- Email: [email protected]
The health of deaf people
Correspondence
We declare that we have no conflicts of interest.
*Limor Aharonson-Daniel, Carolina Tannenbaum-Baruchi, Paula Feder-Bubis [email protected] Department of Emergency Medicine and Department of Health Systems Management, Faculty of Health Sciences, and PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, PO Box 653, 84105 Beer-Sheva, Israel 1
2 3 4
The Lancet. The health of deaf people: communication breakdown. Lancet 2012; 379: 977. Alexander A, Ladd P, Powell S. Deafness might damage your health. Lancet 2012; 379: 979–81. Fellinger J, Holzinger D, Pollard R. Mental health of deaf people. Lancet 2012; 379: 1037–44. Tannenbaum-Baruchi C, Aharonson-Daniel L, Feder-Bubis P. The needs of deaf people during an emergency situation in Southern Israel. Presentated at the IPREDII conference, Tel-Aviv, Israel; January, 2012.
history-taking but it is often the focus of the assessment, providing essential clues about cognitive function. Deaf people display different cognitive competencies that arise through auditory deprivation and exposure to visuospatial, rather than spoken, language, but no neuropsychological tests are validated or normed for use with deaf signers. Even use of highly experienced interpreters is inappropriate, unreliable, and errorprone,5 since psychological validity is lost in translation. The development of specialist neurology services for deaf patients is vital to overcome these problems. A new monthly Cognitive Disorder Clinic for deaf patients at the UK’s National Hospital for Neurology and Neurosurgery already has a 6-month waiting list. We suggest that this is the tip of the iceberg. We declare that we have no conflicts of interest.
[email protected]
I am Chief Executive of the MRC. I am also head of the College of Medicine and Veterinary Medicine at the University of Edinburgh.
Deafness, Cognition and Language Research Centre, University College London, London WC1H 0PD, UK
John Savill
*Joanna Atkinson, Bencie Woll
1
2
It was heartening to see The Lancet1 outline the barriers that deaf sign language users face in accessing general and mental health care. We would like to draw attention to a third overlooked arena: the lack of access to neurology services. Neurological disorders affect an estimated 6000–8000 deaf signers in the UK alone. These individuals experience serious under-representation in clinical referrals and inappropriate assessment, with adverse implications for accurate and timely diagnosis and treatment.2,3 Our current study of dementia in deaf people shows a pattern of late diagnosis. A typical experience is described by Parker and colleagues.4 Accurate diagnosis in the early stage of neurological disease is a particular challenge in deaf patients since not only is communication a barrier to www.thelancet.com Vol 379 June 16, 2012
discovery science, right across the UK. This research is crucial for subsequent translation into improvements in the prevention, diagnosis, and management of disease. Over the past few years, the MRC has maintained a basic medical science spend of more than £400 million per year. Furthermore, the MRC has protected 3-year project grants and early career fellowships, with 113 and 97, respectively, awarded in 2010–11. Indeed, 2011–12 has proved to be a record year for new investigator project grants, with 26 awards and a 28% success rate, based on our research boards’ enthusiasm for iterative interaction with colleagues starting out as university-funded investigators. Early-career basic scientists in the UK’s research-intensive medical schools should take heart—the MRC is still here to support you, because your research will help change lives.2
3
4
5
The Lancet. The health of deaf people: communication breakdown. Lancet 2012; 379: 977. Marshall J, Atkinson JA, Thacker A, Woll B. Is speech and language therapy meeting the needs of language minorities? The case of deaf people with neurological impairments. Int J Lang Comm Disord 2003; 38: 85–94. Atkinson J, Denmark T, Woll B, et al. Deaf with dementia: towards better recognition and services. J Dementia Care 2011; 19: 38–39. Parker J, Young A, Rogers K. “My Mum’s story”: a deaf daughter discusses her deaf mother’s experience of dementia. Dementia 2010; 9: 5–20. Hill-Briggs F, Dial JG, Morere DA, Joyce A. Neuropsychological assessment of persons with physical disability, visual impairment or blindness, and hearing impairment or deafness. Arch Clin Neuropsychol 2007; 22: 389–404.
Catastrophic neglect of basic sciences in medicine Your doom-laden Editorial (April 7, p 1273)1 glosses over the UK Medical Research Council’s (MRC’s) strong and continuing commitment to funding
UIG via Getty Images
an era of security risk during mass gatherings and occasional bombings of civilian populations, the system should be constantly ready. Finally, barriers to health-care provision are also obstacles to studying the health of deaf people. Recruitment of a researcher who is part of the deaf community enables a bottom-up approach towards problems and their solutions and is highly recommended, wherever possible.4
john.savill@headoffice.mrc.ac.uk Medical Research Council, London WC2B 4AN, UK 1 2
The Lancet. Catastrophic neglect of the basic sciences in medicine. Lancet 2012; 379: 1273. Medical Research Council. Research changes lives: MRC strategic plan 2009–2014. http:// www.mrc.ac.uk/About/Strategy/ StrategicPlan2009-2014/index.htm (accessed May 23, 2012).
Assuming that the ultimate goal of basic scientists and health professionals (and The Lancet) is to improve and sustain the wellbeing of humanity, I wish to place your Editorial1 on the neglect of the basic sciences in a wider context than that of medicine. From this perspective, what one observes is a neglect of basic services leading to catastrophic health consequences—eg, 8·5% of deaths in south and southeast Asia are due to diarrhoea, of which 88% results from poor sanitation and dirty water.2 This is despite the availability of cost-effective and simple technology (ie, pipe-borne water) for centuries.3 Inappropriate
For the Deaf People with Dementia Research Project see http://www.nursing.manchester. ac.uk/deafwithdementia/
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We declare that we have no conflicts of interest.
*Limor Aharonson-Daniel, Carolina Tannenbaum-Baruchi, Paula Feder-Bubis [email protected] Department of Emergency Medicine and Department of Health Systems Management, Faculty of Health Sciences, and PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, PO Box 653, 84105 Beer-Sheva, Israel 1
2 3 4
The Lancet. The health of deaf people: communication breakdown. Lancet 2012; 379: 977. Alexander A, Ladd P, Powell S. Deafness might damage your health. Lancet 2012; 379: 979–81. Fellinger J, Holzinger D, Pollard R. Mental health of deaf people. Lancet 2012; 379: 1037–44. Tannenbaum-Baruchi C, Aharonson-Daniel L, Feder-Bubis P. The needs of deaf people during an emergency situation in Southern Israel. Presentated at the IPREDII conference, Tel-Aviv, Israel; January, 2012.
history-taking but it is often the focus of the assessment, providing essential clues about cognitive function. Deaf people display different cognitive competencies that arise through auditory deprivation and exposure to visuospatial, rather than spoken, language, but no neuropsychological tests are validated or normed for use with deaf signers. Even use of highly experienced interpreters is inappropriate, unreliable, and errorprone,5 since psychological validity is lost in translation. The development of specialist neurology services for deaf patients is vital to overcome these problems. A new monthly Cognitive Disorder Clinic for deaf patients at the UK’s National Hospital for Neurology and Neurosurgery already has a 6-month waiting list. We suggest that this is the tip of the iceberg. We declare that we have no conflicts of interest.
[email protected]
I am Chief Executive of the MRC. I am also head of the College of Medicine and Veterinary Medicine at the University of Edinburgh.
Deafness, Cognition and Language Research Centre, University College London, London WC1H 0PD, UK
John Savill
*Joanna Atkinson, Bencie Woll
1
2
It was heartening to see The Lancet1 outline the barriers that deaf sign language users face in accessing general and mental health care. We would like to draw attention to a third overlooked arena: the lack of access to neurology services. Neurological disorders affect an estimated 6000–8000 deaf signers in the UK alone. These individuals experience serious under-representation in clinical referrals and inappropriate assessment, with adverse implications for accurate and timely diagnosis and treatment.2,3 Our current study of dementia in deaf people shows a pattern of late diagnosis. A typical experience is described by Parker and colleagues.4 Accurate diagnosis in the early stage of neurological disease is a particular challenge in deaf patients since not only is communication a barrier to www.thelancet.com Vol 379 June 16, 2012
discovery science, right across the UK. This research is crucial for subsequent translation into improvements in the prevention, diagnosis, and management of disease. Over the past few years, the MRC has maintained a basic medical science spend of more than £400 million per year. Furthermore, the MRC has protected 3-year project grants and early career fellowships, with 113 and 97, respectively, awarded in 2010–11. Indeed, 2011–12 has proved to be a record year for new investigator project grants, with 26 awards and a 28% success rate, based on our research boards’ enthusiasm for iterative interaction with colleagues starting out as university-funded investigators. Early-career basic scientists in the UK’s research-intensive medical schools should take heart—the MRC is still here to support you, because your research will help change lives.2
3
4
5
The Lancet. The health of deaf people: communication breakdown. Lancet 2012; 379: 977. Marshall J, Atkinson JA, Thacker A, Woll B. Is speech and language therapy meeting the needs of language minorities? The case of deaf people with neurological impairments. Int J Lang Comm Disord 2003; 38: 85–94. Atkinson J, Denmark T, Woll B, et al. Deaf with dementia: towards better recognition and services. J Dementia Care 2011; 19: 38–39. Parker J, Young A, Rogers K. “My Mum’s story”: a deaf daughter discusses her deaf mother’s experience of dementia. Dementia 2010; 9: 5–20. Hill-Briggs F, Dial JG, Morere DA, Joyce A. Neuropsychological assessment of persons with physical disability, visual impairment or blindness, and hearing impairment or deafness. Arch Clin Neuropsychol 2007; 22: 389–404.
Catastrophic neglect of basic sciences in medicine Your doom-laden Editorial (April 7, p 1273)1 glosses over the UK Medical Research Council’s (MRC’s) strong and continuing commitment to funding
UIG via Getty Images
an era of security risk during mass gatherings and occasional bombings of civilian populations, the system should be constantly ready. Finally, barriers to health-care provision are also obstacles to studying the health of deaf people. Recruitment of a researcher who is part of the deaf community enables a bottom-up approach towards problems and their solutions and is highly recommended, wherever possible.4
john.savill@headoffice.mrc.ac.uk Medical Research Council, London WC2B 4AN, UK 1 2
The Lancet. Catastrophic neglect of the basic sciences in medicine. Lancet 2012; 379: 1273. Medical Research Council. Research changes lives: MRC strategic plan 2009–2014. http:// www.mrc.ac.uk/About/Strategy/ StrategicPlan2009-2014/index.htm (accessed May 23, 2012).
Assuming that the ultimate goal of basic scientists and health professionals (and The Lancet) is to improve and sustain the wellbeing of humanity, I wish to place your Editorial1 on the neglect of the basic sciences in a wider context than that of medicine. From this perspective, what one observes is a neglect of basic services leading to catastrophic health consequences—eg, 8·5% of deaths in south and southeast Asia are due to diarrhoea, of which 88% results from poor sanitation and dirty water.2 This is despite the availability of cost-effective and simple technology (ie, pipe-borne water) for centuries.3 Inappropriate
For the Deaf People with Dementia Research Project see http://www.nursing.manchester. ac.uk/deafwithdementia/
2239