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LETTERS: Ian Reid and William Notcutt Complexity science BMJ 2002; 324: 171 [Full text]

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Fear of the unknown and the unpredictable

Gary Lafferty   (22 January 2002)

Re: let them eat complexity

Tom P Marshall   (24 January 2002)

Fear of the unknown and the unpredictable 22 January 2002
Gary Lafferty, clinical audit manager Sheffield Children's Hospital Send response to journal: Re: Fear of the unknown and the unpredictable	The popularity of complexity theory and many other attempts at modelling complex situations reflects, I believe, an almost universal loss of confidence in our ability to manage our world within the limits of scientific knowledge and rationalism. Where once pragmatism and judgement might have prevailed we find one tired metaphor after another being paraded in sub-scientific garb. It is no longer acceptable to say, 'we do not know' in answer to a pressing problem. A parallel phenomenon is the inability to accept that all types of risk can not, and perhaps should not, be assessed, managed, removed, or mitigated. There will always be better ways to model phenomena but the models must all have some bases in well-documented observations and be tested for their ability to make useful predictions. However, there are vast swaths of social behaviour in organised settings that are not currently amenable to modelling. To pretend that they can be modelled now, or in the near future, with just a little effort is highly misleading. We have to learn to trust people to use their judgement within systems of governance that achieve accountability while assuming good faith and the possibility of error and accepting the limits of the known.
Re: let them eat complexity 24 January 2002
Tom P Marshall, Lecturer - Public Health Birmingham University B15 2TT Send response to journal: Re: Re: let them eat complexity	From the opening assertion Plsek et al's original article makes sweeping and incorrect assertions. Is health care in the early 21st century really more complex than 50, 100 or 200 years ago? By some measures yes, by others no. We have a single source of finance (NHS), standardised medical and nursing curriculae, the same pharmacologically pure drugs are used across the world. None of these were true even 100 years ago. The claim that Newton saw the universe as a large, simple machine - hardly likely in a man who wrote so extensively on alchemy. Pardon my ignorance but I believed he developed a theory to take account of the empirical observations available to him at the time. Like Professor Reid, I am not persuaded that an analogy between the mathematics of complexity and the day to day functioning of the health service adds anything to my understanding of how people interact. Perhaps I am profoundly stupid. Perhaps the authors of the original article are profoundly insightful. Nevertheless it is the responsibility of the proponent of the argument to demonstrate how an understanding of this kind of mathematics is a necessary prerequisite to good management. How it has improved the lives of health care staff and patients. A skeptic could view this as an attempt to lend a veneer of profundity to common sense. In the empirical tradition, readers are entitled to be skeptical.