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This article is a response to the recent Bill Nye / Ken Ham debate. It’s an article about multi-drug resistant tuberculosis (MDRTB) in Russian prisons. It is also an article about how Jesus lived, what his love looked like in practice, and what that means for contemporary Christians living in a world where scientific inquiry is unfolding at a breakneck and awe-inspiring rate. If you’re confused, you should probably keep reading.

In America today, there is a popular myth that science and religion are in conflict. I’ve heard many scientists, both secular and Christian, dismiss this notion by positing, simply, that science and religion are merely two entirely separate ways of understanding the world, not in conflict, but not really related either. As a scientist and a Christian, I find this dismissal to be unsatisfying. Sure, there is a material world and a spiritual world, but it is not as though God has no bearing on or relevance to the material world. Besides which, acting as though two of the most important parts of my life are entirely unrelated and have nothing to say about one another seems to demand that I split my personality into two distinct parts: the part that shows up to my research group and the part that shows up to church.

Let me tell you what this article is not. This article is not meant to explain how evolution works or clarify the common misconception that humans evolved from modern apes (we didn’t). There are plenty of resources about this topic available already, such at this solid, brief explanation of phylogeny. I am also not going to skewer Creationists, who are, after all, my brothers and sisters in Christ. This article has nothing to say about where humans came from. I’m not going to give my personal interpretation of Genesis or offer my understanding of the relationship between anatomically modern Homo sapiens, Australopithecus, and Pan troglodytes. While these are topics that interest me, they are outside the scope of this article. What I will attempt to do is explain how it is that I can be a Christian devoted to living the Gospel, striving daily to live the life God wants for me, and also study evolutionary biology, without having to split myself into two separate personas that ignore one another.

In the recent debate between Ken Ham and Bill Nye, Ken Ham aimed to illustrate that being a Creationist doesn’t preclude contributing to technological progress. Meanwhile, Bill Nye attempted to drive home the point that religious communities—and, I’ll add, personal relationships with God—enrich the lives of billions of people of faith around the world in spite of the fact that they do not believe the literal Creationist story that Ken Ham espouses. That is to say, believing in God doesn’t require that one be a Creationist. Both men are right. In this article I will complicate the conversation by adding my own perspective as a Christian evolutionary biologist: rather than being at odds, I believe that studying evolution enriches my ability to carry out the work of the Gospel.

In 2012 8.6 million new cases tuberculosis (TB) arose, adding to the millions of existing cases. That same year, 1.3 million people died from the disease (WHO). Think about that. In 2012, the population of the entire state of Massachusetts was 6.645 million people (United State Census Bureau). Imagine if everyone in Massachusetts contracted TB, plus some unlucky folks in New Hampshire. Imagine if more than one in seven of the people you know died in 2012. And they didn’t just drop dead randomly. No, it was painful: unending chest pain, waking up with night sweats, and unrelentingly coughing up blood (American Lung Association a). That’s what TB did in 2012. Some of those who died had probably contracted the bacterium years earlier, but it had been latent, waiting until their immune systems were weak enough to become active and kill (American Lung Association b).

Fortunately, TB is treatable. Unfortunately, while the World Health Organization (WHO) is on-track to meet many of its goals for the treatment of TB, it is nowhere near meeting its goals for detecting and treating MDRTB, which comprises a significant portion of all TB cases. What is MDRTB? The term describes any strain of TB bacteria that is resistant to, at a minimum, both INH and RIF, the two drugs typically used as the first line of defense in treating TB. According to Harvard Professor and Physician Anthropologist Paul Farmer, “MDRTB is difficult to treat and carries a high case-fatality rate when not treated” (Farmer 2005, 180). It often strikes the poor, the sick, prisoners, and other people whose immune systems are compromised, frequently leading to death when effective treatment is inaccessible. I will discuss what effective treatment requires in further detail later on.

In his essay “Cruel and Unusual: Drug-Resistant Tuberculosis as Punishment,” Farmer remarks wryly:

 “It’s easy to find, in the long and grim history of punishment, inventive ways of making prisoners suffer” (Farmer 2005, 179).

TB is contracted through the air by inhaling droplet nuclei containing the pathogen. Since TB can cause people to practically hack their lungs out, these droplet nuclei get all over the place. If you’re in a jail cell with someone with an active infection, there is nowhere to hide. As Farmer puts it, “suffice it to say that overcrowded prisons with poor ventilation are particularly effective amplification systems for the spread of TB” (Farmer 2005, 181). Russia—and the United States, for that matter—has plenty of such prisons (Farmer 2005). When bitter Russian winters keep prisoners inside for months of the year, MDRTB, which is more difficult to treat than standard TB, can spread through the prison population quickly. The very air the prisoners breathe is potentially deadly. The same principle holds for people in crowded living conditions because of poverty.

What does Jesus have to say about the poor, the sick, and the imprisoned?

“Then the King will say to those on his right, ‘Come, you who are blessed by my Father .… For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me …. Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me’” (Matthew 25:34-36,40).

So if we, as Christians, wish to minister to the Lord, we must care about poor people, sick people, and prisoners, and certainly poor, sick prisoners fall within this designation. What does Jesus do when he cares about sick people? He heals them. Healing the sick went hand in hand with his proclamation of the gospel:

“And he went throughout all Galilee, teaching in their synagogues and proclaiming the gospel of the kingdom and healing every disease and every affliction among the people” (Matthew 4:23).

In this verse, “kingdom” is a key word that can give us insight into the significance of Jesus’s work healing the sick. I’m no theologian, so I will default to someone who is a theologian for an explanation, Pope Benedict XVI:

“Jesus himself is the Kingdom; the Kingdom is not a thing, it is not a geographical dominion like worldly kingdoms. It is a person; it is he …. By the way in which he speaks of the Kingdom of God, Jesus leads men to realize the overwhelming fact that in him God himself is present among them, that he is God’s presence” (Pope Benedict XVI 2007, 50).

So proclaiming the “gospel of the kingdom” (Matthew 4:23) is kind of a big deal, and the way that Jesus himself did it was by traveling around spreading the word while simultaneously healing the sick. If we wish to look to Jesus as an example of the ideal way of living and evangelizing, this is a lesson we must heed.

“Now wait a second,” you may be saying to yourself, “Didn’t Jesus heal through faith, not second-line TB drugs?” And if you are saying this to yourself, you are right. When a woman with a chronic hemorrhage that the physicians of the day could not heal followed Jesus through a crowd, saying to herself, “‘If I touch even his garments, I will be made well’” (Mark 5:28), her ailment disappeared instantly upon touching his clothes. The Gospel says, “And immediately the flow of blood dried up, and she felt in her body that she was healed of her disease” (Mark 5:29). Jesus then told her, “‘Daughter, your faith has made you well; go in peace, and be healed of your disease’” (Mark 5:34).

Does this get us off the hook? Does it mean we can put our faith in God and call it a day? This is tempting option and a necessary start, but it’s only a start:

“What good is it, my brothers, if someone says he has faith but does not have works? Can that faith save him? If a brother or sister is poorly clothed and lacking in daily food, and one of you says to them, ‘Go in peace, be warmed and filled,’ without giving them the things needed for the body, what good is that? So also faith by itself, if it does not have works, is dead”  (James 1:14-17).

I expect that Jesus would want us to take practical actions to help people dying of MDRTB or, indeed, they will be dead. “We are told to “be doers of the word, and not hearers only, deceiving yourselves” (James 1:22). When we take action to heal people dying of MDRTB, I feel confident this is the sort of thing Jesus was talking about. MDRTB is a big issue; it afflicts so many people it can be hard to wrap one’s mind around it. Tragedy at that scale is hard to comprehend. Falling back, once again, on scripture for guidance: “When [Jesus] went ashore he saw a great crowd, and he had compassion on them and healed their sick” (Matthew 14:14). Jesus didn’t stumble upon one or two sick people and stop to help. Oh no, it was a “great crowd” and when he has compassion, he doesn’t just stop to pity them, but he postpones his attempt to find a “desolate place” (Matthew 14:13) where he can get some quiet time. Why? Because “he had compassion!” (exclamation mine). And the way he demonstrates that compassion is by “heal[ing] their sick” (Matthew 14:14). Clearly not all Christians are specifically called to be physicians or public health advocates. After all, “there are varieties of gifts, but the same Spirit” (Corinthians 12:4). Nonetheless, I hope I’ve convinced you that those who are taking action to heal people afflicted with MDRTB are serving God through their service to “the least of these my brothers” (Matthew 25:40).

So what is required to detect, treat, and stop the spread of MDRTB in stuffy Russian prisons, overcrowded slums, and elsewhere? First, it requires understanding where MDRTB comes from. The answer: sometimes bacteria make mistakes while they are copying their genomes to split in two. Most of these mistakes are deleterious, but sometimes a microbe gets lucky and the mistake happens to be helpful for its survival in the lungs of a person taking TB drugs. These more resistant bacteria live longer and leave more progeny behind than the rest, an effect that is amplified across the generations. As this is repeated, the entire population becomes more and more resistant to the drugs. Since bacteria replicate quickly, this is a phenomenon that researchers can watch happen over the course of just one poorly-followed treatment regimen in a single patient. Potentially within just weeks, drugs that once worked stop working, and the patient needs new drugs to keep getting better. There’s a term to describe the process that results in MDRTB after exposure to first-line drugs. I’m going to whisper it: evolution by natural selection.

If physicians and policy-makers ignore the fact that Mycobacterium tuberculosis mutate and evolve resistance to first-line drugs, they can continue throwing money at a problem that will only get worse. Most generic regiments aimed at addressing TB outbreaks rely on short courses of INH and RIF. In cases where the bacteria are somewhat resistant to these drugs, however, this go-to treatment does not kill the bacteria and cure the TB, but instead makes the bacterial colony even stronger such that any subsequent therapy is less effective (Farmer 2005). In other words, MDRTB develops. Effective treatment requires understanding how the patient’s particular strain of TB has evolved and figuring out which drugs will actually work. Doing this requires understanding evolution by natural selection, not ignoring it. We can likewise “[c]onsider the case of HIV/AIDS, where phylogenies,” a tool evolutionary biologists use to map species’ family histories, “have been used to identify the source of the virus, to date the onset of the epidemic, to detect viral recombination, to track viral evolution within a patient, and to identify modes of potential transmission” (Baum et al 2005, 979). As Kay Warren, the wife of Pastor Rick Warren, says in her book Say Yes to God, HIV causes untold suffering both for those who are personally afflicted with the disease and for the twelve million orphans it has left in Africa alone (Warren 2010, 12). All the activities phylogenies assist—identifying, tracking, etc.— are critical to stop its path of destruction. And because HIV wrecks the immune system, it has also played a major role in exacerbating epidemics of TB around the world, including those that swept through the New York state correctional system in the 1980s (Farmer 2005, 183). There are plenty of other examples of diseases that can only be managed, treated, and prevented if the evolution of the microbes is taken into consideration.

For Jesus, spreading the good news of the Kingdom of God and healing the sick were activities that went hand in hand. Everywhere he went, he healed. As Christians, we cannot bury our heads in the sand and plead ignorance. We have a responsibility to minister to the sick, and, for me, the study of evolution is an important tool in equipping myself to do this work. “Show me your faith apart from your works, and I will show you my faith by my works …. Do you want to be shown, you foolish person, that faith apart from works is useless? …. For as the body apart from the spirit is dead, so also faith apart from works is dead” (James 2:18, 20, 26). This truth is wretchedly literal in the case of someone with MDRTB: if no one understood the process of evolution occurring in their very lungs, these patients would die. Jesus told us to judge a tree by its fruit (Matthew 7:18-20). Taking the study evolution out of the curriculum of schools is a self-defeating mission because, if properly understood and deployed, this pursuit can be a powerful means by which to be “doers of the word” (James 1:22). And this is how I can be both an evolutionary biologist and a Christian and not split myself in two.

Works Cited

American Lung Association (a). 2014. “Symptoms, Diagnosis and Treatment.” Accessed on 16 Feb 2014. < http://www.lung.org/lung-disease/tuberculosis/symptoms-diagnosis.html>

American Lung Association (b). 2014. “Understanding Tuberculosis.”Accessed on 16 Feb 2014. <http://www.lung.org/lung-disease/tuberculosis/understanding-tuberculosis.html>

Baum DA, Smith SD, Donovan SSS. 2005. “The Tree-Thinking Challenge.”  Science 310: 979.

Crossway Bibles. 2011.The Holy Bible, English Standard Version. Kindle Edition. Good News Publishers.

Pope Benedict XVI, Joseph Ratzinger. 2007. Jesus of Nazareth: From the Baptism in the Jordan to the Transfiguration. Vatican City: Libreria Editrice Vaticana.

Farmer, Paul. 2005. Cruel and Unusual: Drug-Resistant Tuberculosis as Punishment. In: Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press.

United States Census Bureau. 2014. “Massachusetts.” State & County QuickFacts. Accessed on 16 Feb 2014. <http://quickfacts.census.gov/qfd/states/25000.html>

Warren, Kay. 2010. Say Yes to God. Self-published.

World Health Organization (WHO). 2013. “Executive summary.” Global Tuberculosis Report 2013. Accessed on 16 Feb 2014. < http://www.who.int/tb/publications/global_report/gtbr13_executive_summary.pdf?ua=1>