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October 1, 2008

The Conflict Between Complex Systems and Reductionism

Author Affiliations

Author Affiliations: Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan.

JAMA. 2008;300(13):1580-1581. doi:10.1001/jama.300.13.1580

Descartes' reductionist principle has had a profound influence on medicine. Similar to repairing a clock in which each broken part is fixed in order, investigators have attempted to discover causal relationships among key components of an individual and to treat those components accordingly. For example, if most of the morbidity in patients with diabetes is caused by high blood glucose levels, then control of those levels should return the system to normal and the patient's health problems should disappear. However, in one recent study this strategy of more intensive glucose control resulted in increased risk of death.1 Likewise, chemotherapy often initially reduces tumor size but also produces severe adverse effects leading to other complications, including the promotion of secondary tumors. Most important, little evidence exists that more aggressive chemotherapies prolong life for many patients.2-4 In fact, chemotherapies may have overall negative effects for some patients.