About neuroscience and music (mainly classical). Exploring the relationship of music and the brain based on experience of two careers.

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.

November 16, 2013

Health Insurance for Musicians: 'Obamacare'

by Carl Ellenberger, MD

Like all other artists, musicians are among the Americans most likely to lack health insurance. A recent survey* disclosed that a whopping 55% of musicians don't have it. The majority of those (88%) say they can't afford it. Most of the uninsured are freelancers who, under the current system, would have to buy expensive individual policies. 

Those results suggested to the surveyors that artists "are exactly who the Affordable Care Act (aka "Obamacare") was designed to help" and stand to benefit most from because now they can shop for policies on the exchanges or find themselves eligible for Medicaid in their state and not be excluded by pre-existing problems or exorbitant cost. 

Unfortunately, musicians (and non-musicians) also say they are confused by new law, not surprising in view of the well-funded efforts aimed at confusing them. 

In my view, it would be good to try to clear the confusion sometime in the next several months. Despite its recent temporary notoriety, you could do worse than starting at https://www.healthcare.gov.

*The Future of Music Coalition

November 5, 2013

Edward MacDowell; the best composer you don't hear

One of our board members and Chair of the Department of Fine and Performing Arts at Elizabethtown College, E. Douglas Bomberger, has just published "MacDowell" a marvelous biography of the composer Edward MacDowell (Oxford Press, 2013).

MacDowell enjoyed what we might call rock-star celebrity (absent the income) around the turn of the 19th century. Although born in the US, he earned that reputation by writing and performing his works, mostly for the piano with or without orchestra, in France and Germany over 12 years. Partly because of this fame the president and trustees selected him to serve as the first Chair of Music at Columbia University in 1896. In accepting, MacDowell had a grand vision: 
“First, to teach music scientifically and technically, with a view to training musicians who shall be competent to teach and compose. Second, to treat music historically and aesthetically as an element of a liberal education." 
Like Robert Schumann and Hector Berlioz before him, MacDowell was also one of the greatest musician-writers about music. Some of his writing survives, including the notes for his introductory music class. You can download "Critical and Historical Essays" for free from iBooks.
"…in speaking of this art, one is seriously hampered by a certain difficulty in making oneself understood. To hear and enjoy music seems sufficient to many persons, and an investigation as to the causes of this enjoyment seems to them superfluous. And yet, unless the public comes into closer touch with the tone poet than that objective state which accepts with the ears what is intended for the spirit, which hears the sounds and is deaf to their import, unless the public can separate the physical pleasure of music from its ideal significance, our art, in my opinion, cannot stand on a sound basis."
Although recordings of his Piano concertos by Van Cliburn and Earl Wild gave his music a boost decades ago, his music deserves more hearing. I now take Edward MacDowell more seriously and suggest we all should. Douglas Bomberger's book is a good way to start. I downloaded To a Wild Rose from imslp and sat down to the keyboard for the first time in many years. I am also investigating the mysterious neurologic illness that ended MacDowell's life too early, at age 46.