Thursday, December 20, 2007

Evolution 101

This paragraph is taken from an article on sustainability that appeared in last Sunday’s New York Times magazine:

The first story is about MRSM [Methicillin resistant Staphylococcus aureus], the very scary antibiotic-resistant strain of Staphylococcus bacteria that is now killing more Americans each year than AIDS — 100,000 infections leading to 19,000 deaths in 2005, according to estimates in The Journal of the American Medical Association. For years now, drug-resistant staph infections have been a problem in hospitals, where the heavy use of antibiotics can create resistant strains of bacteria. It’s Evolution 101: the drugs kill off all but the tiny handful of microbes that, by dint of a chance mutation, possess genes allowing them to withstand the onslaught; these hardy survivors then get to work building a drug-resistant superrace.

It is indeed Evolution 101, and it has tremendous implications for how physicians, including Orthodox ones, practice medicine. Not too long ago you walked into a doctor’s office with the sniffles and walked out with a prescription for penicillin, never mind that the sniffles are usually caused by viruses, against which penicillin and other antibiotics do not work. Many pediatricians in particular still practice that way, prescribing drugs that they know will not help their patients but will act as a sedative for their mothers. One must wonder how intelligent physicians did not anticipate that prescribing powerful antibiotics with such wild abandon would cause problems. I would hazard a guess that most physicians trained before the 1960s did not study evolution, since most high schools steered clear of it for religious and political reasons. A practicing physician, as opposed to one engaged in research, is more of an engineer than a scientist. He is engaged not in the acquisition of new knowledge but in applying existing knowledge to solve human problems. He need not accept evolution to make use of knowledge developed by scientists using that theory. But when a physician, driven not by good science but by bad religion, denies the central unifying concept of the science that informs his practice, he is reinforced in his reluctance to modify his practice in light of knowledge consistent with that concept. This brings me to an advertisement in the Jewish Press many years ago, when my children still used a pediatrician. It was signed by several well-known pediatricians in my community, including the one who treated my children, who shall go nameless. The ad stated in essence that its signers studied the theory of evolution, found it to be nonsense, and therefore their patients, who presumably attended yeshivot, need not study it. A scientist invites others to replicate his work and improve upon it. He does not tell others, “I studied this so you shouldn’t.” I would not have used that pediatrician if I had not believed him to be technically competent, but seeing his name on that advertisement caused me to lose respect for him as a scientist. Would a physician so contemptuous of the science that enables his profession to advance be receptive to those advances? This soon became a moot point for me and my wife; we stopped using that pediatrician when he stopped accepting our insurance. But that ad stands as a warning for today’s Orthodox community with its increasingly anti-scientific mindset. Steer clear of physicians who are actively hostile to the science on which modern medicine depends. In today's sad times, that might mean, "Steer clear of most Orthodox physicians."

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Anonymous Dr Mike said...

First of all, one can believe in evolution and still prescribe amoxycillin with abandon for every cold and sniffle that walks through the door. There is a wide mental disconnect between the two. When a physician prescribes amoxycillin, he isn't thinking about target bacteria developing resistance, he's thinking "How do I get this whining patient out of my office? I could take 3 minutes and explain how viruses work or I could take 30 seconds and write a useless 'script just to get rid of them."
Patient expectations also play a huge role. I once did an on-call shift for my Family Practice group and saw 36 patients, 34 of whome presented with colds and 34 of whom wanted antibiotics. I wrote NO 'scripts that night but got into at least 10 "heated discussions" over my refusal. Apparently the next night, 16 of the 34 returned and told the doc on call that the guy before refused to treat them properly. Guess how many got antibiotics?
The bottom line is that I contest your assertion about the connect between being an Orthodox Jew and a physician. For me and all the other frum physicians I know, the kippah on the head means an obligation to practice the best quality medicine possible. We don't shirk our Jewish responsibilities and we don't shirk our medical ones either.

Fri Dec 21, 08:34:00 AM EST  
Blogger Neandershort said...

You're right about the disconnect between theory and practice, and it takes courage to do the right thing (which you seem to be doing) when you stand to lose patients to physicians who do the wrong thing. And I didn't mean to put down all Orthodox physicians, only those hostile to science. Medical training might select for students not hostile to science, but the ad in question ran some 20 yrs ago and my reading of the Jewish scene, at least in Brooklyn, is that the anti-science mindset has gotten worse, not better.
With specific reference to the overprescribing of antibiotics, we have a Tragedy of the Commons here, where goods and bads accrue to different people at different times and places. The goods - placebo effects for patients and mothers, getting rid of kvetches - accure to patients, mothers and physicians here and now. The bads - armies of antibiotic-resistant bacteria - accrue to the general public in the indefinite future. But what we do now can come back later to bite us on the behind, and the indefinite future is now. What happens when someone walks through your door with MRSA or penicillin-resistant syphilis? You have to give him something else with higher toxicity and undesirable side effects, or the patient might even die from an illness that, but for doctors' writing useless scripts, would have been cured with a ten-day course of amoxicillin.

Pediatricians in particular have to be health educators and, if male, role models for boys. They simply must take the time to explain the difference between bacteria and viruses, and that antibiotics are useless against viruses. And a boy with a cold whose mother is clamoring for an antibiotic needs to hear something like this from his doctor, if the doctor is a man: You're a strong fellow. You're bigger than these bugs and you're gonna beat them. It will take a week and you'll be a little uncomfortable, but so what? Think of the boys in (Lebanon, Iraq, Afghanistan, whatever). They're a whole lot more uncomfortable than you. Daven for them, keep busy and keep your mind off your discomfort. And here's something (oxymetazoline nasal spray, Claritin, . . .) that will help you feel better until you beat those yucky bugs.

I found that, in the early stage of recovery from a cold, a five-mile run and/or a weightlifting workout would give it the coup de grace.

Sun Dec 23, 12:09:00 AM EST  
Blogger cipher said...

The ad stated in essence that its signers studied the theory of evolution, found it to be nonsense, and therefore their patients, who presumably attended yeshivot, need not study it.

I am absolutely astonished to read this. Here in Boston, most of the doctors aren't frum, but I would guess that the few who are wouldn't share such a belief, let alone give voice to it. In fact, I know a frum physician; I'm fairly certain that he believes in evolution.

Then again, Boston isn't a very Jewish town, certainly not by New York standards. I don't think it would even occur to a doctor here to offer an opinion as to what someone should or should not study in yeshiva!

I would hazard a guess that most physicians trained before the 1960s did not study evolution, since most high schools steered clear of it for religious and political reasons.

You really think this is the case? I would imagine this antipathy to evolution to be a recent phenomenon, a result of the rise of the Christian right, and the Hareidization of Orthodoxy. I can't think that it would have been an issue in secular universities, and certainly not now. The Christian schools may not teach it - but how many doctors do they produce? As far as the Jewish universities are concerned - how many are there? Brandeis, obviously, wouldn't be a problem - and I thought that even YU was teaching evolution now.

You may find this interesting; it's an article from Skeptic magazine entitled, Orthodox Jews & Science; An Empirical Study of their Attitudes Toward Evolution, the Fossil Record, and Modern Geology. The author states that

By definition Jews who accept evolution are not Orthodox (!)

Sun Dec 23, 10:38:00 AM EST  
Blogger Neandershort said...

I know that American high schools steered clear of evolution, and many still do (hence the Dover case two years ago), because I studied the history and I am fairly active in the National Center for Science Education , which defends (!) the teaching of evolution in American public schools. Other advanced countries don't seem to have a problem. School board members are often scientifically illiterate and don't want their chilren taught that "we came from monkeys." Teachers then shy away from the topic because they don't want to be fired. The famous Scopes trial occurred in 1925, and the law on which Scopes was prosecuted was not repealed until 1968. After Sputnik awakened the country to the dismal state of science and math education, the Biological Sciences Curriculum Study published several groundbreaking biology texts that treated evolution appropriately, and the situation began to improve. As we saw two years ago, hostility to evolution is still strong and not confined to the Bible Belt. Here in New York, evolution is central to the curriculum and to the Regents exam that students take at the end of the course, and New York City actually rejected several textbooks because they did not treat evolution adequately, but New York is among the bluest of blue states. Yeshivot, of course, are a different story. With few exceptions, they are a morass of backwardness, and becoming more backward by the day. As a biology teacher, I checked my children's biology books. They were standard texts that discssed evolution and the pages were not torn out. If they had been, the principals would have gotten a piece of my mind.
College is very different. They are not controlled by ignorant school boards and evolution is treated very matter-of-factly, but by the time a haredi kid gets to college his thinking is already shaped by morons like Avigdor Miller, who are considered greater authority figures than mere college professors. YU does teach evolution; I can't see it keeping its accreditation otherwise. But its biology chairman, Rav Tendler, is in bed with the intelligent design people - a sad case of a man's old age embarrassing his youth.

Wed Dec 26, 02:48:00 AM EST  
Anonymous starofdavid44 said...

Dear Zev,

Great column! Blaze away at the neo-appeasers. I don't care to be forced at the point of a gun and jail time (rape included) to wrap up my head in a rag, 100 degree + weather or not.

Please check out my web site tribute to a fine Israeli-American athlete who was murdered by terrorist thugs, then trivialized in a recent film with the murders highlighted in horrific violence with the athletes reduced to a few seconds in a exploitative newsreel, and no speaking parts. The murderers where sympathetically portrayed as fine people with a cause of their own, to which we all owe an ear. As Gandhi said, "It is terrible to be but great to see."

Sun Mar 02, 02:26:00 AM EST  
Blogger Neandershort said...

Star of David -

You might want to read an earlier post of mine. The athlete you refer to, weightlifter David Berger hy"d, studied at my alma mater, Columbia University. I was a junior when he was murdered; I walked around in a mournful daze for months afterward; I now recognize that I was going through bereavement without any of the supports that our community provides to people who lose close relatives. And "bereavement counseling" in the secular society hadn't been invented yet. I still cry when I think of him and the ten others - and I get mad as hell that we are still sleepwalking. What will it take to wake us up to the obvious fact that we are in a war for our existence as free people? Will we have to lose a city for the greater glory of Allah? Will even that wake us up?

Sun Mar 02, 05:30:00 PM EST  
Blogger Yehuda Draiman said...

Israel should have responded sooner - It is Israel’s government fault for this escalation.

For years the Arab population around and surrounding Israel has been bombing with rockets and suicide bombers.

Would the U.S. or any other country shown such restraint while its citizens are terrorized, the answer is absolutely not.

Israel chose restraint. The Arab world sees restrained as a sign of weakness and capitulation.

It is long overdue for Israel to take off the gloves and respond with extreme force and keep the pressure without relenting.

Do not worry about the media or world opinion. You do whatever you have to, to defend your country and its population.

People in the world respect those in power who defend their citizens and not weaklings, even though they may object initially.

If the Arab permit extremist to hide among civilians, they must bear the consequences, it is a right and an obligation to protect its citizens by any means available – no force is too small, extreme force and prejudice is required.

For every bullet a grenade, for every missile a bombardment. When Sharon was defense minister many years ago, that was the policy and it worked, it will work today also.

Anyone threatening the security will be expelled out of their homes and the greater Israel.

Jay Draiman

Mon Mar 03, 01:35:00 AM EST  
Anonymous Anonymous said...

G*d d**n Jamal Al-Gashey and Abu Daoud to eternal HELL.

Why hasn't any reponsible citizen with a honest sense of civic duty killed them both? It's now been 36 years since the murder of the Israeli athletes which they took part in, and they have lived to boast about it all. Israel, wake up!

Fri Mar 07, 05:16:00 PM EST  

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