Evolution Medicine Pseudoscience Science Skepticism/critical thinking

Oh, the shame again: Another doctor embarrassing himself over “intelligent design” creationism

Geez, I might as well just put a paper bag over my head right now around my fellow ScienceBloggers.

You’ve heard me lament before about the woeful ignorance about biology and evolution common among all too many doctors. (You haven’t? Well check here, here, here, and here.) Heck, you’ve even heard me lament about it just a few days ago, my irritation being piqued by a physician by the name of Dr. Geoffrey Simmons.

Now, as if to rub my face in it, Dembski’s crew over at Uncommon Design have made me aware of an orthopedic surgeon named David A. Cook, M.D., who’s adding to my embarrassment. As usual, they make a lot of his qualifications (“Intelligent design” advocates seem particularly impressed by credentials, even if those credentials have little or nothing to do with disciplines that study evolution). For example, he was AOA (Alpha Omega Alpha Honors Society, memberships to which are only given to the top medical students), graduated first in his class, and earned a Merck Award and an Upjohn Award. All definitely very impressive. He also scored the 99th percentile on his certifying examination for Board certification in Orthopedic Surgery. That’s also impressive, but I found it very odd that he mentioned this tidbit, because most surgeons simply say they are Board-certified; they rarely, if ever, mention the percentile they finished at. Basically, if you’re a Board-certified surgeon, no one really cares what percentile grade you got on the qualifying exam, especially not 14 years later. (Heck, almost no one puts their Board exam scores on their CV; doing so would probably provoke ridicule.) To me, Dr. Cook’s mentioning his Board exam score that can only be to try to impress the rubes with how smart he is and thus convince them that somehow he must know what he is talking about when he starts pontificating on evolution. (In other words, “Trust me, I’m a doctor who scored in the 99th percentile on my Board exam.) Dr. Cook also published six clinical papers that don’t look all that impressive, including case reports like this and one case series on MRI of the knee, plus a review article.

All of the above indicates that Dr. Cook is very likely an excellent orthopedic surgeon. But none of it represents adequate qualifications to persuade me to take him seriously when he comments on evolution, and the harping on all of his qualifications appear to be nothing more than a transparent attempt to give him an air of scientific authority when blathering about evolution that, based on the content of what he writes, he clearly does not have or deserve:

Dr. Cook is a graduate of Vanderbilt, home of one of the first IDEA chapters in the nation. I asked him not to be shy about his accomplishments, because people like him are the ones who most effectively communicate to the world that a person can be quite literate in science and still question Darwinian evolution. His example empirically disproves the false claims of Dawkins, Harris, KCFS, NCSE, and others who insinuate that exposure to criticism of the Darwinian orthodoxy will deteriorate scientific understanding.

The only thing Cook’s example “empirically proves” is that it is possible to be an accomplished surgeon and sound like a complete ignoramus when talking about evolution.

Of course, it always amazes me how, on the one hand ID advocates claim that ID is “science” and that, oh, no, it doesn’t have anything to do with their religion at all–perish the thought!–while on the other hand they can’t seem to resist using religious language when discussing their beliefs. In the case of Dr. Cook, his development of “disbelief in Darwinism” is described as a “post-Darwinist conversion,” beginning:

I believed in Darwinian-type evolution up through undergraduate and more or less through medical school. What else was there? My church does not take a position on the subject. We believe that “Man was created in God’s image,” but how God went about it is unspecified. The spectrum of beliefs on this topic among church members spans nearly the entire range; we are only required to accept that God was involved and behind it somehow. I used to just vaguely believe that “evolution is how He did it.”

I always know I’m dealing with a creationist when he refers to “Darwinism” when expressing “skepticism” about evolution. (It’s as if the scientific discoveries of the last 140 years supporting the theory of evolution never happened; here’s a hint, dude: It ain’t 1859 anymore.) And, indeed I am. Of course, he’s representing himself as scientifically literate and therefore more authoritative than your run-of-the-mill ID’er by pumping up his irrelevant qualifications. Indeed, it’s fascinating to see how ID’ers fawn over him in the comments. One commenter points out that being an orthopedic surgeon is hardly a qualification to be taken seriously about evolution, and he’s attacked. The most risible reply comes from a commenter named jpark320 (comment #14), who says:

1) Well I’d have to say this is crazy! Find me a doctor who doesn’t know molecular biology…

2) I think it is very inaccurate to compare Dr. Cook or any physician with a layman in biochemical understanding.

3) Would it be fair to characterize a Ph.D’s understanding of Human evolution abysmal b/c he doesn’t understand the person on a systems lvl?

4) Most Ph.D researchers don’t have any more detailed knowledge of evolution in general. They only have extra knowledge one disease process or pathway (compared to an MD).

5) I’m confident Dr. Cook understands biochemistry.

His confidence in doctors in general and Dr. Cook in particular is truly touching (and naive). Very typical of the medical student that he is. He will come to know better. At least I hope he will.

I graduated from medical school the same time as Dr. Cook did (and took honors biochemistry while doing it), and I can assure jparks that there are many physicians who do not understand molecular biology. Indeed, I was amazed at how simplified the biochemistry I learned was compared to the graduate level biochemistry that I had taken during my undergraduate years. Also, molecular biology has progressed markedly in the 20 years since Dr. Cook graduated (the only reason I keep so up-to-date on it is because I’m an academic surgeon and scientist; the vast majority of physicians forget it as soon as they no longer need it). Besides, orthopedic surgeons, particularly nonacademic ones, are not known for their detailed understanding of molecular biology; they are known for their knowledge of the anatomy of the musculoskeletal system and their skill at repairing bones with power tools and cartilage, tendons, and occasionally nerves and blood vessels with finer instruments. (Indeed, they frequently have to consult their medical colleagues to deal with even fairly straightforward medical problems.) An, sadly, it’s not just orthopedic surgeons who are prone to embarrassing themselves pontificating about evolution. The bottom line, unfortunately, is that most nonacademic physicians in day-to-day practice (and even some in academic practice) do not know anything other than a watered-down basic version of molecular biology, and some don’t even understand that all that well. Dr. Cook may actually understand something about molecular biology (although his writing makes me sincerely doubt that he, in fact, does), but you can’t assume that, just because he is a doctor, he must understand molecular biology.

In any case, Dr. Cook couldn’t resist diving into the same, old tired ID canards in describing the beginning of his “conversion from Darwinism” in medical school:

The more I learned [about the human body], the less sense it made to me that such an incredibly complex, incredibly integrated on all levels entity could possibly have arisen as a result of chance, no matter over what time period and no matter what selection mechanisms were involved. There are just way too many examples of processes, structures, and functions that are not only amazingly complex themselves, but engage in incredibly coordinated cooperation with other parts and functions. Any physiological process you can think of is this way, bone homeostasis being the currently most familiar to me because of my specialty of orthopaedic surgery; how could the amazing feedback system among the intestine, liver, kidney, and bone have arisen without some sort of coordinating agency? Gross anatomy is the same way on a macro level; muscle, nerve, vascular, bone, and joint systems all mesh in an elegance of function.

And when you expand the question to the whole of life it becomes mind-boggling: fish, insects, birds- did you ever look at an ant under a microscope? What awesome little machines they are. And that’s only on the outside. And supposedly primitive creatures like sharks turn out to have sensory and surveillance equipment to put the CIA to shame.

I began questioning fellow classmates and a few professors. By what possible sequence of events could this amazing symphony of form and function have arisen through chance processes? I received no satisfactory answers. The ones who even took the question seriously assured me that there were experts and specialists in the field out there who understood it all, it had all been investigated, and Darwinism was the answer. Just because we students didn’t understand it didn’t mean no one did. I could rest assured that somebody knew all that.

Obviously, Dr. Cook didn’t ask the right people, and, as we now know from my previous rants, it’s quite possible that most of his medical school professors didn’t understand evolution any better than he. Indeed, poor understanding of evolution among medical students is becoming increasingly a problem. I’d be willing to bet that Dr. Cook almost certainly did not ask a bona fide evolutionary biologist to explain how such structures could have come to be. (He should talk to Ivan Schwab about how the eye evolved, for instance. Dr. Schwab is an ophthalmologist and an afficianado of evolutionary biology who writes widely about evolution, particularly as it pertains to the eye). In any case, his reasons for doubting, as with most creationists, boil down to an argument from personal incredulity. In essence, because he can’t understand, believe in, or envision a way that complex structures or biochemical pathways or whatever could have evolved to a state of such exquisite complexity, he conclude that these structures must have been “designed.” science be damned. I always find this sort of argument from ID creationists to be the height of hubris myself, as the person making such an argument comes off as though saying: If I can’t see how this structure evolved, then it must have been designed. Of course, as a fellow surgeon, I’m well aware of the hubris of surgeons and have to be on guard, lest I start to exhibit that most distasteful quality. It’s also an argument that’s profoundly anti-scientific, a God of the gaps argument that goes: Because we don’t yet understand how this or that structure evolved, it must have been “designed.”

Not too impressive for someone with such otherwise impressive credentials in orthopedic surgery. Only an ID’er would think that an orthopedic surgeon with no special training in evolution would be any more knowledgeable about it than the engineers that they are so fond of trotting out to support their pseudoscientific garbage.

ADDENDUM: Oh, no, Dr. Cook did it again in the comments! See comment #32:

Regarding human limb development, the hand is truly an amazing piece of engineering: Just in the finger, the balanced interplay of the extensor complex with both flexor tendons and the beautiful dynamic balancing and coordinating act the lumbrical muscles do (MP flexors, IP extensors; what a great design to facilitate overall function) is an example of irreducible complexity,. Remove just one component and the whole thing is grossly handicapped and dysfunctional.

The opposable thumb is another marvel, from the saddle joint of the first carpometacarpal articulation to the coordination of the thenar muscles with the extrinsic extensors, abductors, and long flexor. It is truly a symphony of inter-related form and function.

The knee is another marvel of coordinated complexity. It also contains an excellent example of structures, the menisci, which were considered nofunctional vestigial remnants like the appendix only a few decades ago but which are now known to be essential for normal functioning and preservation of articular cartilage.

I do not believe there is any way these structures, or any of the other very many examples in the human body, could have arisen by any conceivable pathway of DNA mutation or any of the described rearrangment mechanisms.

I do not buy Dawkins’ hand-waving invocations of incrementality; the more you look at how DNA actually works the less believable those explanations are. And for a whole structure such as these to have arisen as one “mega-mutation” as some have suggested is just ludicrous.

Straw men about evolution (the whole “mega mutation” bit) piled on top of arguments from personal incredulity.

Get me burlap sack. A paper bag won’t be enough to hide my embarrassment.

ADDENDUM #2 1/18/2007, 7 PM: Welcome Dr. Cook to the party in the comments. I have to finish tomorrow’s installment of Your Friday Dose of Woo; so I won’t have time to much in the way of his points until tomorrow night at the earliest (more likely over the weekend sometime); so in the interim I leave in to the capable hands of my readers to try to explain to him where he’s gone wrong. Be nice, now. He already thinks I’m excessively insolent and insufficiently “respectful,” as it is just because I pointed out that, however good a surgeon he may be, he doesn’t understand evolutionary theory or molecular biology very well (he obviously hadn’t read posts like my Reply to a 14-year-old Creationist, Cancer and Fate, or perhaps this, this, and this):

Let’s start with this:

Perhaps you can explain, in molecular biological terms, listing the stepwise sequence of DNA changes (simplified, of course, so my poor moronic brain can grasp it), which occurred to bring about the development of a hand, finger, or knee from, say, the paw or limb of a lemur-like precursor (or whatever form you wish to posit as mammalian (making it easy on you; no need to go back to jellyfish or something which didn’t even have limbs) ancestor to humans.

Of course, if Dr. Cook is as intelligent as he seems, he must realize that hundreds, if not thousands, of papers have been written on the evolution of the vertebrate limb, and that such an answer is very hard to boil down into a palatable blog post. He’s also doing what ID advocates frequently do and demanding that every last detail be spoon fed to him. Fortunately, we probably don’t have to go back to jellyfish. Another invertebrate, namely Drosophila (fruit flies), will do. 😉

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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