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Doublereed Archive - Posting 000081.txt from 2004/10

From: "Grace Tice" <grace.tice@-----.net>
Subj: [DR-L] Better Playing Through Chemistry (article)
Date: Mon, 18 Oct 2004 15:20:18 -0400

This article quotes Dr. Barris, and is written by an oboist. I am not able
to post to the idrs list, so if anyone wants to copy and send it to that
group, feel free.

New York Times
Better Playing Through Chemistry

October 17, 2004
By BLAIR TINDALL

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.

http://www.nytimes.com/2004/10/17/arts/music/17tind.html?ex=1099119511&ei=1&en=a86a78a5fb19ab96

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