Evolution and medicine

Burt Humberg at The Panda's Thumb writes:

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.

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.

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.
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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.
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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.
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Section 2: Professors of Evolution Do Teach in Medical Schools
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Section 3: Nobel Prizes in Medicine Have Been Awarded for Work in Evolutionary Biology