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Writer's pictureDr. Arnold

Whatever, Just Wash Your Hands!



No, I’m not going to weigh in on gender equality in restroom access. But ‘Whatever, just make sure you know what you’re talking about’ was too long for a blog post title, and ‘A little knowledge is a dangerous thing’ was just too bland.


The basic idea behind science is that you don’t accept as fact anything that cannot be reliably proven. This attitude is admirable in its own way, in the right place, if only for its safety: you aren’t going to be tap-dancing near the edge of credibility so long as you limit yourself to provable facts. But there’s a trade-off: you won’t see the incredible vistas available to those willing to leave the safe path and head off into the weeds of the unknown. Still, for most everyday tasks staying on that safe path is the only way to go if you want to make sure you can make it to tomorrow, when maybe you will have the nerve to head out.


It’s been said that mathematics is the only true science. This is in reference to the fact that absolutely nothing in mathematics is accepted unless it can be proven, in two directions: not only must an idea be established to be a cause of a phenomenon, but all other ideas must be proven to not be. This is much more rigorous than any other scientific field, where usually it’s sufficient to show one cause-and-effect relationship. The idea of ruling out alternative explanations is only given lip service, if anything. Biology is a particularly notable offender, where so-called ‘laws’ are quoted that are really nothing more than empirically-derived rules of thumb and little effort is made to prove them even in one direction.


It's this mindset of proving things both ways that sets mathematicians apart most other people. I also feel it helped me be much better at diagnosing an illness. But on much more than just a professional level it drives me batty when I see people making pronouncements of what they consider to be a ‘fact’ that are not, in fact, well… fact.


This is not actually a criticism, though it may sound like it. I’m on the spectrum enough to realize that for most situations in which we are ever likely to find ourselves a one-way proof is quick and sufficient enough, and getting caught up in the minutiae of considering all possibilities can freeze one’s actions at critical moments. It happens to me constantly! But there are many times, especially when one is considering taking actions that will have long-term consequences, that exercising this due diligence is very important. This is where that old adage about ‘a little knowledge’ comes into play and can cause a whole lot of acrimony, bad blood, and downright sore contention that doesn’t have to happen. Not to mention sending one down a path of wrong actions.


There are a lot of ideas in our world that are hotly contested to extremes. Is the earth flat? Did we land on the Moon? Is climate change real, and is it our fault, or is it the result of natural processes we don’t fully understand yet? Let’s take a look at one of my favorites: Evolution as the origin of species.


Anyone who has paid any attention to their biology classes from middle school on up knows that there are two key components to Evolution as a theory: random mutation and natural selection. It’s a nice, elegant explanation and, to hear the biologists present it, seems pretty well tied up. It may be true that my bio professors acknowledged the gaps in their knowledge, but if they did, they minimized it because I always got the impression we had this one down—although it gets a little suspicious when a new discovery is made and scientific journals start gushing about how the news is filling in ‘big gaps’ that none of the rest of us realized existed.


There’s plenty of proof of evolution as a process. A classic example is the peppered moth, in which a light-colored variant predominated over a dark-winged one as it blended into the bark of the birch and poplar trees of its natural habitat. But when the industrial revolution hit in the late 19th Century and soot coated everything, the light ones stood out and became easy pickings for birds. Only the black ones blended, survived, and bred large populations. It wasn’t until pollution was reduced and the natural tree bark again emerged from the crud that the lighter moths rebounded.


Sickle-cell trait is another example. This is a genetic variant in humans that provides protection against malaria infection. Then there are female elephants in Mozambique being born without tusks, an evolutionary response to poachers. And finally, we have bacterial resistance, where incomplete courses of antibiotics kill off common strains of infectious organisms, leaving hardier types that the meds can’t get to.


All well and good, right? Until you try to explain how life on earth in all its diversity arose from primordial single-celled microbes. That’s when you find there’s a third element that is required if you want to use evolution as an explanation for the rise of complex organisms: a gain of function.


For all of Earth’s flora and fauna to arise, things had to get more sophisticated. It’s pretty well established that (for example) the eye has hundreds of unique components that are all required (at the same time) for proper functioning, and have no other purpose—which means they wouldn’t have evolved for some other reason and then been brought together and repurposed. How the eye as a structure evolved is a complete mystery.


This particular requirement of a gain of function is something we haven’t seen yet. The black peppered moths were suited to their artificially-induced environment, but in their natural habitat they were the ones the birds could find. Sickle cell may protect humans from malaria, but it does so at the expense of a loss in efficient oxygen transport that can lead to pain crises and early death. Elephants developed tusks for rooting and defense. Those females without them are not as capable of interacting with their natural environment as their tusked sisters. It’s only the presence of poachers that makes them viable (which is essentially the same idea as sickle cell vs. malaria, or moths and birds). And bacteria? Every population of bacterial infection has a range of subtypes, and the resistant ones are a definite minority. We know this because run-of-the-mill antibiotics still work extremely well. The bulk of any bacterial population is still fairly easy to kill, which proves the resistant ones are smaller populations and thus, evolutionarily, less viable in their natural habitat. In short, evolution does give rise to new species… but so far all those new adaptations we’ve seen are less capable than their predecessors. They only have an advantage due to a local outside threat. This doesn’t mean Evolution Theory is debunked, but it does show why it’s still only a theory (at least this one the biologists acknowledge!)


At the end of the day, the argument about the ability to expand evolutionary processes to Evolution Theory as an explanation for life’s diversity is academic. It has little real-world application aside from giving us a reason to look down our noses at each other. But what about cherry-picking bits and pieces of knowledge to suit one’s own agenda in real time? Where half-truths are used to inspire misplaced confidence in our own decisions, or worse, to convince others to undertake harmful actions against misperceived threats? In the Old Testament the Hebrews were told ‘an eye for an eye’. In the New Testament Jesus gave the Sermon on the Mount, where he explicitly stated to ‘love your enemies’ and officially put an end to the harshness of the Law of Moses (take a look at Hebrews Chapter 9). Isaiah was speaking prophetically when he recorded that Jesus would tell his people ‘Bring no more vain oblations’ (Isaiah 1:13). Scholars may debate why this is; the explanation that makes the most sense to me was that the Exodus through the desert was demanding and there was no room for error, no place to rehabilitate a wrong-doer. But centuries later the time and the resources were available for a higher morality and a more liberal forgiveness. Nevertheless, I often hear people that have had some wrong done to them quote the ‘eye for an eye’ rule as a justification for contention, even violence, because ‘it’s in the Bible’. Well, so is the Golden Rule, my friends. Call me a purist, but I don’t think one should be excusing their behavior by quoting scriptures without having read them all the way through. More than once.


When heathcare professionals are caught up in malpractice cases they can find themselves in a situation like this. Suddenly there are people looking over their shoulder that know nothing about their work aside from what they saw on Grey’s Anatomy, or Scrubs, or worst of all, The Resident. And it’s not just opposing counsel and injured patients and their families; it can be their own hospital or medical group’s admin wonks and legal team. As I mentioned in my blog post here, trials aren’t a chess game so much as they are personality clashes and there’s not nearly as much fact-checking by those in authority as you might hope for.


This is where I come in. There may be standards of care, but human lives are messy and so is their medical care. There can be dozens of factors that bear on any given situation. How much was known, and by whom? When was it known? What options were available and what were the time constraints? Was immediate action needed, or only thought to be? Each case must be evaluated individually so injured parties can get the justice they deserve, good providers can be protected, and no one spends precious time, money, and aggravation chasing down rabbit holes only to come up with egg on their face.


Because if that happens you’ll need to wash more than just your hands.

 

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