Jeremy Struck a Chord: A Public Health Approach to Professional Musicians

His wrinkled skin and weathered complexion hinted at years of arduous living. The sallow hue of his face and slight, bony physique suggested a feeble man in failing health. He was simply clad in shorts, sandals, T-shirt, and a hoodie, all of which reeked of cigarettes. His fingers were crooked, gnarled, and yellow tinged from years of arthritis, overuse, and smoking. Most strikingly, the sullen, morose look emanating from his bloodshot eyes alerted us that this man had a grueling story. The electronic medical record noted that Jeremy was 52 years old, which had to be erroneous; the man across from us appeared to be at least 70.

Jeremy was in our pulmonology clinic for an initial evaluation of hemoptysis and unintentional weight loss, two ominous symptoms that screamed lung cancer. After a detailed discussion of his signs and symptoms and a review of the history of his present illness, our visit proceeded to discussions about his life and social history.

Jeremy had been a professional musician since 17 years of age, and his seductive social life was immersed in the lifestyle of “sex, drugs, and rock and roll” that is associated with rock stars and glorified by the media. However, as he told his story with stark honesty and detail, it was clear that his career was far from the glamorous one that the media portrays. He described a life riddled with financial insecurity, broken relationships, and emotional turmoil, which evidently had transformed this man from a once-vibrant youth to the decayed man standing before us.

Together, we reviewed his results, all of which suggested with certainty metastatic lung cancer. Looking into Jeremy’s eyes, his mournful expression indicated that he knew and accepted he was dying. “I’m 52,” said Jeremy as he reached for a tissue from the box handed to him. “I’ve lived longer than most in my profession.” But 52 seemed awfully young; certainly Jeremy was exaggerating.

The interaction with Jeremy coincided with recent losses in music, including Soundgarden’s Chris Cornell (age 52) and Linkin Park’s Chester Bennington (42). This situation caused us to review musician longevity through our own personal observations, and in them we could see that—once again—2017 continued the lamentable pattern of famous young musicians unexpectedly dying. As a result, we contemplated the following questions: (1) Are musicians more likely to die at a younger age than the general population, and, if so, why? and (2) What are the medical and public health professions doing to uncover and address the health disparities that presumably exist in this overlooked population as a result of famous musicians’ perceived immortality?

Despite numerous difficulties in tracking the health of musicians, the data collected suggest that musicians, especially those who have reached stardom, are more likely to die young than age-matched nonmusicians. Of course, there are counterexamples (e.g., Keith Richards), but they seem to be atypical. An age-matched retrospective study from 2007 showed that North American and European pop stars had significantly higher mortality than demographically matched nonmusicians up until 25 years of fame.¹ In a similar study, rock and pop stars (as compared with controls) died prematurely up until 36 years after fame.² Moreover, Wolkewitz et al. showed that risk of death is two to three times higher among famous musicians in young adulthood than in the general population.³

Finally, a recent study reviewing the death records of 13 195 popular musicians who died between 1950 and 2014 showed a significantly shorter life expectancy relative to similar members of the general population; median ages of death were 45.2 years and 39.6 years for North American and European musicians, respectively.⁴ The cause of this mortality disparity is multifactorial, ranging from substance abuse and mental illness (e.g., anxiety, depression) to poor access to health care and lack of education.^4,5

Bellis et al. showed that the most likely cause of death among 1064 pop musicians was drug or alcohol overdose (28.57% of deaths), and this finding was confirmed in a follow-up study of 1489 famous rock and pop stars.^1,2 Kenny and Asher found that popular musicians died most frequently as a result of violent deaths attributed to substance abuse (i.e., accidents, suicides, homicides) and drug- or alcohol-related liver disease.⁴

Thus, it seems undeniable that musicians are prone to addiction and substance-related deaths, for a number of reasons.⁵ For example, musicians are more likely to suffer from untreated or inadequately treated depression and anxiety than the general population and to use readily available drugs or alcohol to anesthetize their discomfort.^1–5 Compounding this situation is the somber fact that, given their lack of job security in an overcrowded and fiercely competitive market, few musicians are open to discussing and seeking treatment for their psychological problems.^1–5 Moreover, their perceived immortality and immunity from illness can deter them from seeking treatment.^1–5 Also, mental health professionals are often not equipped to address the unique stressors and job-related concerns that most musicians encounter in their everyday lives.^1–5

Few would argue that enormous gaps and inadequacies exist in our understanding and management of musicians’ health. However, this tide seems to be changing. Over the past decade, a new area of medical specialization has emerged that explores stress issues unique to musicians. Moreover, journals, conferences, newsletters, and articles addressing health issues among musicians are becoming widespread.^3–5

But there is much more that can be done. First, a separate discipline in mental health that specifically addresses musicians’ emotional and psychological concerns should be established.⁵ We cannot help but think of anesthesiologists and other physicians at high risk for substance abuse who have found sobriety, freedom, and overall health improvements through physician health programs.^6,7 Similar programs for musicians would be undeniably invaluable. Second, it is imperative that more training programs be implemented that familiarize mental health professionals with specific approaches to reducing musicians’ stress levels, improving their performance anxiety, and helping them develop less stressful lifestyles.^4,5

Third, public health agencies should evaluate workplace settings and educate employers about the health of their musicians; early intervention practices such as employee assistance programs for all musicians would be an excellent goal.^6,7 For instance, because musicians’ compromised health can be considered an occupational hazard, occupational health and safety officers should be deployed to engage in health and safety surveillance of the work environment. Finally, and perhaps most importantly, additional emphasis should be placed on ensuring that mental health services are available to musicians and that employers (e.g., talent agencies) encourage them to access these services.^1–5

Jeremy’s diagnosis of metastatic lung cancer was eventually confirmed, and he opted to pursue palliative care and hospice and forgo palliative chemotherapy. Although Jeremy will likely succumb to his disease, our encounter and the unsettling truths about musicians’ health sparked heartfelt worry for musicians we admire such as Eddie Vedder (52 years old), Mike McCready (51 years old), Anthony Kiedis (54 years old), and other musicians approaching their projected shortened life expectancy. In our roles as medical professionals and public health advocates, the onus to address the modifiable risk factors that perpetuate neglected health disparities among musicians and improve their health outcomes falls on us.