Father Edward Flanagan, the actor Spencer Tracy, and the multibillionaire Warren Buffett all played a role in the creation of the Boys Town communication disorders research program.
As a result, in the last 40 years, more than 300 articles published in The Journal of the Acoustical Society of America (JASA) and many articles elsewhere, have been authored or coauthored by members of the faculty and staff at the Boys Town National Research Hospital (BTNRH). How did Boys Town, an organization known for work with at-risk children, become an important contributor to hearing and speech research?
It all started with Father Flanagan, a young priest who started a program for homeless boys in Omaha, NE, in 1917. In 1921, Father Flanagan’s Boys’ Home moved to a farm outside Omaha that he christened Boys Town. The program became famous during the depression. Spencer Tracy, the great American actor, received an Academy Award (Oscar) for playing Flanagan in the 1938 MGM movie Boys Town, where another famous actor, Mickey Rooney, played the part of a homeless boy. The success of the movie enabled the organization to expand its already extensive national fundraising efforts. Father Flanagan died of a heart attack in 1948 while investigating the need for relief efforts for children in Europe on behalf of President Harry Truman.
Fundraising continued, but the expansion of Boys Town and its programs did not. In the early 1970s, the American financier Warren Buffett was building an investment empire that would make him one of the world’s richest people. When Buffet found that nonprofit foundations were required to report financial information to the US government that was then available to anyone on request, he requested information for Boys Town and was surprised by what he learned. As a result, on March 30, 1972, the Omaha Sun, a weekly newspaper owned by Warren Buffett, used information provided by Buffett to publish a Pulitzer Prize-winning expose of Boys Town finances showing that the organization was sending out 50 million appeal letters per year while quietly amassing an endowment of $209 million that was growing annually. The reporters showed that Boys Town had developed one of the largest direct-mail fundraising programs in the country to raise money that it did not appear to need. In less than a year, this revelation resulted in new leadership, a new board of directors, and a search for new programs to expand the mission and serve additional children.
Dr. Patrick Brookhouser, the chief otolaryngology resident at Johns Hopkins University (Baltimore, MD) in 1972, had grown up near Omaha, still had family in the area, and was closely following the Boys Town events. Pat’s mentor, John Bordley, had hoped to develop an institute devoted to communication disorders in children in Baltimore but was unable to raise the necessary funds. Shortly after the scandal broke and with Bordley’s encouragement, Brookhouser spent a weekend putting together a proposal for a Boys Town Institute for Communication Disorders in Children. In December 1972, the Boys Town Board of Directors agreed to fund the project, with $14 million for a building and an annual budget of $2.2 million. The name was changed in 1989 to the Boys Town National Research Hospital (BTNRH). To avoid confusion, that name is used for the remainder of this article.
The First Ten Years
Brookhouser was named director of the new program at the age of 32. He had no staff or administrative experience, and the Boys Town organization had no experience in the provision of medical services, research, or obtaining federal funding. In retrospect, it is remarkable that the new venture was successful. The BTNRH succeeded, however, because it was able to recruit people for key positions who were interested in a mix of basic and clinical research, wanted to escape the administrative complexity found in universities, were attracted by the opportunity that the BTNRH afforded to build a new research-oriented institution from scratch, and were drawn to the overall mission. Many of these people were recent PhDs willing to take the risk of moving to a new institution, with many remaining at the BTNRH for their entire careers. With no history, no fixed administrative structure, no specific teaching responsibilities, and financial support from Boys Town, they were free to develop programs that maximized impact.
Brookhouser’s proposal called for development of a center for the diagnosis and treatment of children with communication disorders at no cost to their families. Like all Boys Town programs, it would be nondenominational. It also included an interdisciplinary research program, with seven laboratories with an emphasis on what is now called translational research and supported by institutional funds. Most clinically oriented research programs at that time, such as the one at the Central Institute for the Deaf (St. Louis, MO), had grown out of successful clinical programs. The plan for the new center was to develop clinical and research programs in parallel with one another. The clinical programs would include otolaryngology and pediatrics, but the emphasis was on audiology, speech language pathology, learning disabilities, and clinical psychology. While Brookhouser completed his military service, Bordley helped assemble advisory committees and develop more detailed plans.
Senior people were recruited to organize clinical programs in audiology and speech and language disorders, including Donald Worthington from his position as Director of the Army Audiology and Speech Center at Walter Reed Army Medical Center (Washington, DC; now Walter Reed National Military Medical Center, Bethesda, MD), Noel and Arlene Matkin from Northwestern University (Evanston, IL), and Betty Jane Phillips from Kent State University (Kent, OH). The first research advisory committee included Joseph Hind, an auditory physiologist at the University of Wisconsin (Madison), Merle Lawrence, an authority on speech production and founding director of the Kresge Hearing Research Institute at the University of Michigan (Ann Arbor), and Catherine Smith, a noted auditory anatomist.
Murray Sachs, a member of the Johns Hopkins faculty in biomedical engineering and otolaryngology, was instrumental in the development of early plans for the research program but decided to stay in Baltimore rather than move to Omaha as director of research at the new institution. Joe Hind then recommended one of his postdoctoral fellows, Eric Javel as interim director of research. Like Sachs, Javel was a physiologist but his undergraduate degree from Johns Hopkins may have sealed the deal. Javel then recruited the author of this article, a postdoctoral fellow working with David Green, to establish a research program in psychoacoustics.
After a three-year planning period, the initial staff of the hospital moved to Omaha in 1975 and 1976, working out of temporary quarters until a new building was completed in February 1977. Because the BTNRH was a totally new institution, the building was designed, and construction was completed before most of the staff members who would occupy the building were recruited.
The highest priorities in 1976 were to recruit a permanent research director and to obtain additional funding for the research program. Many people contributed to the initial development of the BTNRH, but the research program owes its success to Charles Watson and support from the National Institutes of Health (NIH). Watson was recruited from the Central Institute for the Deaf during the fall of 1976 and moved to the hospital as director of research in January 1977. He was instrumental in the recruitment of additional laboratory directors, the development of initial grant applications, and, most of all, in establishing the tone of the research program, including its academic orientation and high standards for performance. In 1976, the NIH announced a new initiative for institutions currently without NIH funds to provide three years of research start-up funds with a total budget of $300,000. They invited applications in any area of research supported by the NIH and planned to award four such grants. Watson and the other early members of the research staff submitted an application for the March 1, 1977, deadline, only a month after they had moved into the new building. It was the first application for federal funds submitted by the Boys Town organization.
The application was funded with a start date of December 1, 1977. It provided operating funds for the existing laboratories, funds for equipment, and initial operating funds for new laboratories in communication engineering, neuroanatomy, and speech/language, with support for senior salaries guaranteed by the BTNRH. Recruitment of additional staff was initiated during this period and the day that word of funding was received from the NIH, Richard Lippmann accepted the position in communication engineering and W. Bruce Warr accepted the position in neuroanatomy. Ronald Netsell later accepted the speech/language position, joined immediately by Raymond Kent. NIH approval and support for the new research program provided validation that was critical in an organization with no prior experience in research. In addition to the funding, the positive external review of grant applications provided strong feedback to the Boys Town organization regarding the value of the proposed work. It also provided individual laboratory directors the freedom to pursue research topics of great interest to their peers on grant-review panels that might have been difficult to explain to the Boys Town Board of Directors.
Richard Lippmann and Bruce Warr arrived in 1978. Lippmann was interested in the development of new algorithms for hearing aid signal processing, whereas Warr had done seminal work to map the efferent innervation of the inner ear. Ron Netsell and Ray Kent moved from the University of Wisconsin the following year to establish a speech physiology laboratory. By the end of 1978, Javel, Jesteadt, Watson, and Warr had all obtained NIH funding for their research programs, excellent electronics shop, and other research infrastructures had been developed, and the BTNRH had hosted a national research conference combined with a meeting of the Committee on Hearing and Bioacoustics of the National Academy of Sciences. William Kimberling also joined us that year to develop one of the first research programs in the area of the genetics of hearing loss. Kimberling went on to do pioneering work at the BTNRH on the identification of genes causing Usher syndrome, the leading cause of combined deafness and blindness in developed countries. The initial growth phase of the research program ended in 1983, when Watson moved to Indiana University (Bloomington). By that time, there were 18 independent laboratories and important elements of the research program were in place.
Scope of the Research Program
Brookhouser’s initial proposal assumed that the seven laboratories would cover a wide range of disciplines, which is evident in a long history of contributions to neurochemistry, molecular genetics, and biophysics at one extreme and education of deaf children and language development at the other. The emphasis in this review is on work in areas directly related to acoustics as evidenced by publications in JASA, but the existence of research efforts in these other areas certainly contributed to the success of the portions of the research program described here and to the impact of the research program as a whole.
Brookhouser himself made important contributions to academic otolaryngology, but the BTNRH was not in a position to recruit many academically oriented physicians because it lacked the caseload and residency programs found in large academic medical centers. And although the research program was heavily focused on hearing for many years, it has recently expanded into language disorders, functional magnetic resonance imaging (fMRI) studies of neurobehavioral development, and related areas.
Translational Research
Most of the laboratory directors recruited in the initial years came from basic research backgrounds and continued to pursue work in those areas at the BTNRH. At that time, NIH and National Science Foundation (NSF) grant-review panels funded more basic research than clinically oriented research and there was less interest nationally in what is now called translational research that extends laboratory work to the clinic. That was a major goal of the BTNRH, however; so in that sense, we were ahead of the times. Despite the institutional goal, it was difficult to bridge the gap between the research laboratories and the clinics, a problem confronted by many other research programs. Researchers and clinicians met to discuss interesting patients seen in the clinic, but there was little actual research collaboration. This changed in the early 1980s as a result of the recruitment of additional staff.
Turnover in the audiology clinic in 1981 resulted in recruitment of two recent graduates of the University of Iowa (Iowa City), Pat Stelmachowicz as coordinator of audiology and Michael Gorga as head of a human sensory physiology laboratory, with the responsibility for clinical evoked-potential testing as well as research. Stephen Neely joined the research program in 1982 as head of the communication engineering laboratory, the position initially held by Richard Lippmann. Neely had developed the first model of cochlear mechanics that included active elements. Donna Neff joined the research program in 1983. Mary Pat Moeller came to the BTNRH as a master’s level clinician in 1978 but became involved in research in the early 1980s and later received a PhD from the University of Nebraska-Lincoln. In 1994, she became director of our speech, language, and aural habilitation programs, where she provided strong research leadership for these clinical programs. This core group of Jesteadt, Stelmachowicz, Gorga, Neely, Neff, and Moeller remained at the BTNRH for their entire research careers and along with Douglas Keefe, a late arrival in 1995, formed the backbone of the hearing research program.
Examples of Significant Research Contributions
The BTNRH research program has been broad from its inception and has made important contributions in many areas. Download the full report to view research examples and references here.
We attribute this insight to Walt Jesteadt
