[Dixielandjazz] DRUGS & MUSICIANS - Deja Vu?

[Steve barbone]

Oh my, Moose the Mooch and Mezz Mezzrow would love it. Hey maybe these beta
blockers will help us improvise better? Here we go again.

Cheers,
Steve Barbone


October 17, 2004 - NY Times - By BLAIR TINDALL

Better Playing Through Chemistry

RUTH ANN McCLAIN, a flutist from Memphis, used to suffer from debilitating
onstage jitters.

"My hands were so cold and wet, I thought I'd drop my flute," Ms. McClain
said recently, remembering a performance at the National Flute Convention in
the late 1980's. Her heart thumped loudly in her chest, she added; her mind
would not focus, and her head felt as if it were on fire. She tried to hide
her nervousness, but her quivering lips kept her from performing with
sensitivity and nuance.

However much she tried to relax before a concert, the nerves always stayed
with her. But in 1995, her doctor provided a cure, a prescription medication
called propranolol. "After the first time I tried it," she said, "I never
looked back. It's fabulous to feel normal for a performance."

Ms. McClain, a grandmother who was then teaching flute at Rhodes College in
Memphis, started recommending beta-blocking drugs like propranolol to adult
students afflicted with performance anxiety. And last year she lost her job
for doing so.

College officials, who declined to comment for this article, said at the
time that recommending drugs fell outside the student-instructor
relationship and charged that Ms. McClain asked a doctor for medication for
her students. Ms. McClain, who taught at Rhodes for 11 years, says she
merely recommended that they consult a physician about obtaining a
prescription. 

Ms. McClain is hardly the only musician to rely on beta blockers, which,
taken in small dosages, can quell anxiety without apparent side effects. The
little secret in the classical music world - dirty or not - is that the
drugs have become nearly ubiquitous. So ubiquitous, in fact, that their use
is starting to become a source of worry. Are the drugs a godsend or a
crutch? Is there something artificial about the music they help produce?
Isn't anxiety a natural part of performance? And could classical music
someday join the Olympics and other athletic organizations in scandals
involving performance-enhancing drugs?

Beta blockers - which are cardiac medications, not tranquilizers or
sedatives - were first marketed in 1967 in the United States for disorders
like angina and abnormal heart rhythms. One of the commonest is propranolol,
made here by Wyeth Pharmaceuticals and sold under the brand name Inderal. By
blocking the action of adrenaline and other substances, these drugs mute the
sympathetic nervous system, which produces fear in response to any perceived
danger, be it a sabre-toothed tiger or a Lincoln Center audience.

Even the most skillful and experienced musicians can experience this fear.
Legendary artists like the pianists Vladimir Horowitz and Glenn Gould
curtailed their careers because of anxiety, and the cellist Pablo Casals
endured a thumping heart, shortness of breath and shakiness even as he
performed into his 90's. Before the advent of beta blockers, artists found
other, often more eccentric means of calming themselves. In 1942, a New York
pianist charged his peers 75 cents to attend the Society for Timid Souls, a
salon in which participants distracted one another during mock performances.
Others resorted to superstitious ritual, drink or tranquilizers. The pianist
Samuel Sanders told an interviewer in 1980 that taking Valium before a
performance would bring him down from wild panic to mild hysteria.

Musicians quietly began to embrace beta blockers after their application to
stage fright was first recognized in The Lancet, a British medical journal,
in 1976. By 1987, a survey conducted by the International Conference of
Symphony Orchestra Musicians, which represents the 51 largest orchestras in
the United States, revealed that 27 percent of its musicians had used the
drugs. Psychiatrists estimate that the number is now much higher.

"Before propranolol, I saw a lot of musicians using alcohol or Valium," said
Mitchell Kahn, director of the Miller Health Care Institute for the
Performing Arts, describing 25 years of work with the Metropolitan Opera
orchestra and other groups. "I believe beta blockers are far more beneficial
than deleterious and have no qualms about prescribing them."

But use of drugs is still largely secretive. "Inderal is like Viagra," a
woodwind player at a major orchestra said. "No one admits to using it
because of the implication of weakness." Robin McKee, the acting principal
flutist of the San Francisco Symphony, agrees, saying, "It's too bad we're
reluctant to talk about using such a great tool."

Indeed, the effect of the drugs does seem magical. Beta blockers don't
merely calm musicians; they actually seem to improve their performances on a
technical level. In the late 1970's, Charles Brantigan, a vascular surgeon
in Denver, began researching classical musicians' use of Inderal. By
replicating performance conditions in studies at the Juilliard School and
the Eastman School in Rochester, he showed that the drug not only lowered
heart rates and blood pressure but also led to performances that musical
judges deemed superior to those fueled with a placebo. In 1980, Dr.
Brantigan, who plays tuba with the Denver Brass, sent his findings to
Kenneth Mirkin, a frustrated Juilliard student who had written to him for
help. 

"I was the kid who had always sat last-chair viola," said Mr. Mirkin, whose
bow bounced from audition nerves. Two years later, he won a spot in the New
York Philharmonic, where he has played for 22 years. "I never would have had
a career in music without Inderal," said Mr. Mirkin, who, an hour before his
tryout, took 10 milligrams.

For the last two decades, such use of beta blockers has generally met with
approval from the medical establishment. "Stage fright is a very specific
and time-limited type of problem," said Michael Craig Miller, the editor of
The Harvard Medical Letter. Dr. Miller, who is also an amateur pianist,
noted that beta blockers are inexpensive and relatively safe, and that they
affect only physical, not cognitive, anxiety. "There's very little downside
except whatever number you do on yourself about taking the drugs."

BUT now that the drugs have established themselves as a seemingly permanent
part of the classical music world, some musicians and physicians are
beginning to question the acceptability, safety, efficacy and ethics of
using them. One concern is that many musicians use beta blockers without
proper medical supervision. The 1987 survey of orchestra musicians revealed
that 70 percent of musicians taking beta blockers got them from friends, not
physicians. Mr. Mirkin, the Philharmonic violist, first obtained Inderal
from his father, who took it for angina. Others buy it while touring
countries where they are sold over the counter.

Stephen J. Gottlieb, a professor of medicine who published a study on the
effects of beta blockers in The New England Journal of Medicine in 1998,
says beta blockers should be obtained only after a medical examination,
since people with asthma or heart disease could develop problems like
shortness of breath or a slowing of the heart rate. "One-time use of low
doses of beta blockers should be safe in healthy people," Dr. Gottlieb said,
adding that the fatigue, hallucinations, tingling and vivid dreams listed as
side effects in Physicians' Desk Reference would be unusual in those using
Inderal only occasionally. The risks are far more serious for those who use
beta blockers consistently and take up to 700 milligrams of Inderal a day.
Musicians typically take 5 to 20 milligrams in isolated doses.

But some performers object to beta blockers on musical rather than medical
grounds. "If you have to take a drug to do your job, then go get another
job," said Sara Sant'Ambrogio, who plays cello in the Eroica Trio.
Chemically assisted performances can be soulless and inauthentic, say
detractors like Barry Green, the author of "The Inner Game of Music," and
Don Greene, a former Olympic diving coach who teaches Juilliard students to
overcome their stage fight naturally. The sound may be technically correct,
but it's somewhat deadened, both men say. Angella Ahn, a violinist and a
member of the Ahn Trio, remembers that fellow students at Juilliard who took
beta blockers "lost a little bit of the intensity," she said. Ms. Ahn
doesn't use the drugs, she said: "I want to be there 100 percent."

Indeed, the high stakes involved in live performance are part of what makes
it so thrilling, for both performers and audiences. A little onstage anxiety
may be a good thing: one function of adrenaline is to provide extra energy
in a threatening or challenging situation, and that energy can be harnessed
to produce a particularly exciting musical performance. Performance anxiety
tends to push musicians to rehearse more and to confront their anxieties
about their work; beta blockers mask these musical and emotional obstacles.

Some musicians are also grappling with the ethics of better performing
through chemistry. In auditions, which are even more nerve-racking than
regular performances, do those who avail themselves of the drug have a
better chance of success than those who do not? Should drug testing apply to
performers, as it does to some athletes and to job applicants at some
companies? 

"If you look at the logic of why we ban drugs in sport, the same should
apply to music auditions," said Charles Yesalis, a professor at Pennsylvania
State University who studies performance-enhancing drugs. But the issue
receives little attention because, unlike athletes, classical musicians are
seldom called on to represent big business ventures. "If Nike offered
musicians ad contracts," Dr. Yesalis said, "more people would pay
attention."

Speaking from the Athens Olympics in August, Steven Ungerleider, a sports
psychologist and the author of "Faust's Gold," said that beta-blocking
medications are prohibited for some events, like riflery, in which
competitors use the drug to slow the pulse so that they can fire between
heartbeats to avoid a jolt. The drugs are banned in a number of other
sports, including motorcycling, bobsledding and freestyle snowboarding.

But Dr. Miller, the Harvard physician, points out that beta blockers differ
significantly from steroids, which use testosterone to increase muscle mass,
strength and speed. Inderal enables rather than enhances, by removing
debilitating physical symptoms; it cannot improve tone, technique or
musicianship, or compensate for inadequate preparation.

As Ms. McClain's firing demonstrates, the use of beta blockers by students
is a particularly delicate issue. Those who openly use the drugs believe
they have a responsibility to mention them to students suffering from severe
stage fright. 

"If I'm looking out for the welfare of my students, I cannot in good
conscience not tell them about beta blockers," said Ms. McClain, adding that
she would be more careful about how she represented the information in the
future. 

Some teachers believe that coping with performance anxiety is an essential
part of a classical music education and that early use of beta blockers
deprives students of the chance to confront their stage fright. Robert
Barris, a bassoonist and a co-chairman of the music performance studies
faculty at Northwestern University, encourages students to address the roots
of their anxieties while avoiding psychological dependence on chemicals.
Unlike previous generations of musicians, these students can draw on a rich
array of nonchemical treatment options. The new field of performing-arts
medicine includes some 20 centers across the country, many of which treat
stage fright with therapies that range from Inderal to more holistic
approaches like hypnosis, yoga and aerobic exercise.

But several musicians interviewed for this article expressed impatience with
these treatments, which can seem slow and uncertain compared with the
instant gratification and convenience offered by the beta blockers.
"Holistic solutions take work and time to be effective, whereas Inderal is a
quick fix," Mr. Barris confirmed. As it happens, he takes Inderal by
prescription for a heart ailment, and he said that he works to combat any
soporific effects the drug might have on his musicianship by putting extra
energy into his concerts. "No one wants to listen to a secure, accurate but
disconnected performance," he added.

Jim Walker, a former principal flutist of the Los Angeles Philharmonic who
has recorded more than 400 movie soundtracks, says that preparation is the
best medicine. Still, he describes himself as an Inderal advocate, with the
caveat that the drug be approved by a physician. Some of his best students
at the University of Southern California, he said, are too nervous to
deliver a representation of how well they really play and might stand to
benefit from beta blockers.

"It's absolutely legitimate to recommend Inderal to a student who's unable
to perform because of nerves," he added. "If I'd never heard the story about
Ruth Ann McClain, I'd be far more blatant in recommending it."

Blair Tindall, a professional oboist, is writing "Mozart in the Jungle" for
Grove/Atlantic Press. Elaine Aradillas contributed reporting for this
article.