I’ve got a million ways to get it,
Choose one
— Swizz Beatz
Whenever I confess my interests to a blank document, it usually sits at the centre of three domains: complexity, evolutionary biology and microbiology. In my current field of practice, the last one, microbiology, is the one that most of my colleagues can relate to.
We handle complexity in all our lives, and yet this idea hardly echoes in most of my interactions with consultants. Complexity is a foreign concept, and yet, a simple system that can explain complexity is the shower.
One knob unlocks the cold water and another the hot water. Cold water is a given once it lands on your skin. Touch, however, is not the only sense at work. There’s vision too, to estimate if the falling torrent of water is desirable. Then there’s the hot water knob. This one uses temperature as the signal, not just vision. It takes a while before you get the temperature just right. Overshooting is almost guaranteed. As a complex system, the human body operates in such a manner, but with more knobs.
Human bodies contain multitudes of microbes. The microbial ecosystem in your armpit is different from the one at your elbows. These systems co-evolve. Thus, my view of the human body is from a lens that is particularly unique among my colleagues. And the one tool that unites all these fields is a checklist.
Checklists tame complexity, give enough room for evolution in biology, and have been the guiding principle for the persistence of microbes. Since microbes have been existing for billions of years, they are a testament to the Lindy features of a checklist.
In case the phenomenon is new to you, the Lindy effect is the rule of thumb, often dictating the lifetime of non-perishable goods or ideas. It states that if an idea has existed for X amount of years, it is likely to last for another X amount of years. It holds for old concepts, poems, names, and principles.
In biology, microbes have been living for billions of years. They will continue to live for billions more. However, they are not like ideas or non-perishable goods. To unearth this mystery, we can start by studying a system that has the Lindy features. This system is a checklist system.
Cell division
Cells have different dividing mechanisms. The one most people are familiar with is mitosis. Cells, especially if they are capable of movement, are either in one of two states — moving or dividing. For this reason, this cellular process is poetically synonymous with the Heisenberg principle, which states that it’s impossible to simultaneously know the position and momentum of a particle with absolute precision. You have to pick one.
The division process follows a series of steps, with conserved processes seen in several branches of the ring of life. For instance, there must be a duplication of the DNA before the cell divides into two separate entities. The organelles usually divide into two sets. There are then mechanisms to confirm there are adequate numbers for the cell to divide comfortably.
What guides these mechanisms is a checklist system. First, the cell needs to sense particular signals from its environment to trigger the division process. In eukaryotes, the first stage is the most variable, and it’s known as the G1 phase. It has a checkpoint. The cell first surveys whether it has made the necessary division of organelles before it can proceed to the second stage, the S phase. Or, in the words of Hov, onto the next one.
In the S phase, the DNA is duplicated. Once a cell tips into the S phase, there is no going back. Thus, the first checkpoint is essential. However, there are other checkpoints in the remaining phases. The cell needs to confirm that the duplication is complete and up to the required standards.
A finer view of this process reveals that there are more checkpoints inside the DNA, consisting of correction enzymes that regulate the process of replication. An opening reading frame shows where an enzyme latches; it signals the unwinding of the double helix structure. Another enzyme starts to read the uncoiled archive; it then generates the complementary strand. A polymerising enzyme adds nucleotides until the whole strand is copied.
During this copying phase, errors can happen. One of the enzymes checks these errors. In a cell, the error rate is reduced significantly. In a test tube, the error rates are magnitudes higher. The checklist then confirms at the end that the DNA replication is of high fidelity. If it passes the test, it can progress to the next phase, the G2 phase.
In the event that an error is noted, a crucial molecule prevents the transition into the next phase — the P53 protein. It is active in these first two stages of division. Acting together with the Hodor of the cell, the retinoblastoma (Rb) protein, they control the replication of cells. Uncontrolled replication usually leads to cancer.
In most cancers of the human body, the Rb and p53 proteins are implicated. However, sometimes, when the correction is difficult to achieve, p53 can initiate cell death through apoptosis.
What we see inside the cell is a strict checklist system that tames the division process, a central point in Darwin’s theory.
Balancing feedbacks relative to impact they try to correct
Atul Gawande has been one of the strongest proponents of the checklist, as he has seen in different parts of the world the positive outcomes of using checklists in different parts of the hospital. He attests to how checklists tame complex systems. He is not wrong.
Notice how, within a cell, a checklist has tamed the process that guides all living creatures. All living entities are complex entities. The single tool, likely non-obvious to the experts in the fields, is the use of a checklist.
Bugs don’t know how to write, but they can institute a function that mimics a checklist. Signal transduction mechanisms, for instance, follow checklists in the buzzing molecular world inside a cell.
The cramming of organelles and bustle of metabolic functions is similar to our busiest cities. Cartoon demonstrations of cells give a wrong impression of this busy world. These cells have managed to tame the beehive functions using forced functions that match what we see in a checklist.
While I was in medical school, a case of a patient who was operated on for the wrong condition found its way into the media and circulated throughout the country. The reason such a mistake happened? The failure to adhere to a checklist.
Hospitals can be busy. Checklists keep things, as the first part shows, in check.
What’s more, checklists are up to the task. In stable systems, they provide the right amount of balancing feedback to match the impact they aim to correct. Take, for instance, the p53 system. It will not allow a cell to progress without proper DNA replication. It pauses the system, gives room for corrective enzymes to operate, then gives the green light. If the correction is impossible, the apoptotic system is signalled through the mitochondrial pathway.
As powerful as the checklist may be, few cases may escape its powerful grasp. The p53 gene may mutate, resulting in uncontrolled division. Cancer soon follows.
However, the first place to notice the existence of a checklist is in a stable system. The body is one stable system, as is Gaia, our planet. Should there be uncontrolled division, Gaia finds a way of bringing it back to balance. The body, too, has balancing systems. Not all cancers are fatal. Some can be controlled and contained. The malignant ones are, however, notorious for taking our loved ones sooner than we had wished. At a human level, this is somewhat synonymous with a “gestalt” apoptosis — another checklist system to keep ecosystems in balance.
Checklists not only operate at the cellular level but at organ system and ecosystem levels. Harnessing its power, complex systems have managed to preserve themselves, as in the case of microbes, and evolve for as long as there has been room to evolve.
The power to change and system goals
I move onward, the only direction
Can’t be scared to fail, searchin perfection— JAŸ-Z
Checklists are not as strict as I have made them appear to be. From The Checklist Manifesto, Gawande gives a summary of how a checklist is drafted, tested, refined, and eventually adopted. It is, however, not usually set in stone. With more advances in a field, a checklist can change.
When I was getting into medical school, the secondary survey of trauma patients included the ABCs, in that order. A for airway, B for breathing, and C for circulation. By the time I was finishing my internship, the letters were changed to CAB, where circulation was to be reviewed first, before airway and breathing. Checklists can change.
In dynamic systems, the perfect balance between stability and malleability often wins the race. You can have a checklist that has room for changes and one that can actually change while preserving the goal of the system. For instance, in cellular division, there can be an acceptable error rate in DNA replication. These misreads can be beneficial to cells. Indeed, it is the basis of evolutionary biology according to the gospel of Charles Darwin.
From the example of trauma patients, I have also shown how it is the checklist itself that now changes and not the elements preceding certain checkpoints. From ABC to CAB.
This reveals that systems have goals. An entity such as a bacterium or archaea could not have survived the harshest parts of this world if it did not have a goal. The gospel according to Darwin is that the goal is to reproduce. I recall one of the slides taught in medical school states that the goal of a single cell is to produce another. And although it is consistent, I don’t buy it.
I believe the goal of an organism is to persist. I have developed a theory defending my case, not just to introduce a new concept, but to show how it explains those of Natural Selection in a new light.
In science, for a theory to be accepted, it needs to explain all the phenomena the prevailing theory explains, and then some more where the previous one failed. That is what my theory does. I call it Organismal Selection. The same theory underpins that organisms have a single goal — to avoid annihilation.
Complex systems have shown us that the best way to avoid annihilation is by taming complexity. The tool that has survived for billions and, from its Lindy traits, is likely to continue for billions more is a checklist.
Notice that I have phrased my goal in the negative. Natural Selection phrases it positively — to reproduce or replicate. For Organismal Selection, it’s to avoid annihilation. Reproduction is one of the ways a system avoids annihilation. This is one of the simple ways of showing how Natural Selection is nested within Organismal Selection. The keen eye will notice how I too follow the checklist system science uses before adopting a new theory.
Phrased negatively, avoiding annihilation gives a wide latitude of survival options. It’s not only through reproduction. Adaptation, locomotion, or even mutation. Mules, for instance, appear pointless from the perspective of Natural Selection. But why do they continue to live? Organismal Selection shows that they persist despite the fact that they will never bear viable offspring.
A goal such as that of avoiding annihilation further allows different genera to interact. Amazon mollies, for instance, are an all-female species that depends on their close generic cousins to donate their sperm, but only to induce replication of their eggs, not to fertilize them. In such a system, the checklist allows the presence of sperm, but not their fertilization. Once embryogenesis begins, the sperms are usually extruded.
Amazon mollies have been persistent for generations despite the theoretical prediction of the possibility of acquiring lethal irreversible mutations. I can only imagine one tool that has been used. A checklist. You need to have a very strict checklist that notices the sperm is present and then releases it once the female gamete begins to duplicate.
As Atul Gawande reiterates, checklists improve outcomes without necessarily improving skill. What better outcome is there than preserving an all-female complex fish species defying predictions consistent with Muller’s ratchet? How does an entity many perceive to lack cognition ( I, however, think bacteria are conscious), stay for billions of years throughout all of Earth’s metamorphosis? To echo the words of JAŸ-Z, haters don’t like how certain entities survive despite the best theories predicting otherwise. The weapon of choice? A checklist.
What I’m trying to say is…
What I loved about The Checklist Manifesto was that it relieved me of the burden of never knowing enough.
I was always eager to read more. The more I read, the more inadequate I felt. Thus, I have never felt like I had the master key.
Lurking in silence was a solution offered from the very person who encouraged me to continue my voracious reading. Charlie Munger confessed how he ran his ideas and problems through his mental models, checklist style. For years, I have been collecting mental models and trying to synthesize them into usable tools. Little did I know I was building a checklist, a tool our common ancestor has been using for billions of years.
Now, thanks to Gawande, I know I need not fear not knowing much. I just have to rely on my checklist and will have higher-than-expected outcomes even without an increase in training or reading. I was relieved.
My three interests — complexity, evolutionary biology, and microbiology — are vibrant and mysterious but controlled with one ring and one ring alone to control them all.
This song inspired some of the lines used in this article. Source — YouTube