Systemic design and its discontents: Designing for emergence and accountability

“Any machine constructed for the purpose of making decisions, if it does not possess the power of learning, will be completely literal-minded. Woe to us if we let it decide our conduct, unless we have previously examined the laws of its action, and know fully that its conduct will be carried out on principles acceptable to us! (Wiener, 1950)” In this paper we seek to advance the discourse and prospective impact of systemic design through challenges and opportunities centred in perspectives from psychology and ethics. We argue that systemic design is adolescent. It has a growing sense of its power and potential, yet it is prone to clumsiness and yawning lapses. To advance its role in fostering inclusion and flourishing, how might we lead systemic design to greater maturity, responsibility, self-awareness, in a word, to accountability? We assess that systemic design is on track to fulfill its potential as a holistic practice and discourse, akin to an advanced form of service design. Yet for this to happen the community must undertake more careful processes of development. Systemic design needs to balance its ambition and confidence with humility and ethical commitment. Toward this end we propose that systemic design covet skills, insights and awareness from its ‘aunts and uncles’. We indicate that greater use of psychology is needed to inform descriptive work, and more ethics is needed to uphold normative purposes. We advocate developing systemic design theory and practice through the further introduction of concepts from social and group psychology, as well as ethical governance. This groundwork is timely and needs-based, as it sheds light on potentially manipulative techniques at the intersection of choice, persuasion, influence, politics, and other nonlinear, societal forces. Our proactive goal is to better equip systemic design to address complex problems at the level of UN Sustainable Development Goals (SDGs), including equity, diversity and inclusion. We examine developments at the intersection of democracy, social media and automation that are highly unsettling, including the use of Facebook users’ data by Cambridge Analytica in the context of the Brexit campaign and the 2016 US election. In this light we articulate an urgent and remedial call for the systemic design community to develop and uphold a code of professional ethics and conduct, not unlike those adopted by engineers, doctors, management consultants and planners. Pathways We ask, has psychology successfully lent its wisdom to other disciplines? Indeed, behavioural economics is one pathway that has found significant value and traction. This project, which synthesizes demonstrably irrational human motivations and biases into the brittle, positivist models of classical economics, has begat a more resilient and mature hybrid. We take encouragement from experiment and exploration in arenas that hold strong interest for systemic design: policy, governance, community development, economic cooperation, innovation. To better understand inherent systemic design’s risks, and establish historical and critical context, we ground this study with reference to early twentieth century work, including Norbert Wiener, considered “father of cybernetics,” and Freud’s American nephew, Edward L. Bernays, portrayed as “father of public relations.” More than any single figure Bernays understood and anticipated spaces and practices of persuasion including marketing, public relations, and consumer psychology. In the early twentieth century Bernays pioneered forms of ‘advertising without advertising’, that is to say product placement. His works provide considerable architecture for modern mass culture. From their titles alone we may glimpse both the power and pitfalls of industrial, design-fueled techniques of persuasion: Propaganda, 1928; Public relations, 1952; The Engineering of Consent, 1955. Our brief critical review reveals that Bernays ideas are unsettling in their relevance to contemporary concerns and its frank assertion that democracy requires guidance and constraint by a shadowy elite. Bernays’s work has never been well known to the public. This is all the more surprising considering his long and influential shadow. We argue that his work is critical to understanding the use and misuse of persuasion for social purposes. Bernays describes ‘engineering consent’ as follows: “Use of an engineering approach—that is, action based only on thorough knowledge of the situation and on the application of scientific principles and tried practices to the task of getting people to support ideas and programs. (Bernays, 1955)” Purposes We lay out tactical scaffolding for the psychological maturation of systemic design through a discussion of projects led by the authors. Here the values, design principles and choices demonstrate alternatives to the twentieth-century manipulation model and to other inherited, status quo approaches. Skelton outlines the open software platform Betaville, a massively participatory, editable, urban mirror world project elaborated by an international network of partners and collaborators. Van Alstyne presents Strategic Innovation Lab, a large, decade-old Toronto-based social lab dedicated to envisioning possible and preferable futures through participatory foresight. Our strategic goal is to better prepare the systemic design community for two purposes. We want to address complex problems at the level of UN SDGs, including reduction of poverty, hunger, inequality, consumption, and GHG emissions, while boosting wellbeing, sanitation, social justice, innovation, and strong institutions. More troublingly we want to stem and mitigate consequences arising from broad design and deployment of automated and augmented systems in which emergent dynamics lead to unsettling social and political effects. This work extends and deepens the theoretical framework “Designing for Emergence” (Van Alstyne & Logan, 2007), presented in RSD5 Toronto (Van Alstyne & Logan, 2016). Understanding innovation and knowing how we might give rise to desirable, emergent processes within systems requires us to understand emergence — bottom-up forces of morphogenesis. As one exchange at RSD6 pointed out: We don’t design systems, we design pathways through systems. In summary, the purpose and process we are advocating for the systemic design community is to advance our maturity and thereby our positive impact for the many, not the few. In other words, we want to learn to act more responsively and responsibly, to do both risk-taking and risk-management. Is this enterprise deeply intertwined with psychology and ethics? Clearly. Does this describe the primary opportunity and challenge facing Systemic Design as a community? We think it does

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study

Background Since the release of the first global hepatitis elimination targets in 2016, and until the COVID-19 pandemic started in early 2020, many countries and territories were making progress toward hepatitis C virus (HCV) elimination. This study aims to evaluate HCV burden in 2020, and forecast HCV burden by 2030 given current trends. Methods This analysis includes a literature review, Delphi process, and mathematical modelling to estimate HCV prevalence (viraemic infection, defined as HCV RNA-positive cases) and the cascade of care among people of all ages (age ≥0 years from birth) for the period between Jan 1, 2015, and Dec 31, 2030. Epidemiological data were collected from published sources and grey literature (including government reports and personal communications) and were validated among country and territory experts. A Markov model was used to forecast disease burden and cascade of care from 1950 to 2050 for countries and territories with data. Model outcomes were extracted from 2015 to 2030 to calculate population-weighted regional averages, which were used for countries or territories without data. Regional and global estimates of HCV prevalence, cascade of care, and disease burden were calculated based on 235 countries and territories. Findings Models were built for 110 countries or territories: 83 were approved by local experts and 27 were based on published data alone. Using data from these models, plus population-weighted regional averages for countries and territories without models (n=125), we estimated a global prevalence of viraemic HCV infection of 0·7% (95% UI 0·7–0·9), corresponding to 56·8 million (95% UI 55·2–67·8) infections, on Jan 1, 2020. This number represents a decrease of 6·8 million viraemic infections from a 2015 (beginning of year) prevalence estimate of 63·6 million (61·8–75·8) infections (0·9% [0·8–1·0] prevalence). By the end of 2020, an estimated 12·9 million (12·5–15·4) people were living with a diagnosed viraemic infection. In 2020, an estimated 641000 (623000–765000) patients initiated treatment. Interpretation At the beginning of 2020, there were an estimated 56·8 million viraemic HCV infections globally. Although this number represents a decrease from 2015, our forecasts suggest we are not currently on track to achieve global elimination targets by 2030. As countries recover from COVID-19, these findings can help refocus efforts aimed at HCV elimination

Chromosome Xq23 is associated with lower atherogenic lipid concentrations and favorable cardiometabolic indices

Abstract Autosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform replication among 456,893 European participants. Common alleles on chromosome Xq23 are strongly associated with reduced total cholesterol, LDL cholesterol, and triglycerides (min P = 8.5 × 10−72), with similar effects for males and females. Chromosome Xq23 lipid-lowering alleles are associated with reduced odds for CHD among 42,545 cases and 591,247 controls (P = 1.7 × 10−4), and reduced odds for diabetes mellitus type 2 among 54,095 cases and 573,885 controls (P = 1.4 × 10−5). Although we observe an association with increased BMI, waist-to-hip ratio adjusted for BMI is reduced, bioimpedance analyses indicate increased gluteofemoral fat, and abdominal MRI analyses indicate reduced visceral adiposity. Co-localization analyses strongly correlate increased CHRDL1 gene expression, particularly in adipose tissue, with reduced concentrations of blood lipids