This weekend, I have been thinking about complex adaptive systems.
Wikipedia tells me that complex adaptive systems contain multiple diverse interacting components and that the system is structured such that it adapts and learns from experience. At least, it appear to learn. The system is not conscious or reflective on its experience. An ecosystem can be seen as a complex adaptive system.
In a cancer, the malignant cells are themselves diverse: some dividing, others resting; some forming a tumour, others infiltrating adjacent tissues, others again invading blood vessels and migrating. Then there are the array of non-malignant cells: those forming blood vessels; inflammatory cells responding as if this were a healing wound; immune cells perhaps recognising and killing cancer cells, perhaps exciting such killer cells, perhaps damping the immune response. All these various cells are in communication with each other, sending short range messages by direct contact or chemical signals. This complex adaptive system is called the immune microenvironment of the cancer.
I am not prone to hyperbole. Still, I think we* sit on the threshold of a major shift in how cancer can be treated, using new drugs to manipulate the immune microenvironment of cancers. The drugs are becoming available. The challenge is to understand the immune microenvironment sufficiently so we use the drugs effectively.
This piece started with a layer of charcoal, the images driven by recent reading and current music. I tore into the dampened paper creating highlights and texture. This was then obscured by layers of gouache and acrylic paint, allowing charcoal and sea salt to disperse slowly, suspended in the very wet washes. After a week or so looking at it, turning it one way and another, eventually I saw in it a narrative suggesting a complex system.
*”we sit on the threshold of a major shift in how cancer can be treated” – by “we” I mean the worldwide cancer community – patients, carers, researchers, clinicians, health care providers, research institutions, industry and those who commission and fund cancer care