Resolving Complexity Through Synthesis

The complexity of our understanding about the problems in the clinical trials system now (potentially) rivals the complexity of the clinical trials system itself. Often complexity of systems is best understood through complex thought, but developing solutions involves resolving this complexity first. As we move towards a synthesis of our ideas, we hope to unpack this complexity to give us a clear idea of the problems in the system and how we can develop interventions to improve outcomes.

A snapshot of this is provided above. As we move to the left, we chart out the impacts of the relevant problem. Moving to the right allows us to unpack why this problem is present. Visually, here we were considering the upstream reasons and downstream impacts of having a clinical trials system based too closely on the biomedical model of health. Right away, we see a lot of impacts this has on the current system, and how the downstream issues are often interrelated. Upstream, we see that there’s a multitude of reasons why the the biomedical model of health is entrenched in the clinical trials system. This cannot be unpacked in one setting.

But, as a mathematician, it’s critical to understand why a problem exists in a system. Prediction is not only based on what has happened and what is currently happening, but why it happened, and why it is happening. This reductionist method of looking at the system, which I am often chided for by my social science colleagues, has its drawbacks, but its power lies in making assumptions and empirically testing them. At times, an absurd reason for the explanation of a problem through this method can actually lead to deeper insight if we look carefully at its correlates.

At the other end of the spectrum, this method simultaneously allows for holistic approaches to looking at the system as well. By expanding a problem through the impacts and the whys, connections can be made at a systems level (and even with other problems) yielding insights beyond the circles and lines that map out the explanation.

In this phase of the project, restricting ourselves to one methodology of synthesis, or only a few topics of study, could be catastrophic. We’ve come a long way to block out any idea at this point, and while our individual brains might hurt when going through this activity, our collective brain is growing. And it’s a complex collective brain that can resolve the complexity of the clinical trials system.

Sauleh Siddiqui