Music and medicine

What was the first human music? A whistled imitation of a bird call? A rhythmic pounding that mimicked a heartbeat or hoof beat? A croon to soothe a crying baby or comfort a sick friend?

Music was probably born of the natural rhythms of life. So it shouldn't come as a surprise when people who dedicate themselves to life science release their creative energy in music.

Both music and medicine are strict disciplines, even though one is considered an art and one a science. Both demand practitioners who learn complex skills, practice them exhaustively, then impose a set of rules on what's naturally messy–a disease, an injury, a series of unrelated sounds. And both require enormous dedication, so much that it would seem impossible for one person to do both.

But some scientists manage. They realize medicine and music aren't mutually exclusive. Not only can the two disciplines coexist; given the right conditions, they can coalesce.

Rocking researchers

Consider the lyrics of the original love song/lab song She's a Knockout by Ira Mellman, Ph.D., bass player for Yale's biorocking band, the Cellmates. "She knows how to get into your genes/And what recombination means. She's got the magic touch/And I need her oh so much. She's a knockout."

Only a medical scientist is likely to catch the reference to an experimental mouse known as a "knockout," but an average listener would still hear a love song. "It's kind of an interesting niche," says Dr. Mellman, professor of cell biology and director of the Program in Biological and Biomedical Sciences. "You write about what you know."

Dr. Mellman's musical colleague Richard A. Flavell, Ph.D., chief of the Section of Immunobiology and a Howard Hughes Medical Institute investigator, writes songs that are more unabashedly scientific. Dr. Flavell has penned the RO1 Blues, tracking the trials of an investigator trying to win a National Institutes of Health grant, Molecular Millionaire, about a postdoc who wants to earn big money doing biotechnology research, and DNA, to the tune of the Sex Pistols' punk-rock anthem EMI.

Though the Cellmates call their niche biorock, the six-member group doesn't limit itself to its own biologically inspired music. Thanks to a mix of musical cultures and generations, they play everything from Jerry Lee Lewis to The Pretenders to Phish, a contemporary band that contributed the tunes Golgi Apparatus and Down With Disease to the Cellmates' repertoire.

Their venues have ranged from departmental parties to the American Museum of Natural History in Washington, the site of the 1995 annual meeting of the American Society for Cell Biology. "We do it because it's wonderful fun. It's incredible fun," says Dr. Flavell, a leading Lyme disease researcher. "It's an enormous release."

In addition to Drs. Mellman and Flavell, the group includes guitarist Leonard K. Kaczmarek, Ph.D., chair of the Department of Pharmacology; drummer William M. Philbrick, Ph.D., associate professor of medicine; lead vocalist Tamar Boursalian, an immunobiology graduate student; and the group's only non-scientist, Madlyn Flavell (Richard's wife) on keyboards.

Since the band members are best known for their lab work, audiences aren't always sure what they're going to see and hear. "People have expectations that it will be just useless," Dr. Flavell says. But since the members have strong musical backgrounds, the band's sound is remarkably sophisticated. "The level of musicianship is very good," Dr. Mellman says. "Enough of us have done this professionally or close to professionally that we know what the expectations are."

Dr. Mellman trained as a classical musician from childhood, and went to Oberlin College in Ohio to continue his music studies. During his college years, he frequently traveled to New York to play saxophone in recording studio gigs, produced songs, and played with a group he calls "the best managed and best produced band that never made it."

But on a tour playing with Paul Anka's orchestra, Dr. Mellman decided he didn't want to be a professional musician if it meant ending up like some of his colleagues. "You could see that they were automatons, they were dead, and I did not want that." He quit the music program, and ended up majoring in biology.

Dr. Kaczmarek began playing guitar while he was growing up in London. He once played Albert Hall, and as a member of a group called The Exiles, opened for Eric Clapton at the London club Eel Pie Island.

"The trouble is, there were so many bands in London in the '60s. It was incredibly competitive," Dr. Kaczmarek says. So he decided against music as a career. "It's easier to be a scientist playing music on the side than a musician doing science on the side."

Dr. Flavell started playing guitar as a teen-ager in Norfolk, England, and formed his first band at age 15. "We were pretty awful," he admits. His bands improved over the years, and one even played on the same bill as The Animals. But Dr. Flavell says he never seriously considered a career in music, and grew away from it during his postdoc years.

Then in the mid-'80s, he bought a new guitar and set up a recording studio in his home in Boston so he and his wife, Madlyn, could record music together with occasional vocal help from their children.

Some time after Dr. Flavell arrived at Yale, he learned that both Dr. Mellman and Dr. Kaczmarek had played professionally and invited them to dinner. "The ulterior motive," Dr. Mellman recalls, "was to play."

The Cellmates' first real performance was a New Year's Eve party, Dr. Flavell recalls. Eventually the band replaced its mechanical rhythm box with Dr. Philbrick on drums, and recruited Ms. Boursalian as a vocalist. "It just clicked," says Dr. Mellman, who describes her as the best singer he's ever performed with. "It was obvious that if we wanted to work on it, it could be more than just junk."

The Cellmates played at immunology and neuroscience parties and retreats. The first national gig came a couple of years ago, at the official opening of the Massachusetts Institute of Technology's new biology building. "That was fun," Dr. Flavell says. "We actually had the faculty of MIT singing a chorus on the stage." Since then, they've played at a retreat for the drug company Merck, an anniversary party for Princeton's molecular biology department, and at the 1996 Cold Spring Harbor Symposium, where James Watson himself (of the team that discovered the structure of DNA) enjoyed rocking to the music. The musicians even get paid for their work–usually more, Dr. Kaczmarek says, than they're paid for giving scientific talks. "The idea of having scientists play music is rarer than having scientists give talks," he says.

Though they only manage to rehearse every few weeks and play about six times a year, the Cellmates hope to keep going, and possibly make a real recording.

"It's a very good outlet," Dr. Mellman says. "You have to pay attention. It's one of the few things you can do that just wipes the slate clean, reformats the hard disk."

A physical experience

A singer–the one musician whose own body acts as the instrument–may come closest to linking music and biology.

"Music, when it really works, is a physical experience," says Kyle D. Pruett, M.D., a child psychiatrist at Yale's Child Study Center. "It takes over your entire body."

Dr. Pruett, a professional tenor who has performed throughout the region, discovered the phenomenon while singing centuries-old music in a madrigal group in high school. "When you get it right, even if you're 15 years old, it's not an experience your body forgets," he says.

And Dr. Pruett says the musician's need to listen and be patient has helped "incredibly" in his medical practice. He even saw the disciplines merge neatly years ago before one of his first opera performances, Benjamin Britten's Prodigal Son. Another performer, a young boy suffering from stage fright, had locked himself in a bathroom before the show, and Dr. Pruett managed to convince him to perform.

"I think after that experience," he says, "I had become convinced there was a way for me to become a good doctor and a good musician."

Dr. Pruett grew up in an Indiana household in which "music was a given, it was not an add-on." He started singing in a church choir as a boy, and studied voice with the choir director. In high school, he sang in the madrigal group and performed musical comedy. At the same time, his interest in biology was sparked by a teacher who "taught science with the passion of a Shakespearean actor."

"He had such respect for science as a discipline and, really, an art," Dr. Pruett says.

Dr. Pruett came to Yale College and majored in history and music. "I didn't see any point in doing medicine twice. I would do college once and medicine in medical school," he says. He continued to sing, and traveled to Europe with the Yale Glee Club in his junior year. He was invited to sing in Europe, but was told he would have to work harder at his music. "So I spent a summer thinking about it very seriously," he says. "But, in the end, the service commitment had deeper roots in me."

While in medical school at Tufts University, he got a position singing in an Episcopal church. "I think it kept me sane," he says. "It was such a healing environment for me compared to medical school." When he returned to Yale for his residency, he went back to his old music teacher, and began singing opera. "I didn't like opera," he admits. "I liked lieder and musical comedy and oratory and sacred music." Now, most of his musical work is in opera, which he describes as "a true mega-art form." Though Dr. Pruett says he loves being a physician, he sometimes wonders what a musical career might have been like. "There are occasionally moments," he says, "where I wonder, 'What if I had not tried to ride both of these horses?'"

Order and Expression

As the most mathematical of the arts, music seems to hold a particular fascination for scientific thinkers seeking the creative without straying too far from the rational.

"There is certainly creativity in medicine, in the thinking process," says Fredric O. Finklestein, M.D., a nephrologist and clinical professor of medicine. But that creativity is constrained by the structures of science. For a physician, it is often difficult if not impossible to get "that spark of originality" that happens in the arts, he says.

Dr. Finklestein majored in history of music as part of Yale's undergraduate Class of 1963, doing pre-med work at the same time. His senior thesis addressed the creative process in 20th-century music and how composers imposed a variety of rigorous external forms to achieve freedom of expression.

Though Dr. Finklestein still plays piano and clarinet, he doesn't perform. He sees music as a creative respite from his clinical work, and says he doesn't regret choosing medicine over music as a career. "I really enjoy medicine. I really love the work, so I don't really have second thoughts about it in that sense."

Besides, he sees a clear link between the two fields. Both require rigor, practice and discipline. "In medicine we have to pay endless attention to detail," Dr. Finklestein says. "If you're seeing a patient, you have to impose this external rigorousness on taking the history and the physical."

Only after gathering that information can the creative part of medicine begin, leading to the diagnosis. "You have to have an ordered framework in order to have this creative expression," he says. But even in that process, the freedom must be tempered. "You have to impose these external forms on what you do."

He compares the rigor of medicine to what the great, early 20th-century composer Igor Stravinsky said about music: Freedom of expression in music can only be achieved by imposing strict form. Stravinsky, who was born in 1882, explained it like this: "The more art is controlled, limited, worked over," he wrote, "the more it is free." YM