How Do You Start a Revolution for Systems Medicine in a Health Innovation Ecosystem? Think Orthogonally and Change Assumptions.

This paper defines a revolution as an orthogonal change in direction, a 90-degree perpendicular turn from the status quo ways of thinking, being and doing, so as to create a complete break, an abolitionist rupture with current and past ways of producing knowledge. David Bowie was a relatable example of a revolutionary and orthogonal innovator who completely and courageously broke with the past and the present and opened up new vistas in music and performing arts. The late anthropologist and public intellectual David Graeber also argued that a revolution fundamentally changes the assumptions in a given field of inquiry. Changing the entrenched assumptions that are long ossified, outdated or uncritically internalized by a knowledge community and profession can have multiplying revolutionary effects on downstream knowledge production. Thinking orthogonally to change the prevailing assumptions is indeed a revolutionary act. Orthogonal innovation as described in this paper is not a repackaging of an innovation in a different field. An orthogonal innovation is proposed as coalescence of ideas drawn from orthogonal domains, e.g., epistemologically speaking as in medicine and political theory, with an eye to pave the way for unprecedented social change and innovation. Grounding systems medicine in political determinants of planetary health, to link two fields of inquiry that have remained isolated and orthogonal since the 17th century, is nothing short of a revolution and orthogonal innovation in the making. For systems medicine to be a truly revolutionary field, it ought to acknowledge that there is no single-issue health nor single-issue politics.