Medicine and Evolution.

A Final Word: I went by that site today to see what additional comments might have been posted after I left. Here is what remained:

I was referring to your claiming that people were being dishonest in their claims not to be YECs. It’s not that you disagreed with the values expressed by their self-identification, it’s that you didn’t accept that they were who they claimed they were. This makes productive conversation much more challenging.

Does that make sense?

I didn’t claim that people were secret YEC members. I commented that I was astounded at the vehemence of people who described themselves as “non-creationist Christians,” at attacking a person who supports and thinks evolution will be important in medicine in the next 50 years. Read some of the comments in italics below to see if I am overstating this.

I am very concerned, after this, at the role of Fundamentalist Christians in the GOP. They are far less tolerant of other opinion and resemble the global warming alarmists in the unwillingness to allow dissent.

Update #4: I am saving some of the material from the thread to remember what Ricochet is like.

The pseudo sympathy: Mike, frankly, you never had them straight in the first place. The entire thread, you thought you were fending off attacks from a group of Young Earth Creationists, but there was only one YEC among them. The rest of them were believers in one form of evolution of another, and just upset with your attitude.

Attitude !

Do you bear any of the blame for making this thread so unpleasant? I’m perfectly willing to have a discussion with you, and I’m semi-sympathetic to your viewpoint. I’m definitely not a YEC. But I can’t understand why you are being so flippant.
Flippancy is the problem !

No, you’re not. You might try reading the thread. I’ve been listing all the insults over on my own blog as a study of how this happens.

“Mike, I am personally not a young-earth creationist, but I think you are confusing two concepts here. ”

I’m always the one confused. Explained by the Ivy League.

This: “Or would he create a universe that showed millions of millennia of age, even though it was only seconds old?”

Led to this: “It’s nice that you all believe this. Good luck. Let’s hope your doctor doesn’t.”

Now that was my mortal sin to the crowd here. From that the following resulted:

“You are very flippant in dismal of my case for faith. Once again I have no problem believing that someone who believes that God put together the world in 6 days .”can also understand the significance of mitochondria. ”

I doubt that. Instead: “I have a far greater trust of a doctor who believes in God and lives it in his own life rather than one who is merely technically competent and sees the universe, and my life, as a happenstance of evolutionary doctrine.”

Now, the folks who are denying this is about creationism and is about my “attitude” seem to ignore those parts.

“Well that’s a glowing example of inability to actually argue the point. When you encounter indications that people disagree with your conflating micro and macro evolution, imply that anybody who doesn’t believe in the warm puddle or whatever the popular origin of life theory is this week is incompetent. ”

Now there’s a thoughtful statement.

” If I’m just an expression of evolutionary pressures, he might want to trim it up. (Has the advantage of being supported by all the various eugenics of recent history, including the ongoing slaughter of those unborn suspected of having genetic illnesses.)”

So now abortion has been dragged into it.

“You slander many very good doctors with your dismissive remarks.”

And I’m the problem.

“But what followed was a long-winded series of examples that do not make a case that any student of what evolution teaches must believe any of the paleo-biology tall tales about the long long ago history of this and that.”

More friendly repartee.

“In my opinion, the whole argument is silly. Humans simply don’t have the intellectual capacity to comprehend the creation. It’s like a dog trying to understand how a television works;”

More brilliance. My tolerance for this is less than yours or you didn’t read it.

“Mike has argued that we should (or, at least, he would) place professional barriers before those who disagree with his creation myths ”

Another mis-statement of what I wrote. I only mentioned my own letter writing which was not a barrier the last time I checked admission requirements.

“You are the one who said that you would keep Creationists out of med school.”

More mis-statement.

“Believing that the paleo- fields have very badly miscalculated the age of the earth has nothing at all to do with the ability of a doctor to conduct medicine. ”

I guess you agree. I don’t.

I then gave up. This colony of creationists, even those who deny they are “YEC,” wore me out.

UPDATE #3: The attacks continue and it has been several days !

I am also a Christian who doesn’t hold to a YEC point of view. (I would also add, although I hate to flaunt credentials, that I am a more recently trained physician than you, Ivy-League-trained, and hold a faculty position at a medical center that’s a bit fancier than yours.)

So there ! I have decided that I am a Libertarian and not a conservative, if that is what this is about.

UPDATE #2 The pushback has finally succeeded in making me a villain.

(Yes, I know the things I cited don’t make him right about YEC, necessarily. My point is that he’s been successful despite Mike K insisting that people like him should be prevented from being doctors.) ¬∑

This followed a long list of accomplishments by a supposed acquaintance who had had a successful career as, as best I can tell, a pediatrician. This all began with my comment that, aside from not being willing to recommend a student who did not believe in evolution for medical school, I was neutral. I think I am no longer neutral. The “Young Earth Creationist” community seems to have a determination to oppose any evolutionary thinking by anyone. They also seem to have an very convoluted way of explaining why obvious facts are not as they appear.

UPDATE: The pushback from creationists surprised me a bit. I guess it shouldn’t have. I expected “We will just have to agree to disagree” sort of thing. Instead I got an interesting series of attacks on me.

Is it impossible for the Creator to have built all the evidences of age into His new creation? The reality of natural selection isn’t necessarily required to have a long and indefinite period of activity to apply today.

and

Well that’s a glowing example of inability to actually argue the point. When you encounter indications that people disagree with your conflating micro and macro evolution, imply that anybody who doesn’t believe in the warm puddle or whatever the popular origin of life theory is this week is incompetent.

and

There are plenty of good Christian doctors and biologists who are well-versed in cell biology and in how mutations happen and in natural selection processes that affect microbes and higher organisms.

This all reminds me of the epicycles, which were used to explain why Ptolmeic astronomy could not explain certain phenomena like the movement of planets. It took Kepler’s discovery of the elliptical orbits to resolve the matter finally.

The creationists seem determined to ignore the implications of molecular biology about evolution and maintain “Young Earth Creation” in the face of the evidence of ancient biology.

But what followed was a long-winded series of examples that do not make a case that any student of what evolution teaches must believe any of the paleo-biology tall tales about the long long ago history of this and that.

Even Copernicus wanted to learn why the planets did not follow the rules of Ptolmeic astronomy. Today, that is considered rude. I may have to reevaluate my opinion of creationists. I have considered them harmless ill educated religious fundamentalists. They are far more aggressive than I had believed in attacking any disagreement.

I accidentally got into a debate about evolution at another site today. I didn’t want to get into this as I know there are many people, many of whom share my political affiliation, who are adamant about creationism, as the left often refers to it. Still, I have posted my opinions here in the past. I think molecular medicine is going to become even more important in the future and I do not understand how a physician can understand molecular medicine without molecular biology. There are many examples of evolution that must be understood to appreciate certain areas of medicine.

I think a physician can practice as a GP and not believe in evolution. I know a few. They are not likely to understand the future of medicine but they are my age and will not be practicing for long, if they are not yet retired.

Here are a few examples of the role of evolution in medical practice.

It has been known for a long time that sickle-cell trait provides resistance to malaria (the blood cells are less hospitable to the P. falciparum protozoan parasite that is one cause of malaria). This explains the persistence of sickle cell disease in populations where malaria is endemic.

In fact, the malaria parasite has also evolved and the varieties of the organism demonstrate this. Plasmodium vivax needs a specific red cell antigen called the Duffy antigen to infect human red cells.

The protein is also the receptor for the human malarial parasites Plasmodium vivax and Plasmodium knowlesi. Polymorphisms in this gene are the basis of the Duffy blood group system

This is recent information and depends for its significance on an understanding of evolutionary pressure on populations.

While a possible role in the protection of humans from malaria had been previously suggested, this was only confirmed clinically in 1976.[41] Since then many surveys have been carried out to elucidate the prevalence of Duffy antigen alleles in different populations including: [a long list].

Falciparum malaria is now thought to have evolved later than the vivax variety. Why ?

As of 2006, there were an estimated 247 million human malarial infections (98% in Africa, 70% being 5 years or younger).[4] It is much more prevalent in sub-Saharan Africa than in many other regions of the world; in most African countries, over 75% of cases were due to P. falciparum, whereas in most other countries with malaria transmission, other, less virulent plasmodial species predominate. Almost every malarial death is caused by P. falciparum.[4]

It is more prevalent in subSahara Africa because the population there is resistant to the vivax form and lacks the Duffy antigen.

The presence of the parasite in human populations caused selection in the human genome in a multitude of ways, as humans have been forced to develop resistance to the disease. Beet, a doctor working in Southern Rhodesia (now Zimbabwe) in 1948, first suggested that sickle-cell disease could offer some protection to malaria. This suggestion was reiterated by J. B. S. Haldane in 1949, who suggested that thalassaemia could provide similar protection. This hypothesis has since been confirmed and has been extended to hemoglobin C and hemoglobin E,

Sickle cell is a disease of blacks because it reduces the susceptibility to malaria of the falciparum variety. The Duffy antigen is probably an older source of susceptibility and the population lost this antigen because of evolutionary pressure. Subsequently the parasite evolved and the human genome evolved again.

Individuals with sickle-cell anemia or sickle-cell trait do have reduced parasitemia when compared to wild-type individuals for the hemoglobin protein in red blood cells. Studies have shown these genetic deviations of hemoglobin from normal states provide protection against the deadly parasite that causes malaria (Allison, 1954).

This is one example of evolution in medicine. There are others.

The authors also provide examples of how evolutionary principles can direct future research. They reference new research looking into the role of intestinal parasites and autoimmune diseases. The research is based upon the premise that humans co-evolved not only with our intestinal flora, but with certain parasites, such as intestinal worms. Now we live in a largely hygienic environment, and have even taken steps to eliminate parasites. This may have unintentionally deprived our immune systems of needed stimulation, resulting in poor immune regulation, and subsequent increase in auto-immune diseases like asthma and multiple sclerosis.

The classic example of a “hygiene disease” is polio. Paralytic polio was unknown in 1950s Mexico City slum children. When the antigen was isolated, it was found that almost all these children were immune, suggesting previous exposure.

Let’s take another example of potential evolutionary study applied to human disease.

It is now known that certain varieties of prairie vole differ in behavior because of hormone receptors.

One variety has a high level of oxytocin receptor in the brain and exhibits a high degree of social behavior and is monogamous. Another variety showed different binding and is polygamous.

By in vitro receptor autoradiography with an iodinatedoxytocin analogue,specific binding to brain oxytocin receptors was observed in both the monogamous prairie vole (Microtus ochrogaster) and the polygamous montane vole (Microtus montanus).

These brain areas showed little binding in the montanevole,in species difference in the newborn pup’s response to separation which oxytocin receptors were localized to the lateral septum, suggests that an inherent difference in the propensity for ventromedial nucleus of the hypothalamus, and cortical nucleus of the amygdala. Similar differences in brain oxytocin receptor distribution were observed in two additional species, the monogamous pine vole (Microtus pinetorum) and the polygamous meadow vole (Microtuspennsylvanicus). Receptor distributions for two other neurotransmitter systems implicated in the mediation of social behavior, benzodiazepines,and,opioids did not show comparable species differences.

This may be a huge advance in understanding human behavior. Does it fit with creation ? An example.

Frontiers in Behavioral Neurosciences. 2014 Jan 17;7:225. doi: 10.3389/fnbeh.2013.00225.
eCollection 2013.

An evolutionary perspective on the behavioral consequences of exogenous oxytocin
application.

Author information:
(1)Department of Neurobiology, Stanford University School of Medicine Stanford, CA,
USA ; Department of Neurobiology, Duke University School of Medicine Durham, NC,
USA.
(2)Department of Neurobiology, Duke University School of Medicine Durham, NC, USA ;
Department of Evolutionary Anthropology, Duke University Durham, NC, USA.

Oxytocin (OT) is released in response to social signals, particularly positive ones like eye contact, social touch, sexual behavior, and affiliative vocalizations. Conversely, exogenous delivery of OT has diverse behavioral effects, sometimes promoting affiliative and prosocial behaviors, but sometimes suppressing them.

Has this been used clinically ? Yes

Proceedings of the National Academy of Science U S A. 2010 Mar 2;107(9):4389-94. doi:
10.1073/pnas.0910249107. Epub 2010 Feb 16.

Promoting social behavior with oxytocin in high-functioning autism spectrum
disorders.

Andari E, Duhamel JR, Zalla T, Herbrecht E, Leboyer M, Sirigu A.

Author information:
Centre de Neuroscience Cognitive, Unité Mixte de Recherche 5229, Centre National
de la Recherche Scientifique, 69675 Bron, France.

Social adaptation requires specific cognitive and emotional competences. Individuals with high-functioning autism or with Asperger syndrome cannot understand or engage in social situations despite preserved intellectual abilities. Recently, it has been suggested that oxytocin, a hormone known to promote mother-infant bonds, may be implicated in the social deficit of autism.
We investigated the behavioral effects of oxytocin in 13 subjects with autism. In a simulated ball game where participants interacted with fictitious partners, we found that after oxytocin inhalation, patients exhibited stronger interactions with the most socially cooperative partner and reported enhanced feelings of trust and preference.

This is very early but I counseled one of my students who is interested in pediatric neurology that she should learn more about this field as it may provide a treatment of autism.

A knowledge of such topics may be of less significance to primary care providers and the future may find much primary care delivered by non-physician providers like PAs and nurse practitioners. I find medical students far more curious and I struggle to keep up with them in new information based on evolutionary biology.

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