Intended for healthcare professionals

Rapid response to:

Education And Debate Complexity science

Coping with complexity: educating for capability

BMJ 2001; 323 doi: (Published 06 October 2001) Cite this as: BMJ 2001;323:799

Rapid Response:

A Different Approach

I have enjoyed this fresh look at the world of medicine (1) but I am
not sure that swapping the old rules for the mathematics of complexity
theory are right. Maybe the rules of complex systems are simpler and more
fundamental than we think.
Frijof Capra in his seminal work "The Tao of Physics" (2) identifies 6
parameters that should govern scientific

1. Knowledge of the structure does not predict function

2. Process is primary and determines structure.

3. The observer is part of the whole system

4. There are no fundamental equations.

5. All descriptions are approximations.

6. Co-operation not dominance should prevail.

These paradigms can be applied to the world of medicine (2) and have
provided me with a different perspective for my clinical practice. I
suspect they are applicable to all other specialities. If they are
not,then Capra's paradigms are flawed!

I was sorry that Plsek, Fraser and Greenhaulgh (1) did not address
the issue of research in their paper though they indicated that they
planned to.

When I applied Capra's paradigms to the area of research into chronic
pain (3), I was able to understand why such research is so difficult to
undertake. Classical approaches to clinical trials (RCTs for
example)flounder when trying to assess the effects of drugs with complex
neuro-chemical effects in patients who's pains are a complex of
psychological, social and spiritual elements.

A visit to the leading pain journals will reveal the rarity of
classical clinical trials. Yet chronic pain afflicts about 1 person in 12.

In complexity lies the reason why it is so difficult to evaluate the
effects of Beta Interferon or Cannabinoids in Multiple Sclerosis. Current
mainstream clinical trial methodology does not overcome the problem of
complexity in patients. We need new approaches to the evaluation of
therapies that not only move away from the analytical reductionist
approach but also remain rigorous and acceptable.

Yours sincerely


1. Plsek PE and Greenhalgh T (2001) "Complexity science: The challenge
of complexity in health care" BMJ 323:625-628 to 799-803.

2. Capra F. Tao of Physics. London: Flamingo 1992, 3rd Edition

3. Notcutt WG. The Tao of Pain. Pain Reviews 1998;5 203-215

Competing Interests: None

Competing interests: No competing interests

05 November 2001
William Notcutt
Consultant Anaesthetist
James Paget Hospital, Great Yarmouth