“Healthy Fractal Complexity: Breakdown and Disease”

In which Dr. Ary Goldberger revealed insights about organizations through the use of a compelling metaphor: the human body.
Ary Goldberger, MD, Department of Medicine,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston

• Curt opened this session by introducing Dr. Goldberger as a cardiologist by training, and the foremost expert in complexity theory in human physiology.
  
  
• Goldberger explained that his center is the only lab on nonlinear dynamics in medicine in the world. The center was endowed by creator of the children’s book character, Curious George. “Curious George,” Goldberger observed, “is a good metaphor for this new way of thinking.”
  
  
• “A decade ago, I told someone you can’t find a medical book today with the word fractal in it,” Goldberger related. “In 10 years, I added, you won’t be able to find book without it.”
  
  
• Goldberger then explained he would touch on three issues:
  • the non-linear dynamics of cardiac physiology;
  • fractal features of the cardiovascular system;
  • and the breakdown of fractal scaling in disease.

• Linearity is useless. It’s reductionistic. It says that behavior merely reflects the sum of the parts, and there should be no surprises. “That’s pretty dull when you think about it,” Goldberger noted. “It has nothing to do with anything that’s living. It’s a dangerous illusion. The Linear Fallacy suggests that biosystems can be understood by dissecting components and analyzing them in isolation.”
  
  
• The Rube Goldberg Fallacy — faulty belief that the body is like a big Rube Goldberg diagram where you just push the right levers and the right output comes out. Goldberger countered: “It’s crap, dangerous crap, with no sense of connection. But this is how most people think of physiology – and organizations.”
  
  
• Living systems are dynamic. “Our cells operate much more like a dance,” Goldberger said. “We are non-linear system. Outcome is not proportional to input and superposition is not applicable because the components interact. Reductionism doesn’t work. You can’t understand the system by seeing details in isolation. The data are complicated. We are nonlinear mechanisms that don’t depend on details of the system. Many things emerge that are not entirely based on those specifics.”
  
  
• There is a growing need for physiologists to understand all sorts of new ideas: bifurcations, limit cycles, fractals, period-doubling, nonlinear waves, chaos and complexity. Physiologists need to look for the types of patterns that complexity science deals with.

• In fact, the laws of physiology are often fractal, where processes or tree-like objects are self-similar. You can see branches, leading to branches, leading to branches.
  
  
• Fractals in nature include coral, lungs, waves, mountains. Cathedrals are “organic” structures that are “spiney” at many levels. Mandelbrot sets can also be seen as the rose windows of the 21st century.
  
  
• A critical fact largely overlooked in medicine is that when fractal structure is subverted, things get bottled-necked.
  
  
• Among fractal body processes is the heartbeat, which we can see in the interval between spikes of heartbeat. That interval fluctuates in a complex fashion. A normal heartbeat is a wrinkly line. This is a dance-like physical state. The heart rate is regulated by a complex system that enables the heart to beat far from equilibrium. Whether viewed in blocks of 5 hours, 30 minutes or 3 min. the heartbeat tracing displays fractal-like similarity.
  
  
• Music has the same kind of structure. Bach’s Brandenberg Concerti have a frequency spectrum similar to that of a healthy heartbeat. We took fluctuations in heart rate and translated them into music. The result is Zach Davids’ “Heartsongs” – heart-generated notes. Classical Music and healthy heartbeats are both fractal— products of nonlinear control mechanisms and fractals.

• “What goes on when bad things happen to good fractals?” Fractal breakdown either collapses to one frequency and becomes much too ordered, or it becomes much too random and leads to anarchy. Both are death to any system.
  
  
• Fractal variability enables us to make many responses to a variable world. We can cope with the unexpected. It also gives us long-range order. Even in the deepest sleep there’s a great deal of variability – as opposed to Hepatic Comas, where much more “regularity” can be observed.
  
  
• Key Point: “Disorder” is a misnomer. Disorder is actually healthier; order and predictable dynamics are really sickness. Disease de-complicates us, causing our outputs to become too regular. Healthy functions are more chaotic.
  
  
• For health care in the year 2000, that leaves us with several questions:
  • Do we need innovative ways for monitoring patients?
  • Do we have a fractal model for healthy organizations?
  • Do we need a new model for understanding pathological organizations

Copyright © 1999, VHA Inc. Permission
to copy for educational purposes only.