Background and activities
Medical Doctor who has also studied History of Science. My Ph.d investigates what the up and coming field of Systems Medicine will mean for Primary Care
My educational background is purposefully broad and generalistic. It is a combination of a primarily scientific education (Medicine), a humanistic one (History and some Philosophy) and a pragmatic communicational one (Journalism). In History I specialized in History of Science and Professionalism (the subject name was “Knowledge and Power”). In combination with a single semester course in Philosophy of Life and Ethics this gives me a Cand.mag degree (equivalent of four years of University level studies) in addition to my medical studies. I have also previously worker as a Journalist, mostly for Norwegian Aftenposten and A-magasinet. For the time being I am also write popular science articles and commentaries in the lay press in addition to part time work in a primary care practice in Oslo.
Academically, I am interested in why doctor´s think the way they do and how this affects their practice (and vice versa). I am also interested in the degree to which and how the theoretical foundations of medicine can incorporate both the natural scientific and humanistic worldviews in a comprehensive manner. In my own Ph.d project I employ my own broad, educational background within the fields of General Practice and Community Medicine, which offer and need the most comprehensive (or “holistic”) and generalic approach to human beings and their health. This project is anchored to the needs of primary care doctors and their patients and has led me to investigate theoretical questions of special interest to them. I am working at the General Practice Research Unit at the Institute of Community Medicine. Here, we are both interested in employing theoretical insights to shed light on contemporary problems in medicine and in bringing new theoretical insights into medicine from other fields.
What questions are these?
I am especially interested in the clinical challenges often called “medically unexplained symptoms”. These are, in many ways, the “blank spaces” on the maps of medicine, or the mysteries of modern healthcare. These problems, which are very common in General Practice and associated with much suffering and huge costs, are also often called “functional disorders” (as opposed to “organic”) or “psychosomatic”. Much exposed and debated examples are chronic fatigue syndrome or myalgic encephalopathy (CFS/ME), and what by the lay press, patient advocacy groups and some doctors has been called “chronic Lyme disease”. Why are these problems “medically unexplained” and how can we understand them?
With this as an important background, I am interested in what kind of view of patients and knowledge medicine has, and how it affects what doctors do. In contemporary medicine, we often state that we think and practice “biopsychosocially”, but how do the “bio”, “psycho” and “socio” actually relate? How could our actions, thoughts and sorroundings affects our health, considering for example stress and so-called “placebo” and “nocebo” effects? Such questions are associated with philosophical problems such as “free will” and determinism, and the problem of the relationship between nature (genes) and nurture (the environment) and the degree to which our actions are governed by these factors. All of these questions are also associated with how doctors view the relationship between parts (like DNA molecules) and wholes (such as patients in the medical office in all their complexity).
During my medical studies, my interest in such questions led me to write a thesis on so-called “psychoneuroimmunology”. This is a relatively new and integrative field, which studies relationships between what we call “biological” or “physical” (the immune system and the nervous system) and what we call “psychosocial” (e.g. stress, behavior, thoughts, feelings and social relations). Specifically, I wrote a literature review on how the brain is connected to the immune system through the so-called vagal nerve (cranial nerve X) and how signals from the brain can dampen inflammation.
I am also concerned with how the medical profession uses its influence to define parts of human life as medical problems – typically as something that should be dealt with be focusing on bodily parts through pharmacological and other technological means, rather than through personal or societal interventions. This is the problem of medicalization.
All of these educational elements and interests have a place in my current Ph.d project. One important premise for my project is the recent proposal of systems medicine as a future, and primary care-centred strategy for healthcare worldwide – endorsed by the President of WONCA, the international association of general practitioners. Overall, one aim of the project is to advance an understanding of the strengths and limitations systems medicine as a framework for primary health care. Its title is “Systems medicine as a theoretical framework for primary care – a critical investigation”. The Ph.d project springs is the result of two converging forces in medicine: 1) The challenges of medicine, especially the challenges of primary care and 2) so-called systems medicine.
The challenges of primary care can be seen as a consequence of the fact that general practitioners must offer integrated and comprehensive care and that primary care physicians are confronted with human function and dysfunction in their full complexity. The resulting challenges are precisely those mentioned above: A need for a comprehensive theoretical understanding of and approach to the patient as an entity and the root causes of health problems, including how the “biological”, “psychological” and “social” are related. Another is the so-called functional disorders, the medically unexplained symptoms that highlight this theoretical need.
Systems medicine is the application of systems biology to medical research and practice. Systems biology is a new and important development within biology and medicine internationally, which also seems to have an of solving the aforementioned challenges of primary care. It is a biomedical paradigm that is proposed to tackle all components of disease complexity in a “holistic” and even “humanistic” manner. Systems biology can be seen as a reaction to the shortcomings of the current biomedical framework in tackling the complexity of life. Since the human genome project was finished after the turn of the century, it has become increasingly clear that human biology in more complex than anticipated and that knowing human DNA is most often not enough for either understanding human function or predicting future health. Systems biology is proposed as a solution to these problems. Broadly systems biology can be seen as a convergence of molecular biology and so-called genomic or “personalized medicine” and systems theory. Systems theory is the theoretical study of wholes. Methodologically, systems biology and systems medicine rely strongly on mathematical modelling of biological systems, including patients.
What does this convergence between primary health care and its challenges and systems medicine mean? Since systems medicine is to be centred in primary care, we find it important that primary care doctors get a grip of this question.
Scientific, academic and artistic work
A selection of recent journal publications, artistic productions, books, including book and report excerpts. See all publications in the database
- (2016) The new holism: P4 systems medicine and the medicalization of health and life itself. Medicine, Health care and Philosophy. vol. 19 (2).
- (2015) Personalized medicine meets general practice – a SWOT analysis. Gothenburg 16th-18th of June 2015, 19th Nordic Congress og General Practice. Programme and Abstracts.
- (2014) Total health - the holistic overdiagnosis of Systems (P4) medicine. Abstraktbok Preventing Overdiagnosis Conference 2014.
- (2014) Getting personal: Can systems medicine integrate scientific and humanistic conceptions of the patient?. Journal of Evaluation In Clinical Practice. vol. 20 (6).
- (2014) Systems Medicine - holistic and personalized in a humanistic sense?. Abstract book: The First International Conference on Systems and Complexity Sciences for Healthcare An Imperative for the 21st Century.
- (2013) Hva betyr frykt og konflikt for barnd biologiske utvikling? Om stressresponser, epigenetikk og den formbare barnehjernen. Oppvekstrapporten.
- (2013) More focus on personhood - and what that implies. Perspective from the Nordic Risk Group (NRG). Abstract. 18th Nordic Congress of General Practice. Abstracthefte.