The emerging concept of systems medicine (or ‘P4 medicine’—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards ‘precision medicine’. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical (...) holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call ‘holistic medicalization’: Each person’s whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call ‘the medicalization of health and life itself’. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention). (shrink)

Complexity arises from interaction dynamics, but its forms are co-determined by the operative constraints within which the dynamics are expressed. The basic interaction dynamics underlying complex systems is mostly well understood. The formation and operation of constraints is often not, and oftener under appreciated. The attempt to reduce constraints to basic interaction fails in key cases. The overall aim of this paper is to highlight the key role played by constraints in shaping the field of complex systems. Following an introduction (...) to constraints, the paper develops the roles of constraints in specifying forms of complexity and illustrates the roles of constraints in formulating the fundamental challenges to understanding posed by complex systems. (shrink)

Medicalization is frequently defined as a process by which some non-medical aspects of human life become to be considered as medical problems. Overdiagnosis, on the other hand, is most often defined as diagnosing a biomedical condition that in the absence of testing would not cause symptoms or death in the person’s lifetime. Medicalization and overdiagnosis are related concepts as both expand the extension of the concept of disease. They are both often used normatively to critique unwarranted or contested expansion of (...) medicine and to address health services that are considered to be unnecessary, futile, or even harmful. However, there are important differences between the concepts, as not all cases of overdiagnosis are medicalizations and not all cases of medicalizations are overdiagnosis. The objective of this article is to clarify the differences between medicalization and overdiagnosis. It will demonstrate how the subject matter of medicalization traditionally has been non-medical (social or cultural everyday life) phenomena, while the subject matter of overdiagnosis has been biological or biomolecular conditions or processes acknowledged being potentially harmful. They also refer to different types of uncertainty: medicalization is concerned with indeterminacy, while overdiagnosis is concerned with lack of prognostic knowledge. Medicalization is dealing with sickness (sick role) while overdiagnosis with disease. Despite these differences, medicalization and overdiagnosis are becoming more alike. Medicalization is expanding, encompassing the more “technical” aspects of overdiagnosis, while overdiagnosis is becoming more ideologized. Moreover, with new trends in modern medicine, such as P4 (preventive, predictive, personal, and participatory) medicine, medicalization will become all-encompassing, while overdiagnosis more or less may dissolve. In the end they may converge in some total “iatrogenization.” In doing so, the concepts may lose their precision and critical sting. (shrink)

In this paper we explore the organizational conditions underlying the emergence of organisms at the multicellular level. More specifically, we shall propose a general theoretical scheme according to which a multicellular organism is an ensemble of cells that effectively regulates its own development through collective mechanisms of control of cell differentiation and cell division processes. This theoretical result derives from the detailed study of the ontogenetic development of three multicellular systems and, in particular, of their corresponding cell-to-cell signaling networks. The (...) case study supports our claim that a specific type of functional integration among the cells of a multicellular ensemble , is required for it to qualify as a proper organism. Finally, we argue why a multicellular system exhibiting this type of functionally differentiated and integrated developmental organization becomes a self-determining collective entity and, therefore, should be considered as a second-order autonomous system. (shrink)

What does it mean to be an aesthetic beholder? Is it different than simply being a perceiver? Most theories of aesthetic perception focus on 1) features of the perceived object and its presentation or 2) on psychological evaluative or emotional responses and intentions of perceiver and artist. In this chapter I propose that we need to look at the process of engaged perception itself, and further that this temporal process of be- coming a beholder must be understood in its embodied, (...) contextual and dynamic speci- ficity. Through both phenomenological and neuroscientific explorations I analyze what is characteristic about a more “aesthetic stance” and argue that there is a certain asym- metry between beholder and beheld, which has to do with a disengagement of goal- directed action, and which allows for other kinds of perceptual involvement than in a more “practical stance”. It is a multi-disciplinary project integrating a sensorimotor no- tion of aesthetic affordances, 18th century philosophy, and large-scale brain network findings. What ensues is a new dynamic framework for future empirical and theoretical research on aesthetic perception. (shrink)

Nowadays, aesthetics are generally considered as a crucial aspect that affects the way we confront things, events, and states of affairs. However, the functional role of aesthetics in the interaction between agent and environment has not been addressed effectively. Our objective here is to provide an explanation concerning the role of aesthetics, and especially, of the aesthetic experience as a fundamental bodily and emotional activity in the respective interactions. An explanation of the functional role of the aesthetic experience could offer (...) new orientations to our understanding of embodied cognition and of aesthetics as a fundamental part of it. We argue that aesthetic experience, especially its emotional dimension, is an evaluative process that influences the anticipation for stable and successful interactions with the environment. In other words, aesthetics facilitates sense-making as they affect what might be anticipated by an action tendency with respect to an environment. (shrink)

The notion of malfunction is critical to biological explanation. It provides a test-bed for the normative character of functional attribution. Theories of biological functioning must permit traits to operate but, at the same time, be judged as malfunctioning (in some naturalized, non-arbitrary sense). Whereas malfunctioning has attracted most attention and discussion in evolutionary etiological approaches, systemic and organizational ones have been less discussed. The most influential of the organizational approaches (by Saborido, Moreno and Mossio) takes a dual-order approach to malfunctions, (...) as a set of functions that fit first-order constitutive norms but fail to obey second-order regulatory ones. We argue that this conception is unnecessarily complicated (malfunctions do not need to arise as a result of two conflicting orders of norms) and too narrow (it excludes canonical cases of malfunctioning). We provide an alternative organizational account grounded on viability theory. The dynamics of the traits that constitute an organism define the normative field of its viability space: sugar must be replaced at certain rate, blood must be pumped at a certain pace, etc. A trait operates normatively when its effects on the viability space correlate positively with the normative field. Three senses of dysfunctionality might be distinguished: subfunctional operations are those that positively correlate with the normative field but quantitatively fail to match the required speed; malfunctional operations are those that do not positively correlate with the normative field; and, nonfunctional traits either don’t operate at all or operate with null effect on the normative field. (shrink)

Living systems employ several mechanisms and behaviors to achieve robustness and maintain themselves under changing internal and external conditions. Regulation stands out from them as a specific form of higher-order control, exerted over the basic regime responsible for the production and maintenance of the organism, and provides the system with the capacity to act on its own constitutive dynamics. It consists in the capability to selectively shift between different available regimes of self-production and self-maintenance in response to specific signals and (...) perturbations, due to the action of a dedicated subsystem which is operationally distinct from the regulated ones. The role of regulation, however, is not exhausted by its contribution to maintain a living system’s viability. While enhancing robustness, regulatory mechanisms play a fundamental role in the realization of an autonomous biological organization. Specifically, they are at the basis of the remarkable integration of biological systems, insofar as they coordinate and modulate the activity of distinct functional subsystems. Moreover, by implementing complex and hierarchically organized control architectures, they allow for an increase in structural and organizational complexity while minimizing fragility. Finally, they endow living systems, from their most basic unicellular instances, with the capability to control their own internal dynamics to adaptively respond to specific features of their interaction with the environment, thus providing the basis for the emergence of minimal forms of cognition. (shrink)

The current disruption of ecosystems and climate systems can be likened to an increase in entropy within our planet. This concept is often linked to the second law of thermodynamics, which predicts a necessary rise in entropy resulting from all material and energy-related processes, including the intricate organisation of living systems. Consequently, discussions surrounding the ongoing crisis commonly carry an underlying sense of fatalism when referencing thermodynamic principles. In this study, we explore how the understanding of life has been harmonized (...) with thermodynamics to show that entropy production is a consequence of heightened complexity in life rather than its breakdown. Furthermore, it is crucial to perform a thermodynamic analysis of the Earth system as a whole to dispel fatalistic assumptions. The extremum principles linked to thermodynamics do not foretell the precise evolution of complex organisations but rather set the thermodynamic boundaries associated with their development. Ultimately, treating the Earth system as an integrated autonomous entity in which life and human societies play pivotal roles is essential for charting a sustainable path forward for humanity. Understanding how to contribute to thermodynamic states that are more conducive to life, rather than hastening the journey towards chaotic states, is paramount for human survival and well-being in the Anthropocene era. (shrink)

El prefijo “auto” en autoorganización y autopoiesis se refiere a la existencia de una identidad o agencialidad implicada en el orden, organización o producción de un sistema que se corresponde con el sistema mismo, en contraste con el diseño o la influencia de carácter externo. La autoorganización (AO) estudia la manera en la que los procesos de un sistema alcanzan de forma espontánea un orden u organización complejo, bien como una estructura o patrón emergente, bien como algún tipo de finalidad (...) o identidad autoconstruida. En este trabajo nos ocupamos del concepto de AO en el contexto de la problemática sobre la naturaleza la vida y de los organismos vivientes. Este concepto se elabora en diferentes tradiciones científicas y filosóficas, a partir de su origen en la filosofía kantiana. La cibernética trata de emular la organización de los seres vivos y su teleología mediante la construcción de máquinas; desarrolla una perspectiva centrada en la regulación y en la causalidad mutua entre componentes del sistema. Estos trabajos, a veces complementados con la teoría de sistemas y la teoría de la información, son fundamentales para el desarrollo de la ciencia del siglo XX, especialmente las ciencias computacionales y la biología. Una segunda corriente surge desde la termodinámica de los procesos irreversibles alejados del equilibrio a partir, entre otros, de los trabajos de la escuela de Bruselas, en la que la AO se explora como la formación espontánea de estructuras de orden disipativo. Una tercera tradición, tal vez la más profundamente kantiana, se desarrolla en el contexto de la biología del desarrollo e integra a las dos mencionadas previamente, pues combina aspectos de las dos previas en el desarrollo ontogenético. Podemos decir que cada una de estas concepciones de la AO se relaciona con modelos paradigmáticos diferentes. La noción de autopoiesis (AP), por su parte, fue propuesta en los años 70 por los biólogos chilenos Humberto Maturana y Francisco Varela para explicar la organización individual de los seres vivos como un proceso dinámico que genera una identidad desde las operaciones del sistema (Maturana y Varela 1973). Puede decirse que hereda y reorganiza ideas de la tradición de la AO, especialmente la kantiana y la cibernética, para proponer una teoría biológica alternativa. El enfoque autopoiético concibe el fenómeno de la vida y a los seres vivos de forma muy diferente a la teoría de la evolución o la biología molecular que constituían las líneas de investigación predominantes en la biología de su tiempo. La teoría subraya como propiedad básica de un sistema viviente su autoconstitución dinámica como unidad dotada de identidad a partir de interacciones entre sus componentes. Sin embargo, aquellas propiedades de la vida consideradas primordiales en el enfoque darwiniano, como la reproducción o la evolución, se ven como secundarias, pues requieren de la existencia previa de sistemas autopoiéticos. El objetivo de esta voz es examinar diferentes aspectos que configuran las tradiciones autoorganizativa y autopoiética, en especial las tensiones conceptuales internas que permiten comprender los desafíos a los que se enfrentan ambas en el marco de la filosofía y la teoría de la biología, así como la forma en que sus posiciones e intuiciones contrastan con otras perspectivas en biología. (shrink)