November 12, 2003

Hamlet Meets Modern Medical Science
("Odds bodkins man, there really is something rotten in Denmark: Yorick's skull")

By Dr. Howard Glicksman

“Alas, poor Yorick, I knew him Horatio.” Thus spoke Hamlet when he encountered the skull of his former servant. But most people are not aware of what Shakespeare had written for Hamlet to say immediately afterward. For the people of the early 17th century had little interest or knowledge of bodily function. More to the point, they were very superstitious about such things and Shakespeare’s backers, who by necessity were also his censors, convinced young William to strike these lines:

“Odds bodkins man, there really is something rotten in Denmark, Yorick’s skull. But look ye to his other bones as well, Horatio. For in them one can see what must have been for him interminable suffering. Oh, why did I not know this while he breathed and walked among us? For I could have given him succor and support. Oh, what a vile knave I was to this gentle creature who sought my help only to be spurned because of my ignorance and selfishness.”

What on earth can Hamlet be talking about? Well, the formation and maintenance of bone in the skeleton is a very complicated process that involves at least four different types of bone cell, various minerals, vitamins and hormones, and many of the other organ systems of the body. Any defect within these components may cause not only problems with the bones, but also with total body function, as Hamlet is alluding to here. By briefly discussing in this column and the next, three aspects of bone formation and maintenance, I hope to show you just how complex and intricate this system really is and then pose several questions that logically follow from this discussion that must be definitively answered by those who claim the truth of macroevolution

Everyone knows that the skeleton consists of bone. But what most people don’t realize is that bone is a living tissue that is always forming and breaking down depending on the needs and at the direction of the body. Bone is a specialized connective tissue that is essentially a mineralized organic matrix dispersed and formed by living cells. In plain English this means that there are specific cells that are responsible for the growth, formation and turnover of bone which live right within the confines of the bone itself.

The bone-forming cell is able to put down a firm mesh consisting of protein in which it then deposits crystals containing calcium phosphate. The bone breakdown cell is able to undue what the bone-forming cell accomplishes. They are constantly working together to develop and remodel the bone. In addition, there are two other bone cells that help the bone-forming and bone breakdown cells survive by separating them from the bone marrow and the body’s circulation and help them obtain water, nutrients and oxygen from the bloodstream.

Remember, every cell in the body requires these basic components to live. So the bone cells themselves are dependent on the systems in the body that provide them with these vital necessities for life. Systems such as the gastrointestinal tract for absorbing water, calcium and the raw materials for protein mesh formation and energy production, the lungs and red blood cells for bringing in needed oxygen, and finally, the heart and the circulation for bringing all of these necessary components for survival and function to the site for bone formation.

Here are some things to think about when considering the validity of macroevolution, now that we know a little bit about the cells involved in human bone formation. We’ll need to allow for the existence of cells even though we know that chemical evolution and other theories of cellular origin are woefully lacking in substantive scientific evidence. We’ll also ignore the fact that macroevolution cannot as yet explain which of the systems necessary for providing the bone with the vital components for life came into existence first. i.e. the gastrointestinal tract, the pulmonary system, the red blood cell with its hemoglobin, the heart and the circulation.

Which type of bone cell evolved first, what useful purpose did it serve for the body at that time and how did bone formation and maintenance occur without the other three bone cells being present? How did the bone cells develop the ability to do what they do? With respect to evolution, where does the formation and function of bone fit with respect to all of the other organ systems contained in an organism with a complex body plan? How could all of this evolve one step at a time? What are the intermediate stages that plausibly could have existed that finally resulted in bone tissue as we know it?

As far as I am aware, there is no concrete scientific evidence to answer any of these questions. But let’s go on to discuss another aspect of bone formation. Everyone knows that to have strong bones you need to eat foods or supplements containing Vitamin D and calcium. So where does Vitamin D and calcium fit into the discussion of bone metabolism and therefore, what other questions then need to be asked of those who claim the truth of macroevolution?

Vitamin D has many functions within the body but the most important, and the one that we are concerned with here, is its ability to tell the digestive system to absorb calcium. If the body doesn’t efficiently absorb calcium then there won’t be enough raw material for the bone cells to use when they try to form bone. How do we know this? Well, modern medicine is very familiar with various forms of Vitamin D deficiency syndromes which can cause severe disability and even death. Therefore, by extrapolation we’ve come to realize that if there were a total absence of Vitamin D activity in the body, we would not be able to survive. But how does Vitamin D do its job? “Aye, there’s the rub.” as Hamlet would say.

Technically one could argue that Vitamin D is not a vitamin because for those who have adequate exposure to sunlight, nutritional supplementation is not necessary. We each have the means to produce Vitamin D right inside our own bodies. There is a molecule that exists in our skin that I will call pre-pre-Vitamin D.. When this molecule is exposed to ultraviolet light, a chemical reaction turns it into pre-Vitamin D which in turn becomes Vitamin D when it is acted upon by a specific enzyme. Now, my critics could rightly claim that the ability for the body to form its own Vitamin D is superfluous since humans can acquire it from dietary sources, although I doubt that primitive man would have been aware of this vital necessity in his diet. But what they may not be aware of is that neither of these Vitamin D’s is capable of accomplishing anything in the body until it is transported to the liver and then the kidney where it undergoes certain chemical reactions to ultimately create activated Vitamin D.

There’s also one more problem that could interfere with Vitamin D being activated. It’s the fact that Vitamin D is very poorly soluble in serum which would make it almost impossible to transport enough of it in the blood. So how does it get to the liver and the kidney to be activated? The answer is that Vitamin D has its own transport protein to carry it around in the circulation. This protein is made in the liver. Once Vitamin D attaches to its own private taxi cab it is able to reach the liver and then the kidney to be activated. This, now activated Vitamin D, proceeds through the bloodstream where it attaches itself to a Vitamin D receptor in the nucleus of the intestinal cell which results in greatly enhancing the intestinal cell’s ability to absorb calcium from the digestive tract. (See Figure 1)

When reviewing how Vitamin D has its effect on bone formation it becomes evident that without each step along the way the whole system would breakdown and would be nonfunctional. If pre-pre-Vitamin D or the enzyme to convert pre Vitamin D to Vitamin D did not exist, or the mechanisms within the liver and the kidney to activate Vitamin D malfunctioned, or the liver didn’t make Vitamin D transport protein, or the intestinal cells didn’t contain Vitamin D receptors in their nuclei, then calcium absorption would be interrupted and the bone cells wouldn’t be able to function properly and human life on Earth would be impossible. Just ask yourself how this intricate system could have evolved one step at a time? What genetic or cellular changes could have and would have had to have taken place for it to come into existence?

Which function did the liver cell develop first: the ability to start the activation of Vitamin D or to produce the Vitamin D transport protein? What good would it be for the liver to be able to start the activation process of Vitamin D if it hadn’t first produced the Vitamin D transport protein so that the Vitamin D could come to the liver in the first place? And what good would it be if the Vitamin D transport protein was able to transport Vitamin D, but the liver couldn’t start the activation process? And when did the kidney develop its ability to apply the final activating step without which Vitamin D activity in the body would be so reduced that intestinal absorption of calcium would be seriously hampered to the point of certain death? When did the intestinal cells develop a receptor that was specific for activated Vitamin D? Before or after Vitamin D could be activated? If before, what usefulness would they have for the body without activated Vitamin D? And if after, then how did activated Vitamin D exert its effect on the intestinal cell?

These are some of the questions that require answers to validate the theory of macroevolution when we contemplate bones of any age. I’m sure that many of you can come up with even more. Some of my critics have commented that macroevolution does not preclude an organism having had produced biologically useless molecules (a position that I suspect is not prominent in biologically astute macroevolution circles). However, notwithstanding this unusual defense of macroevolution, the more important question still remains unanswered as to, in this particular case, how the biomolecular processes inherent for sufficient Vitamin D activity in the human body could have developed one step at a time within a viable organism?

For remember, medical science has proven that without Vitamin D activity in the body, the body as we know it would not exist. But macroevolution claims a step by step development over time. Here is a perfect opportunity to apply known data about a biological system and what is known to make it fail with a theory that purports to explain how this same said biological system came into being. In my opinion these questions are essentially unanswerable and invariably point to the irreducible complexity of Vitamin D activity in being just one of the many integrated and interdependent biomolecular systems in the body that are absolutely necessary for life.

But we’re not finished yet! Remember poor Yorick? By looking at his bones, Hamlet had surmised what had ailed his servant throughout his lifetime. A cracked skull or a sword wound to the rib could indicate the type of death that a person may have suffered. And chronic changes in the joints from osteoarthritis, weakened bones from malnutrition or defects indicative of bone cancer may have pointed to a long time of suffering. But Hamlet seems to be referring to something more pervasive and long lasting. Something that had a systemic and lifelong effect on the body and eventually could have resulted in Yorick’s untimely death. Can you guess what it may have been? What part of the puzzle involving bones and Vitamin D have we not touched on yet?

In the next column I will discuss how the formation and maintenance of bone is both vital for, and dependent on, a metabolic system that affects almost every part of the body. We’ll then pose some more questions that need to be answered by the NeoDarwinists who claim the scientific validity of macroevolution. And at the same time we may have a better understanding of what Hamlet was referring to when he looked at the skull of his former servant and exclaimed “Alas, poor Yorick, I knew him Horatio.”

Comments and questions about this column or any of the previous ones are welcome at

Dr. G.

Howard Glicksman M.D. graduated from the University of Toronto in 1978.  He practiced primary care medicine for almost 25 yrs in Oakville, Ontario and Spring Hill, Florida.  He recently left his private practice and has started to practice palliative medicine for a Hospice organization in his community.  He has a special interest in how the ethos of our culture has been influenced by modern science’s understanding and promotion of what it means to be a human being.

Copyright 2003 Dr. Howard Glicksman. All rights reserved. International copyright secured.
File Date: 11.04.03