Who says systems are ‘soft’? Demanding legitimacy and center ring in the health truth forum

Who says systems are ‘soft’? Demanding legitimacy and center ring in the health truth forum
Unpublished manuscript
Michele Battle-Fisher

Who says systems theory is soft? Ms. Ronda Rousey became the first female mixed martial arts (MMA) Ultimate Fighting Conference champion in February 2013 in the first ever headliner fight of female UFC fighters in a male-dominated sport. I watched her ritualized “weigh in” against a fine, muscular competitor in Liz Carmouche. There is a strange fractal beauty in administering an arm bar in a padded, neon-bathed chain-linked octagon. But there is a kindred connection to adaptation that must not be lost here. Systems may appear to be the “feminine” counterpart of the masculine, gold standard methods revered in health research today. But complexity is no less important and there is strength and flexibility in those loins. With all of its fractal beauty, mixed martial artists manipulate weaknesses in an opponent. Somehow it is even more intoxicating to see women who have been constrained to the submissive, demure gender role to pin her opponent. If a MMA fighter becomes “static”, she will be overrun by the power of the opposing fighter (agent). We in systems harness the power of normalizing brokerage within ego networks and laser point to uncovering and mitigating weaknesses in an adaptive system. In a previous blog post, I pondered my own stance (http://wp.me/p32X8n-an) on what fidelity is. As I will discuss a recent commentary of Ghaffar et al (2013) and some political stances of John S. Mill, it is time for systems researchers to weigh in and demand legitimacy of what is really going on in the widening chiasm in legitimacy. I fear that if systems remains entrenched in the periphery of influence, the adaptive nature of health disparities will be inadequately explored. This is a monumental omission impeding a more authentic and all-encompassing “truth” of health.
I see quite a few discussions of systems in health in the commentaries and viewpoints sections of peer-reviewed journals. These journal sections are often populated by writings highlighting controversial topics or perceived gaps in the present literature. Ghaffar et al. (2012) speak of “changing mindsets” and getting a place at the big kids’ table of stakeholders. Systems should be getting its own house in order by accepting and follow a unified identity of our own (Ghaffar et al., 2012). There certainly should be some self-love. But I think that before these wonderful aspirations of playing nicely on the playground can happen, time must be taken to grapple with the blockages to the very idea of truth. In other words, can our complex truth be at all compatible with a conventionally accepted statistical truth? Do we accept our own complex truth? Few, aside from the stalwart “all is relative” Geertz-flavored interpretists, question statistics fundamentally. Complexity still has its naysayers.
The will of society, with our funny little orb of health hovering and bobbing within it, aligns religiously with the will of the majority. Mill (1947) wrote “On Liberty” in 1895 as a treatise on the overlay of personal responsibility and an authoritative state. He advocated a balance of pareto efficiency (good for the majority, which is fundamental ideologically to public health) and personal autonomy (translation-but you cannot make me do it for my own good). For the sake of this argument, Mill also defends the existence of protection against prevailing feelings and opinions (Mill, 1947). Many in science would not label our scientific results as feeling “mental models” (or maybe they do???). The explanations that we view as valid or potentially valid are at the mercy of the “denial of usefulness” (Mill, 1947). Why is social network analysis even needed when epidemiology has served well? Let me restate. Why is social network analysis needed when epidemiology has served the existing questions well? That is the point. The questions of social networks and conventional epidemiology differ. Many of the complexity questions have yet to be asked (translated- published in a top-tier journal). Scientific method calls for a sensible harmony among research questions, methods and results. For progress to be made, the need for an alternative intellectual irritant such as the outsider of systems is often necessary to spur discussion and move that health discussion into novel and innovative directions. Mill (1947) wrote: “men are not more zealous for truth than they often are for error”. I add that human nature seeks making adjustments to our reasoning out of realized and accepted necessity. We do not expend unnecessary energy when we are comfortable with the status quo. Mill (1947) explains our propensity toward remedy as being tied to 2 factors: the direction of the sentiment (as in complexity versus convention) and the degree of interest in that sentiment. Otherwise, we are indifferent or opposed to seeking out alternatives. Is pareto efficiency of the public we serve in healthcare adequate served by ignoring complexity? No.

References
Curtis, M. (ed.) (1985). The Great Political Theories- volume 1. New York: Avon Books.
Ghaffir, A et al. (Feb. 9, 2013). Changing mindsets in health policy and systems research. The Lancet. 381, 436-37.
Mill, J.S. (1947) On Liberty. Wheeling,IL: Harlan Davidson.
“Rousey wins first UFC women’s match”. Retrieved on February 25, 2013 from http://www.cnn.com/2013/02/24/us/ufc-women-fight/index.html?hpt=hp_c2.

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