Sunday, August 13, 2017

Parsifal Sydney

Parsifal powerful but could use more of the rite stuff

Conductor Pinchas Steinberg, left, with tenor Jonas Kaufmann as Parsifal. Picture: Keith Saunders

MURRAY BLACK
The Australian
12:00AM August 11, 2017
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Parsifal was Richard Wagner’s operatic swan song. In its renunciation of worldly pleasures and desires in favour of redemption and transcendent grace, it encapsulated the composer’s intellectual and spiritual journey.

It also is the most problematic of Wagner’s operas to present in concert. By eschewing any visual or design element apart from lighting, this Opera Australia performance unwittingly diluted the opera’s impact.

The religious ceremonies in the first and third acts, for instance, are accompanied solely by long stretches of orchestral music. Despite being exquisitely played by the Opera Australia Orchestra, one had little sense of their ritual power. Ultimately, one was left marvelling at the genius of the music but slightly unmoved by the drama.

Wagner had strong views about how tempos should be employed in his operas. Fortunately, conductor Pinchas Steinberg unerringly chose the right tempos. His measured pacing enabled the composer’s expansive, long-breathed lines to soar. Maintaining good balances and clear textures, his subtly applied doses of accelerando and smoothly shaped crescendos generated momentum and excitement when needed.

German tenor Jonas Kaufmann was acclaimed for his performances as Parsifal at the Metropolitan Opera in New York in 2013. His interpretation here was just as fine. Through voice and gesture alone, Kaufmann charted the protagonist’s spiritual journey. All wide-eyed, clear-voiced innocence in Act I, his exquisite soft-grained sotto voce passages captured his character’s sense of wonder and ultimate serenity while his forceful clarity and ringing top register power realised Parsifal’s moments of anguished uncertainty.

Although Kaufmann was the star drawcard, his castmates were equally outstanding. American mezzosoprano Michelle DeYoung made a spectacular impact as Kundry. Strong across her range, her sinuous phrasing, strong dynamic control and appealing tone colours conveyed Kundry’s dual role as siren and penitent. Displaying remarkable stamina and superb diction, Korean bass Kwangchul Youn (Gurnemanz) sang with stentorian power and a focused sense of line, embodying his noble character’s moral authority.

Firm-voiced baritone Michael Honeyman gave an expressive performance as the guilt-racked Amfortas. By contrast, the hard-edged timbre of fellow baritone Warwick Fyfe created a gripping portrayal as the evil sorcerer Klingsor. Bass David Parkin was an imposing Titurel while six of Opera Australia’s leading sopranos and mezzos made an alluring bevy of flower maidens.

Parsifal. By Richard Wagner. Opera Australia. Conductor: Pinchas Steinberg. Concert Hall, Sydney Opera House, August 9. Concert repeated tomorrow and Monday. Tickets: $85-$395. Bookings: (02) 9318 8200 or online. Duration: 5hr 17 min, including two intervals.

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Parsifal review: Opera Australia's performance as close to ideal as possible

Peter McCallum

Parsifal, by Wagner
Opera Australia. Opera House Concert Hall. August 9
★★★★★*

In assembling a cast as close to ideal as one could decently expect, a conductor of venerable wisdom and experience in Pinchas Steinberg, and setting free the sound of a usually straitjacketed orchestra and chorus to weave and waft around the Concert Hall's ample acoustic accommodation, Opera Australia' concert performance of Wagner's most sonically sophisticated opera, Parsifal, creates for listeners a direct path to its essence.

That essence is pure spirit expressed in sound, both sullied and cleansed, both in anguish and in bliss.

Music has always gravitated towards the spirit – it is its natural domain. By stripping away the myriad plot details of Wolfram von Eschenbach's 13th century poem to leave a simple symmetrical three-act structure pivoting around a moment of self-realisation and transformation, Wagner not only crowned his own not-insubstantial achievements, but also created one of the greatest works in the repertoire.

It helps, of course, to have one of the world's great Parsifal singers, Jonas Kaufmann, in the title role. Kaufmann's approach is one of noble restraint.

There is never a hint of flamboyance or contrivance; the whole expressive weight is carried by the voice quality and immaculate polish of tone; by careful modulation of dynamic, colour and intensity; and by purity of diction and vowel.

In the first act and a half, when the character of Parsifal is protected from corruption by unknowing foolishness, Kaufmann was subdued and dissembling like a youth who had smashed the family car and wanted to be somewhere else.

He opened out with magnificently polished focus after the transformative kiss at the centre of Act 2, each phrase beautifully sculpted and graded, each crucial moment spellbinding.

Michelle DeYoung as Kundry also broadens in this crucial transformation. In the first act her voice was richly portentous and coloured. In the seduction of Act 2, she added enveloping warmth and forceful power.

It is key to the work that this duet be the fulcrum, and here it became a riveting point of central focus.

As the wise Gurnemanz, Kwangchul Youn sang with mahogany depth and wonderfully textured roundedness, sustaining this character's crucial framing reflections in the outer acts with centred dignity.

Taking the role of the wounded Amfortas, who represents the spirit in agony, Michael Honeyman's voice captured rich autumnal colours to bring out the character's poignancy.

The image Wagner created of the open bleeding wound to represent a self-inflicted fall from grace, brings to mind the art of Francis Bacon.

That image is taken further in the figure of the self-castrated Klingsor, to whose impotent malevolence Warwick Fyfe brought terrifying ferocity, a keen-edged incisive voice, madly wandering eye and brilliant character portrayal.

David Parkin was stern and sepulchral as the ageing Titurel. Under Steinberg, the great glory of the Opera Australia Orchestra and Chorus was the subtle balance of tone and floating sense of pulse, creating finely graded textures, some firmly grounded and richly blended, others rising above the bass like delicately fractured clerestory light.

Descriptions of Wagner's conducting stress his complete freedom, but Steinberg achieved the unbounded effect of chant and dreamlike association through inner discipline and carefully weighed balance.

Musically, this is one of Opera Australia's outstanding performances in recent decades, leaving the theatrical element to blossom in the imagination.

*While the Herald only rates performances out of five, Peter would have awarded Parsifal 5½ stars if permitted.
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Here is what he has told the Paris Opera:

I’m sorry that my cancellations have been the source of a lot of disappointment and frustration over the past few weeks.

Of course, I can understand the irritation of all those who had organized the expensive trips to come and listen to me. Unfortunately, the performance of a voice of singer cannot be guaranteed and sometimes a singer is facing events that require it to take a long rest.

When I noticed that something was wrong with my voice, at first I thought it was a beginning of infection. The medical examination, however, has given a different result: the side effects of a medicine made burst a small vein on my vocal cords.

So I must stop singing until the haematoma has completely subsided. To avoid permanent damage. Thus, it is with a heavy heart that I must also cancel my representations of the Tales of Hoffmann in Paris.

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Friday, July 14, 2017

Diet & Statin

Dr Mark Porter: The diet that’s almost as good as statins — and I’m proof that it works
Dr Mark Porter

Published at 12:01AM, February 16 2016

Older folk can expect a longer retirement, according to a new report from Public Health England, which shows that over-65s can look forward to another 20 years on average. Yet to enjoy those extra decades you will need an adequate pension and good health. I can’t help with the former but I do have a useful tip to maintain the latter.

At the beginning of the year I embarked on a six-week trial to see whether cutting back on carbohydrates could improve my poor cholesterol profile. The results are in and I am bowled over. The finer details are in the box below, but these are the headline results: I shed half a stone in weight, my cholesterol level dropped by 20 per cent, my triglyceride level by 30 per cent and, according to the risk calculator favoured by the NHS, my odds of succumbing to an early heart attack or stroke have dropped by nearly 15 per cent. Not quite the benefit you might expect from taking a statin, but as near as dammit.

Now I am well aware that one swallow doesn’t make a summer, and just because cutting back on carbs has had such a significant effect on my blood chemistry, it doesn’t mean it will work as well for you. Yet if you are one of the five million or so middle-aged people like me who, thanks to a combination of poor family history and high cholesterol levels, are eligible for statins, I would urge you to take a close look at your diet first. So what changes did I make, and where have the benefits come from?

First some context. At 6ft 2in and 14 stone, I wasn’t particularly overweight but I had a touch of middle-age spread with a BMI of 26 (25 is the upper limit of healthy). My cholesterol was raised (anywhere between 7.3 and 8 over recent years) and, although I ate a healthy diet, I have a sweet tooth and consumed far too much bread.

The plan was simple. I cut out all fruit juices, bread, cakes, biscuits and confectionery. And I restricted other starchy foods such as rice, pasta and potatoes. I carried on taking one sugar in my coffee and I had a free day on Sundays which, on at least one occasion, included sticky toffee pudding at my local pub. I made no other changes to my diet or lifestyle and the result would qualify at the upper end of what most people would regard as a low-carb diet, but it represented a significant reduction for me.

The resulting improvement in my blood profile could have come about in a number of ways. First, the weight loss will have helped. The drop in triglycerides (high levels of which are a risk factor for heart disease) is a direct result of fewer carbs, but a big reduction in fats may also have helped; I have eaten hardly any butter in the past six weeks. Not only is butter a keen component of my favoured sandwiches and rolls, it also features in many carb-rich foods such as cakes and other treats.

One other unintentional change was that I ended up eating more meat, eggs and cheese. Yet, while you would have expected this to have raised my cholesterol level, the opposite happened. And the latest research reflects this — while eating butter is bad for your cholesterol profile, eggs, cheese and lean meats don’t seem to have much impact.

Until I started this trial I was considering statins — which I have tried in the past — but my cardiovascular risk (qrisk.org) has dropped below the new 10 per cent threshold, so I am not going to worry for now.

My only regret is that I wish I had tried this in my twenties. I have never subscribed to the view that sugar is public enemy no 1 — there is so much more to disease than obesity and one nutrient — but I am a convert to the view that too much sugar and other carbs (which the body converts to sugar) are not good for us. My local bakery and my favoured sandwich shop may regret my decision but it is low carbs for me from now on.

The results at a glance

After six weeks cutting back on carbs my weight fell from 14st to 13st 7lb

My fasting cholesterol level fell from 7.3 to 5.9 and my triglycerides from 2.5 to 1.5

My “good” cholesterol (HDL) fell slightly from 1.3 to 1.2

I did not monitor my blood sugar levels because these have always been well into the healthy range, but those at risk of diabetes should expect a significant drop here too.

Friday, June 30, 2017

Lithium 2017

Lithium: The Gift That Keeps on Giving in Psychiatry

http://www.medscape.com/viewarticle/881529_2

Nassir Ghaemi, MD, MPH

DISCLOSURES

June 16, 2017

Wide-Ranging Benefits

At the recent American Psychiatric Association annual meeting in San Diego, an update symposium was presented on the topic of "Lithium: Key Issues for Practice."^[1] In a session chaired by Dr David Osser, associate professor of psychiatry at Harvard Medical School, presenters reviewed various aspects of the utility of lithium in psychiatry.

Leonardo Tondo, MD, a prominent researcher on lithium and affective illness, who is on the faculty of McLean Hospital/Harvard Medical School and the University of Cagliari, Italy, reviewed studies on lithium's effects for suicide prevention. Ecological studies in this field have found an association between higher amounts of lithium in the drinking water and lower suicide rates.

These "high" amounts of lithium are equivalent to about 1 mg/d of elemental lithium or somewhat more. Conversely, other studies did not find such an association, but tended to look at areas where lithium levels are not high (ie, about 0.5 mg/d of elemental lithium or less). Nonetheless, because these studies are observational, causal relationships cannot be assumed. It is relevant, though, that lithium has been causally associated with lower suicide rates in randomized clinical trials of affective illness, compared with placebo, at standard doses (around 600-1200 mg/d of lithium carbonate).

Christoforos Giakoumatos, MD, from the Harvard South Shore Psychiatry residency training program, reviewed the scientific literature on lithium's neuroprotective effects. Extensive animal studies have shown that lithium keeps neurons alive longer. Some human studies also suggest a benefit of lithium in prevention or amelioration of dementia, consistent with its neurobiological benefits. These data support further work to clarify how much, and to what extent, lithium could be useful in human neurodegenerative diseases.

Othman Mohammad, MD, also from the Harvard South Shore program, examined lithium use in children and adolescents, and reviewed a number of randomized trials that showed evidence for efficacy and short-term safety with lithium in acute manic episodes, especially in adolescents. Of note, similar randomized data did not show benefit with divalproex, indicating that there is relatively more evidence for lithium's efficacy and safety in adolescence.

Lithium's Safety Profile

Dana Wang, MD, a senior resident in the Harvard South Shore program, reviewed the kidney effects of lithium and the latest studies quantifying those harms. For instance, in recent data from Sweden, lithium was associated with end-stage renal failure in about 1% of all patients who were treated with it—an effect that occurred over a mean of more than 20 years of treatment.

The rate is somewhat higher if the sample is limited to those who take lithium for a minimum of 10 years; in that case, up to 5% of patients may develop end-stage renal disease eventually. Although these numbers are important, they also indicate that over 95% of lithium-treated persons never develop end-stage renal disease.

Multiple daily dosing of lithium is a major risk factor for such chronic renal harm, and it is a preventable one, because lithium has a half-life of 24 hours and only needs to be dosed once daily. Furthermore, keeping lithium levels low, and thus avoiding acute lithium toxicity, is another preventable risk factor for chronic renal impairment. By dosing lithium once daily at night and at the lowest dose feasible, the risk for long-term kidney harm with lithium can be reduced even further.

Dr Osser ended the symposium by discussing how to manage other lithium-related side effects. He noted that lithium causes less weight gain than divalproex or commonly used antipsychotics, such as olanzapine and quetiapine. Thus, if those agents are used, so should lithium. He also noted some ways in which weight gain can be ameliorated with lithium: for example, educating patients to avoid consuming caloric beverages (such as sodas) when managing lithium-related thirst. Water retention with lithium can be managed by using amiloride. Carbohydrate craving is an important aspect of lithium-related weight gain, and the most difficult to manage.

Conclusion

I provided a commentary at the end of the symposium, where I noted that our oldest drugs are our most effective: electroconvulsive therapy, lithium, monoamine oxidase inhibitors, and clozapine. All of the new drugs developed since the 1970s have not advanced greater efficacy for any major psychiatric condition. They do have fewer side effects, which is important. But the case of lithium reminds us that we should not assume that newer is better.

All patients should be told about the potential range of benefits of lithium, in terms of mortality/suicide and neuroprotection/dementia prevention, in addition to its well-proven mood benefits. If this is understood, then many patients and doctors would perhaps also understand how these benefits could outweigh the risks of lithium. Such risks should be considered limited, with about 1% long-term kidney risk and less weight gain than other commonly used agents.

Thursday, June 22, 2017

Otello

We should champion performance boat design

Wheel of fortune: Ben Ainslie reveals one of the Land Rover designs