Papers by Stefan Topolski
Journal of evaluation in clinical practice, 2014
The purpose of this study was to evaluate the veracity of a theoretically derived model of health... more The purpose of this study was to evaluate the veracity of a theoretically derived model of health that describes a non-linear trajectory of health from birth to death with available population data sets. The distribution of mortality by age is directly related to health at that age, thus health approximates 1/mortality. The inverse of available all-cause mortality data from various time periods and populations was used as proxy data to compare with the theoretically derived non-linear health model predictions, using both qualitative approaches and quantitative one-sample Kolmogorov-Smirnov analysis with Monte Carlo simulation. The mortality data's inverse resembles a log-normal distribution as predicted by the proposed health model. The curves have identical slopes from birth and follow a logarithmic decline from peak health in young adulthood. A majority of the sampled populations had a good to excellent quantitative fit to a log-normal distribution, supporting the underlying m...
Journal of Evaluation in Clinical Practice, 2014
This essay examines the notions of knowledge, truth and certainty as they apply to medical resear... more This essay examines the notions of knowledge, truth and certainty as they apply to medical research and patient care. The human body does not behave in mechanistic but rather complex adaptive ways; thus, its behaviour to challenges is non-deterministic. This insight has important ramifications for experimental studies in health care and their statistical interrogation that are described in detail. Four implications are highlighted: one, there is an urgent need to develop a greater awareness of uncertainties and how to respond to them in clinical practice, namely, what is important and what is not in the context of this patient; two, there is an equally urgent need for health professionals to understand some basic statistical terms and their meanings, specifically absolute risk, its reciprocal, numbers needed to treat and its inverse, index of therapeutic impotence, as well as seeking out the effect size of an intervention rather than blindly accepting P-values; three, there is an urgent need to accurately present the known in comprehensible ways through the use of visual tools; and four, there is a need to overcome the perception, that errors of commission are less troublesome than errors of omission as neither's consequences are predictable.
PLoS medicine, 2015
Barry Saver and colleagues caution against the use of process and performance metrics as health c... more Barry Saver and colleagues caution against the use of process and performance metrics as health care quality measures in the United States.
Purpose The purpose of this study was to evaluate the veracity of a theoretically derived model o... more Purpose The purpose of this study was to evaluate the veracity of a theoretically derived model of health that describes a non-linear trajectory of health from birth to death with available population data sets.
Methods The distribution of mortality by age is directly related to health at that age, thus health approximates 1/mortality. The inverse of available all-cause mortality data from various time periods and populations was used as proxy data to compare with the theoreti- cally derived non-linear health model predictions, using both qualitative approaches and quantitative one-sample Kolmogorov–Smirnov analysis with Monte Carlo simulation.
Results The mortality data’s inverse resembles a log–normal distribution as predicted by the proposed health model. The curves have identical slopes from birth and follow a logarithmic decline from peak health in young adulthood. A majority of the sampled populations had a good to excellent quantitative fit to a log–normal distribution, supporting the underlying model assumptions. Post hoc manipulation showed the model predictions to be stable.
Conclusions This is a first theory of health to be validated by proxy data, namely the inverse of all-cause mortality. This non-linear model, derived from the notion of the interaction of physical, environmental, mental, emotional, social and sense-making domains of health, gives physicians a more rigorous basis to direct health care services and resources away from disease-focused elder care towards broad-based biopsychosocial interventions earlier in life.
In 2004 the American Academy of Family Physicians (AAFP) completed a “Future of Family Medicine” ... more In 2004 the American Academy of Family Physicians (AAFP) completed a “Future of Family Medicine” consensus document which called for a patient-centered medical home (PCMH).
Though the concept of a medical home may be clear, the path to creating such an ideal is not. Health care systems can be very resistant to change. The study of complex systems can
provide new useful insight into how such systems can change and what makes a medical home a better home to promote health. Successful complex systems offer principles which can
support the philosophical precepts for organizational change promoted by the Family Medicine movement for over 40 years.
Doctors often use theory to inform medical practice. The current bio-psycho-social model of healt... more Doctors often use theory to inform medical practice. The current bio-psycho-social model of health may be advanced still further with theoretical rigour. Traditional fields of thermodynamics and newer fields of non-linear dynamics including chaos theory and complex systems science can inform our understanding of the complexity of human health, illness and disease. Commonly accepted aspects of human health may be projected as probabilities over time creating curves of human health potential. Maximum health may be represented by maximum functional complexity. Complexity's relationship to entropy and energy can produce a complex surface that better models the human experience of health and illness from birth to death. Such a potential health trajectory uniting complexity and entropy expands upon earlier theories of health while allowing for unusual predictions and the novel opportunity to test and validate this model of human health.
Talks by Stefan Topolski
"Radical and Fundamental are not opposites in today's world."
Dr. Nikitas Zervanos:
Q: Why d... more "Radical and Fundamental are not opposites in today's world."
Dr. Nikitas Zervanos:
Q: Why does it have to be radical? Why can't it be more fundamental than radical?
Stefan: I believe both are true.
Unidentified Professional
Q: Yeah. I mean really, I mean I know what you mean, because sometimes it does feel radical, especially when you care for a patient like you just described. Because it's very difficult to love a person you don't like, and a lot of these people are just not likeable. They're mean. You described him as a personality disorder, apparently paranoid features and what have you, and he has self-destructive behavior. It is really, really difficult to really care with compassion for people who are like that. And it does take almost, you almost have to be radical to love a person who might described by some as despicable, in a sense of their behavior to themselves and to others.
Stefan: What's fascinating is two things. Is that, and you're right, is that he doesn't fit that ideal box in psychiatry because he never harmed or violated the trust in relationship with friends and family and he would to anything for his mother to his dying day. And he didn't meet the criteria for antisocial. He was quite charming in a way that psychopaths can be, too. Granted. But that he proved through honesty over time, he didn't violate any agreements we had, that it shouldn't feel radical, and in fact if you do open your hearts to take any opportunity today to smile at a child, to give extra candy tonight, who knows what it will be, then it's not radical it's fundamental. It's only radical because we don't follow the calling enough.
Dr. Nicholas Apostoleris:
Q: What I see is more radical, I think of radical as root, going to the root, the central, just adjusted position of society's elite, society's ultimate successes, values that he probably shared within his group, you have the ultra-successes, and you have someone who is, we're wondering, can we connect? Can we advocate? Can we appreciate? So the radical that I hear and the root that I hear, is egalitarian, that poor are rooted in value. Whether the attributes succeed or have failed, and you're connecting someone who has failed in many ways, and yet has a beauty, a poetic beauty to him, and you want to say don't diminish him into psychiatry, if his symptoms, appreciate this as an individual- that's how I see it.
Stefan: Radical and fundamental. They are not opposites.
It Only Takes One - Poetry of Life
Dr. Topolski - speaker
"Chaos Theory and Complexity are examples of new paradigms in post-modern science. They are both ... more "Chaos Theory and Complexity are examples of new paradigms in post-modern science. They are both promisingly nonlinear and interdisciplinary, but as with many paradigm shifts they also may appear strange, threatening, or irrelevant to an established world view. In response the busy and practical clinician demands to know what difference this novel scientific effort may make in their practice of medicine.
Objective: to effectively disseminate the relevant and pervasive presence of chaos and complexity theory in the physiological and clinical sciences.
Design: An interactive workshop with active audience discussion of the broad range of new research methods and findings changing our understanding of human health and disease.
Result: Many areas of clinical application of chaos and complexity will be discussed including human physiology, biomedical illness, critical care medicine, environmental health, geriatrics, home care, public health policy and the biopsychosocial core practice of family medicine.
Conclusion: With an active spirit of inquiry participants can successfully return to their resident practice with a new understanding of human health which they will be able to competently share with fellow students, residents, and colleagues."
Academic leaders in family medicine have cited understanding complexity as crucial to effective ... more Academic leaders in family medicine have cited understanding complexity as crucial to effective healthcare reform because most healthcare reform efforts fail. Further translational research is needed to achieve more evidence-based effective improvements in healthcare delivery. In complex system terms what is characterized as our healthcare system emerges from a root cause analysis of attractor driven behaviors of individual agents and their networking interactions. Objective: to demonstrate a practical application of complex systems modeling to healthcare reform. Design: a review of advances in complex systems theory emphasizing culture and individual contextual factors with their application to reforming healthcare delivery. Result: an integration of recently published findings into a self-similar model of health care delivery emphasizing the role of core values. Conclusion: Reform as fundamental persistent change proceeds from core value change among individual patient and physician agents. Virtue, as a balance between individual core values, is suggested to be central to successful reform. Such virtue is difficult to impose from above in a large complex healthcare system. Complexity may indicate more productive avenues for resource application to reform healthcare delivery.
"The study of complexity has been advanced as a method to better understand health and illness. W... more "The study of complexity has been advanced as a method to better understand health and illness. While varied systems lenses have been proposed through which to view complexity, what we desire is a complex systems model of health which may be tested for validity against real world data.
A pilot individual health potential model using probability theory and simple qualitative observations was developed to guide larger epidemiological efforts. An evolutionary development functional definition of health as genetic survival potential was integral to this work. Definitions of disease, illness, and mortality were mathematically derived from this. Model validation included exploration of its phase space for robustness and a comparison of its manifold to published growth, development, and mortality curves.
Preliminary results show areas of both agreement and divergence between model prediction and human data. One-Sample Kolmogorov-Smirnov analysis of human mortality data showed > 95% concordance with some model predictions when combined with a Monte Carlo simulation. Epidemiological patterns over 2 millenia were consistent and contributed to improvements in the pilot model.
This use of probability distributions over time emphasizes the long-term impact of initial early investments in human health at young ages and is consistent with other published work. New attractors were then derived for health potential and health probability across a population over time. These remain to be validated but may further support the benefit of a fundamental redistribution of health care resources for more effective prevention and treatment of human illness."
Successful complex systems in nature have been studied for insight to improve human health, but m... more Successful complex systems in nature have been studied for insight to improve human health, but much of the field of complexity has grown out of mathematics and the basic sciences. The quantitative naming and conclusions which result sound foreign to practicing clinicians who excel in the subjective and richly qualitative field of human health. This results in poor communication and slowed innovation in both qualitative and quantitative fields. Objective: to improve communication by determining if a novel complex systems concept of health as a dialectic tensor already exists un-named in the thought process of physician healers. Design: qualitative ethnographic exploration of the internal conceptualization of and relationship between health and illness with coding to delineate the role of balance in physician thought. Setting: rural and urban North American primary care practices. Participants: practicing primary care physicians. Instruments: a qualitative structured survey tool with decision point branching and a standardized visual choice set. Result: preliminary similarity exists between practicing physicians’ health understanding and complex systems’ health principles. Conclusion: a traditional tribal behavior of alienation from perceived new and different world views is not aided by the technical nature of work published in the field of complex systems. More openness of mind and less technical jargon may improve physician understanding of complexity in human health.
"Abstract for Computer Modeling
Our healing arts continue to evolve. Physicians carry epo... more "Abstract for Computer Modeling
Our healing arts continue to evolve. Physicians carry epochs of experience forward while testing new ideas today. We now live in a 300 year revolution of modern science built on the human habits and traditions of the past. Newton & Bacon's scientific revolution has, however, become limited by its reductionist, determinist, and linear simplifications. It has poorly advanced the scientific art of Family Practice.
Complexity Science offers a different approach and new methods. Cross-discipline collaboration is vital. Computer science advances have been crucial. Today physicians now have the tools to study complex human health. We search for better theory to inform practice and practice to test theory. We demonstrate several novel computer models of complexity with application to the healing arts today."
"Chaos Theory and Complexity Science - Keys to make the best Medical Home even better.
The cal... more "Chaos Theory and Complexity Science - Keys to make the best Medical Home even better.
The call has gone out for a medical home for every person and every person in a medical home. Our medical non-system, however, is both chaotic and resistant to most beneficial change. Chaos Theory and Complex Systems Study provide new and useful insights into what makes a medical home a home and how to build it "so they will come."
We will review the family medicine applications of Chaos and Complexity and then apply them with clear and robust qualitative-quantitative methods. With large change in health care inevitable, why aren't we using the science of complex change to better understand and improve health care and the quality of the medical home?"
Book Chapters by Stefan Topolski
Handbook of Systems and Complexity in Health, 2012
Handbook of Systems and Complexity in Health, 2012
Uploads
Papers by Stefan Topolski
Methods The distribution of mortality by age is directly related to health at that age, thus health approximates 1/mortality. The inverse of available all-cause mortality data from various time periods and populations was used as proxy data to compare with the theoreti- cally derived non-linear health model predictions, using both qualitative approaches and quantitative one-sample Kolmogorov–Smirnov analysis with Monte Carlo simulation.
Results The mortality data’s inverse resembles a log–normal distribution as predicted by the proposed health model. The curves have identical slopes from birth and follow a logarithmic decline from peak health in young adulthood. A majority of the sampled populations had a good to excellent quantitative fit to a log–normal distribution, supporting the underlying model assumptions. Post hoc manipulation showed the model predictions to be stable.
Conclusions This is a first theory of health to be validated by proxy data, namely the inverse of all-cause mortality. This non-linear model, derived from the notion of the interaction of physical, environmental, mental, emotional, social and sense-making domains of health, gives physicians a more rigorous basis to direct health care services and resources away from disease-focused elder care towards broad-based biopsychosocial interventions earlier in life.
Though the concept of a medical home may be clear, the path to creating such an ideal is not. Health care systems can be very resistant to change. The study of complex systems can
provide new useful insight into how such systems can change and what makes a medical home a better home to promote health. Successful complex systems offer principles which can
support the philosophical precepts for organizational change promoted by the Family Medicine movement for over 40 years.
Talks by Stefan Topolski
Dr. Nikitas Zervanos:
Q: Why does it have to be radical? Why can't it be more fundamental than radical?
Stefan: I believe both are true.
Unidentified Professional
Q: Yeah. I mean really, I mean I know what you mean, because sometimes it does feel radical, especially when you care for a patient like you just described. Because it's very difficult to love a person you don't like, and a lot of these people are just not likeable. They're mean. You described him as a personality disorder, apparently paranoid features and what have you, and he has self-destructive behavior. It is really, really difficult to really care with compassion for people who are like that. And it does take almost, you almost have to be radical to love a person who might described by some as despicable, in a sense of their behavior to themselves and to others.
Stefan: What's fascinating is two things. Is that, and you're right, is that he doesn't fit that ideal box in psychiatry because he never harmed or violated the trust in relationship with friends and family and he would to anything for his mother to his dying day. And he didn't meet the criteria for antisocial. He was quite charming in a way that psychopaths can be, too. Granted. But that he proved through honesty over time, he didn't violate any agreements we had, that it shouldn't feel radical, and in fact if you do open your hearts to take any opportunity today to smile at a child, to give extra candy tonight, who knows what it will be, then it's not radical it's fundamental. It's only radical because we don't follow the calling enough.
Dr. Nicholas Apostoleris:
Q: What I see is more radical, I think of radical as root, going to the root, the central, just adjusted position of society's elite, society's ultimate successes, values that he probably shared within his group, you have the ultra-successes, and you have someone who is, we're wondering, can we connect? Can we advocate? Can we appreciate? So the radical that I hear and the root that I hear, is egalitarian, that poor are rooted in value. Whether the attributes succeed or have failed, and you're connecting someone who has failed in many ways, and yet has a beauty, a poetic beauty to him, and you want to say don't diminish him into psychiatry, if his symptoms, appreciate this as an individual- that's how I see it.
Stefan: Radical and fundamental. They are not opposites.
It Only Takes One - Poetry of Life
Dr. Topolski - speaker
Objective: to effectively disseminate the relevant and pervasive presence of chaos and complexity theory in the physiological and clinical sciences.
Design: An interactive workshop with active audience discussion of the broad range of new research methods and findings changing our understanding of human health and disease.
Result: Many areas of clinical application of chaos and complexity will be discussed including human physiology, biomedical illness, critical care medicine, environmental health, geriatrics, home care, public health policy and the biopsychosocial core practice of family medicine.
Conclusion: With an active spirit of inquiry participants can successfully return to their resident practice with a new understanding of human health which they will be able to competently share with fellow students, residents, and colleagues."
A pilot individual health potential model using probability theory and simple qualitative observations was developed to guide larger epidemiological efforts. An evolutionary development functional definition of health as genetic survival potential was integral to this work. Definitions of disease, illness, and mortality were mathematically derived from this. Model validation included exploration of its phase space for robustness and a comparison of its manifold to published growth, development, and mortality curves.
Preliminary results show areas of both agreement and divergence between model prediction and human data. One-Sample Kolmogorov-Smirnov analysis of human mortality data showed > 95% concordance with some model predictions when combined with a Monte Carlo simulation. Epidemiological patterns over 2 millenia were consistent and contributed to improvements in the pilot model.
This use of probability distributions over time emphasizes the long-term impact of initial early investments in human health at young ages and is consistent with other published work. New attractors were then derived for health potential and health probability across a population over time. These remain to be validated but may further support the benefit of a fundamental redistribution of health care resources for more effective prevention and treatment of human illness."
Our healing arts continue to evolve. Physicians carry epochs of experience forward while testing new ideas today. We now live in a 300 year revolution of modern science built on the human habits and traditions of the past. Newton & Bacon's scientific revolution has, however, become limited by its reductionist, determinist, and linear simplifications. It has poorly advanced the scientific art of Family Practice.
Complexity Science offers a different approach and new methods. Cross-discipline collaboration is vital. Computer science advances have been crucial. Today physicians now have the tools to study complex human health. We search for better theory to inform practice and practice to test theory. We demonstrate several novel computer models of complexity with application to the healing arts today."
The call has gone out for a medical home for every person and every person in a medical home. Our medical non-system, however, is both chaotic and resistant to most beneficial change. Chaos Theory and Complex Systems Study provide new and useful insights into what makes a medical home a home and how to build it "so they will come."
We will review the family medicine applications of Chaos and Complexity and then apply them with clear and robust qualitative-quantitative methods. With large change in health care inevitable, why aren't we using the science of complex change to better understand and improve health care and the quality of the medical home?"
Book Chapters by Stefan Topolski
Methods The distribution of mortality by age is directly related to health at that age, thus health approximates 1/mortality. The inverse of available all-cause mortality data from various time periods and populations was used as proxy data to compare with the theoreti- cally derived non-linear health model predictions, using both qualitative approaches and quantitative one-sample Kolmogorov–Smirnov analysis with Monte Carlo simulation.
Results The mortality data’s inverse resembles a log–normal distribution as predicted by the proposed health model. The curves have identical slopes from birth and follow a logarithmic decline from peak health in young adulthood. A majority of the sampled populations had a good to excellent quantitative fit to a log–normal distribution, supporting the underlying model assumptions. Post hoc manipulation showed the model predictions to be stable.
Conclusions This is a first theory of health to be validated by proxy data, namely the inverse of all-cause mortality. This non-linear model, derived from the notion of the interaction of physical, environmental, mental, emotional, social and sense-making domains of health, gives physicians a more rigorous basis to direct health care services and resources away from disease-focused elder care towards broad-based biopsychosocial interventions earlier in life.
Though the concept of a medical home may be clear, the path to creating such an ideal is not. Health care systems can be very resistant to change. The study of complex systems can
provide new useful insight into how such systems can change and what makes a medical home a better home to promote health. Successful complex systems offer principles which can
support the philosophical precepts for organizational change promoted by the Family Medicine movement for over 40 years.
Dr. Nikitas Zervanos:
Q: Why does it have to be radical? Why can't it be more fundamental than radical?
Stefan: I believe both are true.
Unidentified Professional
Q: Yeah. I mean really, I mean I know what you mean, because sometimes it does feel radical, especially when you care for a patient like you just described. Because it's very difficult to love a person you don't like, and a lot of these people are just not likeable. They're mean. You described him as a personality disorder, apparently paranoid features and what have you, and he has self-destructive behavior. It is really, really difficult to really care with compassion for people who are like that. And it does take almost, you almost have to be radical to love a person who might described by some as despicable, in a sense of their behavior to themselves and to others.
Stefan: What's fascinating is two things. Is that, and you're right, is that he doesn't fit that ideal box in psychiatry because he never harmed or violated the trust in relationship with friends and family and he would to anything for his mother to his dying day. And he didn't meet the criteria for antisocial. He was quite charming in a way that psychopaths can be, too. Granted. But that he proved through honesty over time, he didn't violate any agreements we had, that it shouldn't feel radical, and in fact if you do open your hearts to take any opportunity today to smile at a child, to give extra candy tonight, who knows what it will be, then it's not radical it's fundamental. It's only radical because we don't follow the calling enough.
Dr. Nicholas Apostoleris:
Q: What I see is more radical, I think of radical as root, going to the root, the central, just adjusted position of society's elite, society's ultimate successes, values that he probably shared within his group, you have the ultra-successes, and you have someone who is, we're wondering, can we connect? Can we advocate? Can we appreciate? So the radical that I hear and the root that I hear, is egalitarian, that poor are rooted in value. Whether the attributes succeed or have failed, and you're connecting someone who has failed in many ways, and yet has a beauty, a poetic beauty to him, and you want to say don't diminish him into psychiatry, if his symptoms, appreciate this as an individual- that's how I see it.
Stefan: Radical and fundamental. They are not opposites.
It Only Takes One - Poetry of Life
Dr. Topolski - speaker
Objective: to effectively disseminate the relevant and pervasive presence of chaos and complexity theory in the physiological and clinical sciences.
Design: An interactive workshop with active audience discussion of the broad range of new research methods and findings changing our understanding of human health and disease.
Result: Many areas of clinical application of chaos and complexity will be discussed including human physiology, biomedical illness, critical care medicine, environmental health, geriatrics, home care, public health policy and the biopsychosocial core practice of family medicine.
Conclusion: With an active spirit of inquiry participants can successfully return to their resident practice with a new understanding of human health which they will be able to competently share with fellow students, residents, and colleagues."
A pilot individual health potential model using probability theory and simple qualitative observations was developed to guide larger epidemiological efforts. An evolutionary development functional definition of health as genetic survival potential was integral to this work. Definitions of disease, illness, and mortality were mathematically derived from this. Model validation included exploration of its phase space for robustness and a comparison of its manifold to published growth, development, and mortality curves.
Preliminary results show areas of both agreement and divergence between model prediction and human data. One-Sample Kolmogorov-Smirnov analysis of human mortality data showed > 95% concordance with some model predictions when combined with a Monte Carlo simulation. Epidemiological patterns over 2 millenia were consistent and contributed to improvements in the pilot model.
This use of probability distributions over time emphasizes the long-term impact of initial early investments in human health at young ages and is consistent with other published work. New attractors were then derived for health potential and health probability across a population over time. These remain to be validated but may further support the benefit of a fundamental redistribution of health care resources for more effective prevention and treatment of human illness."
Our healing arts continue to evolve. Physicians carry epochs of experience forward while testing new ideas today. We now live in a 300 year revolution of modern science built on the human habits and traditions of the past. Newton & Bacon's scientific revolution has, however, become limited by its reductionist, determinist, and linear simplifications. It has poorly advanced the scientific art of Family Practice.
Complexity Science offers a different approach and new methods. Cross-discipline collaboration is vital. Computer science advances have been crucial. Today physicians now have the tools to study complex human health. We search for better theory to inform practice and practice to test theory. We demonstrate several novel computer models of complexity with application to the healing arts today."
The call has gone out for a medical home for every person and every person in a medical home. Our medical non-system, however, is both chaotic and resistant to most beneficial change. Chaos Theory and Complex Systems Study provide new and useful insights into what makes a medical home a home and how to build it "so they will come."
We will review the family medicine applications of Chaos and Complexity and then apply them with clear and robust qualitative-quantitative methods. With large change in health care inevitable, why aren't we using the science of complex change to better understand and improve health care and the quality of the medical home?"