Most doctors are not scientists, Ben Carson paper bag edition

Early in the history of this blog, I had a running gag that I’d use every now and then. Basically, it involved humorously extravagant descriptions of how I wanted to hide my face behind a paper bag in sheer embarrassment at the antics of fellow physicians, particularly fellow surgeons. Over time, the gag evolved to my expressing a mock desire to hide my visage behind a metal Doctor Doom-style mask, again, over sheer embarrassment over the idiocy of my colleagues about a scientific issue, again, usually evolution. Sadly, creationist physicians are a very common source of such embarrassment, although I don’t write about them very often any more. They are perhaps the best example to illustrate a point that I’ve made many times: Most physicians are not scientists. While it’s true that being a scientist is by no means a guarantee that one will not be taken in by pseudoscience, it helps. Worse, a disturbing number of physicians fail to abide by Harry Callahan’s wise admonition in Magnum Force:

All too many physicians do not know their limitations, especially with respect to science.

As time went on, I used the gag less and less. As is the case with a lot of gags, it became harder and harder to think of new ways to use it without becoming too repetitive. So it appeared less and less and less, until finally it appeared no more. Indeed, I don’t remember the last time I used it. There was also another issue that contributed to the demise of this recurring joke. I started to encounter physicians with ideas that were worse than just not believing in evolution because they were beliefs that could result in direct harm to patients. I’m referring to the “rise” (if you can call it that) of physicians spewing antivaccine beliefs, doctors like “Dr. Bob” Sears, for instance. These physicians are physicians who betray their profession—and, even worse, their patients. It just wasn’t that funny to me any more.

I’m starting to get that same old familiar feeling about Dr. Ben Carson. Whenever I see him, I want to put a paper bag—or Doctor Doom mask—over my face, the better to hide my shame at a fellow surgeon’s idiocy.

I find the resurrection of this particular feeling in me to be particularly disturbing not just because Carson is a Presidential candidate, thus providing his scientifically ignorant pronouncements far more publicity than they deserve, but because he truly was a magnificent pediatric neurosurgeon. I don’t know if I’m mentioned this before, but I work mere blocks from the Ben Carson High School of Science and Medicine. It’s part of the Detroit Public Schools for students with an aptitude for science and was founded in 2011, before Dr. Carson began his descent into pseudoscience, at least publicly. Back then, Carson was known as a truly gifted—brilliant, even—pediatric neurosurgeon, the chief of pediatric neurosurgery at Johns Hopkins University. When Carson was awarded the Presidential Medal of Freedom in 2008, believe me, he deserved it.

So what happened? I was wondering exactly that during the Republican Presidential debate last week, as I cringed.

You might recall how last week I took an opportunity to recount Donald Trump’s long sordid history of antivaccine statements promoting the idea that vaccines cause autism. I did this intentionally because I knew that the second Republican Presidential debate was nearly upon us and I wanted to remind my readers about his history and to prepare them in case the issue came up during the debate. It did.

Given Trump’s history, it’s unnecessary for me to quote what Trump said about vaccines in the second Republican debate last Wednesday because it was virtually identical to what he’s been saying about vaccines since at least 2007 if not before. Still, it’s useful to set up the context. The question that provoked The Donald’s repetition of his oft-repeated antivaccine tropes from the last eight years was not actually directed at him. After making a reference to the measles outbreak that started at Disneyland earlier this year, moderator Jake Tapper actually asked Ben Carson this question: “Dr. Carson, Donald Trump has publicly and repeatedly linked vaccines—childhood vaccines—to autism, which, as you know, the medical community adamantly disputes. You’re a pediatric neurosurgeon. Should Mr. Trump stop saying this?”

It was obvious that Tapper was trying to provoke an argument between Trump and Dr. Carson. Otherwise, he would have just asked Trump directly about his previous statements about vaccines and autism. It was a golden opportunity for Dr. Carson to defend vaccines, given that earlier this year, Dr. Carson had been quoted strongly defending school vaccine mandates:

“Although I strongly believe in individual rights and the rights of parents to raise their children as they see fit, I also recognize that public health and public safety are extremely important in our society,” Carson, a retired pediatric neurosurgeon, told The Hill in a statement.

“Certain communicable diseases have been largely eradicated by immunization policies in this country and we should not allow those diseases to return by foregoing safe immunization programs, for philosophical, religious or other reasons when we have the means to eradicate them,” he added.

That’s right. Back in February, Dr. Carson opposed religious and personal belief exemptions to vaccine mandates. Last winter, he published an extensive statement in which, while acknowledging the issue of personal freedom, nonetheless came down on the side of vaccine mandates, stating:

I am very much in favor of parental rights for certain types of things. I am in favor of you and I having the freedom to drive a car. But do we have a right to drive without wearing our seat belts? Do we have a right to text while we are driving? Studies have demonstrated that those are dangerous things to do, so it becomes a public safety issue. You have to be able to separate our rights versus the rights of the society in which we live, because we are all in this thing together. We have to be cognizant of other people around us and we must always bear in mind the safety of the population. That is key and that is one of the responsibilities of government.

I am a small-government person, and I greatly oppose government intrusion into everything. Still, it is essential that we distinguish between those things that are important and those things that are just intruding upon our basic privacy. Whether to participate in childhood immunizations would be an individual choice if individuals were the only ones affected, but as previously mentioned, our children are part of our larger community. None of us live in isolation. Your decision does not affect only you — it also affects your fellow Americans.

This was an eminently reasonable position, acknowledging the balance between individual rights and how they can be constrained when an individual’s choices affect other people. Now, fast forward to September and Carson’s response to Tapper’s question:

Well, let me put it this way. There has — there have been numerous studies, and they have not demonstrated that there is any correlation between vaccinations and autism… This was something that was spread widely 15 or 20 years ago and it has not been adequately, you know, revealed to the public what’s actually going on…

This was technically correct. Incredibly tepid and cowardly, but technically correct, although I don’t know what the heck Carson meant about “this” not having been “adequately revealed to the public what’s actually going on.” It’s not as though it hasn’t been widely publicized that science does not support the claim that vaccines cause autism and that Andrew Wakefield’s research was fraudulent. Then, whether it’s because he didn’t want to attack Trump or didn’t want to upset the Republican base (perhaps both) Carson went to undermine what he just said:

Vaccines are very important. Certain ones. The ones that would prevent death or crippling. There are others, there are a multitude of vaccines which probably don’t fit in that category, and there should be some discretion in those cases.

First of all, as Tara Haelle pointed out, all the vaccines on the current CDC schedule prevent death and severe morbidity. Which ones does Dr. Carson consider “discretionary”? I’d love to hear his answer. Later, after Trump once again channeled Jenny McCarthy and her “too many too soon” misinformation, in which it is claimed that children are receiving too many vaccines at too high a dose at too young an age (or, as Trump has put it, “monster shots”) and it is advocated that vaccines be delayed and spread out, Carson actually bought into this antivaccine gambit, saying, “But it is true that we are probably giving way too many in too short a period of time, and a lot of pediatricians now recognize that and, I think, are cutting down on the number and the proximity in which those are done.” The only pediatricians who “recognize that” are antivaccine pediatricians like “Dr. Bob” Sears and antivaccine-sympathetic pediatricians like Dr. Jay Gordon. Delaying and spreading out vaccines just prolongs the time when children are susceptible to vaccine-preventable diseases without any benefit.

Basically, Dr. Carson flubbed a chance to hit a home run defending vaccines. Whether it was his fear of Trump or his fear of his own base, he equivocated, parroted one antivaccine talking point (“too many too soon”) and in the end refused to tell Trump to his face to stop spewing antivaccine misinformation. It was an epic fail. Worse, it was an epic fail in which he basically gave supported antivaccine fallacies, such as the idea that we’re giving “too many” vaccines “too soon” and it’s somehow causing autism. During the same debate Rand Paul, also a physician and surgeon (an ophthalmologist) also implied that there was a problem with “too many too soon,” consistent with his previous antivaccine statements. Overall, I’m not sure which was worse, Ben Carson knowing that antivaccine BS is BS but being too cowardly to say so (leading him instead to pander) or Rand Paul clearly believing that vaccines can cause neurologic damage and that “too many too soon” can harm children.

I wouldn’t be writing about Ben Carson, though, if it were only vaccines. Arguably, Carson knows what is and isn’t antivaccine misinformation; he simply chose not to stand up for science. However, in other areas of science, he’s outright taken the side of antiscience. For example, he’s long been known to reject evolution in favor of creationism, even to the point of arguing that evolution is “encouraged by Satan” and that the Big Bang is a “fairy tale“:

At the Celebration of Creation event, he discussed at length why he believes the Big Bang theory is impossible for him to comprehend.
He said: ‘Now, what about the Big Bang theory? I find the Big Bang really quite fascinating.’

‘I mean here you have all these high-faluting scientists and they’re saying it was this gigantic explosion and everything came into perfect order.’

He explains the same scientists promote the second law of thermodynamics – entropy – which says that things move towards a state of disorganization.
‘So now you’re gonna have this big explosion and everything becomes perfectly organized and when you ask them about it they say “Well, we can explain this based on probability theory because if there’s enough big explosions over a long enough period of time – billions and billions of years – one of them will be the perfect explosion”.

‘So I say, what you’re telling me is if I blow a hurricane through a junkyard enough times over billions and billions of years, eventually, after one of those hurricanes, there will be a 747 fully-loaded and ready to fly?’

Skeptics will recognize the “hurricane in a junkyard” mischaracterization of evolution as a classic creationist fallacy. It gets worse, though. Check out this transcript of the actual speech by Carson at the Celebration of Creation conference, which was organized by the Adventist News Network. Here’s the actual video. It is painful to watch if you have any knowledge about evolution, geology, and other sciences:

As Ed Brayton put it, this is Kent Hovind-level scientific ignorance. It’s a greatest hits of creationist tropes, dominated by the most scientifically ignorant, easiest-to-refute bits of creationist stupidity. Here’s but another taste:

You know, according to the theory [of evolution] it [the eye] had to go pukh! and there was an eyeball, overnight, just like that, because it wouldn’t work in any other way. And when you ask the evolutionists about that they say, ‘well, we don’t understand everything.’ And I say, ‘well, I don’t think you understand anything.’

The evolution of the eye is actually relatively well understood. Seriously, Dr. Carson. Your stupid, it burns.

So why is it that so many physicians fall for pseudoscience like antivaccine views (as Rand Paul, Bob Sears, and Jay Gordon do) and creationism (which Ben Carson and his fellow creationist neurosurgeon Michael Egnor do)? Why are so many surgeons and physicians like Ben Carson? We’ve seen their like before on this blog over the years, ranging from the infamous creationist neurosurgeon Michael Egnor to the antivaccine pediatrician Dr. Bob Sears to the antivaccine-pandering pediatrician “Dr. Jay” Gordon. In all cases, the physician shows that he doesn’t understand science and as a result adopts purely pseudoscientific beliefs, be they creationism, antivaccine views, Big Bang rejection, or any number of beliefs not supported by science. The reason is simple, and my saying what it is might piss off some of my fellow physicians. The vast majority of physicians are not scientists. Many of them think that they are scientists, but they are not.

It’s been a long time since I’ve discussed this, but Dr. Carson’s rise as a major candidate for the Republican nomination demands that I discuss it again because Dr. Carson is taking advantage of a misperception. That misperception is that physicians are scientists. Of course, so deep has been the idiocy flowing fast and furious from his mouth that Andy Borowitz posted what I consider to be the most hilarious take on Carson’s nonsense, Ben Carson Shattering Stereotype About Brain Surgeons Being Smart. Particularly hilarious was this part:

“When people found out I was a brain surgeon they would always assume I was some kind of a genius,” said Harland Dorrinson, a neurosurgeon in Toledo, Ohio. “Now they are beginning to understand that you can know a lot about brain surgery and virtually nothing about anything else.”

Exactly. That’s the case with most physicians.

The reason is simple. Medical training is not the same as scientific training. Yes, science is a prominent part of medical training, but not in the same way it is for scientists. In actuality, although medicine is based in science, it is an applied science. The vast majority of physicians do not do scientific investigation or contribute to scientific knowledge. Rather, they apply known science to the treatment of patients. This is not a knock on them, or an insult, or a criticism. It is simply an acknowledgement of what most medicine is. Medical school is very much more like a trade school, in which students are taught how to take care of patients, than a school teaching how to do science. Basically, medicine as a profession resembles engineering far more than a scientific specialty in that the vast majority of physicians apply science to the problem of diagnosing and treating illness, as engineers apply science to the problem of building things. Again, this is not a knock on either physicians or engineers. How they apply existing science to solve problems (or, in the case of engineers, to build things) can involve incredibly clever feats of mental prowess, but it is nonetheless a very different process than doing science to produce new scientific knowledge.

None of this is to say that physicians (or engineers) can’t be excellent scientists. They can, but such people tend to be a subset of the overall profession. For example, I like to think of myself as a decent scientist, and my publication and funding record indicate that I’ve had some success. I also made it a point to gain additional training by spending years getting a PhD and doing a surgical oncology fellowship that had a significant laboratory research component very much like a traditional basic science postdoctoral fellowship. I also have to point out that I’ve known many physicians who are also excellent scientists.

As an MD/PhD, I’ve straddled both worlds, the world of the clinician and surgeon and the world of the basic scientist. It’s not an easy task, because both worlds require very different skill sets, particularly in surgery. Wearing two hats is not something all doctors can do. For example, when I entered medical school (and I attended what was—and is still—considered to be one of the top tier medical schools in the country) I was surprised at how superficial the teaching of basic science was, from a strictly scientific standpoint. However, from a practical standpoint, the teaching of science in medical school was exactly what was required to take care of patients, no more, no less. For most physicians, that is as it should be. They need to know how to take care of patients, not how to do research.

But, I hear you saying, Ben Carson is a lot like Dr. Mehmet Oz. Before he became a politician, he was an academic neurosurgeon; Dr. Oz still is one. Both have published over a hundred papers. Yet, both have embraced pseudoscience, with Dr. Oz embracing a wide variety of quackery (such as reiki and homeopathy) and Dr. Carson embracing creationist pseudoscience, among other dubious scientific ideas. It’s at this point that I have to speculate a bit. One thing that comes to mind is that if you don’t have the solid grounding in the very philosophy of science, such that it infuses your very being, sure you can do clinical science. You can even be pretty successful at it, as Oz and Carson were. So that’s not it, at least not by itself.

So what is the problem? From my perspective, it boils down to two things. The first is not listening to Harry Callahan’s admonition that “a man’s got to know his limitations.” Surgeons—particularly heart surgeons and neurosurgeons—do amazing things. Dr. Oz can repair a person’s heart, and Dr. Carson can separate conjoined twins. These are matters of life and death, and doing such things requires a level of confidence in one’s own abilities that can easily evolve into arrogance. (Some might argue that most surgeons are pretty arrogant at a certain level to begin with.) So it’s not surprising that doctors like Drs. Oz and Carson might start to think that their incredible skills and knowledge in one area will translate into other areas, such as science unrelated to the narrow specialty they know. The second contributing factor is ideology and/or personal relationships. In Dr. Oz’s case, he became enamored of the idea of the physician-shaman-healer, not to mention that he also married a reiki master. In Dr. Carson’s case, it’s clearly fundamentalist religion that’s led him to reject evolution and the Big Bang in favor of what seems to be a variant of intelligent design creationism. Basically, Ben Carson is now coming across like the brain surgeon in this classic Mitchell and Webb sketch:

Doctors occupy a highly privileged position in society, and because of it their opinions are often given great deference, even on topics about which they are clearly not an expert. For all their accomplishments, it’s nonetheless important to remember that physicians are human and thus prone to the same cognitive shortcomings to which all human beings are prone. All too often, they are also given a status in society as all-purpose experts about all things that can be related to human biology or medicine, including evolutionary biology. The reason that Borowitz article is so spot on devastating is that it states just that in a humorous fashion and uses the example of Ben Carson to deconstruct the idea that brain surgeons are experts at everything. They’re not. Nor are most of them scientists. Their pronouncements outside of their areas of expertise should be judged as you would judge anyone else’s. On matters of science outside of their specialty most doctors are probably no more knowledgeable than an educated lay person and all too often let their professional status delude them into having undue confidence in their conclusions. It’s the sort of behavior we expect from a buffoon like Donald Trump. It’s just depressing to see Ben Carson behaving similarly, albeit with a much less bombastic voice.