Are we being hooked on drugs? a systemic view

Normally, the taking of drugs for health reasons follows the diagnosis of a particular condition which requires this supplement. Ideally this intake is temporary, but in many cases it can become a permanent part of our lives. I came across these cases through a close friend, who was diagnosed with hypothyroidism, a condition through which the Thyroid Gland is unable to produce the quantity of hormones required by the body. In the case of Hypothyroidism, this production is below what would be required by the body. The opposite also occurs, cases when the Thyroid glad produces too much hormones, condition known as Hyperthyroidism.

Throughout my life and studies I have increasingly believed that our human body is a very good adaptive machine, and therefore this permanent drug intake recommendation sounded a bit against what I believed the human body evolution could provide.

This became even more acute some months ago, when an x-ray of  this friend's Thyroid gland showed its severe atrophy to about 25% of its normal size. This nonetheless the fact that she has been taking a supplementary hormone for her condition for the last 20 years. I decided to take a look at this problem with a systemic outlook.

Systemic definition

The health problems that are caused through a deficient hormone level in the body, which in turn is caused by an ill-functioning thyroid gland, can be represented as follows in terms of the System Dynamics methodology:

These have a positive relationship since the higher the hormone insufficiency, the higher the health problems, all else equal. In the same way, the more ill-functioning of the thyroid gland, the higher expected hormone insufficiency. 

To this condition, the accepted intervention is to reduce the hormone insufficiency through a drug that would allow the body to restore the hormone levels it requires. This creates a Balancing Loop as indicted in the following picture:

This can be confirmed through the following though experiment, and simply by following the arrows and considering the polarities of the relationships between variables (either positive or negative): The Higher the hormone insufficiency, the more health problems that are experienced, which in turn lead to a Higher drug supplement intake.Finally, the higher Drug supplement intake leads to a reduced hormone deficiency, closing the loop and counteracting our initial condition (Hormone Insufficiency level).

Side effects of Drug supplement Intake

My next question was then, "ok, the immediate effect of the drug is indeed the reduction of the hormone gap in the body. Are there any other effects that lead to a DEPENDENCE on the supplement drug?". This effect can be explored though the casual link between the drug supplement intake and the state of the ill-functioning gland, as shown in the following picture:

Hypothesis: 

What if a side effect of the drug supplement intake in this case is leading to an ever increasing gland malfunctioning? If this were the case, then the process of drug intake would create a reinforcing loop through its effect in the underlying problem, namely ill-functioning gland. In other words, the presence of increased levels of hormones in the body despite an ill-functioning thyroid gland (increased levels resulting from the drug supplement intake) could be signalling the body that the gland is in fact not required,and the body being an effective system, would then slowly reduce the gland size. 

This would indeed explain the small Thyroid gland size detected in my friend.

In a short period of research, I have not found any documents in regard with the effect of increased hormone levels in the body on an ill-functioning gland. I have however come across several examples of bodily adaptations which denote efficiency in body disposition.

• How does an increased level of hormones affect the development of an ill-functioning endocrine Gland?
• Are there any techniques which aim at the recuperation of Gland function?
• What are the economic incentives that would promote the search for Gland recuperation instead of drug consumption?

Nevertheless System Dynamics has allowed me to take a very interesting first look at this problem.

Systemic thinking in Chile - Historical Cybernetic DSS

Systemic thinking has had sprouts of initiatives throughout the globe for many years and many are not as well known as they should, especially if these happen in countries outside USA or Europe. Last month the MIT Press published the paperback version of a book by Eden Medina, (an MIT Alum) recounting the particular story of the Cybersyn Project in Chile, or the attempt to construct a governmental Distributed Decision Support System (DSS) in the 1970's, developed during Allende's short-lived government and long before the massification of the Internet. This original project was led by a young Fernando Flores under the direct influence of the cybernetics intellectual guru Stafford Beer, and based on the Cybernetic discipline as proposed by MIT's Norbert Wiener.

As I am from Chile, and find myself currently pursuing a MSc. degree at MIT (or SM degree as it is denominated here), it was a very suitable place to come across this story!

Medina's book is based on her 2005 PhD Thesis for the History and Social Study of Science and Technology at MIT  and includes interviews with the main actors in this peculiar story, including interviews in 2001 with the now late Stafford Beer.

The book is an entertaining account of the events that led to the formation of a team that was to develop a cybernetic control system for Chile in the early 1970's, and the vicissitudes this project had to experience until its final cancellation on the day of Pinochet's military coup.

It is particularly interesting to read about the changes experienced by the protagonists throughout the process. In the case of Stafford Beer and in the words of Humberto Maturana, "he arrived to Chile a business-man, and he left a hippie". After the project had its abrupt end, Beer gave his life a considerable change,  abandoning his lifestyle in London to settle in a remote area of Wales in a cabin that even lacked running water, and as a result of his realization of the socially-imposed pressures for unnecessary material possessions.

On the other hand, Fernando Flores changed from the young 27-year-old Chilean minister who having heard of Beer's ideas, contacted him to set up a cybernetics system of government monitoring in Chile. He later went on to study at Stanford and UC-Berkeley and admittedly "noticed the restrictions of cybernetics" within communities undergoing drastic societal changes. He eventually returned to Chile a multimillionaire leading a lukewarm political career.

Cybersyn was an ambitious project that marked a milestone in the history of systemic interventions at a governmental level, and the teachings this experience left behind I consider are still ill-understood. The story is either quickly discarded as the ravings of madmen such as Beer or Flores, or this cybernetic approach, given the political circumstances in which is was carried out, is described as a soviet-style centralized control system.

Still others regard this experience as visionary and far ahead of its time. The book describes the way the project team arranged an intricate system of Telex Machines connecting several specialized command centers in the regions with a centralized command center in Santiago, generating an almost online availability of data to make decisions, system which was very useful during the October Strike.

Other countries followed Chile's lead, including Mexico in 1982 and Uruguay in 1985 (Project Urucib, derived from Uruguay-Cibernetica), but a lack of a decided project leadership such as the one provided by Fernando Flores, did not allow these paradigm-shifting projects to be implemented to the same extent as Cybersyn had been in Chile.