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Congressional Testimony
March 8, 2000, Wednesday
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 3347 words
HEADLINE:
TESTIMONY March 08, 2000 JERI A. LOGEMANN, PH.D. SPEECH-LANGUAGE PATHOLOGY
NORTHWESTERN UNIVERSITY HOUSE APPROPRIATIONS LABOR, HEALTH AND
HUMAN SERVICES, AND EDUCATION LABOR HHS APPROPS
BODY:
Statement of the American Speech-Language-Hearing Association to the
Subcommittee on Labor, Health and Human Services, Education and Related Agencies
Committee on Appropriations U.S. House of Representatives Hearing on Fiscal Year
2001 Appropriations NEWBORN HEARING SCREENING & INTERVENTION and CLINICAL
RESEARCH FUNDING Presented by Jeri A. Logemann, Ph.D. March 8, 2000 Thank you,
Chairman Porter and members of the Subcommittee, for allowing me to appear
before you today. My name is Jeri Logemann, and I am a speech-language pathology
clinician and researcher at Northwestern University. I am also president of the
American Speech-Language-Hearing Association (ASHA) and here today on behalf of
nearly I 00, 000 audiologists, speech-language pathologists, and speech,
language and hearing scientists to urge your continued support for newborn
hearing screening and intervention, and clinical research funding for the
National Institutes of Health (N111-1) and the National Institute on Deafness
and other Communication Disorders (N-EDCD). On behalf of these professionals and
our clients, we appreciate the opportunity to present our views to this
Subcommittee concerning these two issues. I would like to begin by thanking you,
Mr. Chairman, and all the members of your subcommittee for your leadership in
including the Newborn Hearing Screening and Intervention Act, as introduced by
Representative James Walsh, under Title VI of last year's appropriations bill
and in the subsequent budget agreement. In addition, I also would like to
commend you and the subcommittee members in securing a 15 percent increase for
the National Institutes of Health as passed by Congress last year. It is largely
through the efforts of this Subcommittee that our goal of doubling funding for
NIH over the next five years will be realized. This morning, I would first like
to focus my comments on the need to continue and expand support of the newborn
hearing screening and intervention provision to its fully authorized level of
$15 million for fiscal year 2001. This new law enables up to three years of
federal funding for state grants to develop infant hearing screening and
intervention programs through the Health Resources and Services Administration
(HRSA) and the Centers for Disease Control and Prevention (CDC). More
specifically, it directs HRSA, CDC and the National Institute on Deafness and
Other Communication Disorders (NIDCD) to work together to: - Develop and expand
statewide screening program-, - Link screening programs with community-based
intervention efforts; - Monitor the impact of early detection and intervention
activities; and - Provide technical assistance on data management and applied
research. Over twenty national audiological, medical and related consumer
organizations support this legislation. As you know Mr. Chairman, everyday in
the United States, approximately 33 babies (3 infants per 1,000) are born with
permanent hearing loss. Hearing loss is the most common congenital disorder in
newborns- 20 times more prevalent than phenlyketonuria (PKU), a condition for
which all newborns are currently screened. In addition, it is estimated that
another 3 infants per 1,000 are born with moderate hearing loss - a total of 6
infants per 1,000, or over 60 babies born a day - could be identified and
receive needed habilitation with the implementation of early hearing
detection and intervention (EHDI) programs. However, the problem is
that the average age that children with hearing loss are identified in the
United States is 12 to 25 months of age. When hearing loss is detected late,
critical time for stimulating the auditory pathways to hearing centers of the
brain is lost. Speech and language development is delayed, affecting social and
emotional growth, academic achievement and employment options. The cost of late
identification is not only in real health care and public education dollars, but
also the frustration borne by parents and these children who lack appropriate
language skills to compete academically and ultimately in today's "information
age" job market. The good news is that thanks to your Subcommittee's leadership
through the Walsh provision and a surge of new state laws to expand coverage for
early hearing screening and intervention services, our country is on the path to
eradicating delayed detection for hearing loss within the next five years. There
is wide consensus on the expressed need and support for early hearing
detection and intervention. A National Institutes of Health (NIH)
Consensus Panel in 1993 recommended hearing screening of all newborns. The
consensus report concluded that the best opportunity for achieving this goal is
provided by the development of hearing screening programs for newborns in
hospital nurseries or in birthing centers, prior to discharge. The Joint
Committee on Infant Hearing and the newly released U.S. Public Health Service's
Healthy People 2010 health objectives for the nation recommend that all newborns
be screened for hearing loss before 3 months of age and receive intervention by
6 months of age. Advances in technology contain current costs for hospital-based
newborn hearing screening to a range between $25 and $40. Two types of
non-invasive procedures are used to screen newborns singly or in combination: -
Auditory brainstem responses (ABR) are measured by placing electrodes on the
baby's head. Sound is then introduced to the baby's ears through tiny earphones
while the child sleeps. The electrodes measure if the brain is detecting the
sounds. This test is also painless and takes only about 5 minutes. - Otoacoustic
emissions (OAE) are faint sounds produced by most normal inner ears. The sounds
cannot be heard by people, but can be detected by very sensitive microphones
that are placed in the ear canal. During testing, a tiny flexible plug is
inserted into the baby's ear and sound is then projected into the ear through a
plug. A microphone inside the plug records the otoacoustic emissions that the
normal ear produces in response to the incoming sound. The emissions are not
measurable in an infant who cannot hear. Testing is painless and can be done
while the baby sleeps. In addition, recent research has concluded that children
born with a hearing loss who are identified and given appropriate intervention
before six months of age developed language on par with their hearing peers.
Studies have also indicated that detection of hearing loss during infancy
followed with appropriate intervention minimizes the need for extensive
habilitation during the school years, in contrast to 30-year Gallaudet studies
showing that children with hearing loss graduate high school with a 4h grade
reading level on average. Infants identified with hearing loss can be fit with
amplification systems by a certified audiologist as young as 4 weeks of age.
With appropriate early intervention, combined with language (either spoken or
signed) and cognitive development services by a certified speech- language
pathologist, these infants are very likely to develop on par with hearing peers
by school age. The funding level for these state grants through HRSA and CDC is
$7 million for FY2000. And the response by States applying for these grants has
been overwhelming. Over 40 applications from States have been received for the
HRSA grants to help implement statewide early hearing and intervention programs.
According to the agency, only about half of these applications will be awarded
under the current funding level. The CDC anticipates a similar response from
States. Mr. Chairman, we respectfully request that the Subcommittee acknowledge
the need and demand for this assistance to States and fund the Walsh provision
at its fully authorized level of $15 million for FY2001. Already, this funding
has acted as a catalyst to advance statewide early hearing detection and
intervention programs. The number of new state laws this past year has
more than doubled to 24, Another dozen States are currently considering such
action. In short, the opportunity to provide children with hearing loss an equal
opportunity to become productive citizens is here today with your help. Clinical
Research Funding As I noted earlier Mr. Chairman, ASHA supports the
Subcommittee's commitment to double the National Institutes of Health (NIH)
budget by 2003. We are particularly supportive of efforts to increase the
investment in research across all institutes involved with communication
sciences and disorders. Communication disorders are the most prevalent of all
disabling conditions. Approximately 42 million Americans have some kind of
communication disorder. These disorders result in huge costs to the economy in
lost productivity, special education, rehabilitation, health care expenditures
and lost revenues. Since its authorization in 1988, the National Institute on
Deafness and Other Communication Disorders (NIDCD) has been the focal point for
conducting research understanding the normal and disorders associated with
hearing, voice, speech, language, and balance. The NIDCD supports researchers
who devote their careers to finding the causes, sure, and prevention of
communication disorders, such as treatment for swallowing disorders and voice
disorders in patients with idiopathic Parkinson's disease or following stroke.
The public's growing demand for evidence-based treatment options, only
strengthens our conviction that more multi-centered, patient-oriented clinical
research must be supported. Successful research outcomes will help keep Medicare
costs down by decreasing or eliminating some illnesses in senior citizens.
However, I must share my deep concern about the decline in funding for clinical,
patient- oriented research versus basic research at the NIDCD, especially with
respect to multi-center trials. The mission statement of the NIDCD states that
its extramural grant portfolio demonstrates a balance of basic and clinical
research. Unfortunately, ASHA and its members have found this not to be the
case. Mr. Chairman, I urge you and members of the Subcommittee to examine this
issue seriously in order to help ensure that a balanced portfolio of basic and
clinical research funding can resume. Multi- center, patient-oriented clinical
research represents a crucial phase in the conversion of basic research findings
into effective prevention strategies, diagnostic procedures, and treatment
methods resulting in improved communication for individuals. In conclusion, ASHA
respectfully submits the following recommendations to enhance programs in the
areas of research and research training in hearing, voice, speech, language, and
balance. - Increase support for studies addressing the identification of hearing
loss in newborns, infants, and children. Such research could lead to the
development of more innovative, less costly audiometric tests, better
audiological, speech and language treatments for children. - Increase support of
mechanisms that enhance the training of clinical researchers. In order to
maintain the quality of research and scientific inquiry in the next century, we
must diligently commit to develop new researchers capable of furthering the
progress made in the study of normal processes and disorders of communication.
Increase support of interdisciplinary research. The development of innovative
approaches to the diagnosis and treatment of various communication disorders may
be accelerated by interdisciplinary research involving professionals such a
geneticists, neurologists, biologists, and engineers-all working collaboratively
with scientists studying the normal processes of human communication and its
associated disorders. Mr. Chairman and members of the Subcommittee, on behalf of
ASHA and the other professional and related consumer organizations, we again
appreciate the opportunity to provide these comments and your efforts to
eradicate delayed detection and intervention for hearing loss, as well as your
continued support for patient- oriented clinical research funding. And we look
forward to working with you and the Subcommittee as the Fiscal Year 2001
appropriations process moves forward.
LOAD-DATE: March
15, 2000, Wednesday 
