EP. 99: COMPLEXITY AND A THEORY OF LIFE

WITH NEIL THEISE

Feb 13

WITH NEIL THEISE, MD

A complexity theorist and Co-Director of Gastrointestinal and Liver Pathology at NYU Grossman School of Medicine explores how the science of “complexity” explains the emergence of life out of tissues, cells, atoms, and beyond.

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Episode Summary

At the mention of human consciousness and the supposed interconnectivity of all things, your mind probably conjures up the countless books on meditation, alternative medicine, and mysticism that permeate self-help sections of bookstores. But complexity theory attempts to apply rigorous scientific analyses to universal questions of consciousness and being. At its heart, complexity theory seeks to understand how complex behaviors and patterns emerge from simple rules and interactions within a system. This theory, which draws from mathematics, computer science, and physics, challenges our traditional reductionist approaches to biology and reveals how life self-organizes from the substance of our universe, from interactions within the quantum foam to the formation of atoms and molecules, cells, human beings, social structures, ecosystems, and beyond.

Here to tell us more about it is Neil Theise, MD, a pathologist and complexity theorist who in 2023 wrote the book Notes on Complexity: A Scientific Theory of Connection, Consciousness and Being. Dr. Theise is Co-Director of Gastrointestinal and Liver Pathology at NYU's Grossman School of Medicine and is a pioneer of adult stem cell plasticity and the anatomy of the human interstitium.

In the first half of our conversation, Dr. Theise discusses his journey to pathology by way of Jewish studies and computer science during college, what it's like to decipher diseases through his biopsy samples, and the significance of being the doctor that other doctors turn to for guidance on treatments. In the second half of our conversation, Dr. Theise gives us a primer of complexity theory and how it seeks to explain the beauty and mysteries of life.

Neil Theise, MD is a diagnostic liver pathologist, adult stem cell researcher, and complexity theorist in New York City, where he is Professor of Pathology at NYU Grossman School of Medicine. He received his BA in Oriental Studies (Judaica/Hebraica) and a BAS in Computer Science from University of Pennsylvania before earning his MD from Columbia University.
Dr. Theise’s research revised understandings of human liver microanatomy which, in turn, led directly to identification of possible liver stem cell niches. This work, in turn, led to pioneering research into adult stem cell plasticity with publications on that topic in Science, Nature, and Cell. These remain active areas of scientific and clinical investigation.
Stirring complexity theory into this mix, he has extended his work to areas of theoretical biology and more fundamental questions regarding the underlying structure of the universe. In terms of biology, these ideas suggest that alternate models of the body, other than classical (‘Western’) cell doctrine, may be necessary to understand non-Western approaches to the body and health. Moreover, he models the universe as a holarchy of self-organizing complex systems from the quantum vacuum on up through all levels of scale: a view that points to consciousness as the fundamental ground of being of existence and a panpsychist perspective. His work with physicist Menas Kafatos points to three fundamental principles underlying the self-organizing universe: complementarity, sentience (or ‘creative interactivity’), and recursion, evident in different forms at every level of scale. These features map directly to insights regarding the nature of reality from contemplative practices and philosophical inquiry from diverse cultures and spiritual perspectives.
In this episode, you will hear about:
• 4:01 - What a pathologist does and why Dr. Theise finds the work fulfilling
• 8:15 - Dr. Theise’s path to becoming a pathologist
• 15:22 - The unique role of pathologists in learning life-changing information about patients
• 20:42 - What it’s like to be the doctor that other doctors turn to for diagnostic puzzles
• 24:43 - A primer to complexity theory
• 37:03 - The difference between chaos theory and complexity theory
• 40:35 - How Dr. Theise came to study complexity theory and how it relates to our understanding of the body
• 54:38 - Why Dr. Theise believes that people should bring metaphysics back into their lives
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and health care executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] When I mentioned the nature of human consciousness and the supposed interconnectivity of all things, your mind probably conjures up the countless books and articles on meditation, alternative medicine, and mysticism that permeate self-help sections of bookstores or blogs. But complexity theory is the ambitious attempt to apply rigorous scientific analyzes to universal questions of consciousness and being. At its heart, complexity theory seeks to understand how complex behaviors and patterns emerge from simple rules and interactions within a system. Its significance lies in its ability to provide insights into the inherent unpredictability and non-linearity of systems. This theory, which draws from mathematics, computer science, and physics, challenges our traditional reductionist approaches to biology and reveals how life self-organizes from the substance of our universe, from interactions within the quantum foam to the formation of atoms and molecules, cells, human beings, social structures, ecosystems and beyond. It's a heady and dizzying subject, that's for sure. Here to tell us more about it is Dr. Neil Theise, a pathologist and complexity theorist who in 2023 wrote the book Notes on Complexity A Scientific Theory of Connection, Consciousness and Being. Dr. Theise is co-director of the Gastrointestinal and Liver Pathology Service at New York University's Grossman School of Medicine, and is a pioneer of adult stem cell plasticity and the anatomy of the human interstitium. In the first half of our conversation, Dr. Theise discusses his journey to pathology by way of Jewish studies and computer science during college. What it's like to decipher diseases by looking at pieces of people, as he likes to call his biopsy samples, and the significance of frequently being the doctor that other doctors turn to for guidance on treatments. In the second half of our conversation, Doctor Thies gives us a primer of complexity theory and how it seeks to explain the beauty and mysteries of life.
Henry Bair: [00:03:17] Dr Theise, welcome to the show and thanks for being here.
Dr. Neil Theise: [00:03:20] Sure. Thank you for having me.
Henry Bair: [00:03:22] So in 2023, you wrote this book called Notes on Complexity, which is this formidable attempt to describe a scientific framework that encapsulates our existence in being as people in this universe.
Tyler Johnson: [00:03:35] A theory of everything?
Henry Bair: [00:03:37] Yes, a theory of everything. But you're also a pathologist. And I am not joking. When I first came across your book and read your profile on the back cover slip, I immediately texted Tyler and said, I found our pathologist. We are so glad to have a pathologist on the show. Finally. Long overdue.
Dr. Neil Theise: [00:03:59] Oh yay! I'm happy to be that one.
Henry Bair: [00:04:01] So we will go into complexity theory. But before that, we also do want to hear about your journey and work as a pathologist.
Tyler Johnson: [00:04:08] I just want to read from your book. There's this paragraph where you say, ultimately I chose the path of medicine, though I did not land in the kind of direct clinical patient care that I had originally envisioned. Instead, I found sustained pleasure in sitting at a microscope, hour after hour, looking at diagnostic pathology specimens, quote unquote, pieces of people, as I like to say, studying colorful microscopic shapes and patterns, beautiful puzzles that needed to be solved. Of particular note, this specialty afforded me daily opportunities to think scientifically about human bodies. I didn't need culture, dishes or mice to explore biology. I had human tissues and cells to gaze upon. So I wanted to ask, well, two things. The first is that, you know, we have a lot of people who listen to our show who are some who are not involved in medicine at all. And then of the people who are involved in medicine, it seems to skew towards, in many cases towards people in training. So premeds, medical students, whatever. And this is all to say that I think many of them probably don't really even know what a pathologist is or really what a pathologist does. So I'm hoping you can elucidate that for people who may not be familiar. But then I am also hoping you can specifically speak to you, say that you found sustained pleasure in doing this. And I have to say that I'm going to go out on a limb and guess that even among people who go to medical school, there are probably a lot of them who would not anticipate finding, quote unquote, sustained pleasure as a pathologist. So I'm hoping you can talk a little bit about what it is exactly that makes it pleasurable.
Dr. Neil Theise: [00:05:42] Sure. Yeah, I think there are very few people who go to medical school thinking they're going to go into pathology, although more and more that's happening. I'm at an academic medical center, NYU. We have medical students coming in who know, and we even have a fast track to get them into pathology residency training quicker. And I also interview residency applicants, and I'm surprised these days how many knew they were going to go into pathology. Some of them are children of pathologists. Not surprising, but a lot of them aren't. I think that pathology has had a tremendous amount of exposure online in terms of forensics, so I otherwise I don't really know how to explain that except that the lifestyle is obviously considerably more reasonable and controllable than it is for a lot of clinical specialties. But I subspecialize in liver pathology and in particular, this is a liver transplant center. So I do get midnight calls. I cover 50% of the call for the liver transplant team a year. And those are actually some of my favorite times as a pathologist. Within pathology, you can have a subspecialty where you're just at your microscope and you don't really have to talk to the clinicians much, because the diagnoses are pretty much on the slide.
Dr. Neil Theise: [00:07:08] But in liver, it's a medical, you know, there are tumors for sure, where often you don't need to communicate intimately. But for medical liver disease and transplant related liver disease, you're part of a team. And that's my social context. In my career, I have a group of hepatologists and liver surgeons. We all know each other. We're good friends. We're great colleagues. We work well together. And if a transplant surgeon calls me up at midnight with a question. I'm involved with something that's really dramatic and really important and really crucial. And there we are, the surgeon and I, talking in the middle of the night, whether a donor organ can be used or there's a funny finding and someone they've opened up. And it's a conversation. The transplant surgeons have a remarkable instinct for what they're doing. So often I'm supplying them some information, but a lot of what I'm doing at that hour is holding their hand while they come to some conclusion, based on their instincts integrated with this stuff. And that's a privilege.
Henry Bair: [00:08:15] You mentioned that you did not start medical school thinking that this was going to be where you ended up, right? How did you find your way into it?
Dr. Neil Theise: [00:08:23] I had a really tough first few years in medical school, and it's related in part to why I went to medical school in the first place, which was a kind of screwed up way of thinking about my life. I wasn't pre-med when I went to school. I was a science nerd growing up. For a long time, I thought I was going to be a particle physicist. But then I went into six months, the summer of my junior year in high school at the Weizmann Institute in Israel, and there were all these European kids who had studied physics, and I just read books at the library, and I thought, oh, I don't have what it takes. So suddenly I couldn't be a physicist and I wasn't sure what I wanted to do. I went off to college and. I cycled through something like a dozen majors, most of them in the science. But what I wound up with was religious studies focusing on Jewish studies, and I was contemplating going to rabbinical school. And computer science because it was really cool. And this is back in the days of COBOL and Fortran, microprocessors were invented the year I graduated. So suddenly that degree was useless.
Dr. Neil Theise: [00:09:36] But freshman year I was really thinking about rabbinical school, but I was also starting to come to terms with the fact that I was gay. And this is 1977. And I thought, well, if I am, then all I have open to me for my life is to be alone. I'll never get married. I'll never have kids if I become a rabbinic scholar, which is what I was thinking of. I knew academics was kind of what I enjoyed. Then I would, you know, eventually only other dusty old scholars would come to my funeral. And if I outlived most of them, then no one would come to my funeral. And I actually thought this this was me at 18, 19 years old, in my dorm room, contemplating my future. And as this was happening, it was a Tuesday. My mother rang me up because the doctor who had delivered my brother and I, who she worked for as an assistant, died of a heart attack. And the next morning, being Jewish, we have funerals within 24 hours. She called me after the funeral and I said, how was Doctor Robinson's funeral? And she said, it was amazing. All of Hartford turned out for his funeral. And I thought, if you go to medical school, people will come to your funeral. And I became pre-med at the end of the story is. You know, I'm basically doing the same. What I used to do in terms of text analysis for biblical or rabbinic studies, I do in tissues. It really is the same thing. So I wound up coming into the same, you know.
Tyler Johnson: [00:11:14] The connection between Talmudic studies and tissue analysis as a pathologist is one that I'm pretty sure will never come up on the show. Maybe it will, but I'm just saying I'm just putting out okay. I'm not. I'm no longer sure. It took us a year and a half to find a pathologist in the first place, but you never know.
Dr. Neil Theise: [00:11:32] I have spoken to other pathologists who felt similarly.
Tyler Johnson: [00:11:36] It's the little known rabbinical to pathology pipeline. Yeah.
Dr. Neil Theise: [00:11:40] Right. Right. No, it's it's the idea of if you have an academically oriented mind, if you sit in front of things and you come up with more questions than tasks, then, you know, that's sort of what it is. And but I had to find that I had no idea what pathology was. And I went off to medical school and I was really unhappy. I was still closeted, completely stressed out. I was in medical school for completely the wrong reasons. I thought about quitting, but it was the Reagan era, and medical student loans were 23% interest, and they started compounding as soon as you signed for the loan. So already three months in, I could not afford to leave. So that was not a recipe for success. I got very depressed, um, and I failed my second year of medical school by failing pharmacology by one point, and I had to repeat the entire year. Wow. That was Columbia's policy.
Tyler Johnson: [00:12:41] That differs slightly from what medical students now commonly call 'pass now pass later' as the grading system.
Dr. Neil Theise: [00:12:49] So just a little bit of a different vibe. Yeah. Yeah, yeah. It was different. Failing allowed me the cover to go into psychoanalysis, which at the time I thought might actually help me become straight. Fortunately, I had a good analyst who just kept quiet about the fact that that was not likely to succeed, but better outcomes might might follow. And I had the summer off as my classmates were going off into their clinical years, and I just thought, if I leave for three months and come back and they're all confident in their white coats, I'm going to feel awful. So I want to stick around. And I got a job in the pathology department. One of the junior residents, for some reason, had to delay either arriving or coming back. So they hired three medical students for the summer to do the work of one resident, and I was one of them. And the pathology department at Columbia was full of great famous pathologists of the day. And they were all friends. They were all very charismatic. And this wasn't at all like the pathology course. But sitting there with them, with them looking at slides and stuff, it really sparked something. I still went off into third year thinking, no, no, no, no, no, I'm going to do something clinical.
Dr. Neil Theise: [00:14:05] And I did consider psychiatry. But being in analysis while you're a medical student thinking about going into psychiatry, that was a little too intense. And like, who's the patient in the room? And I thought about pediatrics, pediatric oncology, utterly fabulous career. But I did a subinternship alternating with one other person on call every other night. And somehow they were always discharging patients and I was always getting patients. So I finished the month with like 20 patients on my service. Six of them were new diagnoses of cancer, and two had died before the end of the month. And I knew that I would not be the kind of pediatrician I wanted if I put myself through that kind of stress. I didn't have those kind of flexible, porous walls around my psyche. I would have to defend myself too much. So I went back and I did some extra stuff in pathology and discovered I really do love looking at slides, their puzzles, and sometimes their really important puzzles. And I'm the one who can solve them. And it's fabulous being the person in the room in a medical environment who knows the answer. So that's how I wound up in pathology.
Tyler Johnson: [00:15:22] So the Journal of Clinical Oncology, which is my sort of home journal, has a section where people can write kind of narrative essays. And I've read a number of essays over the years about people realizing that there is this period of time which it used to be could be even a week or two between when you would get a patient's results and when you would see the patient in clinic. Now, it tends to be less than that because we have open electronic medical records and all the rest. But nonetheless, there is usually some time when the doctor knows the thing before the patient knows the thing. And people have talked about the kind of psychological burden that it is to know that, you know, something that's going to change someone's life before they know it. But it has occurred to me that while, of course, as the pathologist, you never meet the patient, you know it even before the oncologist does, or the prime or whoever orders the biopsy. Right? Like you're the the first person. Sometimes the surgeon knows if it's obvious based on, you know, gross appearance. But in most cases, you are the first person who sees the bad cells transgressing the membrane or the barrier or the whatever. It's hard for me to imagine what that must be like, right? Because you're sort of sitting there like the fates with their, you know, scissors at the, at the wires or something in your basement office looking at the microscope, figuring out who has cancer and is, you know, probably going to have a really difficult conversation and who is going to who has nothing and is going to walk out of the clinic with this huge weight lifted off of their shoulders.
Dr. Neil Theise: [00:16:44] You know, when I called my parents to tell them I had decided to become a pathologist, they were a little bewildered. My mom spoke to one of the remaining doctors in the practice in which she worked and said, Neil's going to become a pathologist. He's not going to have patience. I don't understand what this means. And he said to her, no, you don't understand. He's going to be the doctor's doctor. Hmm. And so that's true. So all the kinds of things you have to do in terms of holding information, being ready to pass it on, I have to do that for all of you. And you do it, and so do I. And it's both a privilege and sometimes a burden. But when you do it enough years, it's just sort of like you get up and you do it. This is what you're trained to handle. And if you selected your specialty right, it's a good fit. So it feels like it's an okay thing.
Dr. Neil Theise: [00:17:37] The other thing is that I had a real terrific opportunity when I first started doing transplantation liver transplant pathology. I was at Mount Sinai doing a fellowship. It was a new transplant program. And the original design of the program was everybody on the transplant team, which was about 15 to 20 people. Different subspecialties of doctors, nurses, pharmacists, you name it, ethicists. And we would go on walk arounds and see all the patients on Monday evenings together. And within a couple of weeks, my mentor and I discussed it and we withdrew because getting to know the patients too well made it almost impossible to be objective about what was on the slide. And there was a patient very early on in those couple of weeks who both of us had formed a real attachment to, and there was a bad result on a liver biopsy, and we really did not want to see it and realized, no, there's a reason our specialty has evolved, that we're somewhere else. So there are ways in which we learn to handle that. But there are times where it's really hard. And just hearing the stories of my team, I get to know patients in my imagination. The flip side is that you also have to know when you can't. And that's sort of like anything in clinical medicine. You sort of the first step is learning what you need to know. The second step is being able to recognize what you don't know or when you've reached your limit, and you need to ask for help.
Dr. Neil Theise: [00:19:12] And one of those for me, I got misdiagnosed. It's a long story, which I'll spare you, but I was misdiagnosed with terminal cancer for about six days, and that was a pretty interesting experience. But any time I see that diagnosis pop up on a slide in a guy who was around that age. I can't look at the slide. I sort of short circuit and I pass that case off to someone else. There is an emotional thing. We are removed and these are pieces of people. But there is a deep emotional thing here. And the other thing is that unlike anything, including radiology, if a physician gets a test or does a test. And misses the result gets the result wrong. There's many other, perhaps dozens, perhaps hundreds of other streams of information coming in that will catch that. And the woven knowledge from all these different sources will save you from screwing up. Except for pathology. If I get a slide and I say it's cancer and it's not cancer. Everything follows. If I make the reverse mistake. Everything follows. So every single, most of my slides are not that dire. But a significant number of them are.
Tyler Johnson: [00:20:42] Yeah. So we as you know, we have these meetings every week as a medical oncologist called Tumor Board, right where we sit in a used to be in a room. Now it's in a zoom room. But anyway. Different kinds of radiologists, pathologists, surgeons, radiation oncologists, etc.. So the point of the meeting is for all of the different kinds of doctors who take care of cancer patients to be in the same place at the same time to discuss new and complex cases. And part of that meeting will bring up a new case. We'll put the pathology slides on the board or the zoom screen, and then the pathologist will go through the slide and tell us what they see. Which two things about that. One is that even though I've been doing that for ten plus years, the slides that go up, if I'm really being honest, still mostly look like Monet paintings to me. Like I'm, you know, I'm just there saying all of these very big doctor words and I'm just nodding like, okay, yeah, sure. But the other thing, to your point, I have often thought to myself, oh my gosh, like, you know, I have five different indicators that I'm looking at at any given time for how a patient's doing. Right? I have their scans and I have their labs, and I have their clinical status, and I have their physical exam, and I have their story and all of these kinds of things. And if I miss something, they're going to see another doctor in two days who's going to pick up on it. Right. But if some person who is like, totally healthy, hunky dory goes to the dermatologist because they have an irregular mole and they biopsy it and they're trying to figure out if it's melanoma or not, the pathologist is the person. Right. And if the pathologist if it's melanoma and the pathologist or dermatopathologist whatever doesn't pick it up, and then that person just goes on their way for five years and shows up with liver and brain Mets because it wasn't picked up on the original slide. There really is a sort of an isolated, solitary responsibility in a way that maybe only surgeons would be the other people who would sort of be in a in a somewhat analogous position.
Dr. Neil Theise: [00:22:36] But given my history, that was part of its real appeal that, you know, I was the stupid kid in medical school, I had to repeat a whole year. And to have a room full of experts. And I'm the one who has the answer. Oh, man, that's really compensatory.
Tyler Johnson: [00:22:59] Hashtag powerplay or something.
Dr. Neil Theise: [00:23:02] Yeah, yeah. One of the jokes about being a pathologist. The internist knows everything and can do nothing. Surgeons know nothing and can do everything. Pathologists know everything and can do everything. Just too late. But there's a truth there. We have to know all of human disease. And we do. Now, I've subspecialized in liver, so I'm really deep in liver and not so good on brain anymore. But you have to be prepared for all of it. And that's a huge pleasure for me, that I have a depth of expertise in an area where I can speak with authority, and I'm not afraid. And that's, you know, that's the the thrill and hard part of going to medical school. You think you've made a decision about what to do with your life. But you haven't. There's so many options. And what I tell medical students trying to find a specialty and what I tell path residents trying to find a subspecialty is ultimately you can have all sorts of ideas about what you think you should do or want to do, or imagine yourself doing. But by and large, the people who are really successful, I think they meet someone and they go, oh, I want to be like that person. And when you meet that person. Then you actually find what you're looking for. And there's something that sparks that way.
Henry Bair: [00:24:29] Well, thank you very much for going into that and really fleshing out and giving a lot of new ones to the mind of a pathologist is frankly not something that we hear often. We don't really interact with that many pathologists during medical training especially.
Dr. Neil Theise: [00:24:42] Right, right.
Henry Bair: [00:24:43] So, you know, knowing now a little bit of your history even before medical school, your interest in spirituality, it's starting to make a little bit more sense how you then began to explore consciousness and contemplation, meditation. That's starting to make a little bit more sense. But not only do you casually explore it, you've actually dove deeply into it. It's like a whole second career for you, right? You? This is what your recent book was about. So, you know, it's it's such a vast topic that it's a little bit of a struggle to figure out how to begin wrapping our arms around it.
Tyler Johnson: [00:25:20] Just tell us about everything.
Dr. Neil Theise: [00:25:22] Yeah. Sure. Sure.
Henry Bair: [00:25:24] Right. Exactly. So maybe give us, like a brief snapshot of what exactly is complexity theory? What is the goal of complexity theory, and how does it purport to explain the world in a way that is like a paradigm shift from how we used to understand the world?
Dr. Neil Theise: [00:25:38] Okay, so complexity theory is related to what probably many of your listeners have heard of as chaos theory, or at least have heard about fractal geometries, which is the mathematics that underlies chaotic systems. Chaos theory.
Tyler Johnson: [00:25:56] I'm remembering reading Jurassic Park as a 12 year old, right? It has it. Seriously. It had fractal diagrams at the beginning of every unit, and they became more. Yeah. And they became more and more complicated through the book because the iconoclastic mathematician in the book who's played by Jeff Goldblum and the movie, that's his whole thing is chaos theory anyway.
Dr. Neil Theise: [00:26:18] Oh, wow. Cool. So we generally think of scientific descriptions of the world as dealing with equations, or you can think about them in mathematical terms, in particular how the world organizes itself, what kinds of order we find. And so the simplest sort of thing that everyone really implicitly understands is different kinds of order when we think of water. Water can be free flowing liquid. It can be steam, random molecules sort of bouncing around, or it can be extremely well ordered, like in an ice cube, a rigid crystal. And all of those are different forms of order, and they can all be described in fairly straightforward equations for crystals. You're talking about the geometry of the molecular arrangements. We can describe steam even though things are completely disordered. We can talk about it in terms of statistical thermodynamics. We can't tell you where a molecule is, but we can tell you the average kinetic energy statistically, and that corresponds to a particular temperature, for example. And with water we have equations like things we're sort of used to. If you have water flowing through a narrow channel, it goes quickly. If it gets to a wider channel, it moves slowly. You see this in rivers or water coming out of a hose, things like that.
Dr. Neil Theise: [00:27:38] But there were kinds of order in the world that people couldn't describe with straightforward equations like that. And the first one to really be noticed was chaotic Systems chaos. And you see this, for example, in the way clouds form, or the way living objects create certain structures like trees branching or weather patterns. And for those, the difficulty turned out to be in part that you needed to see how order was evolving over time in order to come up with a good computational mathematical model. And for that you required computers to be doing calculations in time. They had to be iterative things over and over again. And so chaotic systems and fractal geometries were discovered, um, late 50s, early 60s. And that seemed to explain all sorts of things, including some aspects of living things. And one of the key important points about fractal geometries, and therefore chaos, is that there's this self-similarity across scales. So you look at a tree trunk and then you look at the first branchings of those. And if you go and close, those look like tree trunks and then those branch into smaller branches, those look like tree trunks and then smaller and smaller until you get to the leaf. And then the leaf may have patterns of veins that do the same thing.
Dr. Neil Theise: [00:29:00] Oddly, some things you see in living systems also appear in non-living systems. So I can show you an image and tell you, oh, this is an arteriogram from dye injected into a patient's artery. And we've done an x ray. And you see these branching squiggly lines getting smaller and smaller and smaller as they go out to the capillaries. And you'll go, aha. And then I'll say, actually that's a picture of the Mississippi River from a satellite. The branching of rivers and the branching of blood vessels looks exactly the same. And in fact, mathematically are often exactly the same. The difference between. Things in the world that are fractal and actual fractals is that actual fractals are self-similar across different scales, or how close you are to the system infinitely, whereas a tree you get to a certain limit of the small branches. So this was chaos theory, and it explained all sorts of things that had not been able to be explained in terms of order in the world. That was pretty successful. But what it still didn't succeed at is explaining life itself. It explains some structures that we find in life, like blood vessels. But it didn't explain how living things happen.
Tyler Johnson: [00:30:15] Can I just pause you before you go on? One thing I want to clarify for us and for listeners, when you say that chaos theory explains some of the phenomenon to which you were referring. Do you mean that chaos theory revealed a hidden order, or a hidden pattern that was there and just not visible before? Or do you mean that chaos theory demonstrated that, in fact, there was no hidden order, there was no hidden pattern, and that it truly was random or chaotic or some mixture of both.
Dr. Neil Theise: [00:30:44] So we run into a problem with language. I have to deal with this early on in the book that there's the popular meaning of the word chaos. What we mean by that in standard usage is completely random total disorder like the molecules in a gas. Similarly with complexity, we think that that means sort of complicated, and it doesn't mean that either. So we have to be careful. So in chaos no, we're talking about something a form of order that's different than total randomness, total disorder. The thing is that people knew that there was some kind of order there, but they just didn't know how to describe it either. You have an instinct for it. You look in the natural world and you see these structures like branching trees or puffy clouds, but no one could figure out how to explain them. It turns out that with chaos theory, you can describe that. When I was a kid in the 60s, weather predictions were awful. They would say what it's going to be later in the day and they'd always be wrong. Forget a day or two down the line, let alone a couple of weeks. Now we have apps on our phones and they're pretty damn good. Weather is a chaotic system and using computers to model weather using chaos theory. Turns out we can predict things. And one of the things about chaos theory is that not only does it predict things, but it predictably predicts things. If you have exactly the same system, and no matter how many times you run it, it will run exactly the same way and give the same result.
Dr. Neil Theise: [00:32:14] There's the classic description of the butterfly flapping its wings in Brazil will lead to a lead to a tornado in Texas. And if that butterfly flaps its wings and in that same structured atmosphere every single time, it will give you that same tornado. That's important now because it's different in complexity, and this has become one of the essential and key things about what complexity has to say about life. So we were getting better. You can read the book for all the details on this. What some researchers found is that when you look at moving from one state of order to another, let's say from ice to flowing water to steam, or from rigidly well-defined things, perfect order like crystals or billiard balls hitting each other that are easy to describe as opposed to total disorder randomness like molecules in a gas moving from order into chaotic systems. There was a zone, mathematically and computationally, that behaved differently than any of those. And that turned out to be the realm of complexity. And what they found there is that interacting individuals, whatever they are, whether you're talking about molecules, whether you're talking about living structures like cells or ants or humans or ecosystems, you have things that self-organize in a way that's predictably unpredictable. You can't predict what they're going to do, but they will organize with each other from the bottom up to give you larger scale structures that look like someone planned them, but no one planned them.
Dr. Neil Theise: [00:34:02] And the example I use in the book is ant colonies. You look at the structures of ant colonies and you see food lines, you know, taking sugar cubes and back to the the colony. And they're building tunnels, and they have a cemetery where they put dead ants. They may organize war parties to raid another ant colony. They may farm fungus. They may harvest leaves from a forest. They do all of these things, but there's no ant in the colony. That's that's organizing what they're doing. The queen ant isn't, in fact, the top of any kind of hierarchy. She just serves a reproductive function. She's one of the most limited of the ants. So how does this happen? And it turns out that the mathematics that describes how this happens lies in the boundary between order and chaos. Not order and randomness, but order and chaotic systems, fractal chaos. And so the phrase that got assigned to this was complexity arises at the edge of chaos, which is very evocative. One of the things that happens in that zone is that it's an information rich zone. This is where information processing sort of goes through the roof. And one way to think about that is that living systems, in order to be living, in order to be creative and adaptive and alive, they have to be taking in information from the environment all the time, integrating it in a rich way, and then finding a response that allows them to continue and to adapt if the environment changes. This is where that's happening.
Henry Bair: [00:35:39] So the phrase complexity arises at the edge of chaos refers to the idea that the most intricate and adaptive behaviors and complex systems occur at a critical point, right between order and chaos, where the components of the system exhibit enough randomness to foster innovation and creativity, but enough stability and order to maintain structure and function.
Dr. Neil Theise: [00:36:03] Right? So complexity theory turns out to describe how life arises from the world, and how life continues to adapt and change in response to a changing environment. It's basically the science of living things. We often think, well, isn't biology the science of living things? We all went to medical school. We think medicine is the science of living things, except that those are reductionist. They pull things apart. So we look at the bodies, we look at the organs, we look at the cells, we look at the molecules as though they are machines, and we're looking at the machine parts, and that the learning the parts will tell us what the whole is. This is like taking apart a clock and putting down the pieces. A really good engineer will look at the pieces of a clock and know without even putting them together. If they put it together, they will get a clock rather than a toaster. But you can't look at the pieces of a living thing and know what you're going to get.
Henry Bair: [00:37:03] Just to really illustrate the difference between chaos and complexity, I want to emphasize that chaos theory focuses on the unpredictability of systems due to initial conditions working within deterministic systems that behave in unpredictable ways. So using the butterfly effect as an example, even though the movement of a butterfly's wings leading to a typhoon may seem random, theoretically, if you knew all of the initial conditions the butterfly's position, the air pressure, humidity, wind patterns, precipitation, solar radiation, and all the other atmospheric factors. And if you had a computer powerful enough, you could run a simulation with all those initial conditions programed in and get the same typhoon every time. Complexity theory, on the other hand, deals with the overall behavior of systems that emerge from the interactions of many parts involving adaptation, learning, and evolution in systems with many agents. No amount of computing power can predict the eventual outcome of a system like how an ant colony develops over time, because every time you run the simulation, a different result occurs.
Tyler Johnson: [00:38:17] My mind is drawn to a couple of things. One is that I remember as I worked my way through what was probably my first sort of beginnings of a biology class in like fifth or sixth grade, and then you have some kind of a, you know, like a junior high biology class and then high school and then eventually got into heavier duty or biology and physics and chemistry and college and then even into medical school, probably partly because of advancement of the science, but probably mostly just because I was getting into more and more advanced classes as we studied, specifically the structure of an atom, things became increasingly complicated, and let's call it increasingly blurry, right? So when you're little, you learn sort of that atoms fit together, kind of like you were talking about. You might learn about the phases of matter, but I think mostly you would study what looks like a nice kind of ball and spoke like an ice cube, right? Where everything kind of fits nicely together or whatever. And then when you get a little further on, then you learn that there's this round thing in the middle called the nucleus, and then you have these little planets orbiting it called electrons. Right. And then as you get further and further, you figure out that actually in like the subatomic and quantum realms, that the electrons are actually nowhere and everywhere all at the same time, and you can't even they don't even exist as a discrete particle, but they're just this sort of probability distribution that has to be described in like wave functions and whatever, and that what you thought in organic chemistry were these nice little like discrete bonds between atoms are actually just functions of probability and etc., etc..
Tyler Johnson: [00:39:45] Right. Which is just to say that I feel like much of the advance of science, both as we have gone down into the microscopic and submicroscopic realm, and also as we have moved into the telescopes that can reach further and further distances, and understanding that has reached further into the galaxy. Much of what we have learned, sort of in a broad sense, is that what we initially thought were these nice discrete Newtonian physics mechanisms that could be described by certain functions that worked the same way no matter where you were, and were always kind of the same, then you have sort of the Einstein revolution that it's all relative. And then, of course, you know, even Einstein was famously skeptical of spooky effects at a distance. Right? The stuff that was starting to be described in the quantum realm. But it's just to say that it actually is never as straightforward as we once thought it was.
Henry Bair: [00:40:35] So, Neil, I don't think we've gotten to this yet. But, you know, we talked a lot about your early career as a pathologist, and we sort of switched gears pretty abruptly into complexity theory. But how did you actually stumble upon complexity theory and what made you want to dive deeper into it?
Dr. Neil Theise: [00:40:52] Well, so first off, I wasn't looking for a way. Complexity theory or otherwise, to explain the meaning of life or my place in the world, or how the world functions, or how to diagnose my slides better. The spiritual thing for me was over here on the one hand, and the scientific thing was over here on the other hand. And to me, they were both resonant ways to understand existence in the world. I think that most people who go into science, they may not remember the feeling, but why did they go into science? Partly they got into school and realized that their brains work really well in that zone. And so there's positive feedback, oh, I can do this. But even before that, why? What would set you up to be open to that? And I think that most people. Who spend their time dealing with the science is started at some very early stage with a sympathy for existence, a sympathy for the world around us that leads to curiosity about what that world is. And because of the way I was raised and my own inclinations, I had two ways to think about that. And I didn't care that our culture says that those things are incompatible. I'm not sure why I didn't care, I just didn't it wasn't it was not a question. So I've done the science and I've done the spirituality stuff. And both of them to me, are routes to understanding the true nature of reality. And it took me into later adulthood to realize, oh, that's what I'm trying to do. But even once I tried to do that, I wasn't thinking about how they related to each other.
Dr. Neil Theise: [00:42:36] That was sort of an accidental discovery. The way I got to complexity theory was I was looking at my slides on liver biopsies, and that work led to figuring out how to prove that human livers had stem cells. And back 25 years ago. That long ago, when I was thinking about this, really only the blood and bone marrow, the lining of the skin and the lining of the GI tract were thought to have stem cells. Livers didn't, brains didn't, hearts didn't, etc. but I saw something under the slide that couldn't be explained by what I had been taught. And when I see something that is unexplained, I think that's a cool question. And let's go do that. That's the fun part of academic work for me. Research work. And that led to finding out that not only do human livers have stem cells, but that doesn't explain all of what the liver does for some of it. We had to look outside the liver. And so I was one of the crowd 20 years ago, around the turn of the millennium, that was discovering that cells from the bone marrow can traffic around the body and become not only blood cells, but cells of the liver, of the heart, of the kidneys, of the brain. And in fact, my group's paper on this kind of phenomenon called adult stem cell plasticity. If people are old enough to remember when George Bush gave an address to the nation about using embryonic stem cells. Our work was the excuse that you don't have to do embryonic stem cell research.
Dr. Neil Theise: [00:44:08] That's adult stem cells can do everything. So opposition to embryonic stem cell research, instead of just being an anti-abortion position, became a logical scientific position. Unexpected unintended consequences. So that stuff happened, and that was the first research I did because of that, that went viral and got a lot of attention. That led me into a conversation with an artist named Jane Prophet. She was interested in how people interacted with virtual creatures online or people who were virtual online. This was the beginning of that kind of being technologically possible, and she created a world of creatures called technosphere. And people would send little creatures into this world. And what they discovered was when there were a few thousand creatures, they started to behave in ways that they hadn't programed. So like ants, they were in a bottom up way, interacting with each other and creating larger scale structures. Like at one point, all the herbivores and carnivores stopped jostling with each other and marched from one end of Technosphere to the other. The herbivores were spontaneously forming herds even though that hadn't been programed. Carnivores were organizing hunting parties that had not been programed. So that was her entry into something called artificial life, which turned out to be complexity theory. So when I was telling her about how stem cells are moving around the body and becoming part of cells to repair different tissues and different organs, she said, that sounds like the way people describe ants as a complex system. And so suddenly I was learning about complexity theory.
Henry Bair: [00:45:54] I see so complexity theory now has many applications, ranging from analysis of the stock market to how organizations develop to artificial intelligence. But can you share with us more specifically about what insights complexity theory has given to your work as a pathologist and to your understanding of our human bodies?
Dr. Neil Theise: [00:46:17] If you're walking around in the desert and you see in the distance on the ground some dark shape, and then you get a closer and you realize, oh, it's not a thing. It's not a shape at all. It's just ants organizing themselves. Well, if you go up microscopically to the ant body or to my finger or something on a slide, you see that there's no body there at all either. It's just cells interacting with each other. And so whether something appears to be a thing or something appears to be a phenomenon arising from interactions of smaller thing, depends on how close you get. So is something a thing? Is my body a thing, or is it a phenomenon arising from smaller things we call cells suddenly becomes a weird kind of question. And we want there to be an answer.
Dr. Neil Theise: [00:47:17] So years ago, because I met Jane, suddenly I had this question in my mind. I'm studying these cells, these stem cells, both on slides from humans and in slides from the animals I was experimenting with. I used to I don't do animal research anymore. I don't particularly like it. But I was doing it back then and I thought I was talking about things that are out there. But then it suddenly occurred to me, no, I'm talking about my own body. I'm studying my own body. And I started to get into this loop of obsession. Where is my body a thing or is it just a community of smaller things? And there came a moment where I was trying to cross the street in New York. The light changed and I had to stand on the corner. And this question was, am I a body or am I cells? Am I a body or am I cells? And the light changes and other people next to me step off the curb? And I couldn't move because my leg had become a flock of cells. I realized what happened, pulled it together and kept walking. It turns out that there is no correct answer. It's absolutely exactly 50 over 50. Your body is both an object, a thing, and also a community of smaller things. And that's called a complementarity.
Tyler Johnson: [00:48:40] A particle and a wave.
Dr. Neil Theise: [00:48:43] Exactly. And when Niels Bohr called wave particle duality a complementarity in quantum physics, he actually believed and wrote extensively about this being a phenomenon across all scales. It was not just something at the quantum level. And it turned out this is one way complementarity is seen in the world, and it arises from complexity theory, which he couldn't know about because it hadn't. It was still 50 years in the future, you know. So what? So for a while I was thinking we were writing papers about how cells self-organize, like ant colony, self-organized, like humans self-organize into neighborhood cities and economies, and members of an ecosystem organize themselves into the biomass of Earth, etc. same thing it cells. But eventually I started to wonder, well, ourselves really a thing themselves either. And in Western medicine and Western biology, what we mean by Western is how we understand living things. Once we could look at them under the microscope. When we could look at things under the microscope. The argument previously was a philosophical question is the body just an endlessly divisible fluid? Or is it made of small subunits called atoms? When they looked in the microscope and saw these boxes with four walls, a ceiling and a floor, they said, oh, if you take a box apart, you don't get smaller boxes, you just get pieces. So this is the smallest unit.
Dr. Neil Theise: [00:50:16] And they called it a cell because it looked like a monk's cell, a prisoner cell. Time would go by and they develop stains and could fill in the nuclei and the endoplasmic reticulum and the Golgi, etc. everything I see under my microscope when I'm making diagnoses, it's the same stuff. We're using the same stains from a few hundred years ago. But what if the technology had been different? What if, instead of seeing the cell membranes, they had seen the nuclei. Then they would have said, oh, look, there's this endlessly divisible fluid. And there are these balls hanging in it. And when the stains allowed them to see the cell membranes, they wouldn't have said, oh, we were wrong. The body's made of cells. They would have said, oh, look, there's semi-permeable partitioning between in the fluid. And so cells have no inherent existence anymore than our body does. At a lower level of scale. They're just molecules floating in water. So what are molecules? Are they fundamental? Well, they're just atoms self-organizing. And those are just subatomic particle self-organizing. And those some of those are smaller subatomic particles. And it's not an infinite regress. It's not turtles all the way down infinitely. You get to a level of scale where you can't have smaller things. And that's called the Planck scale.
Dr. Neil Theise: [00:51:41] It turns out Einstein, his description of space time is smooth works at the galactic scale, at the planetary scale, at the universal scale. But at the quantum scale, it turns out it's particulate. It's in pieces. And you have a smallest unit of space of distance and a smallest unit of time, which is the time it takes light to cross that space. And it turns out that while we think of the vacuum of space as empty, quantum physics, because of this particular nature of space, time is full of energy. And E equals MC squared energy, gives rise to mass and so spontaneously gives rise to tiny subatomic particles which often self annihilate it's matter antimatter like Star Trek engines. But if they don't self annihilate, they interact with each other the way ants interact with each other, and they interact to create subatomic particles, to create atoms, to create molecules, to create the entire structure of the universe. So suddenly from a complexity standpoint, the entire universe is a complex system. And nowhere in it can you find an actual thing that exists as a thing, independent of your observation. And this is where things get really blurry. When we walk into a patient's room, they're there and we're here and they're separate. But at the cellular level, we know that 50% of our cellular body is made up of microbiome.
Dr. Neil Theise: [00:53:23] And we are leaving microbiome wherever we touch anything or anybody, and we're picking up other people's microbiomes. And we know that. Now, if you have people living in community, in an apartment with their pets, there's a single microbiome that just rests on individual islands that think of themselves as separate. But at the cellular level, your boundaries are out here. If you go down to the atomic level, there's no atom in your body that you didn't eat, drink or breathe from the planet. So are we living things that are separate from each other, walking around on this rock we call Earth? Or are we the substance of Earth that in 3.5 billion years has figured out how to self-organize into creatures that misunderstand that they're separate? And if you go down all the way to the quantum level, where is your boundary? Well, as you said, there's nonlocality in quantum strangeness. And what that says is any electron we say is over here is, in fact, a field that extends to the entire edges of the universe. And so at the quantum level, there's no out there, there's just everything inside. And suddenly we're really in weird philosophical, spiritual turf. But I got there because I was looking at stem cells in the bile ducts of a liver biopsy.
Henry Bair: [00:54:46] So your book, interestingly, after going through all the science of it, you go all the way from cell biology all the way down to quantum theory. Your last chapter is an invitation for us to bring metaphysics back into our lives.
Dr. Neil Theise: [00:55:01] Mhm. Yeah.
Henry Bair: [00:55:02] I'd like to close this episode similarly. Right. So for our listeners who may or may not be aware of or may or may not be yet open concepts of embracing metaphysics in their lives. What is your pitch after having done all this medical work and training and this exploration of complexity theory, why is metaphysics important to you, and why should people be more attuned to it?
Dr. Neil Theise: [00:55:29] So where the the Jewish studies led eventually was to looking for some sort of contemplative practice, and it was more accessible in my culture back then to become a Zen meditator than it was to become a Jewish mystic, although that's changed a little now. And so I also pursued the contemplative path, just using your mind to encounter and examine one's mind. And it turns out that leads to the same place. That all of this can be looked at as solid objects, but equally valid. Always equally true is that everything is a seamless whole. And there was a moment in my zendo where I was meditating, and it was a few weeks after the crosswalk situation. I was not doing my Zen practice. I was bodies versus cells. Bodies versus cells. And I looked up at one point and there was an incense stick I had lit on the altar, turning into smoke. Stick or smoke. Stick or smoke. And suddenly I realized that everything in the universe was, as we say in Buddhist terms, empty of inherent existence. There is no thing that is a thing. And suddenly this weird scientific musing I was having started to reflect. Eventually, all of Buddhist metaphysics and aspects of Jewish mysticism and stuff like this. And so I said, I thought that there were these two routes to understanding the true nature of reality, but I just always sort of figured, well, there are two true natures of reality.
Dr. Neil Theise: [00:57:13] It's all a single nature of reality. There's only one reality. The problem with the scientific side is, and you can look at the life of Heisenberg, Einstein, Kurt Gödel I talk about in the book. They understood these things very deeply and their lives were a mess. They weren't really good with other people. You know, Einstein has a great rep. But if you look at how he treated the people around him, not so much. And Gödel, the mathematician recognized and talked about how knowledge wasn't sufficient, what a contemplative path or other paths like a path of service bring you to or a devotional path is an experience of these things. This is an important because I've come up with some intellectual design that I can write about. This is important because people can actually experience these things. If they devote themselves to some kind of careful, sustained practice. And it doesn't have to be overtly religious. Those are forms that work for me. You look at the writing of Walt Whitman, he saw all of this. He did it through poetry. So that's the point to me, is that the science has come round to show that this stuff is not in opposition to contemporary thought, to modern science, modern physics, modern philosophy. In fact, it's the same thing, and we have ways to experience that, and the experience of them is transformative.
Tyler Johnson: [00:58:48] I think if I can sort of add one coda on top of that, when I listen to you talk or I read what you've written, there will probably be some people who listen to this who totally vibe with the whole from, you know, the intergalactic realm to the subatomic realm. And they want to think through the entire sweep of existence through with you on that street corner in New York and other people who maybe not so much, but even for the people who are maybe not quite going to want to go all the way there. I think it is worth saying, I would argue that in everything from the sort of ascendancy of scienceism during the 20th and early 21st century, all the way through to social media and the digital world, we live in a place that is almost irresistibly reductive, right? The modern world wants to break everything down into its constituent parts, and wants to understand everything. As this little thing over here and this little thing over here and this little thing over here, even the structure of modern academia is that way, right? You have to have a super narrow niche, and then you go deep into the super narrow niche. And I think the thing that is beautiful and provocative and potentially most productive about the way that you think about things apart from any particular thought, is just the willingness to cut against that grain. It's the willingness to say, well, okay, but but what do all of these things right? The flow of people across a busy street, the arrangement of cells on a pathology slide or the sweep of the galaxies through space, like, is there a bigger story here? Is there a bigger thing to be told from all of this? And I think that that kind of change in approach, or at least adding that to our our intellectual tool belt, is something that we most often neglect, and that really matters.
Dr. Neil Theise: [01:00:39] I really appreciate you saying that. And what I'd offer you is my favorite quote. From Suzuki Roshi, who was Japanese, came to America, founded the San Francisco Zen Center. And he said, in the mind of the beginner, there are many possibilities in the mind of the expert, there are few. And the practice of medicine to me. Is that in every moment I come to each slide as though it's something, because it isn't something I've seen before. And just be open to what I see. When I look at people walking down the street, just be open to what you see, not what you expect to see. Be open. Pay attention. Every moment is showing us things that we haven't seen before. But like you said, we get conditioned to see things in this way. And we divide them and we divide them. Just take a breath and be present for a moment. See what you hadn't noticed.
Henry Bair: [01:01:43] With that, we want to thank you again, Neal, for taking the time amid your your slides to to come chat with us. It's really fascinating because for a while now, unintentionally, a theme that comes up over and over again in this podcast is that a lot of the wonder and the beauty of human connection and in medicine is that there's an element of mystery to it. That's the word that we keep coming back to. And I think if anything, I mean, your book sort of lays out in a way why that mystery isn't only necessarily there a fundamental part of human existence, but should be something to be embraced and explored. So thank you very much for for sharing your insights.
Tyler Johnson: [01:02:28] Thank you Neal.
Speaker4: [01:02:29] Thank you.
Henry Bair: [01:02:34] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the Doctor's Art.com. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
Tyler Johnson: [01:02:53] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [01:03:07] I'm Henry Bair and.
Tyler Johnson: [01:03:08] I'm Tyler Johnson. We hope you can join us next time. Until then, be well.