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Complexity in Health: An Introduction

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Handbook of Systems and Complexity in Health

Abstract

More of the same, paraphrasing Einstein, can only lead to more of the same, or using Lakoff’s terminology [1], the way we talk about things is the way we think about them. Currently, and in contrast to most other disciplines, medicine remains largely stuck in the simplistic “reductionist” scientific world view and is resisting the move to the complex dynamic “holistic” scientific world view (Table1.1)

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Notes

  1. 1.

    British statistician, decision theorist and leading advocate of Bayesian statistics.

  2. 2.

    For a detailed discussion, see Chap.3.

  3. 3.

    For a more detailed discussion, see Chap.4.

  4. 4.

    For a detailed discussion, see Chaps.14–18.

  5. 5.

    For more detail, see Chaps.5, 11 and 12.

  6. 6.

    For more detail on system dynamics and modelling, see Chap.6; applications of modelling are illustrated in Chaps.33, 44 and 45.

References

  1. Lakoff G, Johnsen M. Metaphors we live by. London: The University of Chicago Press; 2003.

    Google Scholar 

  2. Dörner D. The logic of failure: recognizing and avoiding error in complex situations. New York: Metropolitan Books; 1996.

    Google Scholar 

  3. Lindley DV. Understanding uncertainty. Hoboken, New Jersey: Wiley; 2006.

    Book  Google Scholar 

  4. Cilliers P. Complexity and postmodernism. Understanding Complex Systems. London: Routledge; 1998.

    Google Scholar 

  5. The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.

    Article  Google Scholar 

  6. Leyvraz S, Pampallona S, Martinelli G, Ploner F, Perey L, Aversa S, et al. A threefold dose intensity treatment with ifosfamide, carboplatin, and etoposide for patients with small cell lung cancer: a randomized trial. J Natl Cancer Inst. 2008;100(8):533–41.

    Article  PubMed  CAS  Google Scholar 

  7. Mittra I. The disconnection between tumor response and survival. Nat Clin Pract Oncol. 2007;4(4):203.

    Article  PubMed  Google Scholar 

  8. Blas E, Gilson L, Kelly MP, Labonté R, Lapitan J, Muntaner C, et al. Addressing social determinants of health inequities: what can the state and civil society do? Lancet. 2008;372(9650):1684–9.

    Article  PubMed  Google Scholar 

  9. Hider P. Electronic prescribing: a critical appraisal of the literature. New Zealand Health Technology Assessment (NZHTA), Vol. 5, No. 2. 2002. http://nzhta.chmeds.ac.nz/publications/elpresc.pdf.

  10. Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc. 2008;15(5):585–600.

    Article  PubMed  Google Scholar 

  11. Zurn P, Dolea C, Stilwell B. Nurse retention and recruitment: developing a motivated workforce. Geneva: International Council of Nurses; 2005.

    Google Scholar 

  12. Ali S. Infectious disease, global cities and complexity. Paper presented at the annual meeting of the American Sociological Association Annual Meeting, Sheraton Boston and the Boston Marriott Copley Place, Boston, MA. http://www.allacademic.com/meta/p_mla_apa_research_citation/2/3/7/3/0/p237304_index.html. Accessed 31 Jul 31 2008.

  13. Kuhn M, Siciliani L. Upcoding and optimal auditing in health care (or The economics of DRG creep). SSRN, CEPR Discussion Paper No. DP6689. 2008.

    Google Scholar 

  14. Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA. 2004;291(10):1246–51.

    Article  PubMed  CAS  Google Scholar 

  15. Smith RD. Responding to global infectious disease outbreaks: lessons from SARS on the role of risk perception, communication and management. Soc Sci Med. 2006;63(12):3113–23.

    Article  PubMed  Google Scholar 

  16. Frohlich KL, Potvin L. Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008;98(2):216–21.

    Article  PubMed  Google Scholar 

  17. Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B. Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev. 2005; (2):CD001271 .

    Google Scholar 

  18. Goldberger A. Non-linear dynamics for clinicians: chaos theory, fractals, and complexity at the bedside. Lancet. 1996;347:1312–4.

    Article  PubMed  CAS  Google Scholar 

  19. Stella P, Ellis D, Maser RE, Orchard TJ. Cardiovascular autonomic neuropathy (expiration and inspiration ratio) in type 1 diabetes. Incidence and predictors. J Diabetes Complications. 2000;14(1):1–6.

    Article  PubMed  CAS  Google Scholar 

  20. Wood LD, Parsons DW, Jones S, Lin J, Sjoblom T, Leary RJ, et al. The genomic landscapes of human breast and colorectal cancers. Science. 2007;318(5853):1108–13.

    Article  PubMed  CAS  Google Scholar 

  21. Heng HQH. Cancer genome sequencing: the challenges ahead. Bioessays. 2007;29(8):783–94.

    Article  Google Scholar 

  22. Sutherns R. Adding women’s voices to the call for sustainable rural maternity care. Can J Rural Med. 2004;9(4):239–44.

    PubMed  Google Scholar 

  23. Agency for Healthcare Research and Quality. Treating tobacco use and dependence—a systems approach. A guide for health care administrators, insurers, managed care organizations, and purchasers. In: 2000 UPHS, editor. Washington DC: Agency for Healthcare Research and Quality. 2000. http://www.surgeongeneral.gov/tobacco/systems.htm.

  24. Nishida C, Uauy R, Kumanyika S, Shetty P. The joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic diseases: process, product and policy implications. Public Health Nutr. 2004;007(01A):245–50.

    Google Scholar 

  25. Heng HHQ. The conflict between complex systems and reductionism. JAMA. 2008;300(13):1580–1.

    Article  PubMed  CAS  Google Scholar 

  26. House of Representatives Standing Committee on Health and Ageing. The blame game. Report on the inquiry into health funding. Canberra: Commonwealth of Australia; 2006.

    Google Scholar 

  27. Plamping D. Looking forward: change and resistance to change in the NHS. Br Med J. 1998;317(7150):69–71.

    Article  CAS  Google Scholar 

  28. Snyderman R, Weil AT. Integrative medicine: bringing medicine back to its roots. Arch Intern Med. 2002;162(4):395–7.

    Article  PubMed  Google Scholar 

  29. Suchman AL. A new theoretical foundation for relationship-centered care. Complex responsive processes of relating. J Gen Intern Med. 2006;21 Suppl 1:S40–4.

    Article  PubMed  Google Scholar 

  30. Biswas R, Martin CM, Sturmberg JS, Mukherji KJ, Lee EWH, Umakanth S, et al. Social cognitive ontology and user driven health care. In: Hatzipanagos S, Warburton S, editors. Handbook of research on social software and developing community ontologies. London, UK: IGI Global; 2009.

    Google Scholar 

  31. Martin CM, Peterson C, Robinson R, Sturmberg JP. Care for chronic illness in Australian general practice—focus groups of chronic disease self-help groups over 10 years. implications for chronic care systems reforms. Asia Pac J Fam Med. 2009;8(1):1.

    Article  Google Scholar 

  32. Eysenbach G. Medicine 2.0: social networking, collaboration, participation, apomediation, and openness. J Med Internet Res. 2008;10(3):e22. http://www.jmir.org/2008/3/e22/).

  33. Popper K. Conjectures and refutations: the growth of scientific knowledge. London: Routledge and Kegan Paul; 1972.

    Google Scholar 

  34. Polanyi M. Personal knowledge. Towards a Post-Critical Philosophy. London: Routledge; 1958.

    Google Scholar 

  35. Kurtz CF, Snowden DJ. The new dynamics of strategy: sense-making in a complex and complicated world. IBM Syst J. 2003;42(3):462–83.

    Article  Google Scholar 

  36. Sturmberg JP, Martin CM. Knowing—in medicine. J Eval Clin Pract. 2008;14(5):767–70.

    Article  PubMed  Google Scholar 

  37. Manchikanti L, Falco FJ, Hirsch JA. Necessity and implications of ICD-10: facts and fallacies. Pain Phys. 2011;14(5):E405–25.

    Google Scholar 

  38. Cookson WO. Disease taxonomy—polygenic. Br Med Bull. 1999;55(2):358–65.

    Article  PubMed  CAS  Google Scholar 

  39. Lewis C. Exploring the biological meaning of disease and health. 2003. http://sites.google.com/site/sjlewis55/presentations/vienna2003. Accessed 14 May 2011.

  40. Sturmberg JP. The foundations of primary care. Daring to be different. Oxford, San Francisco: Radcliffe Medical Press; 2007.

    Google Scholar 

  41. Rosenberg CE. Disease in history: frames and framers. Milbank Q. 1989;67 Suppl 1:1–15.

    Article  PubMed  Google Scholar 

  42. Fugelli P. Clinical practice: between Aristotle and Cochrane. Schweiz Med Wochenschr. 1998;128:184–8.

    PubMed  CAS  Google Scholar 

  43. Starfield B. Diseases or morbidity burden? The John Hopkins University’s 2008 ACG International Risk Adjustment Conference, Las Vegas. 2007. http://www.acg.jhsph.edu.

  44. White K, Williams F, Greenberg B. The ecology of medical care. N Engl J Med. 1961;265(18):885–92.

    Article  PubMed  CAS  Google Scholar 

  45. Green L, Fryer G, Yawn B, Lanier D, Dovey S. The ecology of medical care revisited. N Engl J Med. 2001;344(26):2021–5.

    Article  PubMed  CAS  Google Scholar 

  46. Port S, Demer L, Jennrich R, Walter D, Garfinkel A. Systolic blood pressure and mortality. Lancet. 2000;355(3):175–80.

    Article  PubMed  CAS  Google Scholar 

  47. Lynch J, Smith GD, Harper S, Hillemeier M, Ross N, Kaplan GA, et al. Is income inequality a determinant of population health? Part 1. A systematic review. Milbank Q. 2004;82(1):5–99.

    Article  PubMed  Google Scholar 

  48. Wehr TA, Goodwin FK. Rapid cycling in manic-depressives induced by tricyclic antidepressants. Arch Gen Psychiatry. 1979;36(5):555–9.

    Article  PubMed  CAS  Google Scholar 

  49. Wehr TA, Goodwin FK, Wirz-Justice A, Breitmaier J, Craig C. 48-Hour sleep-wake cycles in manic-depressive illness: naturalistic observations and sleep deprivation experiments. Arch Gen Psychiatry. 1982;39(5):559–65.

    Article  PubMed  CAS  Google Scholar 

  50. Wehr TA, Goodwin FK. Circadian rhythms in psychiatry. Pacific Grove, CA: Boxwood Press; 1983.

    Google Scholar 

  51. Marriott HJL. Practical electrocardiography. Baltimore: Williams & Wilkins; 1980.

    Google Scholar 

  52. Chay TR, Rinzel J. Bursting, beating, and chaos in an excitable membrane model. Biophys J. 1985;47(3):357–66.

    Article  PubMed  CAS  Google Scholar 

  53. Lebrun P, Atwater I. Chaotic and irregular bursting electrical activity in mouse pancreatic B-cells. Biophys J. 1985;48(3):529–31.

    Article  PubMed  CAS  Google Scholar 

  54. Holden A, Winlow W, Haydon P. The induction of periodic and chaotic activity in a molluscan neurone. Biol Cybern. 1982;43(3):169–73.

    Article  PubMed  CAS  Google Scholar 

  55. Holden AV, Muhamad MA. The identification of deterministic chaos in the activity of single neurons. J Electrophysiol Tech. 1984;11(3):135–47.

    Google Scholar 

  56. Roy JP, Clercq M, Steriade M, Deschenes M. Electrophysiology of neurons of lateral thalamic nuclei in cat: mechanisms of long-lasting hyperpolarizations. J Neurophysiol. 1984;51(6):1220–35.

    PubMed  CAS  Google Scholar 

  57. Spehlmann R. EEG primer. New York: Elsevier Biomedical Press; 1985.

    Google Scholar 

  58. Prince DA. Microelectrode studies of penicillin foci. In: Jasper HH, Ward AA, Pope A, editors. Basic mechanisms of the epilepsies. Boston: Little Brown; 1969. p. 320–8.

    Google Scholar 

  59. Wintrobe MM. Clinical hematology. 7th ed. Philadelphia: Lea & Febiger; 1976.

    Google Scholar 

  60. Adams RD, Victor M. Principles of neurology. Toronto: McGraw-Hill; 1985.

    Google Scholar 

  61. Marsden CD. The pathophysiology of movement disorders. Neurol Clin. 1984;2(3):435–59.

    PubMed  CAS  Google Scholar 

  62. Purves D, Sakmann B. Membrane properties underlying spontaneous activity of denervated muscle fibres. J Physiol. 1974;239(1):125–53.

    PubMed  CAS  Google Scholar 

  63. Kimura J. Electrodiagnosis in diseases of nerve and muscle: principle and practice. Philadelphia: Davis; 1983.

    Google Scholar 

  64. Miller NR. Walsh and Hoyt’s clinical neuro-opthalmology. Baltimore: Williams & Wilkins; 1985.

    Google Scholar 

  65. Sharpe J, Fletcher W. Saccadic intrusions and oscillations. Can J Neurol Sci. 1984;11(4):426–33.

    PubMed  CAS  Google Scholar 

  66. Yoss R, Moyer N, Hollenhorst R. Pupil size and spontaneous pupillary waves associated with alertness, drowsiness, and sleep. Neurology. 1970;20(6):545–54.

    Article  PubMed  CAS  Google Scholar 

  67. Yoss RE, Mover NJ, Hollenhorst RW. Hippus and other spontaneous rhythmic pupillary waves. Am J Ophthalmol. 1970;70(6):935–41.

    PubMed  CAS  Google Scholar 

  68. Plum F, Posner B. The diagnosis of stupor and coma. Philadelphia: Davies; 1980.

    Google Scholar 

  69. Specht H, Fruhman G. Incidence of periodic breathing in 2000 subjects without pulmonary or neurological disease. Bull Physiopathol Respir (Nancy). 1972;8(5):1075–82.

    CAS  Google Scholar 

  70. Mackey MC, Milton JG. Dynamical diseases. Ann N Y Acad Sci. 1987;504:16–32.

    Article  PubMed  CAS  Google Scholar 

  71. Vaillancourt DE, Newell KM. Changing complexity in human behavior and physiology through aging and disease. Neurobiol Aging. 2002;23(1):1–11.

    Article  PubMed  Google Scholar 

  72. Scheibel AB. Falls, motor dysfunction, and correlative neurohistologic changes in the elderly. Clin Geriatr Med. 1985;1(3):671–6.

    PubMed  CAS  Google Scholar 

  73. Mosekilde L. Age-related changes in vertebral trabecular bone architecture—assessed by a new method. Bone. 1988;9(4):247–50.

    Article  PubMed  CAS  Google Scholar 

  74. Lipsitz LA, Goldberger AL. Loss of ‘complexity’ and aging. Potential applications of fractals and chaos theory to senescence. JAMA. 1992;267(13):1806–9.

    Article  PubMed  CAS  Google Scholar 

  75. Iyengar N, Peng CK, Morin R, Goldberger AL, Lipsitz LA. Age-related alterations in the fractal scaling of cardiac interbeat interval dynamics. Am J Physiol Regul Integr Comp Physiol. 1996;271(4):R1078–84.

    CAS  Google Scholar 

  76. Kaplan DT, Furman MI, Pincus SM, Ryan SM, Lipsitz LA, Goldberger AL. Aging and the complexity of cardiovascular dynamics. Biophys J. 1991;59(4):915–49.

    Article  Google Scholar 

  77. Greenspan SL, Klibanski A, Rowe JW, Elahi D. Age-related alterations in pulsatile secretion of TSH: role of dopaminergic regulation. Am J Physiol Endocrinol Metab. 1991;260(3):E486–91.

    CAS  Google Scholar 

  78. Frolkis VV, Bezrukov VV. Aging of the central nervous system. Interdiscip Top Gerontol. 1979;16:87–9.

    Google Scholar 

  79. Mader S. Hearing impairment in elderly persons. J Am Geriatr Soc. 1984;32(7):548–53.

    PubMed  CAS  Google Scholar 

  80. Stiehm JH, Townsend NW. The U.S. Army War College: military education in a democracy. Philadelphia: Temple University Press; 2002.

    Google Scholar 

  81. Caron D. It’s a VUCA world. 2009. http://www.slideshare.net/dcaron/its-a-vuca-world-cips-cio-march-5-2009-draft. last accessed: 22-Nov-21012.

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Authors and Affiliations

  1. Department of General Practice, Monash University, Melbourne, VIC, Australia

    Joachim P. Sturmberg

  2. The Newcastle University, Newcastle, 3010, Wamberal, NSW, 2260, Australia

    Joachim P. Sturmberg

  3. Northern Ontario School of Medicine, Greater Sudbury, P3E 2C6, ON, Canada

    Carmel M. Martin

  4. Department of Public Health and Primary Care, Trinity College, Dublin, College Green, Dublin D2, Ireland

    Carmel M. Martin

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  1. , Department of General Practice, Monash University, PO Box 3010, Wamberal, 2260, New South Wales, Australia

    Joachim P. Sturmberg

  2. Northern Ontario School of Medicine, Merchandise Mart Plaza, Suite 1212 222, Chicago, 60654, Illinois, USA

    Carmel M. Martin

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Sturmberg, J.P., Martin, C.M. (2013). Complexity in Health: An Introduction. In: Sturmberg, J., Martin, C. (eds) Handbook of Systems and Complexity in Health. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4998-0_1

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