Medical science has progressed spectacularly since the era when malaria was thought to be the result of bad air and witches' breath contained assorted pathologies. The predominant strategy in our grasp for greater knowledge goes by the generic term of reductionism -- the taking apart of the human organism to see what it is made of and how it works.
The microscope and intricate tools of molecular biology have led to warehouses full of new knowledge. Such "atomization" and reductionism have similarly led to specialization and sub-specialization in medicine. A recent survey reports that there are now about 200 subfractions of medicine. (4) Most editorials are critical of this trend. The specialty of bariatric surgery is a particular affront to me.
But such progress by dissection has its limits. A critical article by Nobel prize-winning physicist Philip Anderson in Science a few years ago was entitled "More is Different." (1) This of course is only an echo of what Aristotle taught us two millennia ago: The whole is more, often much more, than the simple sum of the parts.
Mindful of this restriction in reductionistic pursuit, a small group of us put on a conference at the NIH in 1992, which we entitled "the Dynamic and Energetic Bases of Health and Aging." (2) For three days, we held forth on these global ideas, the ideas of networks and how everything is interdependent.
The topic of aging is particularly susceptible to such analysis because aging is not a component issue, but rather a system domain. We discussed various aspects of this, and after our conclusion we wrote a summary report to Elias Zerhouni, who was then the chief of the NIH, and recommended to him that he consider the creation of a Systems Center at the NIH rather than the current numerous silos that barely talk to one another. His response was to appoint Francis Collins, splitter extraordinaire, to be in charge of the whole NIH. So our prescription awaits further emphasis.
Many universities now have developed departments of systems biology. This domain is markedly more complicated than the standard component approach.
The entire gene story is a recital of reductionism gone berserk. Everyone now seems to recognize this. Lewontin's book "Not in our Genes" was the signal for this backlash. (3) Aging's most prominent pathology, frailty, is similarly, subject to a systems analysis. Is frailty a categorical component disease, or is it more the result of a system wide degradation?
The appropriate term for this bottom's up approach is "emergence," in which the hierarchical level of choice is separate and distinct from those above and below and must be informed in situ rather than by extension. (5) A 747 or a lasagna or an elephant are examples of emergent creations that are not inexplicable by adding up their components.
Emergence and complexity have their own temples. The Santa Fe Institute is notable in this domain. I gave a talk there to the scientists a few years ago in which I chose to expound my theories on aging as an emergent scheme. I thought that this might prompt some counter reaction. They looked at me and said, "of course, it is a tautology."
Aging and frailty are not component issues. They are system features. So I, your friendly geriatrician, consider myself a lumper. It is not a tidy job. It is complicated. The complexity is vast. Its uncertainty is even greater, but is this not, in truth, a description of what life is?
To pretend any thing else is a delusion. That is what life is all about and makes it interesting.
Long live us lumpers. Beware of splitters.
References:
1) Anderson P, Rose, Kamen, More is Different Science 1972; 177:492-392.
2) www.biodynamichealthaging.org/confagenda%2011_02pat.
3) Lewontin R, Not in our Genes 1984, Pantheon Press, NY.
4) www.abms.org. accessed 12/11/2013
5) Morowitz HJ The Emergence of Everything Oxford Press 2002, NY