This weeks presentation is a 2009 TedMed talk by David Agus on the application of complexity science to cancer research. The talk focuses on the limitations of trying to understand cancer using reductionist thinking and how this limits potentially significant advances.
Agus illustrates this dramatically, showing that since 1950, after more than half a century of technological advances, extensive research and new treatments, there has only been a marginal improvement in cancer death rates in the US. As he puts it “in general, we haven’t made any impact at all in the war on cancer”. At the heart of this lack of progress, according to Agus, is that much of this effort has focused on symptoms: “our dictionary for describing cancer is very very poor – it’s basically symptoms, its manifestations…”
Meanwhile, some of the most recent approaches that have helped improve recovery rates have dealt at cancer as a complex adaptive system that is interconnected with the wider system of the human body. For example, Agus cites clinical trials showing that taking drugs usually prescribed for osteoporosis and acne actually reduced cancer recurrence by up to 35%.
Finding more ways to treat cancer as a dynamic system is more important and potentially valuable, according to Agus, than ‘focusing down’ and dealing directly with the specific symptoms.
Perhaps obviously, the talk left me thinking about loved ones who have had treatment for cancer over the years.
It also left me reflecting on potential parallels with how we generally study and deal with poverty in developing countries, which as Bill Easterly reminds us again, has also been a 6 decade-long project facing some serious issues. The direct, reductionist approach to poverty holds sway. The expectation is that aid agencies will set out a clear programme and not to renege on their promises, despite how circumstances change. This can be problematic in the extreme.
Olivier De Schutter, Ban Ki Moon’s special rapporteur on food, makes the point in a direct echo of Agus’ talk:
the MDGs, as they are currently conceived, address the symptoms of poverty and underdevelopment, but mostly ignore the deeper causes… the MDGs may divert attention from the mechanisms that produce underdevelopment.”
So what would the ‘war on poverty’ look like if we tried to move away from directly dealing with the symptoms of poverty? One answer might be from the work of John Kay, one of the UK’s leading economists, who advocates ‘oblique strategies’:
paradoxical as it sounds, many goals are more likely to be achieved when pursued indirectly. Whether overcoming geographical obstacles, winning decisive battles or meeting sales targets, history shows that oblique approaches are the most successful, especially in difficult terrain.
Obliquity is necessary because we live in an world of uncertainty and complexity; the problems we encounter aren’t always clear – and we often can’t pinpoint what our goals are anyway; circumstances change; people change – and are infuriatingly hard to predict.