The New England Journal of Medicine blows an opportunity
And almost dropped it when I saw the Table of Contents. Could it be?
Yest it could, right there, and article entitled Faith Healers and Physicians—Teaching Pseudoscience by Mandate, by Robert S. Schwartz, M.D., a deputy editor of the NEJM. Finally, I thought, an article in a prominent medical journal that makes a connection between teaching pseudoscience like "intelligent design" creationism and quackery. It started with a snarky tone appropriate for addressing attempts by activists to promote the teaching of ID in public schools. Still, it's not a tone that I normally associate with NEJM articles:
In the 1939 movie The Wizard of Oz, Frank Morgan plays five roles. In one of them, he is a flimflam hawker of trivia traveling across the plains of Kansas in a horse-drawn wagon. In another, he is the wizard who, concealed by a curtain, manipulates a machine that controls all of Oz. Now, more than 65 years later, another pitchman is rolling across Kansas, but unlike Morgan's bumbling peddler of trinkets and dreams, the new one has no interest in such trifles. It is an articulate and sophisticated anti-evolution movement called "intelligent design." At its core is the idea that a supernatural being — a hidden wizard — has a hidden hand in shaping the living world.
The debate has been prominent in the press and major scientific journals, but it has not been featured in medical journals, nor has it been discussed publicly by leaders of academic medicine or professional medical societies. Some might ask why physicians should care about how we educate our children, and what difference it would make to medicine if we taught children intelligent design as a counterweight to evolution — which, according to the proponents of intelligent design, is a mere theory. But acquiescing to this anti-science movement would have far-reaching consequences for the development of future generations of physicians, for the likelihood of discovering new therapies, and for understanding health and disease.
Some of the supporters of intelligent design are knowledgeable and sophisticated. Phillip Johnson, Professor Emeritus of Law at the University of California, Berkeley, and one of the founders and financial backers of the intelligent design movement, can accurately pinpoint many problems that the theory of evolution has not come close to solving. His criticisms have merit, and his focus on precisely those things that we do not yet know blocks any rational dialogue. But Johnson and his followers always end up in the same blind alley: the problems are too complex to be explained by any proposition other than the existence of an intelligent designer.Uh-oh. He didn't say what I thought he said about Phillip Johnson, did he?
He did, unfortunately.
If you don’t believe me about Johnson's AIDS denialist credentials, go to the Virus Myth site, where he and his writings are prominently featured. Note that the mother of the child who died from her negligence is on its Board of Directors. Consider this lovely fisking of one of Johnson’s more crackpot writings about AIDS, so much like his writings about evolution and "intelligent design." Indeed, Ed Brayton has quipped:It is widely believed by the general public that a retrovirus called HIV causes the group diseases called AIDS. Many biochemical scientists now question this hypothesis. We propose that a thorough reappraisal of the existing evidence for and against this hypothesis be conducted by a suitable independent group. We further propose that critical epidemiological studies be devised and undertaken.
I think he [Johnson] just takes the same article and changes the enemy du jour from "the Darwinian establishment" to "the HIV establishment" or "the AIDS establishment". Phil Johnson is nothing if not a consistent tilter-against-windmills. Whoever he's against, it's a grand conspiracy to hide the truth and, naturally, he's got the Truth™ that the hidebound orthodoxy won't let you hear.
Fortunately, Dr. Schwartz tries to redeem himself in the remainder of the article, pointing out that the confusion between faith and science at the highest levels of public education "can hardly be an asset to the pool of applicants to medical schools and graduate schools in the sciences," asking:
What would it mean to take intelligent design seriously at the medical school level? Its proponents tell us that gaps in our knowledge of how living organisms evolved vitiate the theory of evolution. Might we conclude, then, that the cancer cell and its evolution are so complex that a creative designer must be the cause of cancer? But if the designer created cancer, is it against the hidden hand's will to find a cure for cancer? Is it in accord with the plan of the intelligent designer to receive a treatment for cancer? After all, a Jehovah's Witness would rather die than receive a blood transfusion. Yet today more than ever, the profession needs physicians who can channel scientific discoveries to the sick. What effect will pseudoscience-by-fiat have on medical progress?
If we accept the premise that it is not in the long-term interest of medicine to disguise a faith-based belief as a scientific discipline and indoctrinate future physicians and scientists in a creed that thwarts the science of medicine, what can physicians do now? It seems to me that leaders of professional societies and prominent academicians should start speaking up. At the local level, doctors are prominent and respected. They serve on school boards, and some hold public office. They are influential teachers. Many have religious affiliations, and they surely know the difference between faith and science. Engaging in a public debate about intelligent design is probably not a good idea; any debate about faith and belief will surely end inconclusively. More desirable are education and acting to protect the profession and the public from pseudoscience. The main need now is to begin to understand what the debate is about and to consider its consequences for the future of medicine.
Dr. Schwartz is correct that we as physicians, particularly academic physicians responsible for training the next generation of doctors, should do what we can now. What that means for me is two things: First, any students who rotate in my lab get personal instruction from me in the scientific method and how to evaluate clinical trials. Second, when I'm teaching medical students and residents, I try to inculcate in them the concepts and habit of critical thinking. Just the other day, in fact, I spent some time educating the current group of residents and medical students on our service about what confirmation bias is. I was unpleasantly surprised to discover that not one of them had the slightest clue what I was talking about. I can only hope the lesson sinks in.