Nonsensical Headline of the Day

December 31, 2007

Chip Sales Rose 2.3% in November
Despite Industrywide Price Cutting


DRM, Rossini, One Euro, and Otto Klesz in No Particular Order

December 30, 2007

If you haven’t listened to opera on 1.FM, I’d recommend that you do. The easiest way to listen to the internet station is to use the iTunes software which is free and easy to use. The station has more channels than a millipede has legs, but one of them plays opera 24 hours a day. Otto Klesz has put 500 of them on the station. Inevitably some of the tracks are not in the right order, but he responds promptly to emails calling his attention to error. He also manages the station’s classical music and baroque channels. He’s an internet Prometheus.

So while I’m trying to work out the effect of intracellular acidosis on myocardial mitochondria I turned on Otto’s opera channel. Rossini’s L’Italiana in Algeri has just started. Since this opera is worth more than four Ring Cycle’s combined, I listened. The program bar at the top of iTunes told me that the Isabella was Giuletta Simionato and that the conductor was Carlo Maria Giulini. I recognized Cesare Valletti. I couldn’t identify the rest of the cast. As the first act progressed mitochondrial metabolism drifted away – the performance was so spirited. Giulini had a great cast, but his conducting was as fresh and youthful as the 20 year old composer who wrote the piece. Only Rossini wrote great operas (note the plural) under the age of 25. Not even Mozart could do it. Verdi of course was like a great Madeira, continually getting better with age.

The performance was too good to resist, even though I have multiple recording of the opera I decided to buy it. Obviously the performance was recorded in the 50s; rather than going to or a similar vendor I went to Classical Music Mobile. They had it.

Giulietta Simionato (Isabella), Mario Petri (Mustafa), Graziella Sciutti (Elvira), Mafalda Masini (Zulma), Enrico Campi (Haly), Cesare Valletti (Lindoro), Marcello Cortis (Taddeo)
Orchestra e Coro del Teatro alla Scala, Carlo Maria Giulini (conductor)
Recorded in 1954

Classical Music Mobile (based in Paris) sells classical music and opera MP3s for one euro an album. A twenty minute suite or a three hour opera – no difference. One euro. Also, no digital rights management. What’s the catch? All the recording are more than 50 years old and thus in the public domain. CMM is now up to the early stereo era. The MP3s are encoded at 192 kps and sound about as good as 50 year old recording can – which is quite good. They have a substantial number of operas available and add new material each month.

Listen to the great first act finale of L’Italiana. This to opera what the Marx Brothers are to movies. Act 1 finale L’Italiana in Algeri

The lesson is that DRM is not needed if the price is right. Instead of suing their customers the big record companies should offer downloads at a much lower price than is currently charged. They never should have let Apple steal the business from them. If you belong to BMG’s club you can get a CD for about $3. Download it and it’ll cost $10-$15. What kind of screwed up business model is this? The CD comes in a jewel box and has liner notes. The download costs almost nothing to deliver, has poorer sound, and costs more. The record companies will never stop piracy with DRM. All the moralizing in the world will not change human nature. If EMI et al want to get people to buy their products over the internet they’ll have to reduce prices. It may already be too late. There is so much free music available that they may have irretrievably lost their market.

Back to Giulini’s L’Italiana. Simionato’s singing is matchless save for Marilyn Horne’s impersonation. Simionato had a lush voice that handles Rossini’s ornamentation with ease and verve – a great performance. Almost 98 she probably can still sing the role better than most active mezzos. Valletti has everything the role requires. He was the ideal Rossini tenor and was just as good in person at the Met as he is on this recording. He had the same type of voice that Juan Diego Florez now offers with a little less vocal pressure and a little more elegance. Why Rudolf Bing let him go from the Met at the height of his vocal powers remains as mysterious as virtue. The rest of the cast bounces around with all the vigor and pep that Rossini’s wonderful score demands. Giulini’s conducting is a revelation. It’s only one euro. What are you waiting for?

Prostate Cancer Screening

December 29, 2007

A few weeks ago the local NBC affiliate promoted an area wide program of free prostate cancer screening. PSA (prostate specific antigen) testing was offered by the city’s two largest medical centers at no charge to all comers. So great was the zeal displayed by the commentators that I’m sure women would have been tested had they asked for the test. Our uncertainty regarding the effectiveness of prostate cancer screening is reflected in the comments listed below from major medical organizations concerned with the problem . Even the American Cancer Society which has the most aggressive approach to screening concedes that men at risk for the disease should first discuss the pros and cons of testing before undergoing it.

Obviously offering PSA testing to all comers does not allow for a serious discussion of the issue before undergoing screening. As is so often true, the desire to do good obliterates thought. Despite the uncertainty of prostate cancer screening it is being done on more men each year. Most of these men and their families are unaware of that screening is of unproven benefit. The are several new studies nearing completion which may resolve the issue.

The problem with prostate cancer screening is that we don’t know whether early treatment prevents death from the disease. The authors of the study in the Archives of Internal Medicine (see below) don’t think it does. Most urologists think it does. Does this make a difference? Yes. The treatment of prostate cancer has a high rate of serious complications. Depending on the treatment provided incontinence, impotence, and radiation bowel injury are common. This might not be too high a price to pay to save your life, but it certainly is if the treatment does not reduce the death rate from the disease.

Patients should talk to their doctor about the risks and benefits of undergoing prostate cancer screening before being tested. If their doctor doesn’t bring it up and just includes it as part of his clinical evaluation call him on it. Ask your doctor what tests he’s going to order before they’re done. If he won’t spend the time talking to you about the issue, get another doctor.

See below for more on prostate cancer screening

National Cancer Institute
Finding prostate cancer may not improve health or help a man live longer. Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. It is not known if treatment of these cancers would help you live longer than if no treatment were given, and treatments for cancer may have serious side effects.

There is still a lot of discussion about prostate cancer screening. Are the risks of not finding cancers (and giving men false reassurance) or side effects from tests greater than the benefits of screening? Will a screening programme using the tests we have at the moment reduce deaths from prostate cancer?

The US Preventive Services Tack Force found good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidence that early detection improves health outcomes. Screening is associated with important harms, including frequent false-positive results and unnecessary anxiety, biopsies, and potential complications of treatment of some cancers that may never have affected a patient’s health. The USPSTF concludes that evidence is insufficient to determine whether the benefits outweigh the harms for a screened population.

Prostate cancer is one of the most prevalent forms of cancer in men worldwide. Screening for prostate cancer requires diagnostic tests to be performed in the absence of any symptoms or indications of disease. These tests include the digital rectal examination (DRE), the prostate specific antigen (PSA) blood test and the transrectal ultrasound-guided biopsy (TRUS). Screening aims to identify cancers at an early and treatable stage, therefore increasing the chances of successful treatment while also maintaining a patient’s quality of life. This review identified two trials, consisting of 9,026 and 46,486 participants; however, neither was assessed to be of high quality. This review demonstrates that there is not enough high quality evidence to inform whether or not screening for prostate cancer, via either a DRE, PSA or TRUS biopsy, is more effective than no screening in reducing the number of deaths attributable to prostate cancer. The effects of screening upon quality of life and cost have not been researched in randomised controlled trials. The results from two large trials, to be completed in the next few years, will provide greater information on this issue.
Ilic D, O’Connor D, Green S, Wilt T. Screening for prostate cancer. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004720. DOI: 10.1002/14651858.CD004720.pub2

American Cancer Society
Both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. Men at high risk (African-American men and men with a strong family of one or more first-degree relatives [father, brothers] diagnosed before age 65) should begin testing at age 45. Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40. Depending on the results of this initial test, no further testing might be needed until age 45.
Information should be provided to all men about what is known and what is uncertain about the benefits, limitations, and harms of early detection and treatment of prostate cancer so that they can make an informed decision about testing.
Men who ask their doctor to make the decision on their behalf should be tested. Discouraging testing is not appropriate. Also, not offering testing is not appropriate.

[T]here is no unanimous opinion in the medical community regarding the benefits of prostate cancer screening. Those who advocate regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects. Those who recommend against regular screening note that because most prostate cancers grow very slowly, the side effects of treatment would likely outweigh any benefit that might be derived from detecting the cancer at a stage when it is unlikely to cause problems. Because a decision of whether to be screened for prostate cancer is a personal decision, it’s important that each man talk with his doctor about whether prostate cancer screening is right for him.

A benefit of screening was not found in our primary analysis assessing PSA screening and all-cause mortality (adjusted odds ratio, 1.08; 95% confidence interval, 0.71-1.64; P = .72), nor in a secondary analysis of PSA and/or DRE screening and cause-specific mortality (adjusted odds ratio, 1.13; 95% confidence interval, 0.63-2.06; P = .68).
These results do not suggest that screening with PSA or DRE is effective in reducing mortality. Recommendations for obtaining “verbal informed consent” from men regarding such screening should continue.
Arch Intern Med. 2006;166:38-43.

The Decline of the West or Maybe Just Reuters

December 27, 2007

Does anybody at Reuters read what they post before they send it out?

Most Popular on Reuters


December 27, 2007

As a Christmas present I received a copy of Kenneth Clark’s 13 part survey. I get a lot of DVDs, but rarely find time to watch them. You can’t read or write while you’re watching TV, but some random impulse caused me to watch the first part – “The Skin of Our Teeth”.

Lord Clarks takes the Potter Stewart approach to defining civilization (I can tolerate the British spelling only once). He can’t tell you what it is, but he knows it when he sees it. Given the current demoralized state of the BBC, the series producer, I’m not sure why they continue to make it available. There is no political correctness in his view of civilization.

It is a western phenomenon that arose in Greece and spread to Rome. It disappeared for quite a while – maintaining a solitary outpost in Byzantium. And then it slowly started again in the land of the Franks. Lord Clark regularly calls the barbarians “barbarians”. They of course are not civilized, nor are the Vikings. He sees Islam as a threat to Western Civilization and sees Charles Martel’s victory at the Battle of Poitiers as a seminal event in the rebirth of civilization. Fending off the barbarians, the Norsemen, and the Muslim attack from Spain got us through, in his view, “By the Skin of Our Teeth”.

Clark quietly, but firmly, states that civilization begins with war and ends of boredom. Churchill said the Germany was proof that one could be cultured without being civilized. This is a distinction that Clark clearly believes, though he thinks art defines civilization. He thinks the abstract designs of the illuminated manuscripts produced by largely illiterate medieval monks superior to anything found in Islamic art. Did the BBC recently vet this program? The rebirth of high art in the 10th century was both a cause and a sign that civilization was returning.

Clark obviously believes that Western Civilization, ie Western European civilization is unique. He states that having disappeared once that it can vanish again. This in 1969. It’s not necessary for me to make any further comments on current events. Maybe I’ll watch the second part.

Controlling the Cost of Medical Care

December 25, 2007

This is a version of a talk I’ve given many times. It discusses how the ever increasing cost of medical care might be contained. I no longer think that anything other than divine intervention will control medical costs. The public believes that medical care is a right and thus should be paid by someone else. The best solution would be to eliminate health insurance and replace it with catastrophic insurance which is all that’s really needed, but that will never fly. People will pay for dental care, veterinary care, but not for medical care because that’s a right.

Anyway, this presentation can be used for any noncommercial purpose as long as the original source is cited.

Controlling the Cost Of Medical Care 2005

The Met at the End of the Line

December 16, 2007


If you want to know just how great this country is, come to Lubbock. Lubbock is at the end of the line. It’s like lactate metabolism; the only way out is the way you got in (unless you’re flying Southwest Airlines). Yet look what’s here. A major university – one of the few in the world that has its law school and medical school on the same campus as everything else. A major medical center, a great symphony orchestra, superior housing – but I gush. America’s infrastructure is so deep that it’s good to be at the end of the line. And Lubbock has the Met – at least a HD version.

Last year we didn’t get the Met telecasts, but this year we’ve been added to the list. The Met’s general manager, Peter Gelb, introduced the transmission. He said that it was going to 600 theaters. On the radio broadcast of the performance (I recorded it and listened to it later) it was announced that 100,000 people would see the opera – Romeo et Juliette – on TV. That works out to about 167 people per theater and about the number that were at the show in Lubbock. That number must have more than expected because an usher asked couples to surrender one of their programs because there weren’t any left for the people who were still coming in.

I’ve not been a fan of opera on TV – live or on DVD. A big problem is the close-up. Opera was meant to be seen at a distance. A 50 square foot head that’s sweating, turning blue with each high note, and wearing a fright wig is not a pleasant sight. But when it’s Anna Netrebko’s head that’s filling the screen this quibble sinks. The other big problem is the constant changing of the view. In the theater you’re in the same place all the time. But on TV your vantage is at the director’s whim. Fortunately, the direction of the production was smoothly handled, so well that the viewer paid no attention to it. The picture quality was outstanding and the sound excellent, but nothing like that heard in the opera house. Modern technology can make Juan Diego Florez sound like Lauritz Melchior. Aristotle would not have liked the backstage views of the singer and stage hands that were shown between the scenes. Suspension of disbelief is a casualty of this sort of video overkill.

The set was dominated by an astronomical mien. The moon, galaxies, and stars were projected during each scene. I know, star crossed lovers – but it worked. Frere Laurent had a telescope, and an empty bottle of wine. There so many TV cameras shooting the production that we even got top down shots a la Busby Berkeley, but without the kaleidoscope chorus girls. The doomed teenager’s nuptial bed was suspended above the stage surrounded by stars. The staging and scenery were splendid, but this opera is Romeo et Juliette. And it is with them that it succeeds or fails.

Roberto Alagna alagna-romeo.jpgwas good. Not good enough to carry the show himself, ie be the reason to go, but good enough to keep things moving at the right pace. His voice is not as luscious as it was a decade ago. But Anna Netrebko sang and acted as beautifully as she looked, and she was gorgeous. There was a mini crack shortly after she made her first entrance, but the rest was perfection. The Waltz Song was free and joyous. The vocal high point was “Amour ranime mon courage” in the fourth act. It was all passion and poignance – very moving. Her voice was round, rich, and up to all the arias great requirements. She was equally compelling in the death scene. She’s much better than when I heard in the role a few years ago in Los Angeles. A great singer.netrebko.jpg

Nathan Gunn acted well and looked handsome, but his voice sounded muffled even with all the electronic enhancement. The rest of the cast did all that was needed. Placido Domingo, or one of his numerous clones, conducted. He’s turned into a Fausto Cleva who sings. He was Romeo six times at the Met more than 30 years ago. He did a fine job.

The production had only one intermission, between acts 3 and 4. That’s almost two hours. There should have been a warning by the popcorn stand that buying a large soft drink would be a real bladder buster. Tristan und Isolde is coming later this season. I’d advise those planning to go (not me, I’m not seeing another Tristan until Brigit Nilsson is reincarnated) to see their doctor just before the show and get a shot of antidiuretic hormone and to have nothing to drink starting two hours before the performance.

If the Met can continue to meet the excellent standard set by this broadcast, I’d advise anyone with any interest in opera to go. It seems unless you live in Antarctica that there’s a theater near you that will carry them .  And there were titles – the same as those displayed on the backs of the seats at the Met.