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A Groundbreaking Duet
NIH's Francis Collins, PhD, and Soprano Renee Fleming Team Up to Advance Music Therapy

ARTICLE IN BRIEF

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A SHARED PASSION for music and medicine brought Renee Fleming and Dr. Francis Collins on an NIH-Kennedy Center initiatives to explore music and the brain.

Opera soprano Renee Fleming and NIH Director Francis S. Collins, MD, PhD, have teamed up on a collaborative program to encourage research and create public awareness about music therapy and how music interacts with the brain.

Humans have been using music to ease the burden of disease for almost as long as there have been humans, and music. Ancient shamans used music in rituals to purge “evil spirits” from the bodies of sick people. Greek philosopher Plato wrote “Music is medicine to the soul.” And young David played the lyre for the tormented King Saul, whose symptoms sound much like clinical depression to modern understanding.

Within the past several decades, the field of professional music therapy has gained increasing credibility, as groundbreaking programs like the Institute for Music and Neurologic Function in the Bronx, NY, have used targeted music therapy protocols to help improve mobility, communication, mood and function in patients with Alzheimer's and Parkinson's disease, stroke, traumatic brain injury, and many other conditions. And music therapy made national headlines after it helped Congresswoman Gabrielle Giffords recover her ability to speak after a near-fatal assassination attempt left her with severe left-hemisphere brain damage.

But despite these notable successes, a paucity of major randomized controlled clinical trials has often left music therapy at the margins, rather than the mainstream, of neurologic care.

Now, thanks to the kind of serendipitous encounter that can only happen in Washington, DC, two powerhouse personalities with a shared passion for music and medicine are taking steps to change all that.

A SHARED PASSION FOR MUSIC AND MEDICINE

It was about two years ago when renowned soprano Renée Fleming and National Institutes of Health Director Francis S. Collins, MD, PhD, found themselves guests at a Saturday-night dinner party that also included Supreme Court Justices Ruth Bader Ginsburg, Anthony Kennedy, and Antonin Scalia — and featured entertainment from a less-than-spectacular band.

“Francis pulled out his guitar and we took over and started performing and singing for this group,” Fleming recalled in an interview with Neurology Today. “I had just met him, and I had no idea that in addition to being such an accomplished scientist, he is also an avid amateur musician who plays piano and writes music.”

Fleming had just begun a new position as artistic advisor to the John F. Kennedy Center for the Performing Arts — and as they played and sang, an idea came to her. “I've been interested in the connection between the mind and the body and music for a long time, as a performer, because it's so extraordinarily important in what we do,” she said.

“I would also see studies from time to time about music and the brain and neuroscience, and it seemed to me that it was a growing field of interest. So I said to him, ‘Would you be interested in joining with the Kennedy Center?’ My idea was to amplify the work, to really continue to allow the public to know more about music and what it can do for people, and his idea was to further the field of research in music therapy, which dovetails very well with the project that the NIH now has on the brain.”

That project is the ten-year Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, a $150 million project aimed at developing new tools and technologies to understand neural circuit function and capture a dynamic view of the brain in action. Launched in 2013 by President Obama, the initiative aims to revolutionize understanding of the human brain.

“It seems like this is the golden moment to bring some cutting-edge neuroscience and rigor to the field of music therapy,” Dr. Collins said in an interview with Neurology Today. “Recent research has shown us that music reaches a different part of the brain than spoken words do. It's fair to say that the brain has a ‘music room.’ It must not be there by chance — it must have a purpose, and that purpose must be longstanding or it would not have appeared in this fashion in the brain. Renee and I want to identify how the explosion of new information in neuroscience can intersect with music therapy to make therapeutic opportunities even more powerful.”

SOUND HEALTH INITIATIVE

To do that, Dr. Collins and Fleming have brought the NIH and the Kennedy Center together in the Sound Health Initiative, a new partnership aimed at encouraging research and creating public awareness about music therapy and how music interacts with the brain. Sound Health launched in January of 2017 with a two-day workshop at the NIH featuring 25 leading researchers, clinicians and music therapists from two dozen institutions in three countries. They discussed the current state of knowledge and recent discoveries about how music is processed in the brain, and how this growing body of research is being applied in clinical settings.

That meeting was followed by Music and the Mind, a major performance and workshop event at the Kennedy Center on June 2 and 3, 2017. On the first night, the National Symphony Orchestra and several renowned scientists — including Dr. Collins — presented Sound Health in Concert, an interactive program interweaving performance with scientific insights into the brain's engagement with music.

“It was incredibly inspiring, with a very broad audience that filled the concert hall,” Dr. Collins said.

Saturday's workshops didn't look like the typical breakout seminars you'd see at a scientific meeting. One session on creative aging featured Aniruddh Patel, PhD, a senior fellow at the Neurosciences Institute in San Diego — along with Fleming and DC–based jazz trio Mark G. Meadows & the Movement and a choir known as Different Strokes for Different Folk, composed entirely of people who are recovering from strokes.

In a session on music therapy breakthroughs, prominent researcher Sheri Robb, PhD, of the Indiana University School of Nursing, shared the podium with singer-songwriter-composer Ben Folds. “Having Ben Folds improvise an entirely new song on the spot really makes you appreciate how the brain in improvisational mode can do amazing things,” Dr. Collins said.

Fleming said she was dazzled by the presentations, such as a session on music and childhood development led by Nina Kraus, PhD, Hugh S. Knowles Chair of Audiology at Northwestern University, who is investigating the neural encoding of speech and music and its plasticity. Dr. Kraus was joined by the DC Youth Orchestra to explain basic principles of music and its connection to the brain through demonstration, visuals, and participation.

“She talked about the fact that music instruction helps children do better in school because oral comprehension is improved with music study,” said Fleming. “Of course, we know that music gives you discipline due to the amount of practice. But that it can help you understand conversations better? That was an extraordinary and new discovery for me.”

Fleming was also profoundly moved by performing “God Bless America” at the National Memorial Day Concert on May 28 with US Army Captain Luis Avila, who recovered his ability to speak in part through music therapy after sustaining a traumatic brain injury in 2011.

“Music therapy has allowed other parts of his brain to take over for the damaged areas. He's such a moving guy, with an amazing sense of humor and a fierce desire to live fully,” she said.

The idea behind Music and the Mind was to highlight “the excitement, the opportunity, the potential,” said Dr. Collins. “Music shapes the brain. There's no doubt about music's effect on the brain's plasticity, and that has all kinds of implications both for neuroscience and for education.”

FUTURE COLLABORATIONS

So where does the Sound Health Initiative go from here? That's still being determined, but Dr. Collins and Fleming have a lot of ideas. “We'd like to see, in a way the NIH can sometimes do, catalytic interactions between neuroscience experts and music therapy experts. They've been on a parallel path to a certain degree, and bringing together projects that join those disciplines could be quite useful,” Dr. Collins said.

“We do need more rigorous clinical trials of music therapy; what we've had to date has been mostly on a small scale, and not necessarily randomized to draw compelling conclusions about outcomes. That's an influence that the NIH could offer the field.” (He concedes that much of these ambitions will depend on a still-uncertain budget trajectory for the agency.)

For her part, Fleming has been talking to other major performance institutions — Carnegie Hall, the Los Angeles Opera, the Lyric Opera of Chicago — about hosting follow-up Music and the Mind events. “I would love to continue doing this. Perhaps we can bring together these institutions and collaborate with universities or hospitals, and talk about why music and the arts are in our hospitals now, and how we can make even better use of them to serve patients and families.”

LINK UP FOR MORE INFORMATION:

• Sound Health: http://bit.ly/NT-SoundHealth
    • Collins FS, Fleming R. Sound Health. An NIH-Kennedy Center initiative to explore music and the mind http://jamanetwork.com/journals/jama/article-abstract/2630954. JAMA 2017; Epub 2017 Jun 27.