Old and New Music, on Dying to Give Birth

Recently I saw Inside Llewyn Davis, the new Coen brothers’ film about a folksinger in Greenwich Village. The moving, fictional story takes place in the early 1960s. The protagonist, handsomely portrayed by Oscar Isaac, can’t quite make it as a musician. He roams from one friend’s apartment to another, never quite sure where he’ll go next. There’s a lot you might explore, intellectually, about his journey, a cat named Ulysses and a trip to a Chicago club called the Gate of Horn.

I liked this sad movie, a lot.

What I nearly missed, though, was the significance of one of the songs, “The Death of Queen Jane.” Fortunately an obstetrician-gynecologist and neighbor, Dr. Peggy Polaneczky, reminded me by her post on its relevance to women’s health. The English ballad tells of Jane Seymour, a wife of Henry VIII. She died in October 1537, at less than 30 years of age, days after delivering a male heir. Queen Jane’s labor was prolonged, her death attributed to complications of childbirth.

Image of the actress Carey Mulligan, Inside Llewin Davis

The actress Carey Mulligan, Inside Llewin Davis

Fast-forward 475 years and a bit more…

In 2012, the WHO reported that approximately 800 women die each day from preventable causes related to pregnancy. That figure translates to over 300,000 unnecessary deaths each year, worldwide. Pregnancy-related deaths declined sharply in the United States and most of the world in the 20th Century. The CDC indicates that U.S. maternal death rates have been on the up since 1987. The reasons for this trend are not established. That some are having children at an older age may be a factor. But most pregnancy-related deaths in occur in young women. The problem is particularly grave among African Americans. Likely contributing risks, from 1987 to 2009, include lacking of access to health care, and having chronic medical conditions like diabetes, hypertension and obesity.

Shifting notes –

The music Inside Llewyn Davis is lovely, haunting. Seeking details on the traditional English folksong, “The Death of Queen Jane,” led me through a different sort of journey. Here’s a link to some information on it from the Mainly Norfolk English Folk and Other Good Music ProjectOn YouTube you can find versions performed by Joan Baez, among others. Wouldn’t you know it, the music of her sometimes lover, Bob Dylan, plays toward the closing of the Coen brothers’ film? Dylan has a song, “Queen Jane Approximately,” that was picked up by the Grateful Dead. The consensus on Wikipedia, though, would suggest that Dylan’s lyrics have nothing to do with the Tudor Queen.

At that point I stopped searching for answers about Jane Seymour’s cut life, whether she was in labor for two or nine days, and the meaning of the song. And I’ll close with this sound clip of “The Death of Queen Jane” from Inside Llewyn Davis, performed by Oscar Isaac. You can catch a fragment of the desperate woman’s plea.

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On Sheryl Crow’s Report that She Has a Meningioma, and Singing Loud

This morning CNN fed a headline: Sheryl Crow: ‘Brain Tumor is a Bump in the Road.’ This concerned me, not only because I’m a huge fan, but because in 2006, she began treatment for breast cancer at age 43. “Singer-songwriter Sheryl Crow says she has a brain tumor,” says the first line of the CNN story. I was concerned. It seemed liked she’d been getting a little bit closer…to feeling fine.

Fortunately, the LATimes and People magazine got Crow’s story right. Their headlines, and text, emphasize the benign nature of Crow’s newly-diagnosed condition, a meningioma. Most meningiomas are benign, local expansions of the cells that line the brain and spinal cord. These growths occasionally cause neurological symptoms. Some patients have surgery to relieve or avoid complications of these non-malignant growths, but many don’t need intervention. When I was an oncology fellow I learned that meningiomas were relatively frequent in women with breast cancer, but that association turned out to be untrue. The “lesson” back then was that if a scan shows a brain mass in a woman with breast cancer, you shouldn’t assume it’s a brain met, because meningiomas were not rare in women with a history of breast cancer. According to the NCI website today, meningiomas are more common in women than in men.

Singing ‘Rock and Roll,” on top of a piano

Cancer scares aside – I’m glad that Sheryl Crow’s brain mass is benign, and that she can keep on singing if she chooses. I’ve seen her twice in concert, and she’s amazing. I have several favorite songs of hers, but the most memorable moment from a performance I’ve seen was when she got up on top of the piano at Radio City and sang Led Zeppelin’s Rock and Roll. I wish I could do that! She’s a powerful woman, for sure.


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New Music from an Orchestra of Radioactive Isotopes

For the weekend –

A tweet led me to a fantastically inventive kind of music. The Radioactive Orchestra comprises 3175 radioisotopes. From the website: “Melodies are created by simulating what happens in the atomic nucleus when it decays from its excited nuclear state…Every isotope has a unique set of possible excited states and decay patterns…”

image from the Radioactive Orchestra project

The project, sponsored by a Swedish nuclear safety organization, KSU, encourages visitors to select among the graphed isotopes, listen and learn. You can try composing music on your own, or you can check out a production by DJ Alex Boman on YouTube:


h/t: Maria Popova, @brainpicker, who picked up on this last August at Brainpickings. And to @JohnNosta, who sent yesterday’s tweet.


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iPod Therapy – Why Not Prescribe It?

Yours truly, the author of Medical Lessons, is listening to music while she writes. A live version of the Stones’ “Silver Train” has just come on, and she’s happily reminded of something that happened 30 years ago. Distracting? Yes. Calming? Yes. Paradoxically helps to keep me on track? Yes.

My iPod keeps my mind from wandering further. And it lifts my mood.

And so here, on my blog, which is not peer-reviewed or anything like that, I put forth the medical concept of “iPod therapy.”

“When you’re weary, feeling small…” Music can help.

Today’s news reports that 1 in 5 Americans take drugs for psychiatric conditions. That sounds like a lot to me, but I’m no pharmaceutical surveyor. Of course many people need and benefit from medical help for depression and other mental illnesses.

But, in all seriousness, I wonder how many people might use music like a drug to keep them relaxed, happy, alert…

Why not prescribe music? It works for me, n=1.

Maybe doctors should be recommending iPods, or radios, or Pandora to some of their patients who are feeling down. I hope an academic psychiatrist somewhere, without ties to Apple or Pandora or Bose or other relevant party is coordinating a careful, prospective study of this promising and relatively inexpensive intervention.

As best I can tell, music is non-addictive. Except that if I had to live without it, I’d start humming, or maybe singing, which might be detrimental to those who live near.

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Thoughts on the Death of Amy Winehouse

I feel compelled to write at least a short note on Amy Winehouse, a young woman who was found dead in her London apartment a few days ago. I don’t like to speak ill of the dead, but the truth is I was never a big fan of her music. I wasn’t fond of her highly-stylized hair or her weirdly-curved eyebrows.

Once, when I was 17, a friend told me he always tries to see the good in people, no matter how much they behaved disagreeably. Ever since he said that, it’s stuck. Today his words come through, in contemplating Amy Winehouse’s personality and short life.

I like her for her willfulness, even though it was so destructive.

Amy Winehouse, in 'Rehab' Video

Not a good medical lesson, for sure – or the message most people are telling their kids upon this “teaching moment,” but not everything I care for is just how it should be.

Yes, she should have gotten more help for her addictions. She needed it, that’s obvious. Family and friends, take note!… You can intervene and make a difference in a troubled person’s life.

But sometimes this happens in medicine, when you’re caring for a patient who smokes or drinks or smokes and drinks or does something else unhealthy, or in a family, or among friends – it’s not always so helpful to simply criticize and judge or lecture and point the person to the door.

So here’s another take: to identify something good in the person, and focus on that, and remember that.


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Gregg Allman Stars in Hepatitis C Awareness Campaign, with Merck

This weekend I learned that Gregg Allman, of the Allman Brothers, has hepatitis C. Not just that; he underwent a liver transplant last year for treatment of liver cancer. This information came my way via CNN, in a clip narrated by Dr. Sanjay Gupta. The cable TV crew filmed the old rocker in Macon, Georgia, at the band’s Big House.

Gregg Allman, performing in 2010 (Wikimedia Commons)

“He’s taping a public service announcement for the drug company Merck, about hepatitis C,” Gupta says 40 seconds or so into the clip (italics added, ES).

Hepatitis C stays silent in many carriers, meaning that most people with the virus are unaware of their infected state. The liver-infecting virus spreads most often by contaminated needles, sexual relations or transfusion of infected blood. Over time, the virus tends to cause liver damage and blood problems including anemia and, rarely, a condition called mixed cryoglobulinemia. In patients with long-standing hepatitis C, there’s a significantly elevated risk of developing liver cancer.

For two decades there have been a few, fairly effective anti-viral drugs available for hepatitis C. Treatment generally reduces patients’ anemia and liver disease, which leads them to feel better, and also reduces the risk of the long-term effects of infection, including liver cancer. Last month the FDA approved two new drugs for hep C: Victrelis (boceprevir), manufactured by Merck, and Incivek (telaprevir), by Vertex Pharmaceuticals.

While I have no formed opinion as to which of these new drugs is most effective or less toxic or more affordable in the long term for patients with hepatitis C, I do find it strange that Gregg Allman will be singing for Merck.

Eat a Peach (album cover)

The ethics of this are complicated: On the one hand, it might be a good thing for a music icon to raise public awareness about hepatitis C, so that more people at risk might get tested and then treated early before they develop severe liver disease and cancer, and would feel better. Gregg Allman is in a position to spread that message effectively: “If I have hep C, you might have hep C. Let me tell you about it…” (somewhat in the style of Magic Johnson, on HIV).

On the other hand, the notion of a post-transplant musician serving as the public’s primary source for information on hepatitis C seems preposterous, especially if he’s tied in with a pharmaceutical company with a stake in the matter. The situation is reminiscent of Sally Fields starring in commercials for Boniva, an osteoporosis drug.

You might ask yourself – and it’s not a trivial exercise – who can best, and objectively, inform the public about viral liver infections and the potential benefits of treatment: doctors? (we harbor biases; many have industry ties); patient peers? (Allman is a heightened example, but he’s hardly objective about this, either); newspapers? (or radio…

Will Allman’s be wasted words? (Hard to resist.) Really I’m not sure.

But I might go to Allman’s concert for the American Liver Foundation, at the Beacon Theater, scheduled for July 27.

All for now.




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Faking the News (and Informational Chaos)

Logo for Frontline, a PBS program

I read in the paper this morning that some hackers successfully (?) broke into the PBS website on Saturday night and posted a story that is untrue. According to multiple sources, the fabricated article stated that Tupac Shakur, a rap performer who died in 1996, is alive and living in New Zealand.

Fox “News” (quotations added by ES) reports a group claiming responsibility was annoyed by a recent Frontline show on WikiLeaks. I googled Tupac and readily identified what is said to be his official website, 2pac.com. There’s a page dated sometime in February 2011, on the Legend:

…Born on June 16 1971 in New York City, Shakur’s parents were both members of the Black Panther Party whose militant style and provocative ideologies for civil rights would come to influence 2Pac’s music. At an early age, Tuapc’s love for performance and the arts began to show, as he began acting at age 13 and later enrolled in the Baltimore School of the Arts before dropping out at 17. Shakur broke into the music business with rap group Digital Underground as a back-up dancer and roadie. Eventually Shakur released his first solo album in ’91, 2pacalypse Now. 2Pac’s music career began to grow as his second album, Strictly 4 My N.I.G.G.A.Z included 2 top 20 pop chart tracks: I Get Around and Keep Ya Head Up.

Shakur’s legal battles began after he established his rap career. In the early nineties Shakur faced a wrongful death suit which settled out of court, accusations of assaulting police officers where charges were ultimately dropped, and even an incident where Shakur sustained 5 gunshot wounds from unknown assailants. In 1995 2Pac was sentenced one-and-a-half to four-and-a-half years in prison for sexual abuse. However, not even prison could slow the success of Shakur’s career.

While incarcerated 2Pac’s latest album, Me Against the World, was number one in the pop charts and would later go double platinum. Shakur became the first artist to reach number one in the pop charts while serving a prison sentence. Making the most of his time in jail, 2Pac became a passionate reader. Among his favourites were the works of Niccolò Machiavelli, an Italian Renaissance writer whose works were in part the foundation for western political science. Shakur’s appreciation of his work inspired the nickname: Makaveli.

After serving only eight months of his sentence, 2Pac was out on parole thanks to a 1.4 million dollar bond paid by Suge Knight, CEO of Death Row Records. Now signed with Death Row Records, Shakur went on to create All Eyez on Me, which featured hits How Do You Want It and California Love.

2Pac’s life was cut short in September of 1996 when Shakur became the victim of a drive-by shooting while his car waited on a red light. While Shakur survived the surgery that followed he was pronounced dead almost a week after the attack.

Even today, 2Pac’s influence is wide-spread…

album cover, "all eyes on me"

I have no idea how much of the legend is true, or if the 2pac website is really sponsored by the Tupac Amaru Shakur Foundation. Based on my limited education, I can confirm that Niccolò Machiavelli was an Italian philosopher of the Renaissance period whose writings influence some political scientists today. I might also confirm that guns really do kill people, here and elsewhere. This statement is based on my general knowledge and life experiences as a physician and citizen of the U.S.

In addition, I now know with certainty that at least one of my sons is familiar with Tupac’s music. He identified the artist in passing, while he walked by as it streamed from my laptop. He wondered why I was listening. In truth, I’m not sure about this. Curiosity, I suppose –

You can find some Tupac songs on YouTube. Based on a limited, first-time review this morning, I’d half-recommend Keep Ya Head Up. (You can send a ringtone to your cell phone, through this website with the lyrics.) In another video, he performs a song called Makaveli the Don. You can buy his CDs at Amazon.com, or elsewhere, or read one of several biographies.

My conclusion: It’s an information jungle out there.

The Medical Lesson: It’s hard to know your sources, especially when hackers can pretend to be a public broadcasting service. The only protection, as with health info that might come from a journal or doctor or a textbook in Texas, is having a good education and breadth of knowledge with which to assess the credibility of whatever you read or hear.


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The U-Shaped Curve of Happiness

This evening, when I finished cleaning up the kitchen after our family dinner, I glanced at the current issue of the Economist. The cover features this headline: the Joy of Growing Old (or why life begins at 46). It’s a light read, as this so-influential magazine goes, but nice to contemplate if you’re, say, 50 years old and wondering about the future.

The article’s thesis is this: Although as people move towards old age they lose things they treasure—vitality, mental sharpness and looks – they also gain what people spend their lives pursuing: happiness.

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Doctors Singing On YouTube

A few weeks ago I found some doctors singing on YouTube. They made me laugh and perhaps, even, feel better.

Doctors in Cyberspace

I contacted the singing doctors to check, among other things, that they’re still in business. It turns out that Drs. Barry Levy and Greg LaGana both graduated from Cornell University Medical College just a few years back, in 1971. They’ve been performing together for years and still do.

“Why rant and rave when a laugh will do?” said the New York Times about the pair, in 2004.

Now, they have a YouTube channel. Of the five videos available, my preference is Doctors in Cyberspace (above) but that’s probably because I’m partial to the “I Feel Pretty” melody from West Side Story. Health Care Business, to the tune of “There’s No Business Like Show Business” comes in at a close second and, based on the number of YouTube viewings so far, seems to be the public’s favorite.

Their website is called Damaged Care. You can buy a CD for a holiday gift. Or hire the doctors to entertain at a real-life party or other event: they’ve performed for state medical societies, hospital associations, the AMA, pharmaceutical industry associations, the Federal Reserve Bank of Boston and the General Assembly of the Presbyterian Church among other agencies, and at Off-Off-Broadway venues in New York City.

The Damaged Care Doctors

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The Music of H.I.V.

Yesterday I came upon something I’d never heard before: Alexandra Pajak, a graduate student at the University of Georgia, merges art and science in a novel way. She composed a new work, the Sounds of HIV, based on the virus’s genetic sequence.

A CD, produced by Azica records, will be available later this month. A ScienceRoll post, by Bertalan Meskó, clued me into this fascinating project. He shared the artist’s explanation of her work:

Sounds of HIV is a musical translation of the genetic code of HIV, the Human Immunodeficiency Virus.  Every segment of the virus is assigned music pitches that correspond to the segment’s scientific properties.  In this way, the sounds reflect the true nature of the virus.  When listening from beginning to end, the listener hears the entire genome of HIV.

In English, the nucleotides Adenine, Cytosine, Uracil/Thymine, and Guanine are abbreviated with the letters A, C, T, and G.  Since A, C, and G are also musical pitches in the Western melodic scale, these pitches were assigned to the matching nucleotides.  To form two perfect fifths (C-G and D-A), “D” was arbitrarily assigned to musically represent Uracil.  I assigned the pitches of the A minor scale to the amino acids based on their level of attraction to water…

According to a May, 2010 post in the Daily Scan, the artist has assigned pitches to each viral segment’s properties:

…The composition’s Prelude and Postlude correspond to the first and last 100 nucleotides, and the sections named after the proteins (Proteins 1-9) represent translations of the amino acid sequences…

Upon searching further, I tracked down some partial HIV music clips, available now, at ClassicsOnline. The start of the prelude sounds calm and lovely to my rock-trained ears; other portions are distinct and lively.

I look forward to more listening!

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