Lasker Clinical Award winners (left to right): Dr Blake Wilson, Dr Ingeborg Hochmair and Dr Graeme Clark.
You’re walking down the sidewalk and you spot a friend whom you haven’t seen in eons walking ahead of you on the other side of the street. You yell, “Sally!” several times but she continues to walk on, as if she doesn’t hear you. And then she pulls out her iPod and changes the song and you realize that she really doesn’t hear you, and can’t.
You think about how much you would like to chat with her, if only she could hear you! But she can’t because all sounds, except those she has selected, have been shut out of her world. She is unreachable and isolated, even though there are people all around her.
Maybe this is a glimpse into the world of those who are deaf– not temporarily deaf due to “an obstruction” caused by the latest musical device, but those who are truly deaf, due to an injury or an error in a bit of DNA that prevents the proper functioning of the world’s original musical device: the ear.
Last month, a Lasker award (often referred to as the American Nobel prize) was given to three researchers for their work in the development of cochlear implants. These “bionic ears” have allowed 320,000 people to be able to hear, often for the first time.
One of the three researchers was Graeme Milbourne Clark, who was born in New South Wales, Australia, in 1935. His mom was a creative woman who encouraged his exploratory streak by allowing chemistry experiments in the laundry room and biology experiments in the garden. His dad was a pharmacist in their small, country town of Camden. His severe hardness of hearing made things awkward for his customers because they would have to shout out their medical needs for all in the shop to hear. “ANTI-FUNGAL CREAM, PLEASE!” By the age of ten, Graeme wanted to be an ear doctor.
He enrolled in medical school at the University of Sydney, though his interest in becoming an ear doctor had waned. After graduating in 1957 he pursued his studies in ear, nose and throat surgery in Sydney and then Britain, returning to Australia and a position as an ear, nose and throat surgeon at the Albert Hospital in Melbourne, later becoming senior honorary ENT surgeon there.
Reverence for the sense of hearing
During this time, his fascination with the ear was renewed. He had a profound reverence for the sensitivity and complexity of the sense of hearing while also believing that “our feelings, those of love, hate, pride and loyalty, for example, cannot easily be explained as simply the workings of electrical current and chemistry in the brain.” He understood how important hearing is for our sense of consciousness and our experience of the world.
For this reason Clark was not satisfied with clinical work. He wanted to improve the available treatments, not just implement the status quo. Reading an article by the American surgeon Blair Simmons about his successful use of electrical stimulation to allow a deaf person to hear sounds, though not speech, lit a fire in Clark’s belly: he wanted to do research.
When he sought the advice of Sir John Eccles, a Nobel laureate in neurophysiology, he was told that, at the age of 31, he was too old to embark on a research career. Thankfully, he ignored that advice and began to pursue a PhD.
Reminiscing about that time in his life, he says that, “We [his wife and children] left Melbourne to go and live very poorly [with me] as a research student at the University of Sydney. And, our second-hand car broke down. We couldn’t afford another second-hand car, even. I could spend time thinking about my research at bus stops, walking here and there, instead of worrying about the frustrations of driving in the traffic.”
His first research question was to figure out how the ear actually worked. They knew that sound waves are turned into electrical signals to stimulate nerve cells in the brain, which are then interpreted as coherent sounds. But they didn’t understand the signals being sent. Were they like Morse code– a single tone that gains meaning through its duration and the time in between iterations? Or is the ear more like a piano with a set of many keys each responsible for a different tone?
The device that Simmons had used was a single-channel device that operated solely on the principle of temporal signaling, like Morse code. Clark determined early on in his experiments with cats that no amount of temporal signaling could reproduce the complexity of sound. This suggested to him that hearing involved a mixture of “temporal and place coding,” like a piano.
The struggle to fund research
PhD in hand, he had to find somewhere to further his research. “That was difficult,” he says, “because most people said that it wouldn’t work. In fact, a good 95 to 99 per cent said this, and that meant no job.” However, thanks to his previous work in the city, in 1970 the University of Melbourne appointed him Foundation Professor of Otolaryngology, a department that didn’t yet exist.
Much of his time was spent fundraising because the dean only gave him three staff, some lab space in the mortuary, and $6,000 over two years. With this, he had to build more rooms and renovate others, plus recruit faculty members and pay for research expenses. Needless to say, he had to seek more funding. A significant amount of money eventually came from two generous donors but a lot of money came from sheer persistence and hard work. He held galas; he spoke at luncheons for $100 here or $200 there; he even made bets with his secretary that she couldn’t raise as much money as he could by shaking a tin can in the street during their lunch hours. He always won.
What kept him going? Clark had the experience of his father to urge him on. Not only did his father’s hardness of hearing make things uncomfortable in the pharmacy, it was quite tiring, too. His father had to continually exert himself to understand what people were saying. Clark recalls that, “There were times when Mum would entertain, and Dad would be seen as dumb, because he really couldn’t communicate in the conversations.”
There was also his faith. A devout Methodist, Clark says, “I wasn’t doing this for personal ambition. I was doing it, firstly, to see whether it was scientifically possible but also, with prayer, to see whether I was able to be used [by God] to do some good to help deaf people.”
Not everyone had his vision, though. Clark was criticized by scientific colleagues, who said it wouldn’t work and therefore wouldn’t fund his grants. He was criticized by medical colleagues, who focused on the danger of infections from surgically implanting a device in the ear with wires leading into the brain. He even received some criticism from the deaf community, some of whom didn’t want to be seen as needing to be “fixed.”
Time with the kids leads to a breakthrough
Clark’s strategy for dealing with it all was simple. He chose a very peaceful place to live and he made a point of spending time with his kids. “I made [it] my hobby, in the weekends, to play with them, to share with them. Instead of going to the golf course, I went to the backyard with the kids.”
His approach paid off. At one point, he was trying to figure out how to get the electrode bundle to go around the tiny spiral of the inner ear. It never left his thoughts, bugging him night and day. He went on vacation with his family with the puzzle still plaguing him. “And then, amazingly, one day at the beach, eureka! I was playing around with a shell [shaped] like the inner ear and [I was] putting in bits of grass blades, and realized that if they were bendable at the tip and stiff towards the base, they would actually go around far enough. I raced home from my holidays and tried it out in the laboratory, and it worked. I was able put the multi-electrodes around the tiny spiral of the inner ear.”
The first multiple-channel cochlear implant was put in place during surgery on August 1, 1978. The brave patient was a man named Rod Saunders, who had only recently gone deaf due to a head injury. The surgery was completed without any hiccups but then they had to wait a month for everything to heal before turning on the device and testing Rod’s hearing.
Rod returned to the lab and Clark stimulated his implant and…nothing. He came back a few days later and…still nothing. On their third try, the engineers realized that there had been a loose connection. That fixed, Rod heard a tone, which got louder as they increased the electrical current flowing to his implant. On subsequent tests, Rod was able to process different tones and their timing, as evidenced by his ability to recognize the melody of the Australian national anthem. But he still couldn’t hear speech.
Clark and his team worked with Rod for several more months, trying to learn about how the device was partnering with Rod’s brain while tweaking what they could to improve it. Finally, just before Christmas, Rod heard speech.
“It was one of the most wonderful experiences of my life,” Clark says. “I was so overcome, I went into the next-door laboratory and did what’s not very Australian – I burst into tears of joy.”
Next came several more months of testing and data collection to prove to the scientific world that they had indeed achieved the impossible. Little by little, Clark’s successes wore away the skeptics’ naysaying. It became easier to find funding to fine-tune the device. Eventually they shrunk the size and power requirements low enough to test the device in children under the age of four. Again, their persistence paid off and children born deaf were able to hear sound for the first time, allowing them eventually to also learn to speak.
Today, Professor Clark continues to dream big and work hard. He is not afraid of throwing his weight into cultural debates, like abortion. In 2008, when Victorian lawmakers voted to require physicians to refer for abortions even when they were opposed to them, he joined two other senior physicians in writing an open letter of opposition to the upper house of congress. He continues to seek ways to combine the latest technology with our best understanding of neurology to perfect cochlear implants, to learn how the brain works, and to help people with other neurological injuries, like those to the spinal cord. He is an edifying example of what scientists can do with determination and persistence combined with creativity and a desire to serve others.
Michaela Kingston is the nom de plume of an American scientist who holds a PhD in biology from Johns Hopkins University. She is currently working in the field of medical communications.