by Lewis Thomas
We are not like the social insects. They have only the one way of doing things and they will do it forever, coded for that way. We are coded differently, not just for binary choices, go or no-go. We can go four ways at once, depending on how the air feels: go, no-go, but also maybe, plus what the hell let’s give it a try. We are in for one surprise after another if we keep at it and keep alive. We can build structures for human society never seen before, thoughts never thought before, music never heard before.
Provided we do not kill ourselves off, and provided we can connect ourselves by the affection and respect for which I believe our genes are also coded, there is no end to what we might do on or off this planet.
At this early stage in our evolution, now through our infancy and into our childhood and then, with luck, our growing up, what our species needs most of all, right now, is simply a future.
THE ARTIFICIAL HEART
A short while ago, I wrote an essay in unqualified praise of that technological marvel the pacemaker, celebrating the capacity of this small ingenious device to keep a flawed human heart working beyond what would otherwise have been its allotted time. I had no reservations about the matter: here was an item of engineering that ranks as genuine high technology, a stunning example of what may lie ahead for applied science in medicine.
And then, out of Salt Lake City, came the news of the artificial heart, a functioning replacement for the whole organ, far outclassing anything like my miniature metronome, a science-fiction fantasy come true.
My reaction to the first headlines, on the front pages of all the papers and in the cover stories of the newsmagazines, was all admiration and pleasure. A triumph, to be sure. No question about it.
But then the second thought, and the third and fourth thoughts, dragging their way in and out of my mind leaving one worry after another: What happens now? If the engineers keep at it, as they surely will, and this remarkable apparatus is steadily improved—as I’m sure it can be—so that we end up without the need for that cart with its compressors and all those hoses, an entirely feasible replacement for anyone’s failing heart, what then? The heart disease called cardiomyopathy, for which the initial device was employed, is a relatively uncommon, obscure ailment, entailing very high cost, but for a limited number of patients; no great strain on the national economy. But who says that an artificial heart will be implanted only in patients with a single, rare form of intractable heart failure? What about the hundreds of thousands of people whose cardiac muscles have been destroyed by coronary atherosclerosis and who must otherwise die of congestive heart failure? Who will decide that only certain patients, within certain age groups, will be selected for this kind of lifesaving (or at least life-prolonging) technology? Will there be committees, sitting somewhere in Washington, laying out national policy? How can Congress stay out of the problem, having already set up a system for funding the artificial kidney (with runaway costs already far beyond the original expectations and no end in sight)? And where is the money to come from, at a time when every penny of taxpayers’ money for the health-care system is being pinched out of shape?
I conclude that the greatest potential value of the successful artificial heart is, or ought to be, its power to convince the government as well as the citizenry at large that the nation simply must invest more money in basic biomedical research.
We do not really understand the underlying mechanism of cardiomyopathies at all, and we are not much better off at comprehending the biochemical events that disable the heart muscle or its valves in other more common illnesses. But there are clues enough to raise the spirits of people in a good many basic science disciplines, and any number of engrossing questions are at hand awaiting answers. The trouble is that most of the good questions that may lead, ultimately, to methods for prevention (for example, the metabolism and intimate pathologic changes in a failing myocardium, the possible roles of nutrition, viral infection, blood-clotting abnormalities, hypertension, life-style, and other unknown factors) are all long-range questions, requiring unguessable periods of time before the research can be completed. Nor can the outcome of research on any particular line be predicted in advance; whatever turns up as the result of science is bound to be new information. There can be no guarantee that the work will turn out to be useful. It can, however, be guaranteed that if such work is not done we will be stuck forever with this insupportably expensive, ethically puzzling, halfway technology, and it is doubtful that we can long afford it.
We are in a similar fix for the other major diseases, especially the chronic ones affecting the aging population. Although nothing so spectacular as the artificial heart has emerged for the treatment of stroke, or multiple sclerosis, or dementia, or arthritis, or diabetes, or cirrhosis, or advanced cancer, or the others on the list, the costs of whatever therapy we do possess continue to escalate at a terrifying rate. Soon we will be spending more than 10 percent of the GNP on efforts to cope with such chronic health problems. The diseases are all comparable in at least one respect: it cannot be promised that scientific research will solve them, but it can be firmly predicted that without research there is no hope at all of preventing or getting rid of them.
The artificial heart could, with better science and a lot of luck, turn out to be, one day or other, an interesting kind of antique, similar in its historical significance to the artificial lung and the other motor-driven prosthetic devices that were in the planning stage just before the development of the Salk vaccine and the virtual elimination of poliomyelitis. Or the complex and costly installations for lung surgery that were being planned for the state sanatoriums just before the institutions themselves were closed by the development of effective chemotherapy for tuberculosis.
The biological revolution of the past three decades has placed at the disposal of biomedical science an array of research techniques possessing a power previously unimaginable. It should be possible, henceforth, to ask questions about the normal and pathologic functions of cells and tissues at a very profound level, questions that could not even have been thought up as short a time ago as ten years. We should be thinking more about this new turn of events while meditating on the meaning of the artificial heart.
THINGS UNFLATTENED BY SCIENCE
In one of her Norton Lectures at Harvard in 1980, Helen Gardner had some sharply critical things to say about criticism, particularly about the reductionist tendencies of contemporary literary criticism, and especially about the new New Criticism out of France known as deconstructionism, the reductionist fission of poetry, not line by line but word by word, particle by particle. She was worried about the new dogma that the poem itself cannot possess any meaning whatever, beyond the random insights brought to the words by the reader, the observer. The only reality to be perceived in a line of verse is a stochastic reality arranged by the observer, not by the creator of the line. Miss Gardner is dismayed by this affront to literature. “It marks,” she writes, “a real loss of belief in the value of literature and of literary study, . . . dignified and partly justified by being linked with a universal skepticism about the possibility of any real knowledge of the universe we live in or any true understanding of the world of our daily experience.” The “indeterminacy of literary texts,” she says, “is part of the indeterminacy of the world.”
Joan Peyser, in an introduction to the new edition of her ten-year-old book on modern music, expresses a similar level of dismay at what is happening to contemporary music. She writes, “The lessening of greatness in the music of modern times can be traced to Darwin, Marx, Einstein and Freud”; she adds, “the dissemination of their theories propelled everything hidden into the light; analysis annihilates mystery.”
The geneticist C. H. Waddington asserted in his book on modern art that some of the earliest manifestations of abstract expression in modern painting, notably the work of Kandinsky and his followers, came from a feeling of hostility toward early twentieth-century physics. Kandinsky believed
that scientists were “capable only of recognizing those things that can be weighed and measured.”
Annie Dillard, writing about the impact of modern physics on modern fiction, in a wonderful book on criticism entitled Living by Fiction, says, “nothing is more typical of modernist fiction than its shattering of narrative line. . . . The use of narrative collage is particularly adapted to twentieth-century treatments of time and space . . . a flattened landscape. . . . Events do not trigger other events at all; instead, any event is possible. . . . The world is an undirected energy; it is an infinite series of random possibilities.” “This,” she continues, “is the fiction of quantum mechanics,” and she doesn’t care much for it. She believes that there is meaning in the world, but concludes that the lyric poets are the best equipped of all of us to find it.
I wish the humanists, wherever they are—the artists, writers, poets, critics, and musicians (most of all the musicians)—would leave physics alone for a while and begin paying more attention to biology. Personally, having read my way through a long shelf of books written by physicists for nonmathematicians like me, I have given up looking for the meaning, any meaning at all, in the worlds of very small or very large events. I’ve become convinced that any effort to insert mysticism into quantum mechanics, or to get mysticism out of it, or indeed to try to force new meanings into the affairs of the everyday, middle-sized world, is not for me. There are some things about which it is not true to say that every man has a right to his own opinion. I do not have the right to an opinion about acausality in the small world, or about black holes or other universes beyond black holes in the large world, for I cannot do the mathematics. Physics, deep and beautiful physics, can be spoken only in pure, unaccented mathematics, and no other language exists for expressing its meaning, not yet anyway. Lacking the language, I concede that it is none of my business, and I am giving up on it.
Biology is something else again, another matter, quite another matter indeed, in fact very likely another form, or at least another aspect of matter, probably not glimpsed, or anyway not yet glimpsable, by the mathematics of quantum physics.
One big difference is that biology, being a more difficult science, has lagged behind, so far behind that we have not yet reached the stage of genuine theory—in the predictive sense in which theoretical physics drives that field along. Biologists are still principally engaged in making observations and collecting facts, trying wherever possible to relate one set of facts to another but still lacking much of a basis for grand unifying theories. Evolution is about as close as we have come, and it is certainly a grand and sweeping concept, but more like a wonderful puzzle, filled with bits of information waiting for more bits before the whole matter can be fitted together. It remains, necessarily, an intensely reductionist field in science, requiring the scrutiny of endless details, and then the details of the details, before it will become possible to see a large, clear picture of the whole orderly process, and it will need decades of work, perhaps centuries, before we can stand back for a long look. It may even be that some of the information lies forever beyond our grasp because of the sheer age and volume of planetary life and the disappearance from the record of so many crucial forms, crucial for comprehending the course of events.
In fact, we can look back only a relatively short distance. Up until the 1950s, the fossil record, on which the most solid parts of the structure of evolutionary theory were based, provided a fairly close look at only the last five hundred million years or so. We now know, from the work of Barghoorn, Cloud, Schopf, and others, that there is a period of at least three billion years of life about which we know very little, and for most of that time the sole occupants of the earth were the prokaryotes—bacteria and, I have no doubt, their resident viruses. We tend to use words such as “early” and “primitive” for such creatures, as though we members of the eukaryote world, possessing nucleated cells and on the way to making brains for ourselves, comprise a qualitatively different and vastly superior form of life. We tend sometimes even to dismiss four-fifths of the earth’s life span as a long, dull prologue to the real events in evolution, nothing but featureless, aimless bacteria around, waiting for the real show to begin.
It was probably not like that at all. Leave aside the excitement when the very first successful cell appeared, membranes, nucleic acid, ribosomes, proteins, and all, somewhere in a quiet pool, maybe in the aftermath of a lightning storm, maybe from a combination of energy sources: the sun, ionizing radiation, and volcanic heat. It can be told as a plausible story, easy to imagine, for all the necessary chemical building blocks were at hand (or came to hand) during the first billion years, and it should no longer come as a surprise that beautifully formed bacterial fossils exist in rocks 3.5 billion years old. I wish, by the way, that we had set up a better term—a nicer term—than “primordial soup” for the nutrients and clay surfaces in those early waters of the earth. “Soup” is somehow too dismissive a word for a state of affairs so immensely important, more like the role of the yolk in a fertilized egg (although that doesn’t sound much better). Maybe it is an unexplored tradition in the language of science to flatten out the prose for really huge events: what may be turning out to be the most profound and subtle of all mechanisms in evolutionary genetics is now known, flatly and familiarly, as “jumping genes.”
The first cell to appear on the planet was in all probability just that: a single first cell, capable of replicating itself, and a creature of great theoretical interest. But the events that followed over the next 2.5 billion or so years seem to me even more fascinating. It is entirely possible that the stretch of time was needed for the progeny of the first cell to learn virtually everything essential for getting on in a closed ecosystem. Long before the first great jump could be taken—the transformation of prokaryotes to eukaryotes around a billion years ago—a great many skills had to be acquired.
During those years, the life of the earth was of course made up of vast numbers of individual cells, each one replicating on its own, but it would have seemed to an outside observer more like a tissue, the differentiated parts of a huge organism, than a set of discrete beings. In most places, and in the algal mats that covered much of the earth’s surface for a very long time, the microorganisms arranged themselves in neatly aligned layers, feeding one another in highly specialized ways and developing the mechanisms for cooperation and coordination that, I believe, have characterized the biosphere ever since.
Chemical messengers of precision and subtlety evolved during this stage, used no doubt for the allocation of space and the encouragement (or discouragement) of replication by neighboring microorganisms. Some of these chemical signals are still with us, but now they are emitted from specialized cells in the tissues of higher organisms, functioning as hormones. Insulin, for example, or a protein very similar to insulin with similar properties, is produced by strains of that famous and ancient bacterium, E. coli. Other bacteria are known to make a substance similar to human chorionic gonadotropin. Later, when protozoa and fungi evolved from their ancestral prokaryotes, they came equipped with ACTH, insulin, and growth hormone, all similar to their modern counterparts.
Moreover, the life of the planet began the long, slow process of modulating and regulating the physical conditions of the planet. The oxygen in today’s atmosphere is almost entirely the result of photosynthetic living, which had its start with the appearance of blue-green algae among the microorganisms. It was very likely this first step—or evolutionary jump—that led to the subsequent differentiation into eukaryotic, nucleated cells, and there is almost no doubt that these new cells were pieced together by the symbiotic joining up of prokaryotes. The chloroplasts in today’s green plants, which capitalize on the sun’s energy to produce the oxygen in our atmosphere, are the lineal descendants of ancient blue-green algae. The mitochondria in all our cells, which utilize the oxygen for securing energy from plant food, are the progeny of ancient oxidative bacteria. Collectively, we ar
e still, in a fundamental sense, a tissue of microbial organisms living off the sun, decorated and ornamented these days by the elaborate architectural structures that the microbes have constructed for their living quarters, including seagrass, foxes, and of course ourselves.
We can imagine three worlds of biology, corresponding roughly to the three worlds of physics: the very small world now being explored by the molecular geneticists and virologists, not yet as strange a place as quantum mechanics but well on its way to strangeness; an everyday, middle-sized world where things are as they are; and a world of the very large, which is the whole affair, the lovely conjoined biosphere, the vast embryo, the closed ecosytem in which we live as working parts, the place for which Lovelock and Margulis invented the term “Gaia” because of its extraordinary capacity to regulate itself. This world seems to me an even stranger one than the world of very small things in biology: it looks like the biggest organism I’ve ever heard of, and at the same time the most delicate and fragile, exactly the delicate and fragile creature it appeared to be in those first photographs taken from the surface of the moon. It is at this level of things that I find meaning in Wallace Stevens, although I haven’t any idea that Stevens intended this in his “Man with the Blue Guitar”: “they said, ‘You have a blue guitar,/ you do not play things as they are.’/ The man replied, ‘Things as they are/ are changed upon the blue guitar.’” It is a long poem, alive with ambiguities, but it can be read, I think, as a tale of the earth itself.
Some biologists dislike the Lovelock-Margulis view of things, although they agree that the regulatory homeostasis of earth’s life exists as a real phenomenon. They dislike the term “Gaia,” for one thing, because of its possible religious undertones, and they dislike the notion of design that seems implicit—although one way out of that dilemma is to call the arrangement a “System” and then assert that this is the only way that complex “Systems” can survive, by endless chains of regulatory messages and intricate feedback loops. It is not necessary, in accounting for the evolution and now the stability of the earth’s atmosphere, to suggest that evolution itself can plan ahead; all you need assume is the existence of close linkages of interdependency involving all existing forms of life, after the fashion of an organism. Finally, it is not a view of things, as has been claimed, that is likely to relieve human beings of any feeling of responsibility for the environment, backing them off from any concern for the whole place, on grounds that it runs itself and has done so, implacably, since long before we arrived on the scene. To the contrary, I should think it would have just the opposite effect, imposing a new feeling of anxiety for the environment everywhere. If you become convinced that you exist as a part of something that is itself alive, you are more likely to take pains not to do damage to the other vital parts around you.
