Hubris versus skepticism: The case of neurosurgeon Ben Carson [Respectful Insolence]

November 23, 2015 Orac

As a surgeon and skeptic, I find neurosurgeon turned presidential candidate Ben Carson to be particularly troubling. I realize that I’ve said this before, but it’s hard for me not to revisit his strange case given that the New York Times just ran a rather revealing profile of him over the weekend, part of which included Dr. Carson answering criticism for the really dumb things he’s said about vaccines, evolution, and the like. People like Ben Carson are useful examples of how highly intelligent, people who are incredibly competent in one area can also demonstrate unbelievable ignorance in other areas. Ben Carson, having spent his life caring for patients with incredible dedication and skill, can’t seem to go a day without saying something incredibly stupid now that he’s running for President. Whether it’s pandering to the antivaccine wing of the Republican Party, denying that he used to be a shill for Mannatech, a supplement company whose business practices have been less than ethical, or denying evolution, Carson’s depths of scientific ignorance and willingness to lie have reached crank levels.

So, you might think, if Ben Carson is such a crank and there’s considerable evidence that the views he’s been espousing on the campaign trail are not new, why is it that no one seemed to realize this until Carson entered politics? It turns out that Carson was such a private man that few people knew:

When he was not in the operating room at Johns Hopkins Hospital, performing one of his 400 surgeries a year, Dr. Ben Carson could often be seen walking slowly through the hallways, hands behind his back, nodding, smiling and speaking softly to co-workers and students who approached.

“When he walked around Hopkins,” said Dr. Anthony Avellino, a former colleague, “he was like God.”

Patients and nurses asked him to sign his books. Medical students flocked to his occasional lectures or a campus showing of the TV movie version of “Gifted Hands,” Dr. Carson’s memoir.

One student, Dr. Jonathan Dudley, recalled that “Some of my friends had a big poster of him up in their dorm room.”

It seemed fitting, then, that in 2013, Dr. Carson, who was retiring as chief of pediatric neurosurgery, was chosen to give the commencement address for Dr. Dudley’s class. But that March, during a Fox News interview, Dr. Carson appeared to liken same-sex marriage proponents to pedophiles and “people who believe in bestiality.”

We learn a lot of things in this profile. During his years at Johns Hopkins, Carson was basically a rock star whom seemingly everyone admired. he did way more cases than the average surgeon (around 400 a year compared to the usual 250 a year for the average academic neurosurgeon at Hopkins), and he did some of the most difficult cases. He worked long hours and by all accounts was a good teacher. In the world of surgery, a surgeon who does a lot of cases, many of which are more difficult than average, does them well, and works very hard will earn a great deal of respect and good will. In fact, these are measures of status in the world of surgery, one way for a young surgeon to build a reputation. (Research is another, but, quite frankly, surgeons seem to admire technical skill and dedication more than they admire research, evne in academic settings.)

He was also fairly daring. he would undertake operations to separate conjoined twins. He revived an old operation for seizures, the hemispherectomy, which involves removing half the brain. Surgeons also admire this in other surgeons. So putting together Carson’s work ethic, his technical skill, the number of cases he did, and his daring, it’s not to surprising that he was so universally admired at Hopkins, the only complaints being from partners who had to cover for him so often when he traveled to give motivational speeches and do other events.

Reading this profile, I couldn’t help but wonder whether part of the problem was perhaps that, while he did have to engage in the rough-and-tumble given and take that normally occurs in a high-powered academic department of surgery over his surgical decisions, when it came to his crankier views, such as his belief in creationism and his promotion of cancer quackery, no one ever challenged him. After all, no one seemingly new about them, and those who did seemed able to compartmentalize, just as Carson apparently compartmentalized. It’s not hard to imagine a scenario in which Carson, as he became more and more famous based on his life story as told in his biography, his motivational speeches, and his increasing political activism, started to develop a touch of hubris and that that hubris carried over to his political campaign.

Think about it. Carson is a man who has never held elective office or even run a large organization, such as a company. The entire Johns Hopkins Pediatric Neurosurgery Program only has six surgeons and two physicians’ assistants, which is actually a pretty big for such a program. Add ancillary staff, such as secretaries, nurses, and research faculty and staff and it’s doubtful that there were more than 20 or 25 people in the entire department. This means that Ben Carson thinks himself capable of running the federal government after having only run a small academic department. Not only that, he thinks himself the best qualified person to lead the nation. (Every Presidential candidate thinks himself the best qualified person to lead the nation; otherwise he wouldn’t run for President.) Also consider that Carson has no elective experience. As much as we like to delude ourselves that we don’t want politicians as our President, running a country is an inherently political job. The two can’t be separated. A President skilled at politics, who knows how the federal government works, how its departments work, how the legislature works, will be more successful than one who does not. So right there there’s incredible hubris.

And, as we all know, hubris is the enemy of skepticism. Hubris destroys skepticism because it interferes with the questioning of oneself, one’s belief, and one’s knowledge that must occur as part of critical thinking. Taken to an extreme, hubris can lead one to believe he is never wrong. Already, we see that in Ben Carson. When questioned about, for example, his long relationship with Mannatech, Carson basically lied through his teeth and denied that he was a spokesperson. Whenever questioned about anything, his first reaction is to double down and/or make excuses.

We see this in the interview published by the NYT. For instance, here is what Carson now says about vaccines:

Some people feel that I make the declaration and everybody has to march to my drum.

My point was that there are a lot of people who are so concerned about the load of vaccines that they are getting in a very short period of time that they may abandon the use of vaccines altogether, which would be a very significant public health issue for us. I think we have to be willing to talk with them and to look at alterations in schedule.

When you look at how many times the schedule has been altered by so-called experts, it tells you right there that whatever schedule they come up with is not necessarily the perfect schedule. Take into consideration the concerns of these people and let’s work with them, so that we can get people on the same page, rather than declaring: “I’m the great Oz. No one else could possibly know anything.”

Notice the straw men. No one was looking to Dr. Carson as the arbiter of whether vaccines cause autism and what should constitute the ideal vaccine schedule. However, because he is a pediatric specialist, his opinion does carry more weight to the general public than, say, that of Jeb Bush or Donald Trump. Given his past stance supporting school vaccine mandates, it was disappointing to see Carson change course and start to pander to the “health freedom” antivaccine wing of the Republican Party. It’s even more disappointing to see that he is still pandering to them and still repeating antivaccine “concerns” wrapped in anti-establishment, anti-pointy-headed expert rhetoric.

He does it to the point of some seriously burning stupid:

There are some diseases where I think there is room for discussion. Chickenpox. Now, chickenpox is generally not a fatal disease by any stretch of the imagination. In fact, when I was a kid, they used to have chickenpox parties. Somebody would get it, and they’d bring everybody over so they would get it, too. And then everybody would be immune to it.

Oh,. My. God. Carson is actually parroting antivaccine talking points and blithely dismissing chickenpox parties as though they were OK. You’d think that a neurosurgeon would know the potential complications of varicella. Yes, such complications are uncommon, but they include pneumonia, coagulopathy, encephalitis, secondary streptococcal infections, and more. A doctor should know better. This doctor does not.

He also completely misunderstands the antivaccine movement:

The question for the antivaxers is, do the vaccinations create more problems than they solve? You are never going to convince them unless you are willing to sit down with the data and unless you are actually willing to listen to them and listen to their concerns. That’s been the problem.

I generally am very pro-vaccines and pro-vaccinations. I think they’ve saved a lot of lives and cut down on a lot of morbidity in our society.

I think the problem we are having now is we have an increasing number of antivaxers. I think they are being reactionary. And I think they are being reactionary because of the way things are being imposed upon them.

It is a microcosm of the bigger problems that we are having in our country right now where people try to impose things on everybody rather than sitting down and having an intelligent conversation and looking at the data, looking at the evidence.

This level of naïveté is painful to behold. What on earth does Carson think that vaccine advocates have been doing for all these years but showing the data and trying to convince antivaccine loons that vaccines are not only not dangerous but are safe and effective. Indeed, the very reason for vaccine mandates is because antivaccine activists can’t be convinced with evidence, reason, and rational arguments. You can’t have an intelligent conversation with them. It’s certainly possible to have an intelligent conversation with the vaccine-averse parents (who are very different from the real antivaccinationists), but with hard core antivaccinationists? Not so much.

Then there’s creationism:

I believe the Bible. I do believe it is the word of God. I do believe he created heavens and earth. It says in Genesis 1, in the beginning God created heaven and earth. Period. We don’t know how long that period is before he started the rest of creation. It could be a minute. It could be a trillion years. We don’t know. I have never stated that I have an understanding of how old the earth is. That’s something that a lot of people will ascribe to me.

Organisms, animals have the ability to adapt to their environment. But the evolutionists say that’s proof positive that evolution occurs.

I say it is evidence of an intelligent God who gave his creatures the ability to adapt to its environment so he wouldn’t have to start over every 50 years.

What is it with neurosurgeons and creationism? So Carson might not be a young earth creationist, as he has been accused of in some quarters, but he is clearly a creationist. The problem is that evolution is not only well supported by the existing scientific evidence but is currently the best explanation for the diversity of life.

I’ve said it before (many times). I’ll say it again: Most physicians are not scientists, and highly intelligent people (like Ben Carson) are frustratingly all too often not skeptics.

As I’ve said before, every human being on this planet has the potential to believe the same nonsense the Ben Carson, or maybe nonsense on the same level as what he believes, if not necessarily the exact same beliefs. Add to that the considerable hubris that Carson has exhibited over the last three years, and you have a very toxic combination.

Hubris is the enemy of skepticism because skepticism begins with recognizing how our thinking can go awry, not just Ben Carson or other cranks but you, me, everybody. Critical to that recognition is having the humility to recognize that we all believe things without evidence and to begin to test our most deeply held beliefs against reality in order to determine which ones are supported by evidence and which ones aren’t, testing that must involve seeking out disconfirming evidence. Most importantly, we must have the humility to be able to admit when we are mistaken and be willing to change our minds when the evidence does not support our beliefs.

Ben Carson is a walking, talking, nonsense-spewing example demonstrating that a high level of knowledge and skill in one area does not necessarily make one a skeptic. As importantly, he also demonstrates how, no matter how soft spoken and seemingly self-effacing a person might seem, that does not mean that person is not full of hubris that destroys skepticism and critical thinking.

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