Editorial

Editorial Actions Have Consequences Cochlear Implants: An Update Readers of this editorial should know that I have expressed strong reservations about the implantation of cochlear devices in very young deaf children, especially those 2 years of age or younger. Be aware that I am not unbiased. There are several reasons for my concern. The primary one is an aversion to invasive surgery and the implantation of a foreign object in the head of an infant or toddler with a life expectancy of 80 years or more in order to "cure" a condition —deafness—that is not life threatening. I can understand how parents with little or no prior exposure to deafness or its implications would choose to have the operation for their deaf child, given the publicity that implants have received, including reports of their success, but I would not recommend it. Years ago, in a discussion I had with a surgeon, he expressed surprise that I had concerns about implants when, in his words, he was bringing "the gift of spoken language to deaf children." He concluded that I must be one of those educators who opposed the development of oral skills in deaf children. I assured him that I supported the development of all channels of communication, including oral/ aural, to the greatest extent possible, but I had seen no definitive evidence that implants, per se, were more effective than newly developed hearing aids, which had the advantage of not having to be physically imbedded in the skull and which did not pose the potential danger to the child that surgery did. I also expressed the opinion that no procedure is without complications and we were not sure of the potential problems associated with implants. We went our separate ways without effectively communicating our positions to each other. Since my conversation of several years ago, both implant devices and hearing aids have improved significantly in power and effectiveness, although neither can bring clear speech to all or even most deaf children. There have been numerous reports on the effectiveness of cochlear implants in deaf children, and it is undeniable that they convey speech to many children, but whether more effectively than hearing aids is debatable. Most of the reports I have read have done by professionals who are affiliated with the organizations doing the implants and not by independent agencies. I do not question these researchers' integrity, but I am concerned about the difficulty of conducting research under those conditions. A truly experimental research study would involve the random assignment of large numbers of subjects to different treatments. Some children would receive implants, some would receive hearing aids, some would receive neither, and all would be followed over a number of years. But given federal requirements for informed consent and parental decision making, an experimental or even quasi-experimental study of this nature is out of the question in the United States and most other countries with large numbers of deaf children who have implants. Within this context, there have been disturbing reports recently about the negative effects of common medical treatments or procedures that until now have been accepted as beneficial, without side effects. Now there is growing evidence that many treatments that have been used extensively and routinely are inappropriate and, in some cases, dangerous. The most significant study involved an investigation under the federal Women's Health Initiative of the effects of hormone replacement therapy with thousands of women, some of whom received the treatment and some of whom received a placebo. All subjects gave informed consent . The study, projected to last 8 years, was terminated after just 5 because of evidence that the risks involved in hormone replacement therapy outweighed any benefits. In other words, a therapy that has been prescribed for millions of menopausal women to prevent heart disease actually increases its likelihood, among other side effects. Partly because of the results of the hormone replacement therapy study, a 6-year study of the effects of testosterone replacement therapy in men that had received preliminary approval has been cancelled. The government finds itself Volume 147, No. 4, 2002 American Annals of the Deaf Editorial in a catch-22 situation. A large-scale study...