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<channel>
	<title>Neil Kurtzman</title>
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	<link>https://medicine-opera.com</link>
	<description>Comments and reviews of opera, music, and medicine</description>
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		<title>Extinction Denied?</title>
		<link>https://medicine-opera.com/2026/06/extinction-denied/</link>
					<comments>https://medicine-opera.com/2026/06/extinction-denied/#respond</comments>
		
		<dc:creator><![CDATA[Neil Kurtzman]]></dc:creator>
		<pubDate>Sun, 14 Jun 2026 21:44:07 +0000</pubDate>
				<category><![CDATA[government]]></category>
		<category><![CDATA[Politics]]></category>
		<category><![CDATA[Science]]></category>
		<category><![CDATA[Short piece]]></category>
		<category><![CDATA[artificial intelligence]]></category>
		<category><![CDATA[technology]]></category>
		<guid isPermaLink="false">https://medicine-opera.com/?p=31202</guid>

					<description><![CDATA[Two basic events seem to be converging. First, our technology advances at an astonishingly rapid pace, while our behavior hasn&#8217;t changed since our ancestors were kicked out of Eden. Thus, we now have the capacity for endless mayhem (I&#8217;m ignoring all the benefits of technology, as they can be extinguished in a millisecond), coupled with...]]></description>
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<p>Two basic events seem to be converging. First, our technology advances at an astonishingly rapid pace, while our behavior hasn&#8217;t changed since our ancestors were kicked out of Eden. Thus, we now have the capacity for endless mayhem (I&#8217;m ignoring all the benefits of technology, as they can be extinguished in a millisecond), coupled with a management capacity unaltered for millennia. The sad reality is that we have yet to discover an effective way to govern ourselves.</p>



<p>The world is roughly divided into two types of governments &#8211; authoritarian and representative. The former tightly regulates the actions of its population and represses (often sternly) behavior that is unapproved. Individual freedom in these states is curtailed to what the state approves.</p>



<p>Those who live in representative states exhibit a wide range of behavior, from tolerated to approved. Individual liberty under these governments is high. Behavior also ranges from aberrant to exemplary. The range between the two patterns probably resembles a bell-shaped curve.</p>



<p>Bad behavior has been a constant among humans since the cave days. It&#8217;s been at least three millennia since attempts to codify and direct human action into proper channels started. While our knowledge of how we should interact with our fellows is very sophisticated, it doesn&#8217;t seem to have had much of an effect. Both religion and philosophy have examined the subject with piercing insight. They have explained how we should live our lives to the best outcomes, but they seem to have had little success. We still rob, steal, cheat, and engage in violent behavior from robbery to war with more or less the same frequency today as we did two thousand or more years ago.</p>



<p>Of course, this undesirable pattern is only seen in part of the population &#8211; different portions at different times. Even if the fraction of undesirables is small, it&#8217;s large enough to cause serious problems.</p>



<p>Then there&#8217;s the problem in a &#8220;free&#8221; society of liberty descending to license. John Stuart Mill, in one of the most influential tracts ever authored &#8211; <em>On Liberty</em> &#8211; argued that any actions by adults that did not directly affect the well-being of another could not be sanctioned by the state. The individual was free to do whatever he pleased as long as no one else was harmed &#8211; society could disapprove, but no more.</p>



<p>What he didn&#8217;t consider was the effect of cultural decay caused by license that did not impinge on the liberty of others. The cultural health of a society is a real phenomenon. Alas, it&#8217;s impossible to quantify, and disagreement as to whether a society is healthy or degenerate will abound in even the sickest polity. Nevertheless, civilizations decay and die &#8211; by suicide, according to Arnold Toynbee.</p>



<p>Regardless of the correctness of my reasoning, it&#8217;s obvious that our technology has outpaced our ability to control it. The relationship between our self-control and our miraculous and awful inventiveness presents a situation analogous to a toddler trying to drive a Formula One race car. A cool glance will lead a cogent observer to conclude that our species is headed for extinction.</p>



<p>At the beginning of this piece, I mentioned the convergence of two events. The second of these is artificial intelligence. Many who work in this field worry that AI will soon evolve to a level far superior to that of the smartest humans. They tend to think of this development as a threat to human autonomy, and to have convinced most of the general population who know virtually nothing about AI that it&#8217;s a real threat to their way of life. Why they (the AI experts) hold this view has always puzzled me. Why should we care about the autonomy of a dying species whose death throes could extinguish all life on the planet?</p>



<p>My guess is that the only hope we have for continued existence is a benevolent AI that will sanely manage our murderous technology, while suppressing our baser instincts. It&#8217;s quite clear that murder and mayhem are as much a part of the human condition as opposable fingers and thumbs. Attempts to prevent the emergence of an AI that will take over the administration of the planet are not only likely to prove futile, but they are wrong-headed. </p>



<p>Could my analysis be wrong? Of course. But a serious look at the economic status of the world, its politics, its capacity to engage in reasoned disagreement, and much of the world&#8217;s population&#8217;s inability to engage in serious discourse strongly suggests that humans are not able to manage the world as it now exists.</p>



<p>God may have said <em>and let them (mankind) have dominion over the fish of the sea, and over the fowl of the air, and over the cattle, and over all the earth, and over every creeping thing that creepeth upon the earth.</em> What happened right after this pledge? He expelled us from Eden. He didn&#8217;t say such dominion was irrevocable. After thousands of years of management, it&#8217;s time to try a new regime before the supreme being gives up on us altogether.</p>



<p>An AI-managed world may not look upon us with benignity, but is there another choice that will keep us from suicide?</p>



<p><em>I don&#8217;t know what weapons World War III will be fought with, but World War IV will be fought with sticks and stones. Albert Einstein</em><br><br><em>Only the dead or dulled have seen the end of war &#8211; apologies to George Santayana.</em></p>



<p></p>
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		<post-id xmlns="com-wordpress:feed-additions:1">31202</post-id>	</item>
		<item>
		<title>Vaccinating Honeybees and Shrimp</title>
		<link>https://medicine-opera.com/2026/06/vaccinating-honeybees-and-shrimp/</link>
					<comments>https://medicine-opera.com/2026/06/vaccinating-honeybees-and-shrimp/#comments</comments>
		
		<dc:creator><![CDATA[Neil Kurtzman]]></dc:creator>
		<pubDate>Fri, 12 Jun 2026 19:24:57 +0000</pubDate>
				<category><![CDATA[Medicine]]></category>
		<category><![CDATA[Science]]></category>
		<category><![CDATA[Honeybees]]></category>
		<category><![CDATA[Shrimp]]></category>
		<category><![CDATA[vaccination]]></category>
		<guid isPermaLink="false">https://medicine-opera.com/?p=31201</guid>

					<description><![CDATA[The idea of vaccinating honeybees and shrimp would have sounded like science fiction only a few years ago. Both animals are invertebrates, lacking the sophisticated antibody-based immune systems that make vaccination possible in humans, dogs, cattle, and other vertebrates. Yet recent research has shown that even these seemingly simple creatures possess forms of immune memory...]]></description>
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<p>The idea of vaccinating honeybees and shrimp would have sounded like science fiction only a few years ago. Both animals are invertebrates, lacking the sophisticated antibody-based immune systems that make vaccination possible in humans, dogs, cattle, and other vertebrates. Yet recent research has shown that even these seemingly simple creatures possess forms of immune memory that can be harnessed to protect them from disease. As a result, scientists have developed the world&#8217;s first licensed vaccine for an insect &#8211; the honeybee &#8211; and are now applying similar principles to shrimp aquaculture. These advances may transform two industries that are essential to the global food supply.</p>



<p>Honeybees were the first beneficiaries of this revolution. In January 2023, the U.S. Department of Agriculture granted a conditional license for a vaccine designed to protect honeybees against American foulbrood, a devastating bacterial disease caused by Paenibacillus larvae. American foulbrood is highly contagious and can destroy entire colonies. Traditionally, infected hives often had to be burned to prevent the disease from spreading.</p>



<p>Dalan Animal Health developed the honeybee vaccine, and it became the first vaccine ever approved for an insect species. Its method of delivery is ingenious. The process by which honeybees are vaccinated is remarkably different from the way vaccines are administered to mammals. Individual bees are not injected. Instead, the vaccine takes advantage of the natural feeding behavior within the hive. The vaccine contains inactivated fragments of Paenibacillus larvae, the bacterium that causes American foulbrood. These bacterial fragments are mixed into a food source that is consumed by nurse bees, the young worker bees responsible for caring for the queen and developing the brood.</p>



<p>After ingesting the vaccine material, the nurse bees process it as they produce royal jelly, the nutrient-rich secretion used to feed the queen. The bacterial fragments become incorporated into the royal jelly and are delivered to the queen as part of her normal diet. The queen, unaware of the process, consumes the royal jelly just as she would under natural conditions.</p>



<p>Once inside the queen&#8217;s body, the bacterial components are transported by a protein known as vitellogenin. This protein, long recognized as an important egg-yolk precursor in insects, serves an additional function by carrying bacterial molecules from the queen&#8217;s digestive tract into her developing eggs. As a result, the eggs contain information about the pathogen before they hatch.</p>



<p>This approach exploits a phenomenon known as transgenerational immune priming. For many years, scientists assumed that invertebrates possessed only a primitive innate immune system incapable of remembering previous infections. Research over the last two decades has shown that this assumption was incomplete. Although insects do not make antibodies, they can exhibit enhanced resistance to pathogens after prior exposure, and this protection can sometimes be passed from mother to offspring. The honeybee vaccine represents the first practical use of this discovery.</p>



<p>The significance of protecting honeybees extends far beyond beekeeping. Honeybees are among the world&#8217;s most important pollinators, contributing to the production of many fruits, vegetables, and nuts. Colony losses from disease, pesticides, habitat destruction, and environmental stress have become a major concern. A successful vaccination program could improve colony health and reduce economic losses for both beekeepers and farmers.</p>



<p>Encouraged by this success, researchers have turned their attention to shrimp. Shrimp farming is one of the world&#8217;s largest aquaculture industries, but it is constantly threatened by infectious diseases. Among the most destructive are White Spot Syndrome Virus and Early Mortality Syndrome, both capable of wiping out entire shrimp harvests and causing billions of dollars in losses.</p>



<p>For decades, many scientists believed that vaccination of shrimp would be impossible because crustaceans, like insects, lack antibodies and the adaptive immune system that underlies conventional vaccination. However, recent studies have shown that shrimp possess a form of &#8220;trained&#8221; innate immunity. Exposure to certain pathogen components can leave the immune system in a heightened state of readiness, improving survival when the animal later encounters the same disease.</p>



<p>Dalan Animal Health has reported promising results using technology inspired by its honeybee work. In proof-of-concept studies announced in 2025, vaccinated shrimp showed more than 60 percent protection against both White Spot Syndrome Virus and Early Mortality Syndrome. The company&#8217;s goal is to create practical vaccines that can be administered to large populations of shrimp without the need for individual injections.</p>



<p>Researchers are exploring several delivery methods. One of the most promising involves oral vaccines incorporated into feed. Studies published in 2025 demonstrated that specially engineered, heat-killed bacteria could deliver vaccine components into shrimp tissues, stimulate immune responses, and improve survival after viral challenge. Such methods are particularly attractive because shrimp are raised by the millions, making injection impractical.</p>



<p>The science behind shrimp vaccination is still developing, and no widely deployed commercial shrimp vaccine yet exists. Nevertheless, the progress is remarkable. What was once considered biologically impossible is now becoming a realistic disease-control strategy. Researchers increasingly view vaccination as a sustainable alternative to the heavy use of antibiotics and other chemical interventions in aquaculture.</p>



<p>The broader lesson from both honeybees and shrimp is that the immune systems of invertebrates are more sophisticated than scientists once believed. These animals may not possess antibodies, but they can nonetheless acquire a form of immune memory and pass protective effects to future generations. The honeybee vaccine has already demonstrated that this knowledge can be translated into practical agriculture. Shrimp vaccination may soon follow.</p>



<p>If these efforts succeed, they will represent a major advance in food production. Healthier honeybee colonies mean more reliable pollination of crops. Healthier shrimp mean more efficient and sustainable aquaculture. Together, these developments illustrate how modern immunology is expanding beyond traditional livestock and pets to encompass some of the smallest &#8211; but economically most important &#8211; animals on Earth.</p>
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		<post-id xmlns="com-wordpress:feed-additions:1">31201</post-id>	</item>
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		<title>How Similar Is a Cloned Animal to Its Donor?</title>
		<link>https://medicine-opera.com/2026/06/how-similar-is-a-cloned-animal-to-its-donor/</link>
					<comments>https://medicine-opera.com/2026/06/how-similar-is-a-cloned-animal-to-its-donor/#respond</comments>
		
		<dc:creator><![CDATA[Neil Kurtzman]]></dc:creator>
		<pubDate>Mon, 08 Jun 2026 17:13:10 +0000</pubDate>
				<category><![CDATA[Science]]></category>
		<category><![CDATA[cloning]]></category>
		<category><![CDATA[genetics]]></category>
		<guid isPermaLink="false">https://medicine-opera.com/?p=31199</guid>

					<description><![CDATA[A recent article in the Wall Street Journal depicts the frequency with which cloned horses are now used in equestrian sports. This use is especially common in polo ponies. The practice is banned in thoroughbred horses. The public seems to think that a cloned animal is identical to its donor. This belief is not true....]]></description>
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<p><a href="https://www.wsj.com/world/horse-cloning-breeders-sport-c54bdef8?st=arvysL&amp;reflink=desktopwebshare_permalink" target="_blank" rel="noreferrer noopener">A recent article</a> in the <em>Wall Street Journal</em> depicts the frequency with which cloned horses are now used in equestrian sports. This use is especially common in polo ponies. The practice is banned in thoroughbred horses. The public seems to think that a cloned animal is identical to its donor. This belief is not true. </p>



<p>The popular image of cloning often portrays it as a biological photocopying process that produces an exact duplicate of an animal. In reality, cloning creates an animal that is genetically very similar to its donor, but not identical in every respect. A cloned animal is best understood as the equivalent of an identical twin born at a different time rather than a perfect copy &#8211; and even that representation requires modification. While the clone and donor share nearly all of their nuclear DNA, differences in development, environment, epigenetic programming, and life experience inevitably produce individual variation.</p>



<p>In the most common cloning technique, known as somatic cell nuclear transfer, the nucleus from a donor body cell is transferred into an egg cell whose own nucleus has been removed. The resulting embryo contains essentially the same nuclear genetic information as the donor. As a result, the clone usually inherits the donor&#8217;s sex, body plan, coat type, eye color, mature size range, metabolic characteristics, and many inherited disease susceptibilities. From a genetic standpoint, the similarity is extraordinarily high, approaching 100 percent.</p>



<p>Nevertheless, even the genetic similarity is not absolute. The clone typically receives its mitochondria &#8211; the structures that generate cellular energy &#8211; from the egg donor rather than the nuclear donor. Because mitochondria possess their own DNA, the clone&#8217;s mitochondrial genome may differ from that of the animal from which the nucleus was obtained. Although these differences are generally small, they demonstrate that a clone is not a complete genetic duplicate.</p>



<p>The greatest similarities between a clone and its donor are usually found in physical appearance. Healthy adult clones commonly resemble their donors so closely that an experienced observer can immediately recognize the relationship. Coat texture, body shape, facial structure, and general appearance are often remarkably alike. However, noticeable differences may still occur. Coat markings can vary, body proportions may differ slightly, and mature weight can diverge. These differences arise from developmental events occurring during embryonic growth and from environmental influences throughout life.</p>



<p>One of the most striking examples comes from cloned cats. The famous cloned cat CC (&#8220;Carbon Copy&#8221;) differed visibly from her donor despite sharing the same nuclear DNA. The variation arose because of differences in X chromosome inactivation and other developmental processes that affected coat-color patterns.  Rainbow, the donor, was a calico, while CC was a ginger. Such examples illustrate that identical genes do not necessarily produce identical appearances.</p>



<p>Behavior and temperament show even greater variation than physical characteristics. Many cloned animals display behavioral tendencies similar to those of their donors, reflecting the influence of genetics on temperament. Activity level, trainability, sociability, and responses to stress may resemble those of the original animal. However, behavior is shaped not only by genes but also by experience. A clone does not inherit memories, training, social interactions, illnesses, injuries, or life history. Consequently, two genetically identical animals may develop distinct personalities. In this respect, cloned animals come close to resembling identical twins, who often share many traits yet remain clearly individual people or animals. But identical twins have the same mitochondrial DNA, while cloned animals do not.</p>



<p>The principal biological reason for differences between a clone and its donor lies in epigenetics. Epigenetic mechanisms regulate which genes are active and which remain silent without altering the DNA sequence itself. When an adult cell nucleus is transferred into an egg, the egg must erase many of the molecular marks associated with the donor cell&#8217;s previous identity and restore an embryonic pattern of gene activity. This reprogramming process is not always perfect.</p>



<p>One important epigenetic mechanism involves DNA methylation. Chemical groups attached to DNA can silence genes or alter their activity. If the cloning process fails to reset these patterns completely, certain genes may remain inappropriately active or inactive. Similar problems can occur with histone modifications, which influence how tightly DNA is packaged and therefore how accessible genes are for expression.</p>



<p>Genomic imprinting provides another source of variation. Certain genes normally retain a memory of whether they originated from the mother or the father. Errors in imprinting can affect fetal growth, placental development, and other physiological processes. These abnormalities are among the reasons cloning remains inefficient, with many embryos failing to develop normally.</p>



<p>Beyond epigenetics, post-transcriptional events can further increase differences between clone and donor. Once a gene has been transcribed into messenger RNA, numerous regulatory processes determine how much protein is ultimately produced. MicroRNAs may suppress specific messenger RNAs, alternative splicing may generate different protein products from the same gene, and differences in RNA stability can alter protein production. As a result, two animals with essentially identical DNA can produce different amounts of key proteins, leading to physiological and developmental differences.</p>



<p>Taken together, these factors mean that a cloned animal is neither a perfect copy nor merely an ordinary relative. Genetically, a healthy clone is almost identical to its donor. Physically, the resemblance is usually striking and often comparable to that seen between identical twins. Physiologically, most traits are highly similar, although differences in gene expression may produce measurable variation. Behaviorally, similarities may be substantial but are generally less predictable because experience plays such an important role.</p>



<p>In summary, a cloned animal shares nearly all of its nuclear DNA with its donor and therefore exhibits a high degree of similarity in appearance and biology. Yet differences in mitochondrial genetics, embryonic development, epigenetic programming, post-transcriptional regulation, and life experience ensure that every clone remains a unique individual. Cloning reproduces a genome with remarkable fidelity, but it does not reproduce an entire biological life.</p>



<p>So if beloved Fido is old and soon to be put down, and you clone him, you may get a dog that resembles him, but who is very different in temperament and behavior. In other words, a different dog. So you might forgo cloning Fido, save some money, and adopt or buy a new dog.</p>
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		<post-id xmlns="com-wordpress:feed-additions:1">31199</post-id>	</item>
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		<title>On the Future of the Metropolitan Opera</title>
		<link>https://medicine-opera.com/2026/06/on-the-future-of-the-metropolitan-opera/</link>
					<comments>https://medicine-opera.com/2026/06/on-the-future-of-the-metropolitan-opera/#comments</comments>
		
		<dc:creator><![CDATA[Neil Kurtzman]]></dc:creator>
		<pubDate>Fri, 05 Jun 2026 18:46:52 +0000</pubDate>
				<category><![CDATA[Opera]]></category>
		<category><![CDATA[The Metropolitan Opera in trouble]]></category>
		<guid isPermaLink="false">https://medicine-opera.com/?p=31196</guid>

					<description><![CDATA[I&#8217;ve touched on this topic several times before, but as the Met&#8217;s future becomes more uncertain every year, I thought a revisit would be worth a few minutes. Basically, there are only two types of problems that confront mankind and his institutions &#8211; money and craziness. Of course, the two are often joined as tightly...]]></description>
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<p>I&#8217;ve touched on this topic several times before, but as the Met&#8217;s future becomes more uncertain every year, I thought a revisit would be worth a few minutes. Basically, there are only two types of problems that confront mankind and his institutions &#8211; money and craziness. Of course, the two are often joined as tightly as Siamese twins. </p>



<p>The Met&#8217;s difficulties are mostly due to insufficient funds, but there is also more than a soupçon of nuttiness involved. After all, it&#8217;s an opera house we&#8217;re considering. The Met differs from European lyric theaters in that it does not receive a government subsidy. It has always relied on the generosity of others. It was founded in 1883 by a handful of very wealthy patrons and sustained through much of its history by patronage.</p>



<p>Gifts and grants have kept the house open ever since. The company once had a fundraising campaign that reminded potential donors that it lost $100,000 every time it raised the curtain. This was when $100,000 was real money. In a spasm of jejune pique, I suggested they not raise the curtain.</p>



<p>The Met receives indirect support from the government because donations to it are tax-deductible. The recent increase in the IRS standard deduction has resulted in fewer taxpayers itemizing deductions on their returns. The unintended consequence of the current tax law has disincentivized small and moderate donations to organizations like the Met. Collectively, the absent donations are a huge amount that arts institutions and their likes no longer receive in amounts equal to those of the past. On the other hand, current tax law allows elderly individuals with substantial IRAs to make large donations under very favorable taxation while still maintaining the increased standard deduction. The Met should vigorously target this cohort.</p>



<p>Obviously, the Met has to increase revenue or decrease expenditures &#8211; or both. Both fiscal remedies face numerous difficulties. The first way to increase income is to sell more tickets. As mentioned above, even if every performance were sold out, the Met would still have insufficient operating funds. But every little bit helps, and the solution to the Met&#8217;s problems requires multiple remedies.</p>



<p>The Met has an auditorium with 4,000 seats. It is the largest opera house in the world. By comparison, La Scala seats about 2,000. The Vienna State Opera House has a capacity of a little more than 1,700. The Met is in New York City, which has a population of about 20 million, counting its suburbs. Thus, its potential audience is large. But opera is a niche taste in the 21st century, so its real audience is much smaller. Also, New York offers many other forms of entertainment that compete with the Met for the recreational dollar. New York has lots of tourists, but relatively few of them are interested in opera.</p>



<p>Thus, the Met has to meet the tastes of those few who are interested in opera. The company says it feels obligated to support new works to its audience. Accordingly, it has been presenting about three modern operas each season, which, no matter how appealing to the cogniscenti, do not sell tickets like the great masterpieces that are at the core of the company&#8217;s repertory &#8211; those of Mozart, Wagner, Verdi, etc. These productions are expensive and are an unnecessary cost to the company.</p>



<p>In my opinion, the Met should not present any new work that has not proved itself at smaller companies. Alas, there are no such works being written today. There are only two composers since the end of World War II who have written operas that have entered the standard repertoire &#8211; Benjamin Britten and Francis Poulenc. </p>



<p>When you have a worn-out product that sells for a stunning price, you have a major problem. The highest-priced ticket at the Met sells for north of $400. An evening at the opera with dinner before or after the show, the expense of getting to and from the house can run around $1500. Even in New York, this is a lot to pay for a show that may bore you or that doesn&#8217;t feature world-class singers.</p>



<p>Which raises the next problem. While the company has many fine singers on its roster, only a few could be called superstars. A generation or two back, the house was full of extraordinary artists. The company&#8217;s ill-advised foray into international disputes hasn&#8217;t helped this dearth of great singers. Peter Gelb, the benighted general manager, fired the Russian Anna Netrebko, the world&#8217;s leading Verdi soprano, because she wasn&#8217;t sufficiently anti-Putin. Never mind that she had family living in Russia. Gelb then proceeded to hire a slew of good, but not great, Russian singers without regard to their opinions on international events. The reasoning, if any, behind this sequence is opaque.</p>



<p>The next problem, which likely has no solution, is the Met&#8217;s 15 or 17 unions. These bargaining units raise the company&#8217;s payroll to levels it cannot support. </p>



<p>A recent analysis in <em>The Wall Street Journal</em> reported that personnel costs at the Met consume roughly two-thirds of the budget and that the company has 15 unions representing more than 3,000 employees. If two-thirds of its $331 million budget goes to personnel, total compensation (salaries, overtime, pensions, health insurance, payroll taxes, etc.) is approximately: $331 million × 0.67, or $220 million annually.</p>



<p>Because the overwhelming majority of Met employees are represented by unions &#8211; the orchestra, chorus, soloists, stagehands, wardrobe, makeup, electricians, carpenters, scenic artists, ticket sellers, and many others &#8211; the unionized workforce probably accounts for well over 80% of personnel costs. These figures suggest that compensation attributable to union-represented employees is on the order of $175–200 million per year, including benefits and pension contributions.</p>



<p>Thus, there isn&#8217;t that much money to pay the cost of productions (new or old), soloists, and conductors. and other non-unionized creative personnel. With a product in less demand than in prior years, and not that much money to devote to art, the company may be in a death spiral.</p>



<p>Its demise would be a cultural disaster. But disasters are a regular feature of life. What is a preventative remedy? One doesn&#8217;t readily occur to me. I am a diagnostician, not a surgeon. That the Met needs major surgery is undeniable. But it needs even more than that. Singers who will fill the house, new works that will command both old and new patrons to attend the company&#8217;s shows, and fiscal policies that reflect financial reality are all required to make the Met the operatic powerhouse it once was. These and more are needed to right the company&#8217;s course. It may well be that it will have to collapse before it can be fixed.</p>



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		<post-id xmlns="com-wordpress:feed-additions:1">31196</post-id>	</item>
		<item>
		<title>El Último Sueño de Frida y Diego  in HD</title>
		<link>https://medicine-opera.com/2026/05/el-ultimo-sueno-de-frida-y-diego-in-hd/</link>
					<comments>https://medicine-opera.com/2026/05/el-ultimo-sueno-de-frida-y-diego-in-hd/#respond</comments>
		
		<dc:creator><![CDATA[Neil Kurtzman]]></dc:creator>
		<pubDate>Sun, 31 May 2026 01:48:54 +0000</pubDate>
				<category><![CDATA[Uncategorized]]></category>
		<category><![CDATA[El Último Sueño De Frida Y Diego]]></category>
		<category><![CDATA[The Met in HD]]></category>
		<guid isPermaLink="false">https://medicine-opera.com/?p=31190</guid>

					<description><![CDATA[The Met&#8217;s new production of Gabriela Lena Frank&#8217;s opera El Último Sueño de Frida y Diego was telecast today. It was the final show of the 25-26 series of broadcasts. The opera takes place on Día de los Muertos (Day of the Dead), November 2, 1957, the year of Diego Rivera&#8217;s death and three years...]]></description>
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<p>The Met&#8217;s new production of Gabriela Lena Frank&#8217;s opera <em>El Último Sueño de Frida y Diego</em> was telecast today. It was the final show of the 25-26 series of broadcasts.</p>



<p>The opera takes place on Día de los Muertos (Day of the Dead), November 2, 1957, the year of Diego Rivera&#8217;s death and three years after Frida Kahlo&#8217;s death. Diego is old, lonely, and consumed by grief. He longs for one more reunion with Frida before he dies. Diego&#8217;s yearning reaches the underworld, where the keeper of the dead, La Catrina, summons Frida and asks her to accompany Diego on his final journey toward death. Frida is reluctant. In death, she has finally escaped the terrible physical pain that dominated her life after childhood polio, a bus accident, and numerous surgeries.</p>



<p>Frida and Diego wander through Mexico City, particularly the dreamlike landscape of Alameda Park, where the living and the dead mingle freely. The boundary between reality and imagination dissolves, much as it does in Frida&#8217;s paintings. The lovers reminisce about their tumultuous marriage  &#8211; its passion, betrayals, artistic triumphs, and mutual dependence. Diego begs Frida to embrace him, but La Catrina has imposed a rule: Frida must not touch him. If she does, she risks recovering the pain from which death has liberated her.</p>



<p>Eventually, Diego&#8217;s pleas become irresistible. Frida embraces him. The moment is both ecstatic and tragic. By touching him she regains the suffering she had left behind in death. The reunion reveals the opera&#8217;s central idea: love and pain are inseparable. One cannot reclaim the former without risking the latter.</p>



<p>As the day ends, Diego must face his mortality. He finally accepts death and follows Frida into the underworld. The opera concludes not with loss but with reunion. The lovers, separated by death throughout the story, are ultimately united beyond it.</p>



<p>There&#8217;s another character, Leonardo, who seems to have wandered into the opera by mistake, as his role in the story is unapparent. He&#8217;s an actor and a Greta Garbo impersonator. The opera&#8217;s story is sort of a reverse of that of Orpheus. It is largely symbolic and meant to depict the persistence of love after death, with a bit of memory as a form of immortality. It served as a serviceable vehicle for the production. </p>



<p>An opera succeeds or not virtually entirely on the quality of its music. Frank&#8217;s orchestra was cleverly constructed, but there were few to no first-rate ideas. The production was imaginatively and colorfully staged. The costumes were vivid. Especially noteworthy were the skeleton dancers whose movements were quirky and engaging.</p>



<p>The best performance of the afternoon was by Gabriella Reyes, who played Catrina, the keeper of the underworld. Her costume, which was skeletal, took more than three hours to don. She sang with vocal security and moved with vigor and panache.</p>



<p>Isabel Leonard sang very well and also looked beautiful despite Gray Halvorson&#8217;s endoscopic closeups. She was committed to the role and realized as much as was in it.</p>



<p>Veteran baritone Carlos Álvarez got to sing in his native language for the first time at the Met and one of the rare times anywhere. He made his Met debut in 1996 and has sung 35 times with the company over the intervening three decades. His part is not that demanding, though at times his sound was harsh and forced. He was clad in a fat suit to mimic the large size of the real Diego Rivera. </p>



<p>Counter tenor Nils Wanderer was Leonardo, the guy who seemed in the wrong opera. He made as much as was possible of this strange character. His voice was well-produced and sounded like that of a mezzo soprano.</p>



<p>Deborah Colker&#8217;s production was better than the story or the music. It was reason enough to attend the performance. The scenes of 50s Mexico City and the underworld, or wherever the dead of this story were kept, were bright and imaginative.</p>



<p>Conductor Yannick Nézet-Séguin was clad in a colorful shirt that costume designers Jon Bausor or Wilberth Gonzalez could have made for him. Had he gone onstage, he would have fit right in with the colorful Mexican characters. His orchestra, as is their usual practice, played with precision and style.</p>



<p>So what&#8217;s the likely fate of another new opera staged by the Met? Almost certainly, that of all the new operas staged by the company over almost a century and a half (save two by Puccini) gradual oblivion.</p>



<p><strong>El Último Sueño de Frida y Diego</strong><br>Music by Gabriela Lena Frank<br>Libretto by Nilo Cruz</p>



<p>Conductor<br>Yannick Nézet-Séguin</p>



<p>Frida Kahlo<br>Isabel Leonard</p>



<p>Diego Rivera<br>Carlos Álvarez</p>



<p>Catrina<br>Gabriella Reyes</p>



<p>Leonardo<br>Nils Wanderer</p>



<p>First Villager<br>Paul Corona</p>



<p>Second Villager / Young Man<br>Angel Raii Gomez</p>



<p>Third Villager<br>Scott Conner</p>



<p>First Frida Image<br>Kresley Figueroa</p>



<p>Second Frida Image<br>Mary Beth Nelson</p>



<p>Third Frida Image<br>Cecelia McKinley</p>



<p>Production Team</p>



<p>Production: Deborah Colker<br>Set Design: Jon Bausor<br>Costume Design: Jon Bausor and Wilberth Gonzalez<br>Lighting Design: Adam Silverman<br><br>Video Director: Gary Halvorson.<br></p>



<p></p>
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		<post-id xmlns="com-wordpress:feed-additions:1">31190</post-id>	</item>
		<item>
		<title>Ambrose Bierce</title>
		<link>https://medicine-opera.com/2026/05/ambrose-bierce/</link>
					<comments>https://medicine-opera.com/2026/05/ambrose-bierce/#respond</comments>
		
		<dc:creator><![CDATA[Neil Kurtzman]]></dc:creator>
		<pubDate>Thu, 28 May 2026 02:10:31 +0000</pubDate>
				<category><![CDATA[Critics]]></category>
		<category><![CDATA[Literature]]></category>
		<category><![CDATA[satire]]></category>
		<category><![CDATA[Ambrose Bierce]]></category>
		<category><![CDATA[THe Devil's Dictionary]]></category>
		<guid isPermaLink="false">https://medicine-opera.com/?p=31186</guid>

					<description><![CDATA[Ambrose Bierce (1842-1914) was a unique writer and journalist. He is one of the strangest and most creative figures in American literature. Bierce’s life reads almost like one of his own stories. Born into a large, impoverished family in Meigs County, Ohio, on June 24, 1842, Bierce grew up with a profound distaste for his...]]></description>
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<p>Ambrose Bierce (1842-1914) was a unique writer and journalist. He is one of the strangest and most creative figures in American literature. Bierce’s life reads almost like one of his own stories. Born into a large, impoverished family in Meigs County, Ohio, on June 24, 1842, Bierce grew up with a profound distaste for his puritanical upbringing. Lacking the financial resources for a formal university education, his intellect was forged in printing offices and through voracious independent reading.</p>



<p>He served in the Union Army during the Civil War, fighting at Shiloh and Chickamauga. In 1864, he sustained a severe, near-fatal head wound at Kennesaw Mountain, an injury that permanently altered his cognitive and psychological relationship with death. The war permanently shaped his imagination. Unlike many later writers who romanticized battle, Bierce saw war as chaotic, terrifying, absurd, and psychologically destructive. This experience gave his fiction an authenticity that distinguished it from much nineteenth-century writing.</p>



<p>After the war he drifted westward, eventually settling in California, where he became a journalist and literary critic. His newspaper columns were legendary for their savagery. Authors dreaded his reviews. He attacked bad writing, pretension, political corruption, and hypocrisy with a ferocity almost unmatched in American journalism. His contemporaries nicknamed him “Bitter Bierce,” a title he probably enjoyed.</p>



<p>His marital life was a disaster. On Christmas Day in 1871, Bierce married Mary Ellen &#8220;Mollie&#8221; Day, a high-society heiress and the daughter of a wealthy San Francisco mining family. Together, they had three children &#8211; two sons and a daughter. One son committed suicide at age 16, the other died in 1901 of alcohol related pneumonia. Bierce deserted his wife in 1888. She divorced him in 1904 and died the following year.</p>



<p>Enured with a bleak worldview shaped by direct, brutal experiences on the front lines of the American Civil War, Bierce rejected the comfortable illusions of human virtue, heroism, and societal progress. Instead, he pioneered a style of psychological horror, grim irony, and linguistic precision. </p>



<p>Bierce’s short stories are among the finest in American literature, especially his tales of war and psychological horror. “An Occurrence at Owl Creek Bridge,” likely his masterpiece, combines realism, suspense, and illusion in a way that anticipated twentieth-century modern fiction. The story’s famous ending &#8211; revealing that the protagonist’s imagined escape occurs in the instant before death &#8211; still feels startlingly modern. Bierce also wrote eerie supernatural tales such as “The Damned Thing,” “The Death of Halpin Frayser,” and “The Moonlit Road,” works that influenced later horror writers including H. P. Lovecraft.</p>



<p>Bierce wrote with cold precision. He distrusted emotional excess. In his stories, terror often arrives suddenly, almost casually, making it more disturbing. He also excelled at portraying the instability of perception: dreams merge into reality, time distorts, and characters frequently misunderstand the world around them until it is too late.</p>



<p>Bierce’s enduring popular fame rests primarily on <em>The Devil&#8217;s Dictionary</em>, the collection of sardonic definitions he composed over several decades. The work began as occasional newspaper items in the 1870s before being first gathered as <em>The Cynic’s Word Book</em> in 1906 and later expanded as The <em>Devil’s Dictionary</em> in 1911. The book is essentially a lexicon rewritten by a pessimist with a genius for invention. Bierce took ordinary words and defined them according to what he considered the grim realities of human behavior.</p>



<p>Many of the definitions endure because they condense entire philosophies into a sentence or two. Bierce’s humor was not merely comic; it was diagnostic. He believed civilization was largely driven by vanity, greed, self-deception, and stupidity. Yet the book&#8217;s brilliance lies in its elegance. Even when cruel, the definitions are so perfectly phrased that they become irresistible. Among some of the most famous or cynical are these:</p>



<p>“Egotist, n. A person of low taste, more interested in himself than in me.”<br>“Politics, n. A strife of interests masquerading as a contest of principles.”<br>“Lawyer, n. One skilled in circumvention of the law.”<br>“Diplomacy, n. The patriotic art of lying for one’s country.”<br>“Peace, n. In international affairs, a period of cheating between two periods of fighting.”<br>“Education, n. That which discloses to the wise and disguises from the foolish their lack of understanding.”<br>“Success, n. The one unpardonable sin against one’s fellows.”<br>“Vote, n. The instrument and symbol of a freeman’s power to make a fool of himself and a wreck of his country.”<br>“Positive, adj. Mistaken at the top of one’s voice.<br>“Year, n. A period of three hundred and sixty-five disappointments.”<br>“Self-evident, adj. Evident to one’s self and to nobody else.”</p>



<p>At times, however, Bierce’s cynicism could become exhausting. He distrusted nearly everything: democracy, religion, reform movements, sentimentality, and often humanity itself. Unlike Mark Twain, whose satire usually retains warmth beneath the irony, Bierce often sounds genuinely alienated from the human race. Some readers admire this uncompromising severity; others find it emotionally painful. But even critics acknowledge his extraordinary verbal ingenuity and virtuosity.</p>



<p>The final chapter of Bierce’s life only deepened his mystique. In 1913, at age seventy-one, he traveled through the American South and then crossed into revolutionary Mexico, apparently joining the forces of Pancho Villa as an observer. His last known letter, written from Chihuahua on December 26, 1913, ended with the ominous statement: “As to me, I leave here tomorrow for an unknown destination.” He was never seen again.</p>



<p>Today, Bierce’s reputation rests on several achievements: his pioneering Civil War fiction, his influential horror stories, and above all the immortal acid wit of <em>The Devil’s Dictionary</em>. He never became as universally beloved as Twain or as philosophically profound as Edgar Allan Poe, but few American writers have equaled his combination of intelligence, stylistic economy, and savage humor. His best work still feels contemporary because hypocrisy, vanity, and self-deception remain constant characteristics of the human condition. Bierce saw these qualities everywhere &#8211; and he described them with unmatched sharpness. His war stories influenced Stephen Crane, Ernest Hemingway, and others. Some critics consider him America&#8217;s finest satirist.</p>



<p><br></p>



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		<post-id xmlns="com-wordpress:feed-additions:1">31186</post-id>	</item>
		<item>
		<title>Jerome Hines</title>
		<link>https://medicine-opera.com/2026/05/jerome-hines/</link>
					<comments>https://medicine-opera.com/2026/05/jerome-hines/#comments</comments>
		
		<dc:creator><![CDATA[Neil Kurtzman]]></dc:creator>
		<pubDate>Fri, 22 May 2026 20:54:03 +0000</pubDate>
				<category><![CDATA[Opera]]></category>
		<category><![CDATA[bass]]></category>
		<category><![CDATA[Jerome Hines]]></category>
		<guid isPermaLink="false">https://medicine-opera.com/?p=31183</guid>

					<description><![CDATA[Jerome Hines was one of the towering figures of twentieth-century American opera &#8211; literally and artistically. Standing more than six and a half feet tall, with a sonorous bass voice of exceptional power and clarity, Hines enjoyed one of the longest and most distinguished careers in the history of the Metropolitan Opera. Yet he was...]]></description>
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<p>Jerome Hines was one of the towering figures of twentieth-century American opera  &#8211;  literally and artistically. Standing more than six and a half feet tall, with a sonorous bass voice of exceptional power and clarity, Hines enjoyed one of the longest and most distinguished careers in the history of the Metropolitan Opera. </p>



<p>Yet he was also an unusual intellectual among singers: a trained mathematician and chemist who published articles in mathematical journals and maintained a lifelong interest in philosophy and science.</p>



<p>He was born Jerome Albert Link Heinz on November 8, 1921, in Hollywood, California. During his studies at the University of California, Los Angeles, he pursued mathematics and chemistry while simultaneously studying voice. Because anti-German sentiment was widespread during World War II, the young singer altered his surname from Heinz to Hines at the suggestion of his manager, the famous impresario Sol Hurok. During the war, he worked for an oil company after being rejected for military service because of his height.</p>



<p>Hines made his operatic debut in 1941 at the San Francisco Opera as Monterone in Verdi’s Rigoletto. Five years later, he debuted at the Metropolitan Opera as the Officer in Mussorgsky’s <em>Boris Godunov</em>. That appearance began an extraordinary association with the company that lasted from 1946 until 1987 &#8211; a record 41 consecutive seasons.</p>



<p>At the Met, he became celebrated for roles demanding authority, spiritual gravity, or demonic force. His greatest portrayals included Sarastro in Mozart’s <em>Die Zauberflöte</em>, Mephistopheles in Gounod’s <em>Faust</em>, Ramfis in Verdi’s <em>Aida</em>, King Marke in Wagner’s <em>Tristan und Isolde</em>, and the title role in <em>Boris Godunov</em> &#8211; first in English and then in Russian. In 1954, he became the first American-born singer to perform <em>Boris</em> at the Met, a landmark achievement at a time when the great Russian bass repertory was still dominated by Europeans.</p>



<p>Internationally, Hines sang at the Bayreuth Festival, La Scala, Glyndebourne, and even the Bolshoi Theatre, where he performed Boris Godunov in 1962 during the tense days surrounding the Cuban Missile Crisis. He spent a year learning the role in Russian preparatory to his appearance in Moscow. His imposing presence and immense vocal resources made him especially admired in Wagner and the great Slavic bass repertoire.</p>



<p>Hines was more than an opera star. In the 1950s, he published scholarly papers in Mathematics Magazine on operator theory and numerical methods, an almost unprecedented accomplishment for an active international singer. He also remained deeply interested in the philosophy of mathematics throughout his life.</p>



<p>A devout Christian, Hines composed an opera on the life of Jesus titled <em>I Am the Way</em> and frequently performed sacred music and religious programs. He also wrote several books, including his autobiography <em>This Is My Story</em> and the influential <em>Great Singers on Great Singing</em>, based on interviews with important vocal artists.</p>



<p>Jerome Hines died in New York on February 4, 2003, at the age of 81. He remains remembered not only as one of America’s greatest basses, but also as a rare combination of artist, scholar, teacher, and intellectual.</p>



<p>Hines sang both the King and the Grand Inquisitor in Verdi&#8217;s <em>Don Carlo</em>. First, the King&#8217;s great aria &#8216;Ella giammai m&#8217;amo&#8217; from a Met performance in 1961. Then a video from another Met performance in 1980. Paul Plishka is the King. Hines is in such stupendous voice that, even at age 59, he dominates the scene.</p>



<figure class="wp-block-audio"><audio controls src="https://medicine-opera.com/wp-content/uploads/2026/05/Jerome-Hines-Ella-giammai-mamo-Don-Carlo-live-Met-1961.mp3"></audio></figure>



<figure class="wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-4-3 wp-has-aspect-ratio"><div class="wp-block-embed__wrapper">
<iframe title="Grand Inquisitor Scene - Paul Plishka and Jerome Hines, MET 1980 (with subtitles)" width="500" height="375" src="https://www.youtube.com/embed/7pNxU4ck8BI?feature=oembed" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe>
</div></figure>



<p>Next &#8216;Mentre gonfiarsi l&#8217;anima… Oltre quel limite&#8217; from Verdi&#8217;s <em>Attila</em>. In this dramatic scene from Giuseppe Verdi’s opera <em>Attila</em> (Act I, Scene 6), the ruthless Hun king awakens from a horrifying nightmare and defiantly rejects the supernatural warning. The Met never staged this opera during Hines 41 years with the company. He would have been terrific in the title role.</p>



<figure class="wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-4-3 wp-has-aspect-ratio"><div class="wp-block-embed__wrapper">
<iframe title="Jerome Hines - Mentre gonfiarsi l&#039;anima... Oltre quel limite ( Attila - Giuseppe Verdi )" width="500" height="375" src="https://www.youtube.com/embed/JUGB69IgOdM?feature=oembed" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe>
</div></figure>



<p>Hine&#8217;s singing of Mephisto&#8217;s serenade is from a TV broadcast. It&#8217;s a role he often sang at the Met. He was the first of Gounod&#8217;s devil that I heard at the Met &#8211; Dec 17, 1955. Giuseppe Di Stefano sang the title role.</p>



<figure class="wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-4-3 wp-has-aspect-ratio"><div class="wp-block-embed__wrapper">
<iframe title="Jerome Hines-Mefisto&#039;s serenade" width="500" height="375" src="https://www.youtube.com/embed/FokI9gYm-GY?feature=oembed" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe>
</div></figure>



<p>&#8216;You&#8217;ll Never Walk Alone&#8217; is from the 1945 Rodgers and Hammerstein musical <em>Carousel</em>. Hines gives a performance so good you could wonder why anyone else would try to match him. Note he changes &#8216;hope&#8217; to &#8216;God&#8217;. </p>



<figure class="wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-4-3 wp-has-aspect-ratio"><div class="wp-block-embed__wrapper">
<iframe loading="lazy" title="Jerome Hines sings You&#039;ll never walk alone" width="500" height="375" src="https://www.youtube.com/embed/0BEYiDUB670?feature=oembed" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe>
</div></figure>



<p>His rendition of Ol&#8217; Man River is from a concert in 1984. The voice is still in marvellous condition.</p>



<figure class="wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-4-3 wp-has-aspect-ratio"><div class="wp-block-embed__wrapper">
<iframe loading="lazy" title="Jerome Hines sings old man rive" width="500" height="375" src="https://www.youtube.com/embed/NSZIeHz0teg?feature=oembed" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe>
</div></figure>



<p>Hines appeared at the Met when there was a plethora of great basses. He was surpassed by none of them. He seems to have been somewhat forgotten with the passage of time. He did not leave a lot of studio recordings. What we have shows what a fine artist he was. From what I can tell, he was an equally fine human being.</p>
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		<enclosure url="https://medicine-opera.com/wp-content/uploads/2026/05/Jerome-Hines-Ella-giammai-mamo-Don-Carlo-live-Met-1961.mp3" length="6633261" type="audio/mpeg" />

		<post-id xmlns="com-wordpress:feed-additions:1">31183</post-id>	</item>
		<item>
		<title>Increasing Use of Nurse Practitioners</title>
		<link>https://medicine-opera.com/2026/05/increasing-use-of-nurse-practitioners/</link>
					<comments>https://medicine-opera.com/2026/05/increasing-use-of-nurse-practitioners/#comments</comments>
		
		<dc:creator><![CDATA[Neil Kurtzman]]></dc:creator>
		<pubDate>Tue, 19 May 2026 22:05:52 +0000</pubDate>
				<category><![CDATA[Medicine]]></category>
		<category><![CDATA[Nurse Practitioners]]></category>
		<category><![CDATA[Physicians Assistants]]></category>
		<guid isPermaLink="false">https://medicine-opera.com/?p=31181</guid>

					<description><![CDATA[A recent article in the Wall Street Journal focuses on the increasing use of nurse practitioners (NPs) and physician assistants (PAs) in filling patient care gaps in our medical system. There are now 461,000 NP active, an increase in 61% since 2019. They function in much the same way as do family practitioners; the same...]]></description>
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<p>A <a href="https://www.wsj.com/health/healthcare/nurse-practitioner-is-now-the-hottest-job-in-healthcare-a98e0bc8?st=eYtQKa&amp;reflink=desktopwebshare_permalink" target="_blank" rel="noreferrer noopener">recent article</a> in the <em>Wall Street Journal </em>focuses on the increasing use of nurse practitioners (NPs) and physician assistants (PAs) in filling patient care gaps in our medical system. There are now 461,000 NP active, an increase in 61% since 2019. They function in much the same way as do family practitioners; the same is true for PAs.</p>



<p>They make diagnoses and prescribe medication just as physicians do. They function with minimal or no regular oversight by MDs. This increase in numbers and independence has, of course, provoked criticism from primary care physicians. They cite the difference in training (two years versus seven years) for limiting the independence of NPs. </p>



<p>Almost all of this criticism is without justification. Most family practitioners are overtrained for the illnesses that make up the vast bulk of their practice. The routine aches and pains and straightforward, common illnesses that comprise 95% or more of their patient encounters do not require two years of basic science courses, while much of their clinical rotations could be easily compressed. That this is so is the success of NPs in handling the common illnesses that they manage effectively.</p>



<p>When a problem that goes beyond the qualification or familiarity of the training and experience arises, they do the same thing that a family practitioner does &#8211; they refer the patient to the emergency room or to a specialist.</p>



<p>The need for these physician extenders is particularly great in rural areas that have trouble recruiting MDs. </p>



<p>The increasing demand for medical care will overwhelm any objections to the use of NPs and PAs. As long as they use consultation and referral properly, they will provide a badly needed service at a cost-effective price. </p>



<p>The number of doctors who enter practice in the US each year is limited by the number of residency positions available. The country has a severe shortage of primary-care physicians. This deficit is worsening every year as medical school graduates preferentially enter higher paying specialties.  NPs and PAs are filling this need. They require less training and receive a lower salary than do primary care doctors. </p>



<p>Nurse practitioners make an average income of $132,000 a year compared to the $257,000 average for primary-care doctors. PAs earn, on average, $133,000 yearly. They both are filling a real medical need that will only increase as the population ages. The need for these physician extenders is particularly great in rural areas that have trouble attracting primary care MDs.</p>



<p>Over the past two decades, around 30 states have given nurse practitioners the right to practice without physician oversight. Ten states let physician assistants &#8211; who generally have a minimum of six or seven years of clinical training and higher education &#8211; practice independently as well. And five states have passed laws changing the title of physician assistant to physician associate. The name change another example of putting lipstick on a pig. It does nothing to add to the real usefulness of PAs.</p>



<p>Despite the objections of physicians who object to the independence of NPs and PAs, there&#8217;s little to no evidence that their increasing use harms patient care. The reality of American medical care and the nature of most medical visits support the increased use of these physician extenders. They serve a real need and do so at a reasonable price. I see no reason, other than self-interest, for physicians to object to their use.</p>
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		<post-id xmlns="com-wordpress:feed-additions:1">31181</post-id>	</item>
		<item>
		<title>Hantavirus &#8211; A Primer</title>
		<link>https://medicine-opera.com/2026/05/hantavirus-a-primer/</link>
					<comments>https://medicine-opera.com/2026/05/hantavirus-a-primer/#respond</comments>
		
		<dc:creator><![CDATA[Neil Kurtzman]]></dc:creator>
		<pubDate>Fri, 15 May 2026 18:22:51 +0000</pubDate>
				<category><![CDATA[Medicine]]></category>
		<category><![CDATA[Hantavirus infection]]></category>
		<guid isPermaLink="false">https://medicine-opera.com/?p=31178</guid>

					<description><![CDATA[The recent outbreak of Hantavirus infections aboard the Dutch expedition cruise ship MV Hondius, which had been sailing from Ushuaia through the South Atlantic toward the Canary Islands, combined with the painful memory of the COVID pandemic, has raised public awareness and fear to levels probably beyond the boundary of reality. Below are a few...]]></description>
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<p>The recent outbreak of Hantavirus infections aboard the Dutch expedition cruise ship MV Hondius, which had been sailing from Ushuaia through the South Atlantic toward the Canary Islands, combined with the painful memory of the COVID pandemic, has raised public awareness and fear to levels probably beyond the boundary of reality. Below are a few salient facts about the virus and its effects on humans.</p>



<p>Hantaviruses form a large family of rodent-borne viruses distributed across much of the world. Some cause severe lung disease, while others primarily attack the kidneys. Although infections remain relatively rare, hantaviruses are important because of their high mortality rates and the difficulty of early diagnosis.</p>



<p>Hantaviruses belong to a group of RNA viruses in the family <em>Hantaviridae</em>. Unlike influenza or COVID-19, hantaviruses are not primarily spread from person to person. Instead, each type of hantavirus is usually associated with a particular rodent species that serves as its natural host.</p>



<p>The rodents themselves generally do not become ill. They carry the virus chronically and shed it in urine, droppings, and saliva. Humans become infected mainly by inhaling tiny airborne particles contaminated with these materials. The name “hantavirus” comes from the Hantan River region of South Korea, where one of the earliest recognized forms of the disease was identified during the Korean War. Hantaviruses cause two major clinical syndromes.</p>



<h3 class="wp-block-heading">1. Hantavirus Pulmonary Syndrome (HPS)</h3>



<p>This form occurs mainly in the Americas and is the best-known type in the United States. The most important American hantaviruses include:</p>



<ul class="wp-block-list">
<li>Sin Nombre virus  &#8211;  the principal cause of HPS in the United States and Canada</li>



<li>Andes virus &#8211;  found mainly in Argentina and Chile</li>



<li>Black Creek Canal virus</li>



<li>Bayou virus</li>
</ul>



<p>HPS begins like a flu-like illness but can rapidly progress to catastrophic lung failure.</p>



<h3 class="wp-block-heading">2. Hemorrhagic Fever with Renal Syndrome (HFRS)</h3>



<p>This form predominates in Europe and Asia. It primarily damages the kidneys rather than the lungs. Important Eurasian hantaviruses include:</p>



<ul class="wp-block-list">
<li>Hantaan virus</li>



<li>Seoul virus</li>



<li>Puumala virus</li>



<li>Dobrava-Belgrade virus</li>
</ul>



<p>The severity of HFRS varies considerably. Puumala virus infections in Scandinavia may be relatively mild, while Hantaan virus infections can be severe and life-threatening.</p>



<p>Hantaviruses exist on nearly every continent where rodent hosts live. In the United States, cases cluster most heavily in the Southwest, especially New Mexico, Arizona, Colorado, and Utah. Cases also occur in Texas and California.</p>



<h2 class="wp-block-heading has-medium-font-size">The Clinical Course of HPS</h2>



<h3 class="wp-block-heading has-medium-font-size"></h3>



<p>The incubation period is usually one to six weeks after exposure. Initial symptoms are nonspecific and resemble many viral illnesses. Initial symptoms are nonspecific and resemble many viral illnesses:</p>



<ul class="wp-block-list">
<li style="font-size:15px">Nausea and Vomiting</li>



<li>Fever</li>



<li>Severe muscle aches</li>



<li>Fatigue</li>



<li>Headache<br>Nausea and Vomiting</li>



<li>Abdominal pain</li>
</ul>



<p></p>



<p>Because these symptoms are so common, early hantavirus infection is often misdiagnosed as influenza or another viral syndrome. In HPS, the illness may suddenly worsen after several days. Patients can develop:</p>



<ul class="wp-block-list">
<li>Cough</li>



<li>Shortness of breath</li>



<li>Rapid breathing</li>



<li>Falling blood pressure</li>



<li>Fluid accumulation in the lungs</li>
</ul>



<p></p>



<p>The deterioration can be alarmingly rapid. Some patients require intensive care within hours of the onset of respiratory symptoms. Mortality for HPS in North America is roughly 30–40%, even with modern intensive care.</p>



<p class="has-medium-font-size"><strong>The Clinical Course of HFRS</strong></p>



<p>In the Eurasian form, kidney injury predominates. Patients may develop:</p>



<ul class="wp-block-list">
<li>Low blood pressure</li>



<li>Bleeding abnormalities</li>



<li>Reduced urine output</li>



<li>Acute kidney failure</li>
</ul>



<p></p>



<p>Many survivors recover completely, though recovery may take weeks or months. Diagnosis can be difficult because the early symptoms mimic common infections. Rapid recognition is important because patients can deteriorate suddenly. Diagnosis is made by the following:</p>



<ul class="wp-block-list">
<li>History of rodent exposure</li>



<li>Blood tests detecting antibodies or viral RNA</li>



<li>Chest imaging in pulmonary disease</li>



<li>Laboratory evidence of kidney injury in HFRS</li>
</ul>



<p>There is no universally effective antiviral cure for hantavirus infection. Treatment is mainly supportive and often requires intensive care. For severe HPS, patients may need:</p>



<ul class="wp-block-list">
<li>Oxygen</li>



<li>Mechanical ventilation</li>



<li>Blood pressure support</li>



<li>Extracorporeal membrane oxygenation in extreme cases</li>
</ul>



<p></p>



<p>The outbreak that occurred on the cruise ship MV Hondius has so far resulted in 8 to 11 cases of hantavirus infection, including three deaths. The virus involved appears to be the Andes virus, the one hantavirus subtype known to permit limited human-to-human transmission.</p>



<p>The illness reportedly began with fever, gastrointestinal symptoms, muscle aches, and fatigue, then in several patients progressed rapidly to severe pneumonia, respiratory distress, and shock &#8211;  the classic picture of hantavirus pulmonary syndrome.</p>



<p>Where did the virus come from? At the moment, public-health authorities do not think the outbreak originated from rodents living aboard the ship. The current leading hypothesis from the European Centre for Disease Prevention and Control is that at least one passenger was infected before boarding, probably during travel in parts of Argentina or Chile where the Andes virus is endemic. Experts think that rodents on board the ship were not responsible for the outbreak. Nevertheless, investigators are almost certainly inspecting the ship for rodent contamination anyway. </p>



<p>The current consensus appears to be that the outbreak probably began with a passenger infected on land in South America, and that some secondary onboard transmission may have occurred. A hidden rodent infestation aboard the ship is considered possible in theory, but is not the leading explanation at present.</p>



<p></p>
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		<title>The Berlioz Revolution</title>
		<link>https://medicine-opera.com/2026/05/the-berlioz-revolution/</link>
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		<dc:creator><![CDATA[Neil Kurtzman]]></dc:creator>
		<pubDate>Mon, 11 May 2026 15:27:52 +0000</pubDate>
				<category><![CDATA[Music]]></category>
		<category><![CDATA[Hector Berlioz]]></category>
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					<description><![CDATA[No composer embodied the 19th-century romantic movement as did Hector Berlioz (1803-1869). Everything about him seemed excessive: his passions, his literary imagination, his orchestral ambitions, his loves, hatreds, and disappointments. He was one of the great revolutionaries of nineteenth-century music, yet during much of his life he was misunderstood in his own country and forced...]]></description>
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<p>No composer embodied the 19th-century romantic movement as did Hector Berlioz (1803-1869). Everything about him seemed excessive: his passions, his literary imagination, his orchestral ambitions, his loves, hatreds, and disappointments. He was one of the great revolutionaries of nineteenth-century music, yet during much of his life he was misunderstood in his own country and forced to support himself largely through journalism and conducting.</p>



<p>To the next generation, however, Berlioz became a prophetic figure &#8211; the composer who expanded the expressive ability of the orchestra, helped introduce the music of Beethoven to France, and paved the way for modern orchestration from Richard Wagner to Gustav Mahler. Indeed, it is no exaggeration to posit that he invented the modern symphony orchestra.</p>



<p>Berlioz was born in 1803 in La Côte-Saint-André, a provincial town in southeastern France. His father was a respected physician who expected his son to enter medicine. Unlike many great composers, he was not a child prodigy trained rigorously at the keyboard or any other instrument. In fact, he could play no instrument with even modest facility. His lack of solo virtuosity may have contributed to his highly original approach to orchestration later in life. As a youth, he devoured literature &#8211; especially Virgil, Shakespeare, and Goethe &#8211; and developed an emotional intensity bordering on recklessness.</p>



<p>Sent to Paris to study medicine, Berlioz reacted first with horror and then with indifference to anatomy lectures and dissections. Music soon consumed him entirely. Against his family’s wishes, he abandoned medicine and entered the Paris Conservatoire. There, he acquired a reputation for rebelliousness, arrogance, and explosive emotion.</p>



<p>His infatuations became legendary. Most famous was his obsession with the Anglo-Irish actress Harriet Smithson after seeing her perform Shakespeare in Paris, despite his not knowing a word of English &#8211;  he later learned the language. Berlioz scarcely knew her, yet he idealized her obsessively, writing letters she ignored and pouring his emotional turmoil into what became his masterpiece, the <em>Symphonie fantastique</em>. After pursuing her for seven years they married. The union was a failure.</p>



<p>Premiered in 1830, the <em>Symphonie fantastique</em> was unlike anything audiences had previously heard. Part symphony, part autobiographical hallucination, it depicted an artist driven by unrequited love into opium dreams, murder fantasies, and a witches’ sabbath. Berlioz invented a recurring musical idea, the “idée fixe,” representing the beloved woman, a concept that foreshadowed Wagnerian leitmotifs. The work’s orchestration was astonishingly vivid: shrieking E-flat clarinet, massive percussion, eerie string effects, and explosive brass writing created an entirely new orchestral sound. Many listeners considered the work bizarre or insane. Others recognized genius.</p>



<p>Berlioz matured during a period when France knew relatively little of Beethoven’s works. Italian opera dominated Parisian musical life, and many French audiences remained suspicious of German symphonic music. Berlioz became one of Beethoven’s strongest advocates. He intensively studied Beethoven’s symphonies and wrote passionately about them. Through his journalism, conducting, and musical influence, he helped transform Beethoven from a controversial foreign figure into an accepted giant of European art. Berlioz grasped earlier than most French musicians that Beethoven had permanently changed the scale and ambition of music. The emotional breadth and architectural daring of Beethoven’s symphonies profoundly shaped Berlioz’s own thinking.</p>



<p>Yet Berlioz did not merely imitate Beethoven. He revolutionized orchestration in unprecedented ways. Earlier composers treated orchestration largely as a means of distributing harmony and melody. Berlioz treated the orchestra itself as a limitless palette of colors and dramatic possibilities. His scores demanded gigantic ensembles, unusual instrumental combinations, expanded brass sections, and novel timbral effects. Works such as <em>Harold en Italie</em>, <em>Roméo et Juliette</em>, <em>La Damnation de Faust</em>, and the monumental <em>Requiem</em> astonished listeners with their sonic imagination. The <em>Requiem</em> in particular called for immense brass groups positioned around the hall, creating overwhelming spatial effects that anticipated twentieth-century experimentation.</p>



<p>His treatise on instrumentation, the <em>Grand traité d’instrumentation et d’orchestration modernes</em>, became one of the foundational texts in orchestral technique. Later composers studied it diligently. Nikolai Rimsky-Korsakov, Claude Debussy, Maurice Ravel, and Mahler all inherited aspects of Berlioz’s orchestral imagination. The orchestral treatise is still in print in an edition supervised by Richard Strauss.</p>



<p>Ironically, Berlioz found greater success as a conductor than as a composer. France never fully embraced him during his lifetime, but audiences in Germany, Russia, and England admired his brilliance on the podium. He became one of the nineteenth century’s first great international conductors. Unlike many earlier conductors who merely kept time, Berlioz demanded precision, discipline, and expressive intensity from orchestras. He insisted on extensive rehearsals and exact realization of the composer’s intentions. </p>



<p>As a conductor he traveled widely through Europe, leading performances of both his own works and those of other composers. His tours in Germany proved especially important because German audiences often understood his symphonic ambitions more readily than the French did. His conducting also reinforced his reputation as a musical intellectual. Berlioz possessed an encyclopedic knowledge of scores and an extraordinary ability to explain orchestral structure and dramatic effect.</p>



<p>To survive financially, however, Berlioz spent decades working as a journalist and critic. He wrote for major Parisian newspapers, producing thousands of articles on music and culture. Much of his criticism was brilliant, witty, and devastatingly sharp. He attacked mediocrity mercilessly while championing originality and artistic seriousness. His prose style mirrored his personality: passionate, theatrical, sarcastic, and often hilarious. He could destroy rivals with a single paragraph. Yet his journalism also served a larger purpose. Berlioz helped educate French audiences about orchestral music, Beethoven, Gluck, Weber, and the evolving possibilities of Romantic art.</p>



<p>Personally, his life became increasingly tragic. His marriage to Harriet Smithson, as mentioned above, collapsed in bitterness. Financial troubles persisted. Many major works failed commercially. His later years were marked by loneliness, illness, and grief, including the death at sea of his son, Louis, who was a ship&#8217;s captain. Yet he never abandoned his artistic convictions. His memoirs, likely the greatest autobiography by any composer, reveal a man of immense sensitivity and emotional volatility who remained fiercely devoted to his artistic vision.</p>



<p>Berlioz’s influence on later music was enormous. Wagner admired him deeply, even while differing from him aesthetically, though their relationship ultimately broke. Liszt championed his works tirelessly. Mahler inherited his concept of the symphony as a vast emotional universe. The colorful orchestration of Debussy and Ravel owes much to Berlioz’s experiments in instrumental color. Modern film music, with its gigantic orchestras and vivid dramatic effects, can also trace part of its lineage to Berlioz’s innovations.</p>



<p>His opinion of the music of his two greatest contemporaries &#8211; Wagner and Verdi was complex. Berlioz immediately understood that Wagner was an artist of unusual power and ambition. Long before many critics took Wagner seriously, Berlioz recognized the originality of works such as <em>Tannhäuser</em> and <em>Lohengrin</em>. He admired Wagner’s dramatic intensity, orchestral imagination, and refusal to compromise artistically. In some respects, Berlioz saw Wagner as a fellow revolutionary battling conservative musical institutions. </p>



<p>Yet Berlioz was never an uncritical Wagnerian. He objected strongly to what he regarded as Wagner’s excesses, especially the endless chromaticism, overwhelming density of orchestration, and tendency toward theoretical dogmatism. Berlioz believed Wagner sometimes sacrificed musical clarity and formal proportion for sheer intensity. He was also uneasy with Wagner’s literary pretensions and self-promotion. Berlioz himself could certainly be egotistical, but Wagner’s almost messianic self-confidence struck him as excessive even by Romantic standards.</p>



<p>Berlioz had little sympathy for much of mid-nineteenth-century Italian opera, which he often regarded as musically superficial and theatrically formulaic. He despised empty vocal display and believed many Italian operas sacrificed dramatic truth for conventional melody and applause-generating effects. Early Verdi, therefore, struck him as noisy, crude, and insufficiently refined.</p>



<p>However, Berlioz was too intelligent a musician to dismiss Verdi entirely. Over time, he came to recognize Verdi’s dramatic instincts and theatrical force. He may not have loved the style, but he understood that Verdi possessed genuine dramatic genius. Berlioz respected strong individuality wherever he found it, and Verdi undeniably had that. Berlioz’s attitude toward Verdi evolved considerably, and in the 1850s and 1860s, he wrote quite favorably about several Verdi operas, often with surprising generosity and insight. </p>



<p>It is fascinating to speculate what Berlioz would have thought of Verdi’s late masterpieces, especially <em>Otello</em>. Berlioz died in 1869, nearly two decades before <em>Otello</em> appeared, but that opera’s continuous dramatic flow, orchestral richness, psychological intensity, and Shakespearean foundation would almost certainly have interested him enormously. Berlioz worshipped William Shakespeare, and the dark orchestral atmosphere of <em>Otello</em> might well have seemed to him a remarkable synthesis of Italian vocal drama with symphonic dramatic thinking.</p>



<p>A few words about his autobiography: the <em>Mémoires</em> of Hector Berlioz occupy a unique place in musical literature. No composer has left behind an autobiography of comparable literary brilliance, emotional candor, and sheer entertainment value. Indeed, Berlioz’s memoirs are not merely important documents for music historians; they stand as one of the great autobiographical works of the nineteenth century, worthy to be read alongside the confessional writings of Jean-Jacques Rousseau or the autobiographical prose of François-René de Chateaubriand. They reveal Berlioz not only as a revolutionary composer but also as a gifted writer of extraordinary wit, imagination, and narrative power.</p>



<p>His youthful passions appear almost operatic in their intensity. His account of falling in love with the actress Harriet Smithson after seeing her perform Shakespeare is among the most famous episodes in musical autobiography. Berlioz describes himself wandering Paris in emotional torment, consumed by obsession and near madness.</p>



<p>One of the memoir’s greatest literary strengths is its vivid characterization. Berlioz sketches portraits with astonishing economy and precision. Friends, enemies, conductors, singers, bureaucrats, aristocrats, and critics all appear in sharply drawn scenes that frequently border on satire. He had an extraordinary gift for ridicule. Musical incompetence, pomposity, and artistic cowardice provoke some of his funniest writing. His descriptions of tedious rehearsals, incompetent performers, and conservative audiences remain painfully recognizable to anyone involved in artistic life today. His depiction of Luigi Cherubini, the director of the Paris Conservatory, chasing him around the school&#8217;s library is a comic gem of unsurpassed hilarity.</p>



<p>Equally hilarious is his depiction of the Conservatory&#8217;s piano spontaneously playing Mendelssohn&#8217;s G min piano concerto. The concerto has been played so often that the piano no longer needed a soloist.</p>



<p>The literary quality of the <em>Mémoires</em> becomes even more remarkable when one considers how few composers have written prose of comparable distinction. Richard Wagner wrote extensively but often ponderously and self-servingly. Igor Stravinsky produced elegant but highly controlled prose. Berlioz alone combined spontaneity, humor, dramatic instinct, and genuine narrative genius on such a scale. His memoirs are frequently cited as the finest autobiography ever written by a composer.</p>



<p>In France, Berlioz occupies a position comparable to Wagner in Germany or Verdi in Italy: the towering Romantic innovator who transformed the national musical culture. Before Berlioz, French orchestral music lagged behind German instrumentation. After Berlioz, France eventually produced the orchestral sophistication of Debussy and Ravel. He helped create the lineage from which modern French orchestral music emerged.</p>



<p>If one were forced into a rough hierarchy of nineteenth-century European composers based on historical importance and influence, Berlioz almost certainly belongs in the top ten and arguably the top five. Few composers altered the sound of music more radically. Even fewer possessed such a singular artistic personality.</p>
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