed by antibiotics are not killed by antibiotics, which is sole insight provided by ‘natural selection’ to antibiotic resistance.

I’ve already answered this truly brain dead argument, and I did it four years ago. It’s truly frightening that an apparently respected, senior academic neurosurgeon can exist with such a poor understanding of antibiotic resistance. One example of a success of applying evolutionary principles to disease also comes to mind: The combination drug therapy of HIV. Realizing how rapidly HIV evolved resistance to monodrug therapy, scientists had to develop cocktails that targeted multiple different viral functions in order to decrease the likelihood that resistance can develop.

While I’m at it, though, I can point out that an understanding of evolution is necessary to understand another problem of resistance, namely that of cancer. Cancer becomes resistant to chemotherapy in much the same manner that bacteria become resistant to antibiotics. Similarly, combination targeted therapy offers the hope of turning cancer into a chronic, treatable set of diseases in much the same way that anti-retroviral cocktails have turned HIV into a chronic treatable diseaes. True, a deeper understanding of this process will be necessary if we are ever to have truly personalized medicine in cancer, but we do appear to be on the way.

6) As evolutionary biologists readily acknowledge, there are very few evolutionary biologists in medical schools, and modern medicine has progressed rapidly and far without evolutionary speculations about disease.

Non sequitur. Just because we have progressed far without the intensive use to evolutionary theory, that doesn’t mean evolution is useless to medicine. After all, Dr. Egnor admits that we haven’t used evolutionary theory! In any case, concrete thinking is hindering him again. Evolutionary thinking undergirds many of the algorithms used to analyze genomic data, and genomics is clearly the next wave in many areas of medicine.

7) Evolutionary speculations about disease belong in departments of evolutionary biology, not in medical schools. Any genuine insight provided by such evolutionary speculation can be communicated to medical researchers through the normal process of communication (a brief e-mail, a paper presented at a scientific meeting, etc)

This is just plain silly. There’s a huge difference between seeing abstracts at meetings or brief e-mails and daily contact and collaboration. It’s the latter that really bring the complementary strengths of each collaborator to fruition.

8) The incorporation of evolutionary biology in medical school curricula is a waste of valuable resources. It is the actual proximate scientific explanations for disease that guides medical research. Speculation about biological origins already has a scientific home, and provides little help to medicine.

You know, I think I get it now. Dr. Egnor seems to think that there exist two silos, one called “medicine and medical research” and one called “biology,” and never the twain shall meet. Or, at least, to him the two have little to do with each other. Why? Because, as an ID creationist, Dr. Egnor clearly believes that humans are exceptional and that studying all that biology and genetics in “lower” organisms has little to say regarding how human disease arises and should be treated, hence his perseveration about “proximal causes.” Admittedly, supporters of evolutionary medicine have to be careful not to trod the ground trod before by some evolutionary psychologists, whose “just so” stories resulted in untestable and unfalsifiable hypotheses, but its opponents also need to understand that applying evolution to biology will probably not result in insights immediately and directly translatable to the treatment of disease, at least not in the short term. In many cases, it might not even change day-to-day practice. It will, however, guide research, and a deeper biological understanding of disease.

Unfortunately, Dr. Egnor betrays thinking that drives me crazy. Rather than thinking as a scientist, he is thinking as a technician. He don’t need to know no steenkin’ evolution! Just give him the “proximal cause” of disease and let him cut it out!