Sunday, January 3, 2010

Does Stuttering Attract the Best Minds?

Being safely free of any evidence in this matter, I feel free to ask the question. This is an issue I’ve been wondering about for a long time. Stuttering comes with multiple burdens for the success-oriented student looking for a field to enter. The condition is notorious for its persistence, and few people wants to spend their lives fighting losing battles, or gaining small successes at best. Young researchers are taught to choose topics that lend themselves to successful study results, and, most importantly, paper publication. And in science and medicine, everyone follows the money. Stuttering neither kills nor shortens one’s lifespan. There are no purple-for-stuttering ribbons, and there are no Walks Against Stuttering or telethons to raise private funds for research or treatment.

It is easy to understand how a lack or resources would restrict the ability of researchers to make breakthroughs. The disincentive to enter the field in the first place is a more subtle matter. Some fields loose their attraction after they’ve matured and the Big Problems of the past have been largely solved. Others never attract the best minds because no one seems to make their name in them. Funding agencies look for the best bang for their bucks, constantly looking for the next big breakthrough, and researchers follow the money

We could ask whether the inherent difficulty of the stuttering problem itself is sufficient to explain the lack of advancement in the field, or whether a lack of resources is to blame. Phrased in another way: is stuttering really more difficult to study successfully than other subjects, or is it just a lesser priority than other, equally difficult subjects?

The truth is that not all fields and sub-fields of science attract the same quality thinkers and workers. A comparison of GRE scores (graduate school entrance exams) would reveal a range of averages, with the highly mathematical fields at one end, and the less rigorous, “soft” fields at the other. And within a broad field, the best, most ambitious researchers, professors, post-doctoral researchers and graduate students will gravitate towards work that produces regular, if incremental success, scientific publications in prestigious journals, and professional advancement. Research topics that do not provide such possibilities can become orphan fields, with little money, advance or prestige available. This does not mean that no work gets done - it simply leads to pedestrian research and i-dotting and t-crossing-results rather than dramatic breakthroughs.

One could ask the same question regarding speech therapy. Every therapeutic failure of the past has had its advocates, and many have been licensed professionals and graduates of, no doubt, the best speech pathology programs. I’ve seen multiple discussions of evidence-based speech therapy, but are researchers and therapists properly trained to examine the evidence? The truth of medical research is that many published studies are garbage, plain and simple. They follow the form of the scientific method at a surface level, but they lack the rigor needed to truly answer the question raised. Are speech therapists sufficiently prepared in experimental design and analysis to make sense of the literature of their field? In the same way, we can ask whether they are prepared to analyze their own clinical experiences in a rigorous way. Rigorous critical thinking does not come naturally; it needs to be learned by example and by practice. It is cruel; constantly searching for flaws and questioning assumptions. Does speech pathology education produce such thinkers, or does it produce (hopefully empathetic) speech firemen/women, too busy putting out clinical fires to challenge their own training?

One question has evolved into multiple questions. And all of the latter questions refer us back to the former. What would happen if the best minds in computer science, medicine and physics turned their attention to stuttering? What if the world’s top neurologists and brain researchers took on this topic as their life’s work? And what if Bill Gates dropped one hundred million dollars on funding university chairs, laboratories and clinical researchers dedicated to stuttering? Would it matter, or is the money and effort best used elsewhere? I don’t know, but I suspect that the field could desperately use the kind of brain-power such an effort would bring. No offence to current practitioners, buy the difference between very good and great can be the difference between failure and success.

After Francis Crick teamed with James Watson to discover the structure of DNA during the 1950s, he went on to team with others and perform a series of experiments to determine the genetic code. Molecular biologists still teach from the resulting journal papers, and describe the work as elegant and beautiful. Who today is doing elegant studies of stuttering? Whose work is so tightly constructed that it can rule out all competing hypothesis? It would be wonderful to learn that they are already out there in a lab somewhere. Maybe they are.

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