Organisational Relativity—Changing Our Perspective on Health and Health Care
Nearing the 160th anniversary of the publication of Darwin’s theory of evolution, it is important to reflect that he expressed two sides to the process of evolutionary change, ‘survival of the fittest’ and a ‘tangled bank’. The ‘tangled bank’ he envisaged saw the interplay between organisms of different species ‘dependent on each other in so complex a manner’. More recently, Kauffman reframed the ‘survival’ and ‘variation’ questions in terms of new doors opening for species by variation, rather than survival against the odds due to random evolutionary bias. This alternate view of the ‘adjacent possible’ recognises, as Darwin did, that within organisms there exists natural variation, this variation opens up new possibilities for life to evolve. The ‘adjacent possible’ opened up by the humble telephone has given rise to the Internet, to the success of Amazon, Google, and Twitter, all of which have flooded this space opened up by mass communication and smart phones. Kauffman contests that life exists in the complex domain between ordered and chaotic systems poised at the edge of chaos, where the capacity of a system to evolve is optimised. More recently Noble has introduced the concept of biological relativity in which, in deference to Einstein, contests that there is no privileged position of control in biology, that the genome is neither the ‘blind watchmaker’ nor the conductor of the orchestra. In reality, Noble suggests, it is the complex interaction of the environment with the organism, its cells and intracellular environment that brings out life in all its diversity and co-evolutionary development—Darwin’s tangled bank.
This paper seeks to explode the myth that the biological systems of life, the health disease interface in humans, the organisation of society, or healthcare in particular, can be thought of as having a single central controller which can be manipulated to produce desired outcomes. By exploring the extent of our current knowledge and using lessons learnt from molecular biology I hope to dispel the myth that these systems can succumb to human intellect and, specifically in the organisation of health and healthcare, we need to adopt are holistic approach and abandon a reductionist, simplistic, perspective.
I would like to thank the organisers of the 3rd International Conference for Systems and Complexity for Health, Washington, DC—October 2017, for giving me the opportunity to present the content on which this chapter is based and to Joachim Sturmberg for his hard work, dedication and guidance in allowing my ideas to come to life in print.
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