Five ways ‘Sound of Metal’ is misleading: Interview with Dr Dalia Tsimpida

Sound of Metal was released to rave reviews from critics and audiences alike. It scores 97% ratings on Rotten Tomatoes, 90% from audiences and was described as ‘astonishing’ and ‘sublime’ by Mark Kermode in his 5* review to the Guardian. The film has since scooped multiple industry prizes including two Oscars and a BAFTA Award. The plot centres on Ruben (Riz Ahmed), a drummer in an avant-metal band called Blackgammon and his partner Lou (Olivia Cooke) who is also the band’s guitarist and singer. The opening of the film focuses on their touring lifestyle, immersing us in the loud fog of their gigs and the quiet mornings spent in their RV. Then, quite suddenly, we step with Ruben into his hearing loss. The film’s sound editing allows us to experience the muffled noises that the character is hearing and to understand his stress and frustration as he tries to clear his sinuses, hopeful that this is just a temporary problem. This is the jumping-off point for the rest of the story, which follows Ruben as he tries to adjust to life without sound.

I loved Sound of Metal. The performances were convincing, the sound editing created an immersive experience and the plot was gripping. It is rare for films on disability to break through, so it was also a welcome change to Prime’s usual offerings. I did have some questions, though: aspects of the film that jarred and didn’t ring true to my experience as a healthcare professional and a psychologist. To explore these queries with someone who really knows about this stuff, I reached out to Dr Dalia Tsimpida. Dr Tsimpida is a Chartered Psychologist and postdoctoral researcher at the University of Manchester who is an expert in audiology and health policy. She is currently leading the PLACE study into hearing loss prevalence in the UK, and has previously published several studies in this area. Dr Tsimpida became interested in hearing loss through her previous occupation as an Aircraft Weapons Technician. During her work, she and her colleagues were exposed to high levels of noise but many chose not to protect their hearing, with some experiencing significant hearing loss at an early age. When I spoke with her, Dr Tsimpida was highly sceptical about Sound of Metal, highlighting five misleading inaccuracies in its portrayal:

  1. Hearing loss is usually gradual, not sudden like Ruben’s.

“Hearing loss nearly always develops gradually and people don’t see it as a dramatic health problem” Dr Tsimpida explained. “In fact, on average people persevere with declining hearing for approximately 10 years before they seek help and take up a hearing aid.” Dr Tsimpida also highlighted that it is usually specific pitches or frequencies which are lost before loudness or decibels become a concern. “This harder to detect yourself” she said, “because the frequencies unaffected in the range of the average human speech (see image below) appear pure and clear”.

  1. Sudden hearing loss would not result from over-exposure to loud noise.

“In the film, there is no explanation of what caused Reuben’s hearing loss” Dr Tsimpida observed, “and the cumulative effect of several risk factors such as noise exposure wouldn’t lead to a sudden hearing loss like this.” Dr Tsimpida instead suggested that hearing deterioration is a lifelong process. A hearing loss event such as the one shown in the film would be considered an acute “emergency”, and would most likely have a specific and identifiable cause.

  1. Hearing loss diagnoses do not occur on the spot.

In Sound of Metal, Ruben goes to a pharmacist who immediately refers him to an audiologist who then diagnoses him and gives him a long-term prognosis, all within the same day. “This doesn’t happen. It’s so misleading” Dr Tsimpida said. “It takes a lot of time for the problem even to be acknowledged and identified. This usually happens in primary care, and then there’s a referral to secondary care. It takes some months for sure. Then, after an intervention such as a hearing aid, there are follow ups with the audiologist, to ensure that the hearing aids are working at the right levels by completing real ear measurements”.

  1. Support for hearing loss is easy to access and doesn’t involve living in a commune.

In the film, we see Ruben drive out to an isolated spot in the countryside where he joins a commune-style community for the deaf. The purpose of the community is about supporting deaf people and integrating those with new hearing loss into the Deaf community. “I am not aware of any communities like this”, Dr Tsimpida responded. “There are communities known as ‘Deaf Clubs’ but these do not operate as communes and are primarily made up of people who are born deaf and who communicate with Sign Language. They are not designed to accept people who have suddenly become deaf and need supporting.” Dr Tsimpida was also concerned that this portrayal would detract from the wealth of support that is available in the general community. She said, “For example, the National Association for Deafened People in the UK is a hard of hearing community which brings together people with different levels of hearing loss and different communication needs. Members learn of different support available, such as lip-speaking, sign supported language, speech to text reporting (real time captioning) and assistive listening devices such as hearing aids and cochlear implants, whatever works for them.”

  1. People are extensively prepared and supported for receiving a Cochlear Implant

Sound of Metal shows Ruben waking up from his Cochlear Implant operation, apparently unaware that it involved the by-passing of his ear canal and surprised by his total deafness. He then seemed further surprised when the implant was activated and he couldn’t immediately understand the sounds he was hearing. “In reality, there is a whole process before someone gets a Cochlear Implant” Dr Tsimpida explained. “They meet with other Cochlear Implant users and learn from them what will happen. The Hearing Loss Association of America has also responded to this in their statement. Afterwards, there is activity therapy and psychological therapy to help individuals to gradually become used to it. It’s not like going to the dentist!!”

Despite all this, Dr Tsimpida suggested there was one surprisingly accurate aspect of Sound of Metal. This was its portrayal of a strong ideological difference between Deaf communities and the use of Cochlear Implants, which I thought must have been exaggerated. “Yes, this can happen” she said. “Being a member of Deaf Communities means rejecting the view that deafness is an impairment. They have their own language and they do not feel that they lack anything. They do not feel they need to be fixed. They can even be offended by people who think that their cultural identity is not enough, and that they should rehabilitate their hearing.” In fact, Dr Tsimpida thought that Joe’s (Paul Raci) polite rejection of Ruben following his Cochlear Implant operation is an accurate representation of the reality.

Unsurprisingly, overall, Dr Tsimpida said she was disappointed with the film. “They approached the topic in a black and white way – he had to join either the Deaf community or receive a Cochlear Implant – and both sides were presented inaccurately.”

Primarily, Dr Tsimpida felt the film was a wasted opportunity to highlight truths about hearing loss and to tell people how they can protect their hearing. “There is a stigma that hearing loss is something that happens only to older people. However, my research suggests that hearing loss is closely related to lifestyle, rather than just age.  Hearing loss is largely preventable while young and it can also be increased by unhealthy lifestyles like poor diet, smoking, and chronic exposure to high intensity sound. The World Health Organization currently estimates that over 1 billion young people are at risk of hearing loss due to unsafe personal use of portable music devices! I would have liked the film to recommend things that young people could do to prevent their health.”

How to start a journal and beat the academic publishing racket

Academic publishing is a multi-billion pound industry, with profit margins reportedly higher than those of Apple, Google and Amazon. It has always struck me as a racket: academics sign over their work to private businesses for free, and then their universities pay the same businesses hefty fees in order to read what they publish. Academics are also responsible for editing these journals and providing the peer-reviews, usually for free.

It hasn’t always been this way. In a remarkable brief history of the academic publishing industry, Stephen Buranyi highlights the key role of Robert Maxwell, a brash business tycoon whose greatest desire was to “be a millionaire”. Maxwell arrived on the scene just after the Second World War, which was a key turning point in academic history. The post-war years saw a huge growth in the number of people attending higher education and also in the academic publishing trade. In 1950, there were 10,000 journals published worldwide, but by 1980, this was had reached 62,000. Robert Maxwell and other businessmen capitalised on this growth and took the opportunity to privatise what had previously been a largely non-profit sector. There is now growing awareness that this industry is both ludicrous and detrimental, unwieldily costly and harmful to the progression of science. However, solutions are slow in coming. While open-access journals are growing, the majority of these charge fees for publication that far outstrip real costs. For these reasons, I have been intrigued and encouraged to see the development of peer-reviewed open access journals which do not charge authors to publish with them. These include Musicology Research Journal (MRJ), whose Chief Editor is Dr James Williams, Senior Lecturer at the University of Derby, and Psychreg Journal of Psychology (PJP), whose Chief Editor is Dennis Relojo-Howell, founder of leading psychology blog Psychreg. These journals offer a solution that previously would have been regarded as impossible: they are both free to the authors and free to readers. I spoke to Williams and Relojo-Howell to understand more about their journals.

Why start a peer-reviewed academic journal?

As both Williams and Relojo-Howell attested, self-publishing an academic journal is a significant amount of work. So why do it? Williams said his motivation arose from his experience as a PhD Student and early career researcher. “Acceptance of manuscripts in current musicology-based journals can sometimes feel a little elitist. Editors and traditional publishers prefer to go with already-known academics, and are less likely to take on manuscripts from early-career scholars”. Williams also described his dissatisfaction with the traditional academic publishing industry, and its money-oriented focus. MRJ meets this gap by focusing on publishing the work of early career researchers, and by managing all copy-editing and manuscript management in-house. Relojo-Howell’s motivation was different. As a psychology blog editor, he had begun to receive blog post submissions that were overly long and technical. These posts weren’t suitable for publication as blog posts, but he could see their importance and academic merit. He created the journal to provide an outlet for these articles, and to broaden the overall scope of Psychreg. 

Ten steps for starting a journal

Whatever the focus of your journal, the steps for setting one up are similar.

  1. Identify the gap. What is the need your journal will meet? How will it improve information sharing in your field? Once you’ve identified this gap, you need to set the scope of your journal. Decide which types of articles you will include, and those you won’t.journal website
  2. Build a website that will home your journal. A full description of this process is beyond the capacity of this article (and my expertise!) but the key parts of this are to buy a domain name, find a web hosting company and then prepare the content within this. Popular web-creation platforms are, and Relojo-Howell suggested that it’s also worth looking into the Public Knowledge Project: this provides Open Journal Systems (OJS), federally funded software designed to support the set up and management of open access journals.
  3. Set up an editorial board. Both Williams and Relojo-Howell highlighted the importance of this. First, this group can provide the strategic direction and support that can get your journal started and help it grow. Second, this group can provide credibility to the project. As Relojo-Howell said, “When I started, potential contributors were only interested in who was on the editorial board. I have never been asked about the journal’s impact factor”.
  4. Involve associate editors who can provide support. Williams described the importance of including a multi-skilled team. “We have editors with different areas of expertise and varying skillsets, including people who are familiar with copy-editing and academic publishing”.
  5. Call for papers. You can spread the word about your new journal via social media, personal networks and by contacting other relevant university departments. Neither Williams nor Relojo-Howell had found this aspect challenging. As Williams said, “We have only ever advertised the journal in the UK, but we have received submissions from Australia, Canada, the USA and Asia”.academic publishing
  6. Manage your submissions. Traditional journals use manuscript-management software, but this comes with a steep price tag. “I contacted Emerald about their systems”, Relojo-Howell said, “but they asked for £38k”. Open Journal Systems (OJS) provides an alternative, free-to-use alternative, but this isn’t necessary. “I use a spread-sheet to keep on top of submissions”, Williams said. “It works fine”.
  7. Copy-edit and type-set your articles. While this may feel like a challenge, both Williams and Relojo-Howell said it was possible to do using widely available software. Williams said that he uses Word and Adobe programs to provide a professional-looking finish to his articles. Relojo-Howell commented on the fonts he uses: “I use a combination of paid-for fonts and some free Google fonts”.
  8. Apply for an International Standard Serial Number (ISSN). For us in the UK, this involves submitting an application to the British Library. Williams suggested that the British Library will expect to see evidence of around 3-4 previous publications and a commitment to continue publishing on a regular basis.
  9. Plan how to give your articles a Digital Object Identifier (DOI). DOIs are a string of numbers, letters and symbols used to permanently identify an article of document and link it to the web. Relojo-Howell recommends using Zenodo for this purpose. Initially funded by EU project funding, Zenodo is now open to all research outputs and offers its services free of charge for open access publishers.
  10. Wider registration. There are a variety of international platforms with which to register journals, including Web of Science, PubMed and SCOPUS. This type of registration seems to be a longer term process, however. Relojo-Howell said he had contacted both the Directory of Open Access Journals (DOAJ) and Thomson-Reuters, but they indicated that they would expect journals to be up and running for closer to five years before they would register them.

Other considerations

  • Finding peer-reviewers. My colleagues who edit traditional journals have described to me the challenges of finding peer-reviewers. While Williams and Relojo-Howell suggested this could also be challenging with new, open access journals, Williams suggested a personal touch could help support a positive response rate. “We approach academics who are working closely in the field of the article, and send personal requests. 60 or 70 per cent of the time, they agree”.
  • Clarify that you are a genuine academic ground-roots initiative. Unfortunately, at the same time that the genuine open-access field is growing, the number of predatory journals is proliferating at great speed. In a previous post, I clarify the warning signs of academic spam emails. However, if your potential contributors are concerned, let them know that the first clear distinction is that predatory journals ask for large sums of money and usually offer to rush through submissions at great speed. The second clear distinction is your academic board. You can signpost potential contributors to contact your board members for reassurances, if they are concerned.

Is it worth it?

Both Williams and Relojo-Howell admitted that their journals were time consuming and offered no financial benefits. However, what is clear is that starting these journals offers significant job satisfaction. As Williams said, “I saw it as a real problem – I wanted to help other graduating PhD music students… I don’t think I have reaped any rewards for myself, but I do know a lot of people now. It’s great for networking”. Similarly, for Relojo-Howell, the reward lies in contributing towards open science: “I wanted to demonstrate that dissemination of science can be reconstructed to become more democratic – a science that is shared for wider consumption”.

Seven ways to spot academic spam

This week I read an editorial by Becker and colleagues (2019) which warned against the dangers of “online solicited content journals”. These predatory journals use academic spam emails to elicit contributions from researchers and are fast becoming the dark shadow of the academic publishing industry. While academic publishing is notoriously lucrative, the impact of this has generally been to hold science back, rather than to promote misleading findings. High profile cases of academic misinformation have been thankfully rare, supporting continued public trust in academics. However, Becker and colleagues warn that solicited content journals threaten this. For a fee, these journals offer authors the opportunity to have their work published within weeks; a stark contrast to the months-long, soul-searchingly slow process inherent to most standard academic journals. These journals often purport to be peer-reviewed but the quality of this is highly questionable. Becker and colleagues suggest that authors could be tempted to submit to these predatory journals by the offer of a fast publishing process. They warn that circumventing peer-review risks introducing misinformation to the academic publication process.

However, the biggest problem, I believe, is confusion. These journals approach researchers as soon as they have a single academic publication, presumably lifting their email addresses from the author contact details of published papers. For a new or lay researcher, their invitations can be very confusing. Furthermore, these emails appear to be becoming more sophisticated in their approach. They are not restricted to eliciting journal submissions, either: I now receive about as many spam emails requesting my ‘gracious presence’ at various conferences. Below I offer seven tips for distinguishing academic spam from genuine invitations:

  1. Avoid all invitations that look like a mail shot. Watch out for signs that the email could have been completed with mail-merge software. If your name is back to front (Dear Johnson Judith), your co-authors are also listed, an email address is used in place of your name or a title of one your papers is pasted in its entirety, it is probably not genuine. 
  2. If the invitation requires you to follow a link, it is most likely spam. Any personal invitations to contribute a paper, chapter or conference submission will ask you to respond to the person who emailed you.
  3. Do not agree to read receipts from unknown contacts. Read receipts are usually requested when something is urgent or otherwise a priority. I have never received a genuine invitation to submit a paper, chapter or talk which requested a read receipt.
  4. Don’t be fooled by flattery. If I receive any email that begins, ‘Dear eminent professor’, I delete it. This person clearly does not know me. Spam emails are usually both overly enthusiastic (think, ‘greetings for the day!’) and overly complimentary.
  5. If it sounds too good to be true, it probably is. If they’re offering some limited time, cut price deal on article publishing fees, what they are offering you is not worth any fee. Similarly, if the conference they’re inviting you to is in Valencia, Hawaii or Phuket, be sceptical. I’ve yet to receive an academic spam email inviting me to speak in Birmingham. 
  6. If an unknown contact asks you a stupid question, bin the email. The most sophisticated academic spam I’ve received yet asked me for the contact details of one of my high-profile collaborators. Although I was confused (she’s the first hit on google if you type in her name), I obliged with a response. Having enticed me into a conversation, the spammer then replied saying that my collaborator was hard to get hold of, but they’d be delighted if I could contribute to their journal.
  7. Do your own research on the spammer. Look up the journal you have been contacted about: does its website resemble those of bona fide journals? Who else has published in it? Which databases is it indexed with? Conferences can be even harder to figure out. However, most genuine academic conferences will be aligned with a university, professional organisation or healthcare organisation. In the absence of this, you can look up the conference’s history and their previous and present speakers. After all – the most important thing about any conference is the opportunity to meet with other researchers and professionals in your area.