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)

The concept of “autonomy”, once at the core of the original enactivist proposal in The Embodied Mind, is nowadays ignored or neglected by some of the most prominent contemporary enactivists approaches. Theories of autonomy, however, come to fill a theoretical gap that sensorimotor accounts of cognition cannot ignore: they provide a naturalized account of normativity and the resources to ground the identity of a cognitive subject in its specific mode of organization. There are, however, good reasons for the contemporary neglect (...) of autonomy as a relevant concept for enactivism. On the one hand, the concept of autonomy has too often been assimilated into autopoiesis and the implications are not always clear for a dynamical sensorimotor approach to cognitive science. On the other hand, the foundational enactivist proposal displays a metaphysical tension between the concept of operational closure, deployed as constitutive, and that of structural coupling ; making it hard to reconcile with the claim that experience is sensorimotorly constituted. This tension is particularly apparent when Varela et al. propose Bittorio as a model of the operational closure of the nervous system as it fails to satisfy the required conditions for a sensorimotor constitution of experience. It is, however, possible to solve these problems by re-considering autonomy at the level of sensorimotor neurodynamics. Two recent robotic simulation models are used for this task, illustrating the notion of strong sensorimotor dependency of neurodynamic patterns, and their networked intertwinement. The concept of habit is proposed as an enactivist building block for cognitive theorizing, re-conceptualizing mental life as a habit ecology, tied within an agent’s behaviour generating mechanism in coordination with its environment. Norms can be naturalized in terms of dynamic, interactively self-sustaining, coherentism. This conception of autonomous sensorimotor agency is put in contrast with those enactive approaches that reject autonomy or neglect the theoretical resources it has to offer for the project of naturalizing minds. (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)

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)

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)