Music, Mind, and Medicine
Dr. Tramo | 08.06.20 | Episode #1
Meet the Expert
Dr. Mark Tramo
Dr. Mark Tramo is a Professor in the Departments of Integrative Biology & Physiology, Neurology, and Musicology at the UCLA Schools of Letters & Science, Medicine, and Music and a Director of the Institute for Music & Brain Science and Co-Director of the UC Multi-Campus Music Research Initiative.
He is a 2015 recipient of the UC President's Research Catalyst Award and has been awarded grants from the National Institute on Deafness and Communication Disorders, National Institute of Neurological Diseases and Stroke, McDonnell-Pew Program in Cognitive Neuroscience, National Organization for Hearing Research, Grammy Foundation, and other foundations to conduct original research on the neuroanatomy and neurophysiology of music perception and cognition for over 25 years.
He did his doctoral dissertation, Neural Representations of Acoustic Information in Relation to Music & Voice Perception, at Harvard with David Hubel, Marge Livingstone, and Nelson Kiang. trained in Neurology and Cognitive Neuroscience at Cornell with Fred Plum, Jerome Posner, and Michael Gazzaniga, and studied musical theater with Lehman Engel and John Hood at the Yale Schools of Drama and Music.
Winner of the Harvard Provost's Award for Educational Innovation in 1997-1998. He founded the world's first Music and the Brain course at Harvard College in 1997 and served on the Steering Committee of the Harvard University Mind/Brain/Behavior Initiative from 2000-2009.
Dr. Tramo has lectured at Carnegie Hall, Lincoln Center, the National Academy of Sciences, Smithsonian Institute, Aspen Ideas Festival, Yale, Stanford, Duke, and elsewhere around the world. His work has been published in Science, Journal of Neurophysiology, Journal of Cognitive Neuroscience, Neuropsychologia, Neurology, Contemporary Music Review, Music & Medicine, and other professional journals.
Katie Butler: Hi, I’m Katie Butler. I have had the pleasure of working with Dr. Tramo closely with his institute of Music and Brain Science project, I am a Music Mends Minds student volunteer from UCLA and aspiring profession in the world of music cognition, so I am really excited to be here and excited to hear your thoughts, Dr. Tramo.
Brandon Carone: My name is Brandon Carone, I also work as Carol’s assistant for Music Mends Minds, I graduated from UCLA last year and have been interested in music cognition for as long as I can remember. I am currently working at the UC San Diego Veterans Medical Research Foundation to conduct research on traumatic brain injury.
Dr. Tramo: Very cool, well our future is in youth, right Carol?
Dr. Tramo: Two propitious individuals for the future I think.
Katie: Well, it is my pleasure to introduce our first interviewee for the Music Mends Minds public education podcast. Dr. Mark Tramo M.D., Ph.D. is a neurologist affiliated with the Ronald Reagan UCLA medical center and the Los Robles hospital and medical center in Thousand Oaks, California. He is also a lecturer at the UCLA David Geffen School of Medicine and the UCLA Herb Alpert School of Music and a lifeline musician and songwriter. A 2015 recipient of the UC President’s research catalyst award, Dr. Tramo has been awarded grants from the national institute on deafness and communication disorders, the national institute of neurological diseases and stroke, Grammy Foundation, and other foundations to conduct research on the neuroanatomy and neurophysiology of music perception and cognition over 25 years. Aside from founding the world’s first music and brain course at Harvard University, Dr. Tramo has given lectures on music and the brain at Carnegie Hall, Lincoln Center, the national academy of sciences, Yale, Stanford, Duke, and numerous other world-class establishments. Thank you so much for being here, Dr. Tramo.
Dr. Tramo: My pleasure, thanks for having me, Katie.
What was your career path like?
As you would imagine, I was a musician way before I went to medical school. I started writing songs towards the end of elementary school, wrote and recorded a rock musical in high school, and ended up going to Yale in part because of its music school and drama school. I had to make a decision towards the end of med school whether I would accept the position in the neurology residency at Cornell medical college of Manhattan or continue to audition for RCA who was asking for more material.
Happily, I think in retrospect, I took my neurology residency at Cornell, which was very fortuitous. At Cornell, Fred Plum, who was an absolutely fantastic neurologist, had started four divisions that were research-oriented, pretty much ahead of the neurology department’s time, and one of them was a division of cognitive neuroscience that he created by bringing in Mike Gazzaniga, who is widely recognized as one of the pioneers of cognitive neuroscience. In his program project, he had an auditory section and there was an assistant professor he was working with at the time, John Sides, who was using the dichotic listening technique which is pretty much what psychologists were using before the brain imaging days to look at hemispheric differences in auditory perception.
At that time I was still making demos and was in a Tribeca recording studio in manhattan and all of a sudden I saw these keyboards with equipment and floppies and it was right when MIDI came out. I had just been reading about how supposedly timbre perception was a right hemisphere function based on one study in epilepsy patients who had had temporal lobectomies. I heard the stimuli that were used in that experiment that sounded basically like foghorns and I thought this is not what musicians think of as timbre. We think of it as a distinctive tonal quality of sound, not some sound that we have no familiarity with. So I convinced Mike that because the auditory system crosses multiple times in the brainstem, that doing dichotic listening studies really was not the way to go because it was fraught with potential errors and that was turning out to be true. So I convinced Mike that we could use the same paradigm he was using for touch perception and visual perception and play these different instrument sounds and see if each hemisphere could match a picture to the sound. and it worked. We showed that both hemispheres were actually able to perform the task, the left hemisphere had a slight advantage over the right hemisphere, and that timbre perception was not strictly a right hemisphere function and then we did the actual experiment that Brenda Milner had done with our patients and showed that for unfamiliar sounds, like the seashore timbre sounds, the right hemisphere was actually the only hemisphere that could do the task, which in the world of split-brain, any time you get the right hemisphere better than the left it’s always like a home run. And so that’s how I got my research career started.
There was a lot of pressure actually to go into areas of clinical neurology like basic research in Alzheimer's disease or develop a clinic as opposed to doing something as outrageous as going to work on music and the brain in the 1980s. But basically there were three of us in the early years of the field, two of whom now run the BRAHMS institute up in Montreal, Isabelle Peretz, and Robert Zatorre, and we are all about the same age. We just pressed on and told our chairs as we were growing up this was something that was important to study and we, of course, had to succeed in getting funding for the research that we were planning to do and fortunately for me, being in the program project with an established world-renowned neuroscientist like Mike Gazzaniga, was a big help in me getting my first grant to be able to do this kind of research. So it was totally logical and planned in the sense that I was seeing all these neurological patients and I wondered why there is so little in the literature about music perception and so much about language. That led to the following thought processes of how do you do an experiment? How would you go about actually having a testable hypothesis that you can design an experiment to test in a laboratory? And that’s a big step and something that is important to do basic laboratory research.
Can you tell us about the Institute for Music & Brain Science?
The Institute for Music and Brain Science was founded in the early 2000s and the motivation there was one, getting support for randomized controlled clinical trials and two, having some freedom to do research on how the brain works as it pertains to music in the post 9/11 era when, with the funding constraints, everything had to be more directly disease-oriented. So, we had an auditory neuroscience initiative and a cognitive neuroscience initiative along with the health and medicine initiative and we were able to raise money to do experiments that we otherwise wouldn’t have been able to do if we had had to go through the federal funding system. We also did some non-empirical ad hoc work, some of which have been going on at UCLA with the mind and music program. For example, we sponsored a summer concert series for in-patients on Saturdays. And then we have an educational mission, that we can be doing a lot more in teaching young people how to read and how to do math by making video games that are fun. It’s kind of this whole thing about “what is so bad about fun?” Why isn’t it a fun part of education or healthcare? Why can’t we make it more fun? And that is the foundation for the concept of edutainment.
You mentioned some of the grants you got in the past, what was it like navigating the scientific community at the beginning of your career when music cognition was an emerging field?
It was being stubborn and a little bit rebellious. When I entered the Gazzaniga lab, the deal was, because I had trained in neurology, I really knew neuroanatomy, and Mike needed someone who did neuroanatomy and he had a project in the lab that we called the brain print project. At that point in my research career, I would be doing all the neuroanatomy for the brain print project, which really wasn’t my thing, but it became my thing, and then if I would put half my time towards that for the lab as a whole, then I could have the other half doing what I wanted to do, but with a lot of constraints like it better be good, and it better be experimental, and you better know what you are doing.
When I moved from Cornell to Dartmouth, John Sheve Beruccio was in psychology there and we got together and he had been doing research on chord perception and since I was mostly a rhythm guitarist and songwriter, that’s what I was interested in, like why does this chord progression work? Or why do I pick that chord instead of this chord? And I had that basic question just from writing. Again, no way to plan for that but by having an open mind and looking for ways to do things, the opportunity presented itself and we did experiments on musical chord progressions with stroke patients and split-brain patients.
Once we had the preliminary data from those experiments and from my timbre experiments, the name of the game with the NIH for getting grants is you almost have to have already done the experiments that you are proposing to get money to do. It’s so competitive. There’s not a big difference between being creative in science and being creative in music and the arts. Because, when you get an NIH grant, usually they’re somewhere between 3 and 5 years and in that 3 to 5 year period the standard is one paper a year minimum. So if you don’t have a couple of hits in high impact journals over those 5 years you’re probably not going to get your next grant the way you’re not going to get your next recording contract or your next major league baseball contract. When you have your money from the label to make a record and they’re paying for your producer for you, within that 3 or 5 years, you better have a couple of hits, or they’re not going to sign you after your contract runs out. And it’s that way with the NIH. I mean, you do have to keep up, no matter what field you are in, but if you’re not breaking new ground, not sharing your knowledge with other people, as opposed to really being out there and realizing that you’re going to be re-evaluated every 5 years or so, you may not be able to continue on in that capacity and may have to find something else to do in 5 years if you can’t get your grant.
As a neurologist and researcher, you have found both theoretical and clinical benefits of music. Why do you think music is not often utilized in our healthcare system, and what might change this in future years?
It is very hard, if not impossible to do a randomized controlled trial using any one aspect of lifestyle because there are so many variables that are moving that it’s hard to isolate that one variable as being responsible for an outcome. That being said, the way we learn new things is not by making neurons but by making new connections. So, we can rationalize that if you maintain a mentally active lifestyle, then you are going to be making new connections and we can infer that we are making new connections which would mean an advantage in terms of maintaining brain health later in life. This brings us to music. How many things can a human do that involve so many parts of the brain all together in real time? There really aren’t that many things that we do that can do that. If you are older and you took piano lessons when you were younger or even if you didn’t and you want to learn how to play the piano for the first time, you’re going to be engaged. You’re going to be using your motor system, your somatosensory system, your visual system, your vestibular system, and obviously your auditory system. So, how many things are there that actually could involve that many parts of the brain to keep the mind active so that the brain is A. forming new connections and B. losing established connections at a slower rate?
As a pioneer in the field, what does it feel like to witness the advances in music cognition and neuroscience over the past 25 years?
It’s exciting to see. I think we always felt like it’s got to be interesting. We didn’t realize when we were building the field that there would be so many young people who really wanted to pursue careers in it and that’s been I think the biggest blessing of trying to stick with it and develop programs has been meeting people who see that there is a lot of work to be done, but that it is something that is valuable to develop from a scientific and medical standpoint. You have to have a thick skin to work in the field like when you audition as a musician or an actor and realize that it’s going to be bumpy so I think as the seniors looking at it we have the same concerns for young people going into the field that we have for ourselves: Is it sustainable? Is there going to be funding? And what do we need to do to make sure that you can get funding? I think the bottom line here is that good science does get rewarded. In the basic science arena, things are a lot better now that the head of the NIH, Francis Collier, said we need more research on music. For doing cognitive neuroscience or auditory neuroscience research on music, I think that it is now, for younger generations, much more fundable than it was for our generation, but there’s still the issue of the anecdotal stuff. Why do we even need to do experiments or randomized controlled trials when we have music therapy? The answer is that the one on one music therapy thing is a lot like psychotherapy in that it depends on how good the therapist is and how good a transference the therapist makes with an individual. You’ve basically got a factor in there, which is the therapist, that you can’t control. There are still people who would benefit from music therapy, but it’s not going to push the envelope in advocating for these things in the healthcare arena the same way randomized clinical trials would.
There are several articles supporting the idea that music can benefit the brain throughout development. Can learning an instrument or participating in a choir late into adulthood still be advantageous for brain health?
It is very hard, if not impossible to do a randomized controlled trial using any one aspect of lifestyle because there are so many variables that are moving that it’s hard to isolate that one variable as being responsible for an outcome. That being said, the way we learn new things is not by making neurons but by making new connections. So, we can rationalize that if you maintain a mentally active lifestyle, then you are going to be making new connections and we can infer that we are making new connections which would mean an advantage in terms of maintaining brain health later in life. This brings us to music.
How many things can a human do that involve so many parts of the brain all together in real-time? There really aren’t that many things that we do that can do that. If you are older and you took piano lessons when you were younger or even if you didn’t and you want to learn how to play the piano for the first time, you’re going to be engaged. You’re going to be using your motor system, your somatosensory system, your visual system, your vestibular system, and obviously your auditory system. So, how many things are there that actually could involve that many parts of the brain to keep the mind active so that the brain is A. forming new connections and B. losing established connections at a slower rate?
What is something that you hope to see in the future of music cognition research?
Well, I think for music cognition research there are just so many things. With respect to pitch, which of course is the foundation for both melody and harmony, there is historically and currently still a lot of research done on pitch perception, but I think for me rhythm would be one area that I’d like to see a lot more experiments coming out on and I guess secondarily I would be interested in seeing more research in the harmony realm. Another thing that I’d like to see is students, and professors in music schools getting more involved as participants in research being done by cognitive neuroscientists because it is so relevant to us understanding talent and creativity and how it relates to neural plasticity.
Another one I think is really needed, and we are not really exploring especially with what the interests of ethnomusicology experts are these days, is looking at nonwestern listeners and trying to understand from experimental, cognitive science, psycho-acoustic perspective, what are the universals that are independent of culture? A lot of ethnomusicology is about differences and honoring differences and promoting differences.
Actually, one of the main thrusts these days in power structures and how politics and economics influence music is trying to get away from thinking that what is similar is not interesting, and understanding that for a biologist, the universals are inherently interesting. There are a couple of studies where investigators have gone into remote villages that are barely touched by western music. It’s that kind of fieldwork, not just conveniently doing things over the internet, but actually looking at the way cultural anthropologists do their work, which is very different from the way experimental psychologists do their work and trying to find some way to tap into and understand the universals in global music. In fact, the idea of reverse-engineering the brain through music is very interesting.
Frequency selectivity is a fundamental property of auditory neurons and frequency differences and ratios are the basics of music theory, so that’s probably not a coincidence. Music is basically tapping into frequency selectivity and other things that we have yet to know. I certainly would like to see more in the realm of neural coding and single-unit or multi-unit recordings. There’s just a lot of fMRI which is gross anatomy and gross physiology but we don’t really know how individual neurons represent the information and encode the information. That’s a great area that can be expanded for music cognition research and kind of getting away from the same old “where is this? Where is that?” fMRI perspective and actually looking at what those neurons are doing and how they’re representing various aspects of pitch, harmony, and rhythm.
Another area that’s of great interest in the clinical realm is music perception in cochlear implant patients because it turns out it’s a lot easier for them to do speech recognition than it is for music to sound good. If you can make the music sound good then you’ve really got something. Being able to decode the speech is easy compared to doing music, so experts in cochlear implant research often regard music as that gold standard.
How Dr. Tramo got interested in the electric guitar?
Everyone who is around my age still has Beatlemania. I mean it really is an example in the extreme of collective behavior. The Beatles had the money, they had the fame, they had everything but they were tough on themselves, they just kept getting better and better and moving music forward and doing new things so if you’re growing up learning to play guitar, you are trying to keep up. You get the songbooks, and there are chords you didn’t know that you were learning. Kind of a weird thing that happened to me was in 1964 there really weren't a lot of, especially young kids, playing electric guitar.
Fortunately for me, my music teacher would let the last 5 minutes of lessons be playing more like ventures and Dick Dale 50s rock and roll where he would play rhythm and I would get to play lead for 5 minutes. In 1964 I was signed to two shows at the World’s Fair and that was significant to me because with respect to the Beatles, The Ed Sullivan show was in February, A Hard Day’s night was in August, and then in December I was signed to two shows at the World’s Fair and I felt like, “Hey, I’m gonna be a Beatle!” So it really got imprinted on me. That love of music that came at a very early part of my life I think inspired me to want to stick with it and continue playing and writing. But, it really is the case that I think a number of us in the field do have music backgrounds. Nobel laureate David Hubel is one of our founding board members and he said in his society for neuroscience autobiography, “I would never give up my love of Bach instilled in me by my grade school piano teacher for any degree of success in neuroscience.” And that’s coming from someone who won the nobel prize.
What is the most astonishing thing that you have found in music throughout your life?
I would have to go with the phenomenon that music and musicians can bring about such a strong collective response. Why would teenagers attack policemen and break windows just to see a group of singers? Darwin would have a field day with that because he thought a lot of music had to do with sexual selection and emotional expressions in animals and humans. The military has been using music to demoralize soldiers or interrogate prisoners. So I guess the astonishing thing for me is, in addition to the power of music to heal and the power of music to do all these great things, the power of music to turn teenagers into this rioting mass and to scare soldiers not to attack. The power of music to do those things, as someone who loves music and plays music, but to see its power, in such a large collection of people that way, that to me is the most astonishing thing about music.
You are also the co-director of the University of California Multi-Campus Music Research Initiative. What have you and your fellow researchers been studying over the past few years, and is this initiative still active?
The initiative is active within a number of the laboratories of the co-directors at this point. So three of the co-directors are located at probably the most active of the locations currently, UC San Diego, where there are two laboratories. One is the Swartz Center for Computational Neuroscience, where Scott McKay, who is the principal on our initiative, and John Iverson whom I mentioned earlier, do research mostly looking at EEG and brain-body interfaces. Sarah Creel is at UCSD in the Cognitive Science department and she works on developmental psychology. She is interested in music and cognitive development. Peter Genatta at UC Davis Psychology, who has been around forever, like Isabelle, Robert, and I, is a superb fMRI experimenter. He is published in ERPs and he is particularly interested in music and memory. Julene Johnson is at UCSF in the nursing school and is working with Peter Genatta on a grant looking at memory and Alzheimer’s disease.
Certainly, Julene would be someone for Music Mends Minds to talk with about her program. She has a grant from the National Institute of Aging, and it’s looking at singing in nursing homes and quality of life measures, so she would be the more geriatric specialist among the co-directors. Ramesh Balasubramaniam is the head of neuroscience at UC Merced and he, like Dr. Iverson, is interested in sensory-motor integration and rhythm. Of course, both of them are drummers, so they’re very interested in how the auditory system, the kinesthetic system, and the movement system all work in concert during rhythm generation and music performance. It’s really their basic science protocols that we would try to incorporate if we were to do clinical trials with Parkinson's patients.
The popular media is notorious for oversimplifying scientific findings. What are some common misconceptions that you’ve come across in the media that you would like to debunk?
That music is a right hemisphere function. It involves both hemispheres and there’s no music center in the brain. It's really a network of widely distributed collections of neurons that participate in music cognition.
How are dementia patients and other patients facing neurodegenerative disease able to remember songs of their past?
There’s something in the amnesia literature called Ribot’s law, whereby when you have something like a traumatic brain injury, you have a period of anterograde amnesia, which affects memories that are encoded after the head trauma, and then you have a period of retrograde amnesia, which impact memories encoded before the trauma. It’s well known in clinical neurology that the more recent memories are lost more easily than the remote memories. So, if we can apply a model that’s based more on an acute brain injury to something that has to do with a chronic progressive brain injury like Alzheimer’s disease, then it appears to be the case that older memories are better preserved than more recent memories. A second factor is a part of having a good memory is forgetting a lot of stuff, you have to be selective about what you remember, and one way the brain has done this is if there’s an emotional impact of an event or an emotion tied to an event it will be remembered better than if there’s no emotional tag. The current understanding is with declarative memory and episodic memory, which are mostly verbal based memories when people talk about them, we know that the hippocampal system is the most important in that aspect of memory. However, when you combine an emotional tag with some episodic event, the amygdala gets involved, and the amygdala is also in the medial temporal cortex and it works in synergy with the hippocampus to encode and consolidate that memory so you can later retrieve that memory from storage. That’s a second reason that it may be the case that music is better preserved as you are older.
For the members at Music Mends Minds, they are not only playing songs that they have heard in the past and that they have known for years, they are also learning new songs as well. How would you say that playing an instrument is different from simply listening to music from the past?
The memory literature emphasizes that there is no singular aspect of memory. It’s much like emotion. We use the word emotion, but when you actually do research on emotion, there is no “emotion.” It’s either fear or anger or joy and they all involve different parts of the brain so there’s no one part of the brain or even one function that you can think of as just being emotional. For memory, a lot of the research points to the idea that so-called procedural memory (or muscle/motor memory) is stored in a different part of the brain than episodic declarative memory, which is what bothers my Alzheimer’s and Parkinson’s patients the most. It is often the first thing they notice, that they have trouble coming up with names, which the literature shows is not that unusual by the time you’re in your mid-60s.
The ability for the Music Mends Minds musicians to be able to learn new music is built up from the idea that they are not just learning this sound, they are learning how to make the sound. They’re encoding the music, at least in part, in procedural memory, and in so doing they are also drawing on motor skills that they developed and repeated. I think that’s another aspect of why remote memories like musical memories in Alzheimer’s patients are relatively preserved is they are “overlearned.” In other words, you have heard that song over and over again your whole life. It may not be that often, but it has made its appearance in your experience repeatedly over the course of your lifetime.
So what I think is happening with the Music Mends Minds patients is that a lot of the encoding and storage is done in terms of procedural memory and when they are recalling it, they have that to facilitate the retrieval of the memories and they’re not just doing it auditorily like trying to remember a new melody.
What would you suggest to students who are interested in conducting music cognition research?
I would say take all your basic science courses, you need those basic skills, those laboratory skills, you need to have a good foundation in neurophysiology and neuroanatomy, and I think maybe something that’s not appreciated is understanding experimental psychology. In particular, you should know how to do an experiment in the tradition of experimental psychology. So that means usually, in addition to taking the required courses, you should get involved in some level of research in a lab that is doing something that is relevant to what you are interested in. Just seeing how a good psychologist does a good experiment, which you’ll learn by reading the journals but also watching people do it, is really an essential component to developing the skillset that you need.
You don’t need to do too much before going to graduate school. You just need some exposure and you need your basic science courses. I think of all the things, as I’ve shared with my students, I would emphasize that if you think you are going to pursue a career in science and do research, especially if it is going to be in the realm of cognition, learn how to program. Currently, MatLab and Python are languages that are in widespread use in the laboratories that do this brand of research. One of the reasons I did my physician-scientist award as graduate school was so I could take computer programming and acoustics courses that I didn’t have in my medical training. Even though I wouldn’t necessarily do the programming eventually, I would know how to do the programming and how to talk to a programmer about what I needed to do to set up for data collection, for stimulus synthesis and calibration, and for data analysis. If you just know how to formulate the setup of the program, maybe not write all of the code, but really understand what needs to be done, you would have a leg up walking into graduate school that way. Another thing to mention for your audience is the society for music perception and cognition, which was really a fledgling society in the 90s but really has grown enormously and has regular conferences around the world. Those conferences are helpful if you want to figure out, what are the experts doing here? Is that the kind of research I want to do? I would encourage anyone who is thinking about graduate school to go to society for music perception and cognition conferences and see what is out there. Conferences are how you get to meet people so you’ll find a lot of warm reception at those events. You also get to talk to graduate students and sometimes you really get the inside scoop from their scoop on what they went through to get there, even more so than someone like me who isn’t in the same environment as you are now. We have a number of professional organizations that exist on the Institute of Music and Brain Science education site. It may be the case that you would want to belong to a few, like the society for neuroscience and the acoustical society of America. There are also people on campus at UCLA that are actively conducting research that you could approach like Marco Iacoboni, Martin Monti, and Greg Bryant.