Remembering Lewis Thomas
โThe Lives of Lewis Thomasโ (Issues, Fall 2024), by Joseph J. Fins, stirred powerful memories. As an intern at Bellevue Hospital in New York City in 1971, I eagerly awaited The New England Journal of Medicine, hoping it would contain one of his โNotes of a Biology Watcher.โ Two essays in particular remain vivid. The first described what Thomas called โhalfway technologyโ in medicineโโthe kinds of things that must be done after the fact, in efforts to compensate for the incapacitating effects of certain diseases whose course one is unable to do very much about.โ Citing examples such as organ transplantation, he noted that โit is the kind of thing that one must continue to do until there is a genuine understanding of the mechanisms involved in disease.โ Here I was thinking these were singular technological achievements, when in reality, Thomas was telling me, they were proof of our ignorance. Self-satisfaction immediately gave way to humilityโand a commitment to more detailed research on fundamental mechanisms of disease. It was a lesson that I never forgot and has guided my entire career.
The second essay included a quote that fit perfectly into my recent presentations on the role of chance as a key factor in determining human phenotypes, separate from genetic inheritance and environmental exposure. Stochasticityโthe quality of lacking any predictable order or planโis intrinsic to biology, not a frustrating temporary impediment to ascertaining absolutely certain predictions and prognoses that will evaporate when we have a more precise understanding of a phenomenon. Pointing out that nature uses stochasticity during fertilization to ensure that there are roughly equal numbers of males and females, and that differentiation and development rely absolutely on stochastic events, sometimes helps make the point. But the best way comes from another quote from that essay: โThe capacity to blunder slightly is the real marvel of DNA. Without this special attribute, we would still be anaerobic bacteria and there would be no music.โ In a flash, this illuminates the key evolutionary concept. And hearkening back to Finsโs highlighting Thomasโs โPoetics,โ by juxtaposing anaerobic bacteria and music he surprises us and forces us to think about what it means to be human.
Self-satisfaction immediately gave way to humilityโand a commitment to more detailed research on fundamental mechanisms of disease. It was a lesson that I never forgot and has guided my entire career.
That quote also came to mind when I served on the National Academy of Sciences/National Academy of Medicine committee that produced the 2017 report on Human Genome Editing. That experience led me to reflect on the biases and subliminal messages conveyed by the language used to describe genetic variation. As a physician who has witnessed the profound impact of some genetic variants on human health, I understand why terms with negative connotations such as DNA replication โerror ratesโ and โinfidelityโ are commonly used. But from an evolutionary standpoint, as seen through the lens of Thomasโs quote, might not these stochastic variations be considered โexploration ratesโ? I even became concerned about the word โeditingโ in the title of our report because it carries a connotation of โcorrectingโ or โimprovingโ that has important consequences for individuals living with the variants some would like to edit. I wished Thomas could still help us construct a new lexicon of value-neutral words to describe genetic variation. We need scientific poets for this important task. But when I looked at the essay again, I found that Thomas had beaten me to the punch. โTo err is human, we say, but we donโt like the idea much, and it is harder still to accept the fact that erring is biological as well,โ he wrote. And then he added, โBiology needs a better word than โerrorโ for the driving force in evolution. Or maybe โerrorโ will do after all, when you remember that it comes from an old root meaning to wander about, looking for something.โ
Barry Coller
David Rockefeller Professor
Physician in Chief
Vice President for Medical Affairs
The Rockefeller University
On learning that a biography of Lewis Thomas was in the works, a doctor told me the effort puzzled him. What major discovery did Thomas make to deserve a biography? He made some original scientific observations, I replied. But what the doctor was overlooking was the equal importance of the compassion, empathy, and concern for public understanding of science and medicine that Thomas exhibited in his career. It included writing, lecturing, and a willingness to put aside the piles of paper awaiting his decisions in everyday business to chat with colleagues about progress, problems, and wonderment in their research, even world affairs.
I was one of those who personally benefited from Thomasโs interest in improving the public understanding of science and medicine. When I was considering making a transition from clinical medicine and public health to full-time journalism at The New York Times, colleagues and friends strongly urged me to seek Thomasโs advice. What I was contemplating was novel. I knew that several doctors wrote novels in their spare time. But I knew of no physician who worked as a reporter for a daily newspaper, and I had worked part-time for a regional newspaper. As an EIS officer (Epidemic Intelligence Service) at the Communicable Disease Center (as it was known before becoming the Centers for Disease Control and Prevention) and the editor of its Morbidity and Mortality Weekly Report, I tapped my limited journalistic eye to add the flavor of a newspaper to the staid statistical bulletin. It was 1968 and Thomas was three years away from beginning his โNotes of a Biology Watcherโ for the New England Journal of Medicine. I was at the University of Washington in Seattle and Thomas was the medical dean at New York University. So he had no reason to slice a few minutes out of his day for me.
I was one of those who personally benefited from Thomasโs interest in improving the public understanding of science and medicine.
But he did. I related my interests when we met for a half-hour appointment after lunch and he spoke about his interest in communicating science broadly. He cited Berton Rouecheโs โAnnals of Medicineโ articles in The New Yorker, which had introduced me and many EIS colleagues to epidemiology. Roueche and Thomas were close friends, and Roueche had called on me when he visited the CDC. Thomas was writing essays but yearned about being a journalist himself. As he cast aside other business, our discussion lasted until quitting time. I enjoyed many discussions with Thomas about medicine and journalism until the end of his life. Anyone who had the privilege of spending time with Thomas went away the wiser.
Lawrence K. Altman
Former Medical Correspondent and โThe Doctorโs Worldโ Columnist, The New York Times
Clinical Professor, New York University Medical School
Global Fellow, Woodrow Wilson International Center for Scholars, Washington, DC