Daughter of the Regiment in HD – April 26, 2008

April 27, 2008

I know I said I’d used up my life’s allotment of performances of Donizetti’s bonbon, but Dessay and Florez at the Met was too tempting to pass up. Laurent Pelly’s production moves the opera’s time to that of World War I. But when you set this opera is irrelevant. It succeeds or fails with its title character. Natalie Dessay was as bouncy as a spaldeen. She looked like a combination of Fanny Brice and Edith Piaf on steroids and happy pills. She took over the stage and brought this tired old mish mash to life. Vocally and histrionically she was perfect; forget about a mini-crack. She has a gift for comedy that’s unmatched by any soprano I can think of. When she wasn’t on stage the piece sagged to its proper level – sub par Donizetti, which is still better than almost anyone else. Her performance was one of the rare instances when an artist carries a work far beyond its usual potential. Wonderful. If you were just listening to Dessay’s performance you missed 90% of its impact. She’s truly a singing actress.

There’s a tenor in this opera. Dessay’s star power might have eclipsed a usual tenor, but the estimable Juan Diego Florez managed to be noticed. The current King of the Tenorinos (John Osborn is just as good, but doesn’t have as good a press agent), Florez tossed out the barrel of high Cs at the end of “Pour mon âme” with ostentatious ease. He has repeatedly said that the second act aria, “Pour me rapprocher de Marie” is the harder of the two. And for him it obviously is. Runs and high notes show off his bright and glinty voice. Its hard edge makes singing a long line a little more difficult. He did his best with the second aria, but it was clear he was working hard to make it effective. Osborn did more with the number. Tito Schipa who would have omitted all the high notes (in both acts) would have been perfect for this aria.

Now about the encore of Tonio’s first aria. There wasn’t one. Mr Gelb apparently couldn’t bring himself to press the encore button that travels with him wherever he goes like the nuclear football that follows the President of the US wherever he goes. Florez, who couldn’t have sung the aria any better at the prima than he did on Saturday, was obviously ready for a second launch, but Mission Control refused permission. (I love mixing all these metaphors and similes.) Since everyone was expecting an encore its absence was a real downer. Mr Gelb must have considered the cheering that followed Florez’s performance insufficiently rabid.

The rest of the cast did not get in the way which is all that is required of them. Allessandro Corbelli was appropriately jolly as Sulpice. Felicity Palmer was appropriately stuffy as the Marquise Of Berkenfield. And Marian Seldes was appropriately tottering as the Duchess of Krakenthorp. I wonder if Krakenthorp has some extra meaning in French. Marco Amiliato conducted appropriately.

There were sets and costumes, but if you turned Mme Dessay loose on an empty stage with just a few props the performance would be just as successful as it was with sets and costumes. When she leaves this production there will be little reason to continue it.

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Mental Health Problems After War Service

April 18, 2008

Nearly 20% of Veterans who served in Iraq are said to have to have post traumatic stress or major depression according to a study by the Rand Corporation. Everyone seems to be racing ahead of everyone else to embrace these finding lest they be thought negligent or insensitive. A word of caution, though the full report is is available from Rand, no one commenting about it (including me) seems to have read it. And none of the accounts of it I have seen mentions controls.

In order for this study to be meaningful there would have to be at least two control groups similarly studied. One would contain age and sex matched civilians. A second would contain age and sex matched veterans who had not served in a war zone. Absent these controls the finding cannot be adequately interpreted.

Doubtless this study will fill agendas that go beyond health care for veterans. But we can hope that this report was based on adequate information. If I had to bet I would place my wager on the absence of adequate controls.

But even if there were adequate controls the issue of observer bias would still be unresolved. The person doing the psychiatric evaluation will have his own feelings and prejudices about war and military service. These cannot be avoided or suppressed. There’s no way that the evaluator can evaluate without knowing the military history of the subject. Bias no matter how surreptitious will creep into a study like this one. If the study was based on a questionnaire it’s results are even more tenuous.

Studies like this one often excite but far less often inform.

Here’s how the Rand Corp’s web site describes the study:

Data collection for this study began in April 2007 and concluded in January 2008. Specific activities included a critical review of the extant literature on the prevalence of post-traumatic stress disorder, major depression, and traumatic brain injury and their short- and long-term consequences; a population-based survey of servicemembers and veterans who served in Afghanistan or Iraq to assess health status and symptoms, as well as utilization of and barriers to care; a review of existing programs to treat servicemembers and veterans with the three conditions; focus groups with military servicemembers and their spouses; and the development of a microsimulation model to forecast the economic costs of these conditions over time.

It doesn’t sound very reassuring. It seems to be a questionnaire with all the attendant errors such surveys intrinsically contain. It also doesn’t seem to have any controls. You can buy the Rand monograph for $55.50.

Hypertension in the Very Old

April 17, 2008

Virtually all physicians treat their hypertensive patients who are 80 years old or more. The evidence for the effectiveness of this treatment in very old patients has up till now been lacking. The New England Journal of Medicine has published a paper, Treatment of Hypertension in Patients 80 Years of Age or Older, that shows a benefit of treating hypertension in octogenarians.

The paper claims a little more than it actually demonstrates by pushing some of its conclusion a bit past the usual 5% likelihood of chance typically used in scientific papers. For example, it says that there was a 30% decrease in fatal or nonfatal stroke; p= 0.06.

The patients in the study were all 80 years old or more and had a systolic blood pressure of 160 mm Hg or more. The were randomized into two groups of about 1900 patients each. One group was treated with a placebo while the other received the diuretic indapamide. The treated group also received the angiotensin converting enzyme inhibitor perindopril as needed for additional blood pressure control. The controls received additional placebo.

As can be seen above blood pressure fell more in the treated patients than in controls. But also note that there was a large drop in the blood pressure in the placebo group. Also note the absence of error bars for each point. There was a large standard deviation for each point which would have diluted the case the authors were trying to make, ie that the positive outcomes noted were the result of blood pressure lowering. The paper does not mention if there was a statistically significant difference in the blood pressures between the treated and untreated groups. Instead they say that there was a statistical difference in the number of patient who reached target blood pressure; less than 150 systolic and less than 80 diastolic. Twenty percent of controls reached target blood pressure compared to 48% in the treated group (p<0.001).

Other significant findings in the study were a reduction in all death from stroke and all cause mortality.

The most striking finding, which was of far greater significance both statistically and clinically, was the reduction in heart failure events.

This finding is so important that it alone would justify treating 80 year olds with antihypertensive medicines. But which drugs should the physician use? Here the interpretation of the study gets a little cloudy. Diuretics and ACE inhibitors lower blood pressure. Hypertension is the leading cause of heart failure. So lowering blood pressure should reduce the incidence of heart failure. But these drugs also have a favorable effect on heart failure which goes beyond their effect on blood pressure. It is possible that at least part of the reduction in heart failure events noted in this study is the result of the drugs studied and would not be fully duplicated if blood pressure were lowered to the same degree by drugs of other classes. Thus all one can conclude is that diuretics and ACE inhibitors are beneficial when given to very old hypertensive patients. Whether thiazide diuretics would produce the same result seen with indapamide also is uncertain. All ACE inhibitors seem the same, so I think other ACE inhibitors would be just as effective as perindopril.

Why the authors of this work chose to use indapamide and perindopril which are not as widely prescribed as thiazides and other ACE inhibitors is not clear. It could be related to the study’s sponsor Servier which makes indapamide and perindopril. My guess, but it’s just that, is that thiazides and any ACE inhibitor would produce the same result.

La Boheme in HD – April 5, 2008

April 7, 2008

La Bohem 3rd Act

How many times can one watch La Boheme without being bored?. Apparently it is impossible to be bored by any halfway competent performance of Puccini’s masterpiece. Saturday’s HD performance of Zeffirelli’s venerable staging from the Met was better than the minimum level necessary to ward off ennui. It’s been performed so many times at the Met that if the singers and musicians pause for just a moment the production will do the opera on its own. When the show is finally set aside it should be sent to the Smithsonian where it can do La Boheme in an endless loop for the whole world do enjoy on visits to the nation’s capitol.

The performance was certainly worth the $22 price. I wouldn’t have paid $300 for it. Parts of the staging work better on the big screen than in the house. The first and last acts are set in a tiny garret set far back from the front of the stage and very high. In the house the Bohemian’s apartment is too far from the audience for comfortable viewing. On TV there’s no problem as the camera zooms close in. Zeffirelli seems to have taken Yakima Canutt’s staging of the chariot race in Ben Hur as his inspiration for the second act. There were more people onstage than were at all the Iowa caucuses. Here again the big screen was useful.

Angela Gheorghiu was fine as Mimi, though the closeup was not her friend. She’s at an age where she’s got all the voice and experience she needs for the part, but not where she can sustain a point of view a few feet from her face. This would not have been a problem if you were in the auditorium 100 feet from her rather than 2000 miles away. Vocally, she’s got the part down cold.

Ramón Vargas has graduated from bel canto to Puccini without much trouble. He has a lush tenor that is more secure at its top than it was earlier in his career. But his high notes are still a bit tentative. The best singing came from Ludovic Tézier as Marcello. He also acted the part convincingly. I’d like to hear him in a bigger part. Ainhoa Arteta was a vivacious Musetta. Paul Pliska in his 1524th Met appearance was effective as Benoit and almost invisible as Alcindoro in the commotion of Act 2. As a meteorological aside, what were all those people doing outside on Christmas Eve in Paris where the average temperature on that day is about freezing? This issue of temperature is especially noteworthy as the Bohemians spent most of the first act kvetching about how cold it was indoors.

Oren Gardus made almost nothing of Colline’s big moment – the Coat Song. Quinn Kelsey conversely made as much as possible of the sixth Bohemian, Schaunard. Nicola Luisotti who is as breezy as a balloon conucted very well, which is to say you paid little attention to him. All and all, a good show. I suspect that the thousands of people seeing La Boheme for the first time loved it.

Finally, its hard to swallow a story about starving young Parisian proto-hippies who look like poster boys for the metabolic syndrome. Well, two of them did – Vargas and Kelsey.

La Boheme Met April 5, 2008

Why Giuseppe Di Stefano Was Unique

April 2, 2008

Giuseppe Di Stefano occupies a special place on the list of the greatest tenors of the last century. I will try to show why with a few examples of his singing that show him at his best.

You will often hear singers and critics admit to admiring the “young” Di Stefano. When you do you are encountering someone who masks confusion and conflict by being patronizing. It’s a response to the tenor’s short period at his peak, barely a decade, in contrast to his long life. No one says they admire the “young” Callas though she was at the top for about the same time as GDS. Ten years of being as great as Di Stefano was is long enough to require no qualifier.

First start with the voice. In its prime it was the most beautiful Italian tenor I ever heard. To my ears even more lush and ravishing than Gigli’s. In his 1951 recording of Che gelida manina the voice was at its pinnacle. The tone is gorgeous. It is not spread or open as it later became. The high note is focused and thrilling. His modulation of the aria’s final word “dir” is one of those small touches that differentiate him from everyone else who has sung the piece. To the beauty of the voice add his ability to find meaning and make great effects in ways that no on else did and you have the combination that made Di Stefano unique.

The quartet (Dunque e proprio finita?) that ends the third act of La Boheme, recorded at the same time as the aria above, shows his distinctive ability to convey meaning and sing pianissimo with full vocal support. “…alla stagion dei fior” is unmatched by any other tenor who’s recorded the number. It’s pure genius.

Di Stefano also set the standard for Cavaradossi in Tosca. His rendition of “E lucevan le stelle” combines both tonal beauty and inimitable phrasing. It speaks for itself. No one has ever made as much of the line “Le belle forme discioglieia dai veli!” as he did.

Mario Del Monaco said Di Stefano was a dramatic tenor in temperament, though not in voice. It was this temperament that made him a great interpreter and which also compelled him to sing roles that his temperament demanded but which prematurely destroyed his voice. Canio in Pagliacci was a role he couldn’t avoid. Though he spent his vocal capital every time he sang the part, he was magnetic as Leoncavallo’s cuckolded clown. The famous aria that concludes the opera’s first act (Recitar!) was never sung with greater effect. While he shouldn’t have sung the spinto parts he added to his repertoire, he wouldn’t have been the artist he was had he been resistant to this temptation. Listen to the opera’s final few minutes – Suvvia cosi terribile. Canio has spent half of the evening trying to learn the name of Nedda’s lover When he does the explosion of his emotion is palpable; no other tenor manages this effect.

Don Alvaro in Verdi’s La Forza Del Destino was another role that put too much strain on his voice. Richard Tucker had the ideal voice for this part. But Di Stefano still managed to add something different to his impersonation of Alvaro. This performance of O tu che in seno agl’angeli from a September 1960 performance in Vienna shows the tenor in remarkably good form considering how far into his vocal decline he was by this time though he was still under forty . Even then he could occasionally come up with something hard to match.

Di Stefano’s diminuendo on the high C in Salut demeure is an extraordinary tour de force. This recording is from a 1950 performance in San Francisco. He was still capable of the effect at the end of 1955 which was when I heard him do it at the old Met. It shows how a singer who was so often criticized for bad vocal technique also possessed a technique that was matchless.

La Favorita was an opera that Di Stefano was made for. This 1949 performance of “Spirto gentil” had to be encored. It displays all of the tenors strengths – the great piano, emotional density, and the lush voice. Alas there is also some openness in the high notes. But so what.

Manon was the Opera in which he made his debut. “Le Reve” displays all his strengths. This performance is from 1948 just two years after his debut. It too was encored. How the 26 year old tenor had reached this level of artistry is unfathomable. Touched by God seems as good an explanation as any.

The world’s most enduring popular songs are those from Naples. Di Stefano sang these songs with the same passion and intensity that he gave to opera. In this repertoire nobody comes close. Everybody sings Core ‘ngrato. Di Stefano recorded the song many times. Here’s an especially good version from a 1950 concert.

It’s human to fully value what you had only after its gone. Pippo’s voice departed almost half a century before its owner left us, but now that both are gone I think that his place among the greatest singers will become clear. I’ve heard many great artists and it’s fruitless to rank them. But when it comes to magic Di Stefano stands alone.

Di Stefano, of course, should have the last word. Listen to the way the emotion changes in the song’s refrain. It defines his art. O sole mio

Addendum: After I posted this piece I received an email asking how I could have been so foolish as to leave out Di Stefano’s 1947 recording of Lamento di Federico. On short reflection I agree it was an egregious omission, so here it is. While I was at it I decided to add two Sicilian folk songs which Pippo sings with such simple beauty that your heart will skip a beat. They’re also from 1947. Cantu a Timuni and A la Barcillunisa.

Addendum 2: If you wanted to create the perfect tenor and you could do anything you could think of you’d make Jussi Björling – golden voice, wonderful technique, ringing high notes. The blue print for Björling existed before he did. But you couldn’t make Giuseppe Di Stefano until after you’d heard him. He was unique, sui generis, without precedent.

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