Systems Modelling

StingWatch: an environment–social–technological Nexus model for systems medicine

“He who saves one life, saves the entire world” — Sanhedrin 37a

“Whoever saves a life, it will be as if they saved all of humanity” — Surah Al-Ma'idah 5:32

As stated in the intro section of our project, developing an effective, safe and logistically available antivenom for scorpion envenomation is a necessary step towards reducing deaths, but by itself is insufficient. Because of the feedback of our stakeholders, we decided that synthetic biology on the way it is traditionally defined and applied could not really make a sufficient impact in combating alacranism, so we decided to change the focus of our project a little bit. Alacranism has shown to require 3 simultaneous efforts in order to prevent cases of envenomation, and to prevent deaths derived from those cases: education and changes in communities with incidence of scorpion stings, broadening access to health services, and enhancing or developing antivenoms (Boyer, 2013; Riano-Umbarila et al., 2025). Microbial production is an intervention only on the last point, focusing only on it would limit the impact of our project.

We expanded the scope of our project. We wanted to use the same systemic engineering analysis that are currently used in systems, synthetic biology and metabolic engineering. Our goal was to provide a comprehensive framework at multiple levels to help decision makers improve outcomes for victims of scorpion stings. We started with a simple line of thinking, we can apply similar bioengineering principles often used on microbial communities, cell factories, and humans, to human communities, pharmaceutical production systems, and healthcare. We were aware that system thinking has been applied to medicine and social sciences, so we started researching on ways to connect these frameworks into a consolidated systems approach to animal envenomation.

Our approach reorganizes traditional components of iGEM teams into a coherent engineering cycle that aims to have impact beyond wet lab. We used modeling as the central framework to guide integrated human practices, and education in a systemic approach that combines systems ecology, biology, medicine and epidemiology. At its center we are using modeling to turn different parts of our project into effective engineering cycles. Readers are probably familiar with the iterative bioengineering cycle DBTL. We still utilize this framework while expanding it with similar approaches better suited to explain and work with social and healthcare systems.

Avoiding techno-fixation

Early on, stakeholders and advisors cautioned that focusing only on developing microbial antivenoms would be insufficient to make an impact on the issue of scorpion stings in Mexico. This concern moved us to explore other ways to systemically address the issue. While the term wasn’t used back then, part of our project seeks to avoid techno-fixation. Techno-fixation is a term derived from the related techno-determinism and techno-optimism. Essentially, we live in a world of increasing technological development where complex issues such as climate change, biodiversity loss, and epistemic crises are increasingly framed as technical problems that can be overcome with novel engineering solutions. Techno‐fixation encapsulates this tendency, emphasizing a belief that technology alone holds the key to solving existential challenges, while often displacing or ignoring the underlying social, political, and environmental dynamics at play (Certomà et al., 2024; Ditmar, 2024). Sustainability has needed broad systemic changes to ensure it is an achievable goal ever since the use of the Our common future definition (Development that meets the needs of the present without compromising the ability of future generations to meet their own needs) (UN. Secretary-General & World Commission on Environment and Development, 4). This definition of sustainability has drawn critics that argue that technology can improve measurable conditions, and that social, economic, and cultural policies intended to achieve sustainable development can impede technological progress and force change against individual and personal liberty. In this sense techno-fixation is entwined with a capitalist logic, one where environmental and social issues are reinterpreted through the lens of market efficiency and measurable outputs (Certomà et al., 2024; Hallström, 2022; Kaiserfeld, 2015). Our approach seeks not to take away merit from technological development, not to argue against it. We seek to include technological development in a framework where it helps solve systemic problems, while acknowledging that by itself it is insufficient to solve systemic challenges. We work this framework in the context of healthcare focused on animals particularly scorpion envenomation.

A systems approach

Systems theory has biological origins but has greatly expanded since. The desire to apply similar tools and methodologies to those used in systems biology to other types of problems is not new. Through the years, and especially in the wake of the 2020 pandemic, calls have been made to address systemic challenges in healthcare. Systems medicine and epidemiology have risen and gained renewed popularity in recent years (Angione, 2019; Auffray et al., 2009; Ayers & Day, 2015; Dammann et al., 2014). We decided that a systemic approach to the issue of scorpion stings would be best to reflect the complex, non-determinist reality of human society, education, sustainability and healthcare. Our framework is informed by systems biology, medicine, and epidemiology.

The 4 Ps

The XXI century has brought new challenges to medicine, as diseases like diabetes, cancer, neurodegenerative diseases, and other chronic illnesses become leading causes of death, particularly in older individuals; preventable conditions like accidents, self-termination, and violence become more common among younger individuals. The traditional model of medicine, one that reacts to medical emergencies as needed has proven limited in its capacity to deal with these new challenges (Bohîlțea, 2025; Flores et al., 2013; Vogt et al., 2016). The advent of systems medicine has fostered the emergence of a new paradigm known as P4 medicine, which is built upon four interrelated pillars: predictive, preventive, personalized, and participatory medicine. By integrating comprehensive molecular information (genomic, proteomic, metabolomic, and more) with advanced computational modeling and patient-generated data, this approach shifts healthcare away from reactive treatment toward proactive wellness management. Systems Medicine Systems medicine seeks to understand biological processes as integrated networks rather than isolated events. The emergence of the 4 Ps is a natural extension of this philosophy, as their combined implementation can transform the traditional, reductionist framework into one that comprehensively addresses both disease and wellness. The integration of predictive, preventive, personalized, and participatory components allows for robust patient stratification, early therapeutic intervention, and dynamic treatment modifications over time (Auffray et al., 2009; Ayers & Day, 2015; Slim et al., 2021; Vogt et al., 2016).

Initially, the emphasis was placed on understanding disease at the level of individual genes, proteins, and metabolites. However, a growing body of evidence now indicates that environmental exposures, social determinants, and behavioral aspects are equal, or in many cases, more important in shaping disease risk and outcomes. Structural violence and socioeconomic disadvantages have been shown to significantly impact chronic diseases such as HIV/AIDS and tuberculosis in populations facing poverty and political instability. Similarly, social stressors and environmental risk factors have been linked to chronic inflammation and a host of age-related diseases (Ahmed et al., 2020; Bohîlțea, 2025; Chakraborty & Maity, 2020; Farmer et al., 2019).

A framework that uses the 4Ps to study and address the social, environmental, and health determinants of envenomation has the potential to better address the issue of scorpion stings in Mexico. While the existing health model is one that uses prevention, and to a lesser extent prediction and participation, we aim to contribute to a shift in paradigm that addresses all 4 points:

Predictive. At the heart of the 4P model lies predictive medicine, which leverages cutting-edge technologies and data analytics to forecast potential health risks. This dimension harnesses high-throughput sequencing, proteomics, and metabolomics alongside nontraditional variables such as economic indicators and environmental quality data to build comprehensive risk profiles. By integrating information about air quality, exposure to toxins, and local socioeconomic conditions with genetic risk factors, predictive models can stratify patients more accurately into risk categories. This enhanced predictive capability is crucial for the early administration of targeted preventive measures, especially in high-risk communities that may be disproportionately affected by adverse environmental conditions or socioeconomic deprivation (Bohîlțea, 2025; Chakraborty & Maity, 2020; de Magalhães Brito & Magagna, 2020; Farmer et al., 2019). Our approach to predictive healthcare uses historical data of scorpion stings, combined with social and climatological data to determine future trends in scorpion envenomation using an LSTM model, to allow stakeholders to respond and make informed decisions before stings happen.

Preventive. Preventive medicine within the 4P framework proactively addresses disease risk by targeting lifestyle and environmental factors long before pathology manifests in clinically relevant forms. Preventive strategies are designed not solely on an individual basis, but also at the population level, where interventions may include public health policies, community-centric programs, and tailored behavioral modifications. The integration of socio-economic and environmental determinants into prevention efforts is exemplified by initiatives that focus on urban planning improvements, pollution mitigation, and the promotion of healthy dietary practices in economically disadvantaged regions. By adjusting public health strategies to account for local determinants, such as neighborhood safety, access to recreational spaces, and food deserts, preemptive measures become more effective in curbing disease incidence (Bellazzi & Zupan, 2008; Biesecker, 2013; Janssens et al., 2018). In our project we leverage deep learning tools to find risk factors in populations, with the end of communicating them to high level decision makers in public and private sectors to design new preventive strategies for these communities.

Personalized. Personalized medicine considers the vast heterogeneity among individuals by tailoring diagnostic and therapeutic interventions to the unique characteristics of each patient. Personalization is significantly enhanced by considering not only the genetic and phenotypic characteristics of the individual but also by incorporating data regarding lifestyle, economic status, and environmental exposures. Sophisticated diagnostic tools now enable clinicians to create highly individualized treatment plans that account for variations in drug metabolism, treatment responsiveness, and potential side effects. However, without incorporating external determinants, such as the patient’s ability to adhere to complex therapeutic regimens due to economic constraints or the influence of environmental stressors, the efficacy of personalized treatments remains limited (Boccia et al., 2020; Chan & Ginsburg, 2011; Janssens et al., 2018). In the context of scorpionism personalized medicine must include the limitations of the Mexican healthcare system. Our project addresses personalized medicine by using optimization strategies that aim to improve localized outcomes in marginalized communities and by working with stakeholders to develop personalized strategies.

Participatory. The participatory dimension of the 4P framework fundamentally redefines the patient–clinician relationship by fostering a culture of shared responsibility. This model recognizes that optimal healthcare outcomes are achieved when patients, families, healthcare providers, and community stakeholders engage collaboratively in the decision-making process. Incorporating social, economic, and environmental data into participatory platforms enriches these interactions by ensuring that care plans are rooted in the lived realities of patients. Active participation not only leads to more relevant data collection but also results in greater adherence to preventive measures and personalized treatment regimens. Digital platforms, patient portals, and community health networks enable real-time feedback and continuous engagement, thereby transforming traditionally hierarchical care models into inclusive, data-driven partnerships (deBronkart, 2018; Hood & Auffray, 2013; Jun et al., 2018). As part of our project we are working with stakeholders towards open and democratized medical approaches, one where communities have an active role in determining their health outcomes.

A larger engineering cycle

The DBTL cycle was developed to work in bioengineering, integrating metabolic engineering, systems biology and synthetic biology (Li et al., 2022; Pouvreau et al., 2018). It is an effective framework to develop biological systems with defined uses. We decided to apply a similar, iterative approach to social systems. Based on the principle of biological levels of organization, we initially decided to use the DBTL cycle at different levels, from molecular to ecosystem. However, it became apparent, upon reviewing existing social frameworks, that the DBTL cycle would be inadequate in working with social components. We decided to use different approaches, DBTL for molecular and production level engineering. For other levels, mainly social, healthcare, and logistics levels we utilized the double diamond framework. The double diamond framework is another iterative design framework that has been used in social and medical environments. The framework similarly to DBTL consists of 4 steps: discover, design, develop, and deliver (Bermejo-Martínez et al., 2024; Rian et al., 2024; West et al., 2018; Zhou et al., 2021). While biological and social systems have many intrinsic differences they share many commonalities from an engineering perspective, they are both complex networks of agents that contribute to a system. They both benefit from systemic approaches that avoid reductionist determinism. Finally, they can both be worked in iterative design cycles, combining mathematical modeling, experimental and social work.

As such the modeling section of our project gained a new characterization, it had to work not only with traditional bioengineering work alongside wet lab, it also had to integrate human practices, education, and sustainability along 3 systems to ensure a systemic strategy on how to improve outcomes for animal envenomation:

  • Preventive medicine. Preventative medicine in our case works mainly on an education axis. It requires people to have accessible, understandable, and accurate information on how to prevent scorpion stings, what to do in case an envenomation occurs, and how antivenoms work. Modeling works here by analyzing historic data, discerning groups of victims and making recommendations on how to focus resources that better address these groups.
  • Healthcare systems and logistics. In the event that a person is stung and they seek medical care, receiving an antivenom improves their outcome by a significant margin. To ensure that outcome, greater access to healthcare is needed. We use modeling to optimize logistical models to ensure that antivenom will be available in the case of scorpion envenomation, and process data to better understand the needs of doctors at the local communities to better inform high level decision makers that can direct resources to them.
  • Developing a new antivenom. Even with our new approach we still did the classic aspects of modeling for bioengineering that are typical of any iGEM teams. We build modeling at the molecular, metabolic and genetic circuit levels, to improve our cell factory and the corresponding production process.

These 3 systems are being tackled in a model-oriented approach to generate a comprehensive systems engineering approach to the problem of scorpion envenomation — one we have dubbed StingWatch.

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