Context and health outcomes

Abstract

In their analysis of context on health outcomes, Zelda di Blasi and colleagues1Blasi Z Harkness E Ernst E et al.Influence of context effects on health outcomes: a systematic review.Lancet. 2001; 357: 757-762Summary Full Text Full Text PDF PubMed Scopus (957) Google Scholar note inconsistency in the effects of emotional and congnitive care. This study is important since it shows the limitations of modern science: the confident assumption that the world can be understood by a reduction into its component parts; and the application of rule based methods that assume a linear relation between cause and effect.The science of complex adaptive systems recognises a world in which events are directed by the non-linear interaction of many parts.2Cilliers P Complexity and postmodernism. Routledge Press, London1998Google Scholar This new approach infers a limit to predictability that emphasises the importance of the interaction between agents in a system and not the outcomes of this process. An outcome is seen as something learned, which leads to a decision to take certain actions in the knowledge that such action will generally lead not to an issue being solved, but to a new situation in which the whole interactive process can begin again. Organisational action is never that of the active autonomous individual but always occurs in a relation that people have with each other.These interactions organise themselves with reference to themselves into emergent processes of relating at the next point in time on the basis of the historically evolved identities without knowing in advance how the system is going to evolve, or even understanding the current system as a whole. The communication is not digital, algorithmic, or processed, but is arranged as narrative and propositional themes that organise the response of those individuals in their being and doing.3Stacey R Strategic management and organisational dynamics: the challenge of complexity. Pearson Education, London2000Google Scholar The focus is on the primacy of the rich interactions, not the outcome.The unsuccessful application of metaanlysis to the complex non-linear interaction of interpersonal relations reflects the limitations of modern medical science. It is time to move on. In their analysis of context on health outcomes, Zelda di Blasi and colleagues1Blasi Z Harkness E Ernst E et al.Influence of context effects on health outcomes: a systematic review.Lancet. 2001; 357: 757-762Summary Full Text Full Text PDF PubMed Scopus (957) Google Scholar note inconsistency in the effects of emotional and congnitive care. This study is important since it shows the limitations of modern science: the confident assumption that the world can be understood by a reduction into its component parts; and the application of rule based methods that assume a linear relation between cause and effect. The science of complex adaptive systems recognises a world in which events are directed by the non-linear interaction of many parts.2Cilliers P Complexity and postmodernism. Routledge Press, London1998Google Scholar This new approach infers a limit to predictability that emphasises the importance of the interaction between agents in a system and not the outcomes of this process. An outcome is seen as something learned, which leads to a decision to take certain actions in the knowledge that such action will generally lead not to an issue being solved, but to a new situation in which the whole interactive process can begin again. Organisational action is never that of the active autonomous individual but always occurs in a relation that people have with each other. These interactions organise themselves with reference to themselves into emergent processes of relating at the next point in time on the basis of the historically evolved identities without knowing in advance how the system is going to evolve, or even understanding the current system as a whole. The communication is not digital, algorithmic, or processed, but is arranged as narrative and propositional themes that organise the response of those individuals in their being and doing.3Stacey R Strategic management and organisational dynamics: the challenge of complexity. Pearson Education, London2000Google Scholar The focus is on the primacy of the rich interactions, not the outcome. The unsuccessful application of metaanlysis to the complex non-linear interaction of interpersonal relations reflects the limitations of modern medical science. It is time to move on.