~e; EM heartbeat (netfuture)

From brian carroll <human@electronetwork.org>
Date Sun, 24 Oct 2004 11:23:24 -0500

From-- Steve Talbott stevet (at) OREILLY.COM
Date-- Thu Oct 21, 2004  2:17:03 PM US/Central
Subject-- NetFuture #157


                     Technology and Human Responsibility

Issue #157     A Publication of The Nature Institute      October 21,  
              Editor:  Stephen L. Talbott (stevet@oreilly.com)

                   On the Web: http://www.netfuture.org/
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Editor's Note

Quotes and Provocations
    The Heart's Song
                          QUOTES AND PROVOCATIONS

The Heart's Song

The image of the heart as a "ticker" generating a clock-like beat is the
product of a mechanical age.  Such an image did not always prevail.  The
historical psychologist, Jan Hendrik van den Berg, has pointed out that
when the idea of a beating heart was broached a few hundred years ago,  
was regarded by many people as downright crazy; this just wasn't the way
they experienced the "whispering, wailing, loving, longing tale" of the
body's rhythmic center.  It is easy to overlook how thoroughly the
character of our perceptions is dictated by our mechanistic habits of

If the older view seems romanticized and imprecise, you ought to look at
the work of Ary Goldberger, a cardiologist and director of the  
for Nonlinear Dynamics in Medicine at Boston's Beth Israel Hospital.
Goldberger has long sought clues to human health by attending to the
heart's subtle and, you could almost say, artistic performance.  His
conclusion is that the normal heartbeat "is more a dance than a march".

Perhaps the most striking thing about Goldberger's research is its
highlighting of the organic richness of the heartbeat.  Contrary to
expectation, even under the quietest conditions there are continual and
scarcely predictable variations in rhythm, but these variations are not
merely random.  By bringing the mathematical tools of chaos and  
theory to bear on recordings of the heart, Goldberger's team has found,
amid all the unpredictable variation, a deep, complex patterning.
Strikingly, they discovered that only under certain diseased conditions
does the heart degenerate into mechanical regularity.  Pathology,
Goldberger remarks, turns out to be "very monotonous".

Obviously, this has tremendous bearing upon the various efforts to  
artificial heart-assist or heart-replacement devices.  If the heart's
performance is unpredictable, surely it is because there is a two-way,
cause-and-effect relation between heart activity and all the other
processes of the body -- a complex interaction that is in turn an
expression of the organism's governing unity.  How do you integrate a
mechanical device into an organism in this way?

If the complex patterning of the heart's rhythm is an expression of the
whole organism, so, too, we can assume, is much else in the body.
Goldberger's lab is now looking at other physiological patterns as well,
such as those exhibited in the human gait.  Our walking, it appears, is
also subject to continual variation within an organic pattern of order,
and the researchers think that degradation of this order may be an
indicator of diseases such as Huntington's, Parkinson's, and  
A database has now been set up by the National Institutes of Health for
collecting all sorts of physiological data sets and making them  
to researchers like Goldberger.  You'll find the database and associated
resources at http://www.physionet.org.

As a side-project, the Beth Israel researchers have devised a way,
involving various sorts of statistical processing, to translate heart
rhythms into a crude kind of music.  The interval between beats is
conveyed through the pitch of sounds, while rapid changes in interval  
one beat to the next are represented by tinkling sounds.  A  
hum corresponds to a running average of the heart rate.  According to
Gareth Cook, writing in the *Boston Globe Magazine* (Feb. 22, 2004),

    As a rough test of the system, a group of undergraduates was given
    soundtracks created from healthy and sick hearts.  Surprisingly, the
    students were able to distinguish between them, even though they had  
    medical training.

Cook remarks further that "the sounds generated by healthier hearts seem
more organic, with the tones varying in unpredictable ways".  By  
as the diseased heart loses some of its natural variability and beats  
mechanically, the corresponding music sounds "more grating".  Sicker
hearts "sound more like something created by a machine, like bad techno
music".  (You'll find examples of the soundtracks at

Of course, the music at issue here -- from healthy and sick hearts alike
-- *is* created by a machine.  We need to keep this in mind so that we  
be alert to the artifacts and abstractions by which the musical
translation separates us from the heart itself.  Actually, the  
here is extreme, with the music representing little more than certain
quantitative measures.  But, of course, these measures do correlate with
some aspects of the heart's performance.  And the diagnostic  
of a more qualitative presentation -- even when it is a mere re-clothing
of abstractions -- reminds us of the value of qualitative assessment.   
can be sure that those undergrads would have had a more difficult time
distinguishing healthy from sick hearts if they had been given, not a
soundtrack, but the usual data sets.

But, nevertheless, because the synthesized soundtracks do represent  
only a
set of mathematical abstractions, most of the heart's perceptible
performance is missing from this re-presentation.  All of which makes it
seem rather odd that in the literature about Goldberger's work I have  
yet found anyone offering the most obvious comment:  "Gee, if we want  
we can go far beyond these soundtracks.  We can listen to the full
symphony of the heart itself -- and we can even add to this a direct
perception of the blood pulsing through arteries".

There are, after all, medical traditions where listening to the heart  
feeling the pulse are taken to be crucial for diagnosis.  Moreover,  
working within these traditions have long insisted upon the same truth
that has so excited the more recent researchers:  a sensitive attention  
rhythm and sound, pattern and variation, can give us access to  
of health and ill-health throughout the entire organism.

One wonders whether we've got here another case where the abstracting
enthusiasms of the complexity theorists (valuable enough in their proper
place) will smother the qualitative sensitivities they might have
encouraged.  Given our reigning propensities, the smothering is not
terribly difficult.  The skill of pulse-reading and stethoscope use,  
emphasized in medical training and practice, is already a nearly
disappeared art.  In a letter to the *New York Times Magazine* (June 13,
2004), George Mallis, a medical doctor, cites a case where mitral-valve
stenosis (narrowing of a heart valve) was misdiagnosed twice by
echocardiogram.  He goes on to say that the diagnosis could have been
achieved routinely "using traditional skills, including auscultation  
a stethoscope", adding:

    It is unfortunate, if widely acknowledged, that the skills needed for
    such bedside diagnosis are rapidly disappearing as young physicians
    come to depend more and more on technology like echocardiography.   
    there are ever fewer mentors to teach these clinical skills.  This
    case, with its delay in diagnosis, illustrates that it is patients  
    suffer when these skills are lost.

All this indicates a double aspect of medical science today.  New  
repeatedly points us toward the crucial value of qualitative assessment,
but because our love of technical procedure is so great, we continually
employ mere technique, not to support our own, ever greater powers of
perception (wherein the technique could have tremendous value), but  
to substitute for those powers.  This, of course, is the risk of
technology in general.  The question regarding Goldberger's work is
whether, once he has succeeded in drawing attention to the intimate
revelation of the heart's song, there will be any physicians left with  
time, interest, and skill for actually hearing it.

Related Articles:

"Between Discordant Eras", an essay examining how we got from the
"whispering, wailing, loving, longing" heart of an earlier time to the
beating heart of today, and asking where the truth lies between these  


"On Being Wholehearted" in NF #140, concerning the limitations of a
mechanical view of the heart:


"The Lure of Complexity" in *In Context* #6.  This essay (along with its
sequel) looks at the abstracting tendencies of the complexity theorists.



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