The previously undiscovered organ known as the “interstitium” revisited: The Deepak Chopra connection

Yesterday, wrote about some rather interesting science that’s already been invoked as a potential mechanism by which acupuncture can work. I’m referring to the “interstitium,” which was the subject of a number of stories last week about how this finding represented the discovery of a hitherto unknown new organ. I, of course, was less than impressed.

If you want the details of just what the interstitium is and how it was discovered, check out yesterday’s post. The CliffsNotes version is that the interstitium is a network of fluid-filled spaces in various organs that appear to communicate with the lymphatic system and could serve as the conduit for immune proteins and cells, a repository for “third space” fluid, a potential “shock absorber” for cells, and even a route for cancer cells to metastasize. However interesting this discovery is, it is a stretch to call the interstitium a new organ, however. At the time, I thought that the person responsible for the “interstitium as a previously undiscovered new organ” narrative had to have been some PR flack at NYU who promoted that narrative in a press release, even though no mention of a new organ is found in the actual paper reporting the discovery of the interstitium. Maybe, I speculated, Neil Theise, the pathologist whose observations sparked the study, had been played and just decided to go along with the study. Partially arguing against that was his invocation of his discovery as a potential mechanism by which acupuncture might work, but I gave Theise the benefit of the doubt.

That was a mistake, as I discovered when a friend pointed me in the direction of some more information and after Kavin Senapathy published an article in Slate yesterday showing that Theise is very much into New Age nonsense, to the point of apparently being tight with, of all people, Deepak Chopra. But, first, his Twitter feed:

We discovered a new human organ! Maybe the biggest by volume! Introducing: the interstitium! 20% of the body (~10 liters) of an average young adult. https://t.co/SHv3nzqnPm… @DeepakChopraMD @DeepakChopra @carolynfrangel @NondualScience

— neil theise (@neiltheise) March 27, 2018

That’s right. There’s Dr. Theise on the very same day his study was published online by Scientific Reports, touting the claim that he and his team had discovered a new organ. Not only that, but he tagged Deepak Chopra and Menas C. Kafatos, who co-authored You Are The Universe: Discovering Your Cosmic Self and Why It Matters, as well as Carolyn Rangel, President of Deepak Chopra LLC, and Rudy Tanzi, who’s co-authored multiple books with Chopra, including Super Genes: Unlock the Astonishing Power of Your DNA for Optimum Health and Well-Being. He also tagged the Twitter feed for Science & Nonduality, whose website demonstrates some serious woo. I also note that Dr. Theise tags these people a lot. A lot.

Then there was this link that Theise retweeted:

This is how I’ve been hiding from scientists for so long. #interstitium pic.twitter.com/x8dEuE1WNo

— Interstitium (@Interstitium1) March 28, 2018

Interestingly, this Twitter feed for someone going by the handle of Interstitium was created in March 2018 and, as of the time I wrote this last night, only 18 Tweets. All of them are about the “interstitium” as described in Theise’s paper. This Twitter feed almost certainly must belong to Theise as well. In a way, I’ll give the guy credit. Some of the Tweets are kind of funny:

What’s your body’s biggest organ? Get your mind out of the gutter! It’s me, the #Interstitium.

— Interstitium (@Interstitium1) March 30, 2018

Can’t wait until I’m a #Jeopardy clue! #Interstitium

— Interstitium (@Interstitium1) March 30, 2018

20% of your body’s weight is #Interstitium fluid. So be nice to me and I’ll help you fit in your skinny jeans.

— Interstitium (@Interstitium1) April 3, 2018

Theise is also touting his paper on his own Twitter feed:

What do you think, John Oliver? #LastWeekTonight #nametheneworgan

— neil theise (@neiltheise) March 29, 2018

He also describes himself as a “consciousness theorist,” which to me is a red flag for major woo:

#LGBTscience! MD, Liver pathologist, anatomist (new anatomy of “the interstitium” of every human organ SOON), stem cell biologist, philosopher of science (Godel anyone?), consciousness theorist. Breaking social/science boundaries x30! Queer science is thinking outside the box!

— neil theise (@neiltheise) February 11, 2018

Indeed, in May Dr. Theise is scheduled to speak at the Sivanada Ashram Yoga Retreat in the Bahamas, where he, along with Chopra’s co-conspirator Menas Kafatos, along with Debashish Banerjee and Swami Brahmananda will “further explore the intersection of consciousness, or Brahman, and human perception,” as well as:

• How universal awareness gives rise to the universe through the experiencing process
• How different states of consciousness create different realities
• How consciousness will inform the future of medicine, technology, and social well-being
• Qualia-based medicine such as Ayurveda, Chinese Medicine, qigong, and energy healing
• The relationship of qualia to subtle energy fields, the chakras, 
the Buddhist wheel of awareness, and sacred geometry
• Shared resonance of qualia through community.

That’s some serious woo there. I also discovered a whole lot of other woo. Indeed, seeing Theise’s Twitter feed and doing some searches on his name revealed a whole lot. I also learned in this report:

What’s next for Theise, Carr-Locke, and Benias? They’re bracing for feedback, but looking forward to the as-yet-unexplored, boundary-pushing potential of the interstitium. Theise said their team had submitted their paper to eight different journals (one sending the feedback that a new organ was “not of interest to a general audience”) before finally being accepted by Scientific Reports.

I wondered in my last post why, if this finding were so groundbreaking, it had been published in Scientific Reports, an open access journal published by Nature Publishing Group that has been known for a propensity to publish dubious studies promoting New Age nonsense and even antivaccine pseudoscience. Now, I will admit to some articles that I have submitted to more than one journal before they were finally accepted. However, eight is a whole lot. My personal record for the number of journals I’ve submitted the same manuscript to before it was accepted is only four, and after that I swore I would never bother to submit to that many journals again, given how much of a pain that it was. I can only wonder which journals they submitted to and how far down the scale they had to go to get into Scientific Reports. On the other hand, in terms of impact factor, Scientific Reports is not too shabby at 4.259. Be that as it may, much is explained by this observation, namely that a lot of journals either weren’t interested or found serious deficiencies in Theise’s manuscript.

I also learned from Senapathy that it wasn’t just Science Friday or The Cut that included Theise’s musings on how the “interstitium” could explain acupuncture and other alternative medicine modalities. It was CNN and Business Insider too. She also confirmed what I started figuring out by looking at Theise’s Twitter feed:

Theise is a liver pathologist and stem cell researcher. He has long been interested in legitimizing alternative medicine practices. He’s collaborated with alternative medicine and New Age movement mogul Deepak Chopra on articles, podcasts, and YouTube videos, even speaking at a Chopra Center seminar. In 2003, he wrote in Tricycle, a western Buddhist perspective magazine, on how his meditations helped him discover “the synergy between dharma practice and scientific inquiry.”

I started perusing some of the links I found about Theise, and this is an understatement. For instance, Theise has a website. His biography asserts:

Subsequently, while continuing laboratory and clinical research, he has extended his work to areas of theoretical biology and complexity theory, defining a “post-modern biology.” These ideas suggest that alternate models of the body, other than Cell Doctrine, may be necessary to understand non-Western approaches to the body and health.

Uh-oh. He believes that there has to be some sort of special pleading in the description of human biology, an alternate model of the body, to understand “non-Western” approaches to health. A perusal of his CV shows that he’s long been giving talks on various similar topics. He’s been a Zen Buddhist for a number of years, and it’s become apparent that his religious beliefs are very much intruding into his science. He’s featured on the Chopra Center website, and that’s never a good sign as far as a person’s attitude towards woo goes.

However, I was curious just what Theise meant by his assertion that alternate models of the body might be necessary to understand “non-Western” approaches to the body and health. It didn’t take me long to find his 2009 article, Beyond Cell Doctrine: Complexity Theory Informs Alternate Models of the Body for Cross‐Cultural Dialogue. The first part of the article starts out with a bit of an exaggeration, representing “cell theory” as the be-all and end-all of “Western” medicine and biology, citing multiple papers in which he argues that stem cells and our newer understanding of cellular plasticity somehow means that cell theory is “incomplete.” Cell theory, of course, is the theory that all organisms are made up of cells, that they are the basic structural and organizational unit of all organisms, and that all cells come from preexisting cells. The modern version of cell theory takes into account newer discoveries in science since the time cells were first identified and cell theory solidified a couple hundred years ago, such as the ideas that energy flow occurs within cells, heredity information flows between cells, and that cells have the basic chemical composition.

Theise’s basic idea seems to be that stem cell plasticity, the trafficking of cells between organs, recent insights regarding stem cells, repression and de-repression of gene expression, and the application of Complexity Theory to cell and molecular biology all call for the reevaluation of cell theory. In his paper on cross-cultureal dialogue and how alternative models of the body could allow us to “understand non-Western medicine” he starts out making some provocative, but not too out there, observations. For instance:

What if the technology had been different? What if the first structures visible with the new technology had been the nuclei, not cell walls or membranes? Then, a very different answer to the ancient debate would have been conceived. The body would indeed look like an endlessly divisible fluid, only with small little globes suspended in it. Twenty years later, with the advent of histochemical staining to demonstrate cell membranes, the fluid theory of the body would not have been jettisoned; rather, the new structures perhaps would have been described as semi permeable partitioning of the fluid continuum.

This is an interesting speculation, but it doesn’t really tell us how this alternate model of the body would have changed medicine. Yes, it’s true that what the body looks like will change depending upon the scale we chose to use, as Theise argues:

Changing scale will also yield other possible models. A nanoscopic view of the body is quite different than a microscopic view. Cells cease to exist at that finer scale level; indeed the body itself ceases to be apparent. The body’s functions become dominated by quantum effects very different from effects seen at higher scale, some of which even clearly manifest at higher levels. Examples of biologically relevant quantum effects include the importance of quantum tunneling for the energy requirements of some enzymatic action23, 24 and the above described role of Brownian motion in providing energy of movement for interacting single molecules as described above.

Quantum. Yes he went there. No wonder he likes Deepak Chopra so much. He also takes the simple observation that the structure of the body looks like at different levels of scale, and how cell theory is not a useful model molecular scale, and tries to apply it to “Eastern” medicine by portraying such “non-Western” medicine as looking at the body from a different scale, like looking at it as a fluid interrupted by membranes or at a subcellular level. it does not go well. First, after stating that prejudice against acupuncture isn’t the only thing that makes it difficult to study in the West, but a very simple other observation. Basically, he admits that there is no anatomic correlate for acupuncture points or meridians. Because of that:

To explain it in Western terms, we must identify what is going on structurally at the acupuncture points. Yet if one dissects these areas, one does not find an underlying anatomic structure that is readily described by our standard categories: there are no nerves, lymphovascular structures, tendons, fascial planes, or muscle fibers at these points or along the meridians. If they cannot be described in terms of our standard gross anatomy, they cannot be described by cells, the building blocks of that anatomy. Thus, it appears that the model of cell doctrine is, at least to date, inherently incapable of explaining acupuncture. While it is a consistent model and thus successfully produces hypotheses concerning many observable bodily phenomena, which can be tested and refined, it is also an incomplete model.

That’s right. Because “Western” medical models like cell theory can’t explain acupuncture, to Theise these models must be incomplete. In other words, if there are no structures in whatever model in “Western medicine” you like to choose that can explain acupuncture, he’ll just accept the non-evidence-based models postulated by quacks:

Tibetan medicine speaks of different “bodies” which co‐exist within our single body: a coarse body, a subtle body, and an energy body. Previously, these phrases always conjured in my imagination overlapping, superimposed “bodies” that were independent of each other and probably only metaphorical (my typically Western bias).

However, when discussing how the body might function or appear at different levels of scale in small groups of American and Tibetan doctors and scientists, the possibility that there was more substance to these terms became apparent. Is it possible that “other bodies” of the Tibetan and other systems actually correspond to our bodies at different levels of scale? If so, can we appreciate medical philosophy and science of other cultural systems, such as the Tibetan system, not as naïve metaphor, but as poetically expressed, yet still precise approaches to considering how the body is put together and might be repaired if injured?

Leading Theise to conclude:

Various changes in perspective and scale of observation lead to alternate possible models–also incomplete but possibly also of great use–that may reveal the accuracy of some Asian models, despite the seemingly metaphorical terminology employed in those systems (from a Euro‐American perspective). Limiting ourselves to cell doctrine means that some bodily phenomena may remain resistant to cell‐based hypothesis formation and testing.

In other words, it science doesn’t support acupuncture, change the models science uses until it does. Notice the assumption here, which is that acupuncture works and that if acupuncture works there must be some mechanism that explains it. If “Western” medical models, like cell theory, do not provide an explanation for acupuncture, then they must be incomplete. That is the crux of Theise’s argument. Again, Theise is wrong in his very premise. Acupuncture doesn’t work. As I like to say, it doesn’t matter where the needles are placed. It doesn’t even matter if the needles are placed. Indeed, twirling toothpicks against the skin produces the same effect. Basically, acupuncture is nothing more than a theatrical placebo. It does not work any more than placebo. He even tries to invoke a bastardized version of Heisenberg’s uncertainty principle, which he calls “cellular uncertainty”:

When we first proposed this principle, the reference to Heisenberg (“cellular uncertainty”) was intended to be more metaphorical than real. However, we now see that, as with elementary particles, “cellular uncertainty” is not an artifact, a limitation of our incomplete technological abilities to study the cell. Rather, a cell’s existence is contingent on the level of scale at which the body is observed. Without inherent, scale‐independent existence the cell is by definition “uncertain” precisely in the meaning of Heisenberg: by examining the cell we change the cell.

I can sense the physicists in my readership grinding their collective teeth. Basically, Theise seems to be making the common mistake of confusing the uncertainty principle, which states that there is a limit to the precision with which certain pairs of physical properties of a particle, known as complementary variables, such as position x and momentum p, can be known, and the observer effect, which notes that measurements can’t be made of certain systems without changing something in the system. Here’s the thing. The observer effect can be quantified. By itself, that the observer effect exists for a system doesn’t mean the model that system represents is incomplete. I do so love bad analogies to physics, and I suspect my physicist readers will have more to say, maybe even to tell me I got it all wrong. Hey, I’m just a simple surgeon, but I suspect I understand these things better than Theise does. Let’s just put it this way. Theise seems to be going even beyond confusing the uncertainty principle with observer effects. The changes in the cells and other biological structures that occur from our observing them are really artifacts of the technology we use to measure them, such as the need to fix cells for histology or isolate DNA to sequence it. I’ll point out that he has published the same sort of argument on the Chopra Center website and here.

If you don’t believe how far down the rabbit hole Dr. Theise has gone, take a look at some video interviews he did with Deepak Chopra. First, here he is in a preview of a longer interview (which requires a subscription to Curiosity Stream), going deep into Choprawoo about evolution and the “sentient universe” in which the two ask if consciousness is the driver of evolution:

“There is sentience at all levels, from ultramicroscopic to galactic”? Ugh. What’s being peddled in the video is basically just warmed over intelligent design creationism, substituting the “sentience of the universe” as the guiding force for evolution instead of God. It’s the sort of drivel that Chopra is known for, given that Chopra detests the idea that evolution could be a random process (he also hates the idea that behavior can be deterministic), and has spewed many times over the years. No wonder Theise and Chopra are buds.

Here he is in 2016 being interviewed by Chopra for Sages and Scientists:

In this, we learn that Theise is heavily into “nonduality” and consciousness. For some reason, most of the video is blackscreen after the first four minutes or so. If you want the full effect of Theise’s views, though, check out this appearance at Chopra’s Sages & Scientists in 2013:

And here he is at Chopra’s conference in 2014, in which he talks about liver transplant recipients who have memories from the donor, as though the donor’s liver somehow transfers memories its previous owner to the recipient:

Michael Shermer tries to add some skepticism to this whole discussion, but he’s mostly outnumbered, the token skeptic. That year, Chopra also apparently wanted evolutionary biologist Jerry Coyne, but Coyne rebuffed him. Be that as it may, clearly Neil Theise is tight with Deepak Chopra. He seems to show up at Chopra’s conferences almost every year.

After learning all that I have about Neil Theise, I’ve been thinking about his “discovery” of the “interstitium.” Knowing what I know now about how he views “cell theory” to be incomplete because it doesn’t provide a means of explaining acupuncture, I can’t help but view the “interstitium” as he describes it in a different way. Specifically, I’m a hell of a lot more skeptical that this is a real finding that will stand up to scrutiny by other scientists. After all, a close relationship with Deepak Chopra does not exactly imbue me with confidence that Neil Theise is dedicated to rigorous science. In fact, I now strongly suspect that Theise “discovered” the interstitium because it is the sort of discovery that confirms his preexisting beliefs and provides him a means of “explaining” how acupuncture and other alternative medicine can supposedly produce systemic effects from local manipulation, because, above all, he believes that acupuncture works even though it is only a theatrical placebo. Indeed, until I see other scientists not associated with Deepak Chopra reproduce some of Theise’s key findings, I’m just going to file this “discovery” of the “interstitium” in the “unproven and probably false” category.