Dyslexia’s hidden contours

Sally Shaywitz scores a hit with a scientific guide to diagnosing and treating reading disorders.

By Cathy Shufro

At least one child in five has dyslexia, a congenital “wiring glitch” in the brain that makes it hard to master what neuroscientist and behavioral pediatrician Sally E. Shaywitz, M.D., calls “the most elegant and complex of human abilities—learning to read.”

Dyslexia is an inherited problem that cuts across class, race and language, says Shaywitz, professor of pediatrics. Yet “significantly less than half” of American children with dyslexia are even identified. Shaywitz finds this frustrating because researchers have developed reliable diagnostic procedures and evidence-based instruction that, in young students, may even rewire the brain. “A huge gap, almost an abyss, separates what we know and what happens to people with reading problems,” she says.

Shaywitz has helped close that gap through her own research and clinical work and by writing about the science of reading and dyslexia. Her goal, she says, is “making a complex disorder understandable and treatable.” Five years in the writing, Overcoming Dyslexia: A New and Complete Science-Based Program for Reading Problems at Any Level (Alfred A. Knopf) has brought Shaywitz sustained national attention since its publication in spring 2003. Soon after, Time ran a cover story on the topic that featured Shaywitz prominently. A year later the book, a national bestseller that Publishers Weekly called “groundbreaking,” was in its 10th printing; it is also available on tape and CD.

Shaywitz became interested in reading disorders during her pediatrics residency at Albert Einstein College of Medicine in the late 1960s, when she first heard mothers despair because their seemingly bright children were foundering at school. Reading ability is falsely taken as a “proxy for intelligence,” says Shaywitz, and so children with dyslexia often feel stupid or ashamed. Shaywitz has heard many dyslexic adults recount “horrible memories of being asked to read aloud in class.”

And yet, paradoxically, Shaywitz finds that among people who are smart and creative, the “crème de la crème,” a seemingly disproportionate number have dyslexia—medical school professors among them. “I can tell you, a significant proportion of them have been in my office, with the door closed, telling me, ‘I must be the only one,’” says Shaywitz.

Graeme L. Hammond, M.D., professor of surgery (cardiothoracic), who has grappled with dyslexia since childhood, says he was gratified to see that the disorder was finally getting the attention of scientists and the public when he watched Shaywitz discussing dyslexia on The NewsHour with Jim Lehrer in 1998. In the epilogue of her book, Hammond joins well-known dyslexics, including novelist John Irving and financier Charles Schwab, in describing the toll it took. Hammond describes how dyslexia, like many other handicaps, helps develop different, perhaps latent, pathways such as perseverance and innovation to accomplish goals.

In her book, Shaywitz describes dyslexia as a phonological weakness. That is, readers with dyslexia have trouble translating letters on a page into sounds they represent. Although people with dyslexia do learn to read more accurately over time, they do not read rapidly or automatically. “What remains for people with dyslexia is how hard they have to work, how much effort they have to put in,” Shaywitz says.

The book also corrects several misconceptions. Writing letters backwards or transposing them is common among novice writers and doesn’t suggest dyslexia. And although schools identify three boys with dyslexia for every girl, researchers find no significant difference in the prevalence of reading disabilities in girls and boys. But boys get more attention—they tend to be more rambunctious—while many struggling girls go unnoticed and unidentified. The book includes checklists of signs of dyslexia and suggests which tests are effective for diagnosis. Tests for accuracy may miss dyslexia, especially in teenagers and adults; testing fluency is essential.

Shaywitz says educators have remained largely ignorant of the huge advances in understanding dyslexia. “The whole notion that there’s science or evidence hasn’t been part of the culture, so teachers haven’t been provided with the tools.” Furthermore, schools often provide only unproven, sporadic remediation for a chronic problem.

The book draws on a decade of laboratory research at Yale on differences in brain function between skillful and struggling readers. Shaywitz conducted those studies in partnership with her husband, Bennett A. Shaywitz, M.D., professor of pediatrics and neurology. (Both Shaywitzes are also on the Child Study Center faculty.) World-renowned leaders in the use of imaging to study reading, the Shaywitzes have discovered what they call “functional lesions” in the left occipitotemporal and parietotemporal regions (behind the left ear). These lesions correspond exactly with physical lesions in people who have lost the ability to read because of a stroke or brain tumor. They discovered this correspondence using functional magnetic resonance imaging, studying metabolism in the brain to show which parts of the brain readers use as they decode texts. YM

Bookshelf is a new column in Yale Medicine focusing on Yale authors and books of interest to the medical school community. Send ideas to Cathy Shufro at cathy.shufro@yale.edu.

Book notes

For My Next Act: Women Scripting Life After Fifty
by Karen Baar, M.P.H. ’81 (Rodale Press) Speaking partly from her own experience of a midlife divorce, Baar describes how women are examining their life experiences, taking a critical look forward and shaping plans for their futures.

Dermatology
by Jean L. Bolognia, M.D. ’80, HS ’84, professor of dermatology, Joseph L. Jorizzo and Ronald P. Rapini (Mosby) This two-volume reference set encompasses the current knowledge in the field. Covering adult and pediatric clinical dermatology and dermatologic surgery and therapy, it provides evidence-based support for therapeutic recommendations.

Abetting Madness: The Role of Illicit and Prescribed Drugs in Promoting Psychotic and Manic Disorders
by Malcolm B. Bowers Jr., M.D., HS ’65, professor emeritus of psychiatry (Xlibris Corporation) The author argues that vulnerability to major psychoses is related to genetic factors that may be set in motion by the use of prescribed stimulants and antidepressants as well as illegal drugs, including cannabis, cocaine and LSD. Bowers suggests an approach to the prevention of some psychotic disorders based on this hypothesis.

Hayots Badeevuh: Reminiscences of Armenian Life in New York City
by Levon Z. Boyajian, M.D. ’56, HS ’60 (Taderon Press) This narrative revolves around the Boyajian family and their circle of friends in Washington Heights, N.Y., in the aftermath of the Armenian genocide of 1915. Boyajian gives us a view of his life as a child and adolescent, recounting personal dramas and tragedies and anecdotes about his community through two world wars and the Depression.

Living Outside Mental Illness: Qualitative Studies of Recovery in Schizophrenia (Qualitative Studies in Psychology Series)
by Larry Davidson, Ph.D., associate professor of psychiatry (New York University Press) Davidson offers first-person narratives illuminating people’s experiences of schizophrenia and recovery. The author shows how listening to people diagnosed with schizophrenia can affect clinical practice and social policy.

Drugs 101: An Overview for Teens
by Margaret O. Hyde and John F. Setaro, M.D., HS ’86, associate professor of medicine (cardiology) (Twenty-First Century Books) This book provides teenagers with an overview of drugs and drug abuse, offering straightforward information about illicit drugs. The authors discuss the emotional, physical and psychological ramifications of drug use.

Investigative Pathways: Patterns and Stages in the Careers of Experimental Scientists
by the late Frederic Lawrence Holmes, Ph.D., former Avalon Professor of the History of Medicine (Yale University Press) Holmes, chair of the Section of the History of Medicine from 1979 to 2002, examines the careers of six pre-eminent scientists: Antoine-Laurent Lavoisier, Claude Bernard, Hans Krebs, Matthew Meselson, Franklin Stahl and Seymour Benzer. Holmes finds unifying themes as he explores the motivations for their research, how they asked questions and solved problems, and the breakthroughs they achieved.

Unexpected Odyssey: From Merchant Sailor to Hyperbaric Physician
by Eric P. Kindwall, M.D. ’60 (Best Publishing Company) Kindwall chronicles his varied career which has included not only studies at Yale and Harvard, but also submarine school, service in the merchant marines and the CIA and a professorship in hyperbaric medicine.

Pediatric Complaints and Diagnostic Dilemmas: A Case-Based Approach
by Samir S. Shah, M.D. ’98 and Stephen Ludwig, M.D. (Lippincott Williams & Wilkins) Through the exploration of 119 actual cases, the authors show how to recognize key diagnostic patterns for more accurate evaluation of pediatric illness and injury.

George Beadle, An Uncommon Farmer: The Emergence of Genetics in the 20th Century
by Paul Berg and Maxine F. Singer, Ph.D. ’57 (Cold Spring Harbor Laboratory Press) The authors provide a biography of the Nobel Prize-winning “giant of genetics” and president of the University of Chicago. Beadle’s work from 1940 to 1960 marked the transition from classical genetics to the molecular era.

Carlos Montezuma, M.D., A Yavapai American Hero: The Life and Times of an American Indian, 1866-1923
by Leon Speroff, M.D., HS ’66 (Arnica Publishing) This book documents the life of one of the first Native American physicians. A Yavapai Indian, Montezuma was taken in the 1870s from his family as a boy by Pima Indian warriors, who sold him to an itinerant photographer. He ended up in Chicago, where he took advantage of unexpected educational and social opportunities, ultimately becoming a doctor and championing his tribe’s land and water rights.

The descriptions are based on information from the publishers.

Send notices of new books by alumni and faculty to Cheryl Violante, Yale Medicine, P.O. Box 7612, New Haven, CT 06519-0612, or via e-mail to cheryl.violante@yale.edu.

In Circulation

Medical library makes the transition from print to electronic journals

These days a physician reading a medical journal is as likely to be peering at a monitor as paging through a magazine. Nonetheless, Yale medical librarian Daniel Dollar, M.L.S., says libraries are still in the “horseless-carriage days” when it comes to making the switch from paper to pixels.

For instance, librarians still distinguish between an “online journal” and a “journal.” “One day we’ll call them all journals,” says Dollar, digital resources librarian at the Harvey Cushing/John Hay Whitney Medical Library.

Not that physicians and researchers are still riding horses. One service that links citations to full-text articles tracked nearly 190,000 electronic requests for articles at Yale in 2003. That figure represents only “the tip of the iceberg,” Dollar says, because articles can also be downloaded from a journal site; through library subscription services, such as MDConsult; through the library’s online catalog; or through its listing of e-journals. The library subscribes to 3,300 medical journals online and 2,300 in print. Most of those titles overlap, but some journals are available in only one form or the other.

Electronic journals add to the library’s costs, for two reasons. First, the library generally pays a surcharge of 5 to 15 percent to add electronic access to a journal that the library already carries in printed form. Second, many readers who once paid for their own copies of journals now rely on electronic access and have dropped their subscriptions. In response, publishers are charging libraries more. “There’s a reallocation of funds,” says Dollar. “We have titles that have gone from a few hundred dollars to several thousand dollars.”

Online journals have many advantages, Dollar says; they take up no shelf space and are accessible remotely. “Folks in the hospital don’t have to run over here to get a full text of an article,” says Dollar. And online articles sometimes include raw data not offered in print. But print articles also have their virtues: they may have better graphics, the ads they contain keep subscription costs down, and the reader’s ability to page through an entire issue may lead to serendipitous discoveries.

By far the greatest advantage of print journals is that it’s obvious how to archive them: simply bind and save them. It’s not nearly as clear how to archive electronic journals. Who should be responsible? Libraries? Publishers? If an electronic journal ceases publication, what happens to its archives?

To grapple with these questions, Yale has joined a Stanford University-based consortium of publishers and libraries called LOCKSS (“Lots of Copies Keep Stuff Safe”).

“We’re in transition,” says Dollar. “It’s exciting, because we get to reinvent ourselves. But it’s a time-consuming process, and we may stumble along the way. … Essentially we’re taking the library and putting it on a desktop.”

—Cathy Shufro

In Circulation is a new column focusing on Yale’s Cushing/Whitney Medical Library.



Mootha		Barry



Agre		Andrews

On campus

Merging data sets to fight human disease

The sequencing of the human genome has spawned a wealth of knowledge, much of it now available online. According to Vamsi K. Mootha, M.D., a postdoctoral fellow at the Broad Institute in Cambridge, Mass., this is making possible new approaches to medical research. “The real challenge,” Mootha said in a talk sponsored by the Department of Genetics in March, “will be to integrate these data sets with each other as well as with what we know from the previous literature.”

As an example, Mootha described his participation on an international team that sought the gene mutation responsible for Leigh syndrome, a fatal metabolic disorder that is prevalent in a region of French Quebec. The team had first determined that the culprit gene was one of 30 on chromosome 2. “The critical feature of the disease suggested that there might be a mitochondrial pathology,” Mootha said. Using this clue, the team analyzed RNA data sets and a map of mitochondrial peptides to home in on their target. “Using relatively freely available data we were able to identify the candidate gene,” Mootha said.

—John Curtis

Biomedical research for the world’s neediest

In 1990 a drug called eflornithine came on the market to treat African sleeping sickness. But a drug marketed to impoverished Africans would never turn a profit, so in 2000 it was adapted for another, less urgent, use—removing facial hair. Then, said Michele Barry, M.D., HS ’77, an international campaign by groups such as Médecins Sans Frontières (MSF) shamed the drug company into restoring the drug’s original mission of treating sleeping sickness.

Only 10 percent of worldwide biomedical research spending is devoted to diseases that afflict 90 percent of the world’s people, Barry told a March meeting of the Justice and the Allocation of Health Care group, a seminar series organized by the Interdisciplinary Bioethics Project. Barry, a professor of medicine and public health and director of the Office of International Health, says MSF has formed an international partnership to develop medicine for three very neglected diseases that infect millions of people around the world—Chagas disease, African sleeping sickness and leishmaniasis. The partnership, the Drugs for Neglected Diseases Initiative, hopes to have as many as seven drugs available within 12 years. Barry, president of the American Society of Tropical Medicine and Hygiene, has coordinated her society’s cooperation toward achieving this goal.

—J.C.

Stumbling across water channels, and a Nobel Prize

In two talks on campus in March Peter C. Agre, M.D., noted with amusement that when he was applying to medical schools, Yale turned him down. And, in an equally self-effacing vein, when he described the work that won him a share of the 2003 Nobel Prize in chemistry, he attributed it to “blind luck.”

Agre, a professor of medicine and biological chemistry at Johns Hopkins University School of Medicine, described his groundbreaking research in similar terms at the 12th annual Robert W. Berliner Memorial Lecture and at the 56th annual meeting of the Associates of the Cushing/ Whitney Medical Library. “We weren’t even looking for water channels,” he said of his discovery that explained how water crosses biological membranes. Agre was studying Rh blood group antigens and became curious about a mysterious protein that kept turning up in his experiments. He detoured from his original research and identified the first of a family of water channel proteins, which he dubbed aquaporins.

“It’s sort of like driving in a remote part of Vermont and coming upon a city of 200,000 people that’s not on the map,” he said.

—J.C.

With acupuncture, an integrated view of the body

Acupuncture entered the American consciousness in 1972, when a journalist on President Nixon’s trip to China fell ill with appendicitis. Soon after, an account of acupuncture’s relief of his postoperative pain and swelling was in the news.

Early in the 20th century, however, acupuncture was seen, even in China, as a folk remedy. In a talk in March sponsored by Colloquia, Workshops and Lectures in History of Medicine and Science, Bridie J. Andrews, Ph.D., assistant professor of the history of science at Harvard, said it took a young Chinese doctor to make it acceptable. In the 1920s Cheng Dan’an turned to acupuncture to treat his own back injury, for which the Western medicine he admired could only prescribe opiates. Intrigued by the success of the treatment, he applied his knowledge of anatomy to acupuncture and in 1932 published a book showing new acupuncture points. In 1993 magnetic resonance imaging suggested that certain biochemical pathways are affected by acupuncture. “Biomedical research into acupuncture,” Andrews said, “is producing a much more integrated view of body function, which is something that biomedicine has been striving for for some time.”

—J.C.


			Originally published in Yale Medicine, Summer 2004. Copyright © 2004 Yale University School of Medicine. All rights reserved.