Intended for healthcare professionals

Education And Debate Complexity science

The challenge of complexity in health care

BMJ 2001; 323 doi: (Published 15 September 2001) Cite this as: BMJ 2001;323:625

The Citizen's new Toolkit

Dear Sir

I am delighted that Prof Ian Reid has declared some support for my
musings and whilst he puts his foot delicately in the waters of Lake
Pseudoscience , I have torn all my clothes off and gone running in up to
my neck.

Those who know me will be in no doubt that, if there is one person
who would not dream of allowing NHS management to stifle the enabling
messages of Chaos (and it is no theory surely), it is I. I am fortunate in
having a mind that does both..and. Indeed, I always know when I am
depressed because I lose the sense of wonder that I always experience when
I am well, on considering life's complexities and the revelations of
scientific discovery.

Reductionism is not part of my ethos, because my brain wants to put
it all back together again to see the bigger picture, not the dis-
aggregated one. Perhaps, the very loss of this ability when depressed is
because at that point key elements of my brain are themselves dis-

So, I can clearly see the Emperor's Toolkit, indeed I can see right
through him - but surely the point of that story was that the Citizens
beheld his nakedness, whilst he was blissfully unaware. My enthusiasm for
what is not pseudoscience, but as established as any of its scientific
progenitors, is that it enables the Citizens to see that the Emperor is
naked, while the buffon tries to pretend that he knows better and
continually lauds it over them with all his pomp and flatulence.

There, an entire paragraph with no mention even of clinical
governance, evidence-based medicine or performance indicators.

Yours Faithfully

Dr Chris Manning

Competing interests: No competing interests

02 October 2001
Chris Manning
Chair Depression Alliance and CEO PriMHE (Primary care Mental Health and Education)