Wednesday, August 31, 2016

Uncertain Health in an Insecure World – 92


Life offers up subtle themes and catch phrases that connect deeply to the human mind. When music powerfully evokes a particular person or place, like the animal characters in Peter and The Wolf (Sergei Prokofiev, 1936), it’s called leitmotif.

Leonard Cohen wrote of such evocation in his folk gospel anthem, Hallelujah:
“Now I’ve heard there was a secret chord,
That David played, and it pleased the Lord… 
Well, it goes like this, the fourth, the fifth,
The minor fall, and the major lift,
The baffled king composing Hallelujah…”

Such soulful notes resonate to the very core of our beings.

Bono has called Hallelujah, “the most perfect song in the world.” But it didn’t become popular until decades after it was written in 1984. The head of CBS Records called it “a disaster.” The Rolling Stone review of the album, Various Positions, did not even mention the song. Velvet Underground’s John Cale covered it beautifully in his 1991 Cohen tribute album, and Jeff Buckley breathed life into it in 1994 three years before his death. But there was only a ripple of interest. It was only when Rufus Wainwright resurfaced it in the 2001 Shrek movie soundtrack that public awareness grew. 

Is there magic to making musical hits?

University of California at Berkeley engineers studied the structure of 1,300 songs to determine what makes popular music move the human brain. Their ‘hook theory’ posits that certain chord progressions are more pleasing to the ear. Many pop songs are written in the easy to play keys of C or G – they are full of those common chords – so no surprise there. Songs in the key of C (and its relative minor, A) are by far the most frequent. F and G chord progressions are also very common (above), lending to the common criticism of formulaic “four chord pop songs” featuring C, A minor, F and G chords. Songs written in C major (or I) are best wrapped up with G major (or V) chords. That’s why the G to C (or the V to I) chord resolution is so common in popular music.

However, as pointed out by lead hook theorist, Dave Carlton (below left), some of the greatest pop songs eschew this convention, using the F chord (IV) before the C major (a IV to I chord progression) to great effect: Let It Be (The Beatles, 1970, above), Don’t Stop Believing (Journey, 1981), She Will be Loved (Maroon 5, 2002), I Need You Now (Lady Antebellum, 2009) and Edge of Glory (Lady Gaga, 2011).

Carlton notes that classical musicians use different chord progressions when composing. And even pop song writers with classical training – like John Mayer (1998 Berklee School of Music graduate) in Who Says (2009) – approach the composing craft differently. Philadelphia public radio WHYY Radio Times host Marty Moss-Coane explored the musical success formulas behind the classic pop songs of summer. In July 2014, she interviewed Ryan Mikayawa, another UC Berkeley hook theorist (above right). Mikayawa noted that the unique chord progressions in John Legend’s All of Me (2014), while reminiscent of some prior hits, were neither plagiarized nor formulaic.

What does music do to the human brain? Well, if you’re a pop music megastar, different things.

When visiting Montreal in July 2007 for The Police’s reunion tour concert, Gordon Matthew Thomas Sumner (a.k.a. Sting, above) agreed to undergo a functional magnetic resonance imaging (fMRI) brain scan at McGill University’s Montreal Neurological Institute. The lead MNI psychologist, Dr. Daniel Levitin, asked him to listen to music during the fMRI, which showed that “pieces of music that you or I wouldn’t have seen as similar, his brain saw as similar.

Sting’s brain triggered similar patterns (below) when listening to his Englishman in New York, and to The Rolling Stones’ (I Can’t Get No) Satisfaction – both songs start with a low E on the bass. Again, when Sting listened to the Beatles 1960’s hit Girl and Astor Piazzolla’s composition Libertango – both in minor keys with an identical 3-note motif – his cerebellar fMRI activity was comparable.

Remarkably, normal non-musician volunteers’ brains did not make these subtle connections.

Can restoring normal brainwaves help to treat brain injury and disease?

A line of research led by University of Toronto neuroscientist Dr. Luis Fornazzari has shown that artists and musicians suffering from multi-stroke vascular dementia can still express art from memory, even when they fail completely at simple daily tasks and recent event recall.  “Due to their art, the brain is better protected [against] diseases like Alzheimer’s, vascular dementia and even stroke.” Fornazzari believes that, “… the talent and the art per se gives [them] reserve when the brain requires that reserve.” One of his severely affected dementia patients, Mary Hecht, was a sculptor. Mary quickly sketched a portrait of cellist Mstislav Rostropovich (below) when she heard of his 2007 death over the radio. While drawing, her thoughts were clear and her words articulate – otherwise, she couldn’t tell time, remember simple words or identify certain common animals.

So there is neuroscience to music.

In artists, it connects brain patterns and reconnects lost memories.

And exposure to music does rewire neural circuits.

In children, it helps with focus, memory and attention skills.

There is a secret chord.

“But you really don’t care for music, do you?”

Although baffling to some, we in the Square still listen, in search of the divine.  

Wednesday, August 17, 2016

Uncertain Health in an Insecure World – 91

Monkey Mind

Buddha was part messiah, part psychologist.

Some 2,500 years ago, Buddha watched crazed monkeys flinging themselves through the treetops… jumping and chattering non-stop. Buddha related these non-human primate antics to the world’s constant clammering for the human brain’s attention. Taming this “monkey mind” through meditation would release a higher power, and offer transcendence towards a deeper state of consciousness.

So just “Where does the mind stop and the rest of the world begin?

The mind-brain interface is a centuries-old conundrum that remains at the center of this debate. Concrete thinkers (scientists) support the skull-skin demarcation. Abstractionists (philosophers) hold that the mind’s effects are projected externally. A third more modern school of thought reflects an active role of the environment in driving cognitive processes.

In 1998, Andy Clark and David Chalmers (above) described computer interactions with the human mind in an article titled, The Extended Mind. They depicted human problem-solving – the precise placement of geometric shapes into sockets – in three ways. In one approach, humans asked the computer questions that mentally maneuvered the shapes until they fit. The second operator physically manipulated the computer screen image until alignment occurred. Finally, in what the authors’ projected as the “cyberpunk future”, a third operator with a neural implant performed both mental and physical rotations faster than ever. The Catch? – the neural implanted operator must choose which mode to use based on differing demands for attention and impacts on other concurrent brain activities.

This prescient philosopher duo suggested that the neural implant scenario was not “exotic”, and that rapidly advancing computing power had provoked this very issue. They posited that human reasoners lean heavily on any and all available external supports. Computations once done with an abacus or using pencil & paper gave way to the slide ruler, were supplanted by the digital calculator, and then made obsolete by the computer microprocessor. Despite initial resistance to the extended mind theory (EMT), modern mobile device technology now rings their hypothesis true.

Enter social media.

An old adage holds that you need to repeat things 7-8 times for some people to “get it.” Today, social media provides 70-80 repeats a day. Scientists understand that in any human-computer interface, the brain shares internal tasking operations with externally modulated inputs. Social media influencers count heavily on such cognitive manipulations for their follow “success.”

Now wrap your head around the mind-device interface.

Modern mobile devices are more than inert tools. They’re an extension of the human brain… potentiating a higher consciousness. The technology we use becomes part of our mind – integrating without being physically implanted. For centuries, we’ve extended bodily functions with technology – wheels, prosthetics, cars, canes, even electric guitars. Wearable devices now enhance sensorial perception.

Healthy humans have surrendered a number of basic brain functions to technology.

iPhones need not be implanted in our brains to influence our minds. For example, they offer a conveniently mind-numbing alternative to number recall, day planning functions, personal navigation, etc. Blind persons can use iPhones to register their surrounding topography in ambient colors, providing visual imagery far beyond simple glass lenses.

Alzheimer’s patients get a memory boost from external cues, like refrigerator Post-it notes.
Brain chauvinists overvalue what is happening in the brain (biology), versus the external drivers of what the brain is doing (technology). Consciousness offers us mindfulness (philosophy), but true feelings reside at the psychic core of our minds (psychology). Mercifully, none of these “-ologies” are reproduced by artificial intelligence... Yet!

Increasingly, our minds exists outside our consciousness.

Go ahead and query Siri – “Is my iPhone an extension of my mind?” Her simple answer is, “Interesting question.” Then ask her, “Is my mind an extension of my iPhone?” Siri promptly directs you back the EMT and to Andy Clark’s 2009 book, Supersizing The Mind.

Neither philosophers nor Siri do well with such untenable dualisms.   

Give a monkey an iPhone, and… it wants a banana.” (… so you fill in the blank). Seriously, unlike we evolved (read technology-addicted) humans, monkeys can turn their brains off from such externalities. So for non-human primates, at least, there’s hope.

The movie Futureworld eagerly awaited The Extended Mind. But make no mistake – as in 1976, in 2026 there will be a final reckoning.

We in the Square want see what an iPhone-12 can do for the primate mind.

But for now, the human price of technology is clear.

It’s the monkey mind!

Friday, August 5, 2016

Uncertain Health in an Insecure World – 90

“Lake Daze”

I’m on vacation. Not for the entire month of August, like some fortunate Europeans friends. A mere week away from The City will have to suffice. And even that is half over!

Just what have I learned on vacation?

First55% of American workers don’t take all of their paid vacation.

According to GfK Public Affairs and the U.S. Travel Association, in 2015 we left a cumulative 658 million vacation days unused and $61.4B in forfeited benefits. Why not?? – 28% say that they fear falling behind while sitting on a beach, while 19% think it will help them get a promotion, and 17% fear that they’ll lose their job. When was the last time one of your co-workers was fired on vacation?

Second - you can’t swim in a data lake, no matter how big the data.

Gartner IT defines a data lake as a set of disparate data assets collected in addition to the originating data source. These data assets are stored in a near-identical format to the native source format, for use by experts who can explore data refinement & analytic techniques independent of the system-of-record compromises that are implicit to traditional data repositories like data marts or data warehouses. In the hands of Hadoop wizards, data lakes can eliminate data migrations and data silos, reduce the cost of data transformation, and help to leverage big data analytics.  Given that only 20% of data are structured (orange), the need to direct the flow of the other 80% – big data (blue) – remains critical. Hadoop can mix and manage orange and blue box data together (below).

Without Hadoop, big data lakes are “all water and no substance.”
Thirdvacations can wreak havoc on our personal routines.

On Day 1, I received a Garmin Forerunner 235 fitness tracker as a gift; I’ve been anxiously tracking my pulse rate 24/7 since. Wearable technologies are great motivators. My device lets me program daily fitness goals… hitting a pulse of 165 on the run near my VO2max is a rush! And it prompts me to “Move!” after a brief period of inactivity. Digital health LinkedIn leader Paul Sonnier did burst my bubble by sharing a PCWorld report that hackers love to break into mobile health (mHealth) apps! In recent testimony to the U.S. Congress Energy and Commerce subcommittee, mHealth apps often lack good privacy or security safeguards, creating portals into electronic health records (EHR) where secure information is harder to edit out. With mHealth apps installed in one-quarter of U.S. mobile devices, only a few vendors seek permission before sharing your data. Third parties aren’t yet bound by U.S. federal HIPAA privacy rules, so the potential for exploitation is great, especially when start-ups are lacking the cash to invest in such controls.

So for now, unless I give Garmin permission to save my little data on The Cloud, I’m still in control.

Fourthwe never really leave the job behind.

This week, my patients are being covered by colleagues within my medical group.  The patient portal in our EHR is activated, but like most large health systems, we do not require its routine use. Theoretically, the portal should connect my patients to me (or my office) by email using a convenient, safe and secure on-line connection. This digital health business sector is undergoing massive growth, in an effort to virtually connect patients to providers, or to their own personal health information (PHI). Such capabilities are part of the Obamacare “meaningful use” (Stage 3, Objective 5) requirements, that will soon virtually manage healthcare benefits & payments, provide prescriptions and add appointments. hopes that such enhanced patient access can improve patient outcomes. Unfortunately, a Commonwealth Fund study of a cohort of 7,609 seniors from 2011 to 2014 (JAMA August 2, 2016, Vol. 316m No. 5) shows that these digital health tools do not reach the very population that needs them the most (below). Altarum Institute and Robert Wood Johnson Foundation research indicates that low income and non-English speaking vulnerable populations have unique cultural needs and are less likely to access healthcare information.

Just because you have access to technology doesn’t mean you’re fluent in using a program that’s based in technology.”

Last The best things in life take time.

For example, Quincy Jones’ Thriller baby back ribs recipe recommends eight hours of cooking time. They’re Oprah Winfrey’s fav ( ) and well worth the wait. So I dedicated a whole day to making them, and so should you! On my non-culinary days off, I learned that daytime social media is just like daytime television… lots of POP… and little sizzle. Influencers relay redundant quick-hitting infomercials about political extremes, biological drug benefits, financial planning and healthier life habits. Despite all this powerful new knowledge, I feel pretty much the same – digitally un-transformed.

So when floating away from the Square, there is still some peace to be found, if one is selective and disciplined.

Fortunately, the lake is long and my data network is spotty.