March 16, 2014

Random Thoughts on a Cold Sunday

If you didn't hear Gilles Vonsattel's spectacular Ives Concord Sonata at Leffler Performance Center last night, I am sorry for you. Gilles' father is a neuropathologist.

If you didn't attend the Met HD Live Werther yesterday I am sorry again for you. We thought it was one of the best HD Live productions this year. Maybe I'll read Goethe's novel. Gilles' wife, Sarah, expecting their first child, played in the orchestra's violin section. (They have au pairs lined up.) 

I was also sorry to learn of the passing of Iola Brubeck. Here are some things you might not have known about a wonderful woman.

Catching up on my reading. I found some fascinating items:

 "No part of the brain is not connected to some other part of the brain, either directly or indirectly." --Dr. Damien Fair, Oregon Health and Science University. The current map of connections, still very rudimentary, reminds me of the airline map in the seat pocket on my last flight. If this fascinates you, check out the Connectome Project.

  • "We come into the world knowing almost nothing. You can trace almost all of your behaviors to learning as opposed to genes. Language, riding a bicycle, how you button your shirt -- basically everything is learned, which means once that information gets into the brain it has to be turned into a stable form." --Dr. Jeffrey Lichtman, Harvard University (Note that he said "behaviors")


  • Among all schools at Yale, the School of Music has the most international students: 87 of 215 (40%). Yale College (undergrads) has 11%.

  • In deciding how of face the near-inevitability of sharing their last decades with prostate cancer, men may first need to examine their philosophy of life and then earn a Ph.d. in Statistics. N Engl J Med 2014; 370:932-942. Don't expect much help from your doctor; s/he probably doesn't have time: Diagnose This; How to be your own best doctor. Harper's Magazine, April 2014. Or: When Doctors Don't Listen, Leana Wen and Joshua Kosowsky, 2012.

  • Lured back to Russia in 1936 and hoping to rescue a faltering career, the composer, Serge Prokofiev was largely disappointed--and then the exit doors closed. He walked out in his wife, Lina, to move in with a much younger student, "thinking well enough of his wife to summon a physician to ensure that she was well cared for," according to Simon Morrsion, who wrote the recent Serge and Lina: The Love and Wars of Lina Prokofiev. Seven years later Lina was arrested and spent 8 years in the gulag. When she was released Prokofiev had died (obscurely in 1953 on the same day as Stalin). Lina spent her remaining 33 years as his cultural ambassador, attending concerts, donating papers to archives, and giving interviews to journalists. The Soviets, surprisingly, eventually recognized both marriages. --from a review by Orlando Figes, New York Review of Books., Mar 6

March 11, 2014

Hearing with our Eyes

A researcher at the University College of London, Chia-Jung Tsay, studies how we evaluate a performance of music. What makes us think a performance great, or not? 

The results are stunning: we use our eyes!

To make a long story short (as my mother used to say, but I recommend reading it*) Tsay selected two groups of subjects, each numbered in the hundreds: one group were professional musicians and the other just plain folks (musical novices). She presented them performances from two different categories: 1) a highly ranked ("world class") orchestra, say the Chicago Symphony, and 2) an average regional orchestra, say a fictitious Fargo Philharmonic. Each 'performance' was six seconds long by: 1) sound recording, 2) a silent video recording, and 3) recordings with audio and video, all of the same passage in the music. Subjects viewed similar performances of chamber ensembles, prize-winning v. just average ones.

Tsay described in great detail her experimental methods and statistical evaluation of the results of dozens of separate tests. They seem rigorous and complete to me. She had to make sure that none of the subjects got clues to the right answers to the single question: which of two performances in each test was by the supposedly higher-rated ensemble? 

Again, to oversimplify the results for clarity: the only times significant numbers of either group of subjects identified the prestigious ensembles correctly (more frequently than by chance) were when they viewed the silent video performances! Even the musicians couldn't distinguish the Fargo Phil from the Chicago Symphony by sound recordings!

One additional subtest also showed similar results when the video narrowly focused on the one member of an ensemble who appeared to be the de facto 'leader' of the group. When the camera focused on the 'followers,' the subjects' responses were no better than chance.

There is more detail in the report, but all followed this same pattern supported by robust statistics. As in all research, insightful critics can often discover hidden bias that could change the results and conclusions. And, as in all research, someone else needs to repeat the experiments and confirm or deny these results.

My criticism would be that I need longer than six seconds of music to make any judgement about it. 

Like all good research, the results of this one raise additional questions. Will 'rankings' of recordings change as more people experience them on YouTube than on audio recordings? What are the implications for those of us who champion "live music?" Should we re-evaluate the recent policy of auditioning candidates for orchestras behind screens? (Tsay doesn't mention that it began when 'old white men' conductors had certain biases.) Should music schools change their teaching? Are the 'best' orchestra conductors ranked that way by their appearance? Have the people who make 'music videos' known this for years? At least now I understand Kenny G!

Of course, it stands to reason that, as all the musicians said to the experimenter: "it's the sound that counts." We all know that ranking orchestras and ensembles is no more accurate than ranking college football teams, though no money rides on the former. (Or does it?)

*The vision heuristic: Judging music ensembles by sight alone


February 25, 2014

What's 'charitable' about making music?

I am not a regular reader of Forbes but when my investment guy, Phil DeMuth, sends me a link to his column, I read it.

Phil's Forbes article, "The Death of Big Charity," opened my eyes. It was inspired by a book released this month by Ken Stern, former CEO of National Public Radio, With Charity for All. Reading it will, at the very least, make you think twice before donating to a non-profit, tax-exempt 'charitable' organization. 

Such as Gretna Music. 

In the US charities of all kinds (tax-exempt under section 501(c)(3) of the US tax code) number 1.1 million and collect $1.5 TRillion a year: educational, health, shelter for the homeless and animals, preservation of land, athletics (you knew that the NRA, NFL and hundreds of college Bowl Games are tax-exempt charitable institutions?), arts and culture, religious, and scientific research--to name a few categories.

If your organization achieves charitable status from the state and federal IRS, as has almost every applicant (at a rate of 50,000 per year) for decades, you have a 99.5% chance of keeping it forever, regardless of how (or whether) you carry out your charitable mission. No one ever checks.

One view of the main problem holds that charities focus more on getting donations and their own aggrandizement and continuation; less on their mission. They neglect "infrastructure," such as a system for rigorous financial checks and balances, or (horror) an effective plan for executing their mission. As accountability for their outcome, many offer only glossy promotional materials boasting of selected individual successes, not statistical results of careful studies proving they succeed in doing what they claim. Non-profit hospitals, for example, are no more charitable in any sense than for-profit hospitals. The main beneficiaries of many charities are the people who work for them and their executives, among them parish priests, many of whom can rake in compensation as huge as hedge-fund managers.

Regarding the performing arts we must adopt a very broad view of 'charity.' What's 'charitable' about an organization like the Metropolitan Opera? I mean, charitable enough to justify their handouts from federal and state taxpayers, most of whom haven't heard of Nessun Dorma. Stern: "With most tickets running into the hundreds of dollars, the opera is not just the playground of the wealthy; it is their gated community."

Before you close your checkbook let me make a brief case for giving us ("Small Charity") a tax-deductible(!) contribution in addition to buying a ticket for one of our concerts. 


Why can't we exist only on ticket revenue?


The kind of music we play, ever since the time of its origin, has required patrons because it was valued (understood, appreciated) mainly by a small segment of the population. Initially the patrons were royalty (some still are). Contemporary patrons are governments, individuals, universities, foundations, or corporations, each having their motivation, altruistic or not. Entertainment with broad popular appeal (like rock music or football) can bring more ticket revenue and even profits. Nevertheless, Bach, Beethoven and Brahms have survived for centuries! Their music is good and timeless.


What do we deliver in return for support (beyond 'enrichment' of lives)?


Employment for hundreds.
Gretna as a better place. (I know because I live here.)
Inspiration for residents and businesses to locate in Gretna.
Inspiration for young people to enter several fields of music.
Introduction of thousands to music and musicians they would never have heard.
Introduction of hundreds of people to hundreds of other people with similar interests.


What is our best (in hard numbers) measure of outcome?


We have survived 39 years through frugality, sound financial management and uncompromising quality of our 'product.'
"During the 2007-2009 recession the nationwide ranks of arts organizations swelled by more than three thousand--at a time when public participation in the arts was dropping and existing arts organizations had to fight for their piece of declining public support." 
--(Ken Stern)
We are now stronger than ever.

The moral of this story is that "Sniff, Cigars, and Tobacco" and "Big Charity" may not survive our generation, but great art and music, and flowers, will.

The Death of Big Charity by Phil DeMuth

Music at Gretna, Inc., is a Pennsylvania non-profit corporation. A copy of the official registration and financial information may be obtained from the Pennsylvania Department of State by calling toll-free within Pennsylvania, 1-800-732-09999. Regsitration does not imply endorsement.

February 18, 2014

The Plight of Music Criticism

"As far as music criticism is concerned, I think the decline of the role of music critics is indicative of a general cultural trend: the [in]ability, or [lack of] desire, to listen critically. This is the unavoidable result of a culture that does not emphasize a proper music education or its vast history. If you don’t value the education, you’re not going to value the subject very much, regardless of how it makes you 'feel'. Consequently, everything has been reduced to a matter of personal opinion, where all positions are equally valid, without any critical thinking, crucial listening, drawing distinctions, etc. – I mean, these are the building blocks of the Western tradition going back to the Greeks! 
Part of an interview with Paul Jacobs, Chair of the Organ Department at the Juiliard School in the San Francisco Examiner, February 16, 2014
More, but I recommend the entire interview:
"…. We should strive to increase our expectations for what music can do for us in our lives. Then we'll be less satisfied with what the latest pop-star puts out – that’s not to say that one doesn’t have the right to listen to it – but I believe these pop hits are woefully incapable of offering a glimpse of all that music has been and has the potential to be. 
"A greater awareness for the rich history of music is something that must be regained.
"An art form is only secure if there are those willing to sacrifice for it. Fortunately, there is an army of dedicated, intelligent young musicians who understand what is at stake. Not just classical music, but the very soul of our culture."

February 7, 2014

Monster of the Steinway: Ives' "Concord"

Essays Before Sonatas 
(program notes for our March 15 concert by Gilles Vonsattel)

Beethoven, Sonata “Moonlight” 
No. 13 in C# minor (op. 27, #2)

“Quasi una fantasia” means, though not in a simple and direct sense, “in the manner of an improvisation.” It also means that this work shares an important feature of fantasias by Mozart, Haydn, and others, an unpredictable number of sections that use different kinds of figuration patterns. The sections are played without pause. One result is to blur the impression that each movement is an autonomous whole with a full cadence at the end, and so it blurs the notion that individual movements are the main units of organization.... the first movement passes directly on to the second and the second to the third. 

The hypnotic first movement, a world classic from the day of its publication, seems like an immense slow improvisation. The Berlin critic and poet Ludwig Rellstab (1799-1860) applied the label “Moonlight,” because the first movement suggested to him "a boat visiting, by moonlight, the primitive landscapes of Lake Lucerne." Above the notes of the opening Adagio Beethoven wrote that it should be “played with extreme delicacy.” The sonata progresses from the dreamlike C-sharp-minor Adagio sostenuto to the graceful D-flat Allegretto and on to the tragic and powerful Presto finale with crackling arpeggios and exploding fortissimo chords. The sonata-form Presto agitato finale completes the formal architecture of the cycle with enormous energy. The emotional crescendo of the three movements is unlike any other early Beethoven sonata, the percussive element being essential.

Rzewski, Winnsboro Cotton Mill Blues

When the Freedom Riders rode interstate buses into the segregated South during the 1960s, they were beaten and arrested in Winnsboro, SC. Lead Belly, the late Pete Seeger, and others sang the traditional blues song, Winnsboro Cotton Mill Blues. Rzewski reworked it for the piano. On January 20, 2014 the town of Winnsboro, called by residents, "the Charleston of the upcountry," "closed to honor Dr. Martin Luther King."

Frederic Rzewski (zheff-skee) began playing piano at age 5. He attended Phillips Academy, Harvard and Princeton. His teachers included Randall Thompson, Roger Sessions, Walter Piston and Milton Babbitt. During a formative trip to Italy in 1960 he studied with Luigi Dallapiccola he began a career as a performer of new improvisatory piano music. Later he co-founded Musica Elettronica Viva that conceived music as a collective, collaborative process, with improvisation and live electronic instruments.

Ives, Concord Sonata
One of the most curious, wonderful things about the “Concord” Sonata is the obsessive assault it mounts on Beethoven’s Fifth Symphony. Da-da-da-dum has become such an emblem, an audible logo, of classical music; the four notes express our whole tuxedoed, staid obsolescence, our desire to perpetuate ourselves. The sternness, the immediate minor-key attitude, the inescapable upbeat leading to downbeat, the timbre of the sustaining strings, full throttle... all of this captures perfectly the terminally uncool, that which in classical music takes itself too seriously, refuses to relax.
--Jeremy Denk, from the liner notes of his recording, Jeremy Denk plays Ives. I highly recommend it.
When Ives was a student at Yale in the eighteen-nineties, son of a Danbury CT bandmaster with an experimentalist streak, he knew that he wanted to devote his life to writing music, but he also knew that the kind of music he wanted to write would not be understood by most people. Prudently, he founded an honest, ethical, but highly profitable insurance company in New York City, ran it responsibly, treated his employees well, and became a multimillionaire. 

But Ives lived a double life. His other passion was writing music, not the traditional, “proper” Europhilic music he learned in composition classes. He knew very few listeners would like it, but was determined to write what he wanted regardless of its popular appeal. He wanted to “stretch ears.”

When Ives published the Concord in 1921, he accompanied it with a thirty-thousand word Essays Before a Sonata: 

"These prefatory essays were written by the composer for those who can't stand his music--and the music for those who can't stand his essays; to those who can't stand either, the whole is respectfully dedicated." 

"The following pages were written primarily as a preface or reason for the [writer's] second Pianoforte Sonata--"Concord, Mass., 1845,"--a group of four pieces, called a sonata for want of a more exact name, as the form, perhaps substance, does not justify it.... The whole is an attempt to present [one person's] impression of the spirit of transcendentalism that is associated in the minds of many with Concord, Mass., of over a half century ago.... The first and last movements do not aim to give any programs of the life or of any particular work of either Emerson or Thoreau but rather composite pictures or impressions. They are, however, so general in outline that, from some viewpoints, they may be as far from accepted impressions (from true conceptions, for that matter) as the valuation which they purport to be of the influence of the life, thought, and character of Emerson and Thoreau is inadequate.The four movements are, “impressionistic pictures of Emerson and Thoreau, a sketch of the Alcotts, and a Scherzo supposed to reflect a lighter quality which is often found in the fantastic side of Hawthorne.”

Only the most intrepid readers will continue on from this point. Warning: the music you will hear on March 15 comes from the same brain as the prose....

Emerson
It has seemed to the writer, that Emerson is greater--his identity more complete perhaps--in the realms of revelation--natural disclosure--than in those of poetry, philosophy, or prophecy. Though a great poet and prophet, he is greater, possibly, as an invader of the unknown,--America's deepest explorer of the spiritual immensities,--a seer painting his discoveries in masses and with any color that may lie at hand--cosmic, religious, human, even sensuous; a recorder, freely describing the inevitable struggle in the soul's uprise--perceiving from this inward source alone, that every "ultimate fact is only the first of a new series"; a discoverer, whose heart knows, with Voltaire, "that man seriously reflects when left alone," and would then discover, if he can, that "wondrous chain which links the heavens with earth--the world of beings subject to one law." In his reflections Emerson, unlike Plato, is not afraid to ride Arion's Dolphin, and to go wherever he is carried--to Parnassus or to "Musketaquid”....

Hawthorne  
The substance of Hawthorne is so dripping wet with the supernatural, the phantasmal, the mystical--so surcharged with adventures, from the deeper picturesque to the illusive fantastic, one unconsciously finds oneself thinking of him as a poet of greater imaginative impulse than Emerson or Thoreau. He was not a greater poet possibly than they--but a greater artist. Not only the character of his substance, but the care in his manner throws his workmanship, in contrast to theirs, into a kind of bas-relief. Like Poe he quite naturally and unconsciously reaches out over his subject to his reader. His mesmerism seeks to mesmerize us--beyond Zenobia's sister. But he is too great an artist to show his hand "in getting his audience," as Poe and Tschaikowsky occasionally do. His intellectual muscles are too strong to let him become over-influenced, as Ravel and Stravinsky seem to be by the morbidly fascinating--a kind of false beauty obtained by artistic monotony. However, we cannot but feel that he would weave his spell over us--as would the Grimms and Aesop. We feel as much under magic as the "Enchanted Frog." This is part of the artist's business....

The Alcotts  
If the dictagraph had been perfected in Bronson Alcott's time, he might now be a great writer. As it is, he goes down as Concord's greatest talker. "Great expecter," says Thoreau; "great feller," says Sam Staples, "for talkin' big ... but his daughters is the gals though--always DOIN' somethin'." Old Man Alcott, however, was usually "doin' somethin'" within. An internal grandiloquence made him melodious without; an exuberant, irrepressible, visionary absorbed with philosophy AS such; to him it was a kind of transcendental business, the profits of which supported his inner man rather than his family. Apparently his deep interest in spiritual physics, rather than metaphysics, gave a kind of hypnotic mellifluous effect to his voice when he sang his oracles; a manner something of a cross between an inside pompous self-assertion and an outside serious benevolence. But he was sincere and kindly intentioned in his eagerness to extend what he could of the better influence of the philosophic world as he saw it. In fact, there is a strong didactic streak in both father and daughter. Louisa May seldom misses a chance to bring out the moral of a homely virtue. The power of repetition was to them a natural means of illustration. It is said that the elder Alcott, while teaching school, would frequently whip himself when the scholars misbehaved, to show that the Divine Teacher-God-was pained when his children of the earth were bad. Quite often the boy next to the bad boy was punished, to show how sin involved the guiltless. And Miss Alcott is fond of working her story around, so that she can better rub in a moral precept--and the moral sometimes browbeats the story....

Thoreau  

Thoreau was a great musician, not because he played the flute but because he did not have to go to Boston to hear "the Symphony." The rhythm of his prose, were there nothing else, would determine his value as a composer. He was divinely conscious of the enthusiasm of Nature, the emotion of her rhythms and the harmony of her solitude. In this consciousness he sang of the submission to Nature, the religion of contemplation, and the freedom of simplicity--a philosophy distinguishing between the complexity of Nature which teaches freedom, and the complexity of materialism which teaches slavery. In music, in poetry, in all art, the truth as one sees it must be given in terms which bear some proportion to the inspiration. In their greatest moments the inspiration of both Beethoven and Thoreau express profound truths and deep sentiment, but the intimate passion of it, the storm and stress of it, affected Beethoven in such a way that he could not but be ever showing it and Thoreau that he could not easily expose it. They were equally imbued with it, but with different results.

Go to Gretnamusic.org or call 717-361-1508 for tickets to the concert by pianist Gilles Vonsattel, Saturday March 15, 2014, 7:30 pm in Elizabethtown College's Leffler Center for the Performing Arts. Dinner buffet reservations are due on Monday before the concert.

February 1, 2014

Making Music May Delay Dementia

The act of playing a musical instrument calls upon multiple interconnected brain abilities. For example, balance, when I stand as I usually do to play the flute; vision, to interpret a printed language ('code') on a music stand; motor control, activation of a practiced and primed finely tuned system to receive and execute the instructions of the code; memory, to call up a Bach Sonata from its book shelf in the temporal lobe with a connection that sends instructions to the motor system; coordination, between tongue and both hands fitted precisely into a tempo and rhythm; deep-breathing and breath control, to last through an entire phrase; expression and emotion (phrasing, dynamics, style), layered on to the sounds to fit the character and 'message' of the composition; critical listening system to evaluate my own sounds--pitch, tone quality, fit into an ensemble, pace, tempo--in a feedback loop that makes instant corrections to all the functions mentioned above as needed; and so forth. All instruments demand similar and other abilities.
Whew! That is a major workout for the brain! And it's less expensive and (for me) more interesting than most 'cognitive exercises' I can purchase on the internet or pursue at a local AARP gathering or occupational therapy department. To cap it off, playing music with others is my favorite 'social activity.'
Researchers in 2003 followed older participants to study the relative contribution of various specific activities--like board games, puzzles, group discussions--for 5 years. Those participants who frequently played a musical instrument were less likely to have developed dementia compared to those who rarely played. This protective effect of playing music was stronger than that from the other activities. Physical activities (walking, swimming, etc) did not appear to confer any protective benefit in the development of dementia in this particular study. (They have in others.)
Another group of scientists in 2007 examined the beneficial effects piano lessons in old age. They compared naïve participants randomly allocated to an experimental group (6 months of intensive piano lessons) to a control group that did not have lessons. The experimental group received a half-hour lesson each week and was required to practice independently for a minimum of 3 hours each week. After this period of musical training, the piano players showed improvements on tests of working memory, perceptual speed, and motor skills, while the control group did not.
More recently (2010) researchers in this field concluded:
"To minimize the deleterious effects of aging on brain function, elderly individuals need to engage in demanding multisensory, cognitive, and motor activities on an intensive basis. Accordingly, a training program that is designed specifically to facilitate brain plasticity, or engage multiple brain regions (especially the frontal and prefrontal areas), may counteract some of the negative consequences underlying disuse associated with aging. One activity that has the potential to stimulate and preserve cognition is music making." (here, with a good review of this topic)
These observations even provide another argument for early music education. If you have ever played an instrument, it is far easer to take it up again, even when you are elderly, than it is to start cold for the first time in later life.


November 24, 2013

Alternative Medicine; Four Ways to Spot a Quack

In my experience musicians turn more often than average to ‘alternative medicine' for help with problems, or just with hope to improve their health. The list includes the “Three ‘R’s,’” Reiki, Reflexology, Rolfing, and chiropractic, acupuncture, massage, vitamins and a zillion 'dietary supplements’ (and don't forget coffee enemas).

Reasons for this preference aren’t difficult to divine: medical ‘providers’ can be cold, rushed, clinical, and expensive; many musicians can’t afford health insurance (see Nov 16); health recommendations change often as science stumbles along a tortured path toward truths, offering complex answers to simple questions like, “Should I be taking Lipitor?” And finally, as imaginative people, musicians may be tempted by magical and exotic claims and practices.

A book I just finished can be a good earthbound guide: Do You Believe in Magic? (HarperCollins 2013) by Paul Offit, M.D., a skeptical mainstream medical authority at Children’s Hospital in Philadelphia. Dr. Offit discusses the immense alternative medical industry.

He does not, as you might expect a mainstream academic to do, reject alternatives, but instead shows some can actually work, even as well as conventional medicine and surgery in certain situations. They work through the placebo response: a proportion of people with symptoms, pain or headache for example, will obtain relief from a sugar pill. Studies reliably show a success rate of around 30%, or higher, if the therapist is caring and convincing. The placebo response is not a product of trickery or deception; it accompanies actual physiological/chemical changes in the brain, such as production of endorphins, similar to changes evoked by other means like talk therapy and medications.

Acupuncture, for example, is one way of triggering the placebo response. It includes ritual, tradition ('proven over centuries'), positive expectations, value (cost), and perceived competence of a skilled practitioner exhaustively trained in an ‘ancient art.’ The needles don’t even have to puncture, just prick, so long as the patient experiences the other magical wonders. If the stage directions are followed and the performance goes well, acupuncture can generate a response in the brain and the patient may experience relief, albeit usually temporary. 

If you believe in them and their method, capable and caring practitioners of most alternative methods, chiropractors to reflexologists, can trigger your placebo response. Of course in the long term, the elephant in the room for all therapies is time; the body, given time, has remarkable power to heal itself. Back pain, for example, will naturally resolve in seven weeks in 85% of episodes, regardless of what happens during that time. Impatience may take us to a therapist who will, of course, accept the credit.

Such 'laying on the hands’ by the alternative industry may be what is missing in encounters with mainstream physicians, those who conduct an interview while typing and staring at a video terminal. Healthcare without the caring.

As in mainstream medicine, alternative practitioners include the incompetent and even charlatans. Bias may lead both to do what is good for their revenue in place of what serves the health of their patients. The number of unnecessary surgeries and drug prescriptions over the last century probably matches the scale of money spent on unproven therapies and supplements.

In sixteenth century Holland the word “kwakzalver” meant a pitchman who quacks like a duck while promoting salves and ointments. The word translated to English became “quack,” anyone who proffers false cures. One of Offit’s chapters, “When Alternative Medicine Becomes Quackery” lays out telltale signs.

Offit's first sign of quackery is a recommendation against conventional therapies that are helpful or even lifesaving. “Chinese herbal therapy for people with HIV looks much more promising” (than western medicine). That was published by Andrew Weil eight years after AZT had been shown to decrease HIV replication. 

One of my favorite medical laws is: “when you go to jiffy lube, you get an oil change and when you go to a [surgeon, chiropractor, etc] you get [whatever s/he has been trained to do]." If a chiropractor tells you that cracking your back will benefit your breast cancer as effectively as medical therapy, he’s a quack. Any practitioner who claims any of the above alternative methods will cure any life-threatening disease like cancer is a quack.

The second indicator of quackery is promotion of potentially harmful therapies without adequate warning. Before cracking your neck a chiropractor should disclose to you that such manipulation has caused strokes. I saw that happen in a child and similar cases appear in medical journals. 

All substances, whether ‘natural’ or ‘synthetic,’ ‘medication’ or ‘supplement’ (economic and political distinctions, not medical ones), have risks and can harm. (Calling a substance a 'dietary supplement' allows it escape the watchful eye of the FDA.) Acupuncture needles have been extracted from lungs and can spread infection.

A third quackery indicator is the draining of patients’ bank accountsAlternative practitioners like Weil and Deepak Chopra are industries, now online, that peddle vitamins, herbs, supplements and proprietary ‘formulas’ as well as books that have made them and others like them (and TV evangelists) millionaires. The efficacy of most formulas are based on the claims of celebrities using their authority as graduates of the Today Show or Oprah.

Finally, the fourth way of crossing the line into quackery is by promoting magical thinking. Offit cites the example of useless titanium necklaces claimed to cause “longer lasting energy, less fatigue, shortened recovery time, and more relaxed muscles.” They are favored by baseball players, and are modern equivalents of copper bracelets to prevent arthritis. No evidence shows they channel electricity for health. (I'm tempted to put football helmets on the same list. They prevent lacerations of the scalp but not injuries to the brain.) Artists, I suppose are more prone to thinking in magical terms, energy fields, meridians, and astrology, than in the tedious, time-consuming and more complex universe of science.