Stop Trying to Sell Hearing Aids and Get Busy Guiding Consumers with Hearing Difficulties to Action



Author: Terry Mactaggert

Six years ago, I wrote an article, published in Audiology Practices, arguing that significant change should be anticipated in the hearing health marketplace. A combination of new technologies, major demographic trends, and emerging consumer attitudes towards their well-being basically guaranteed that development. Disruption of the traditional business model would occur as a result of those forces as well as the immense opportunity of unfulfilled demand perceived to be available by many outsiders, some of whom already had had millions of customers. The article went on to describe in more detail the new, less expensive devices that would be marketed, the additional channels that would make them available as well as the Internet becoming the major communication source for persons seeking help with their hearing and communication. Since then, I have written several blog posts describing this inevitability in more detail. Since these posts, more than a year ago, several key questions remain: How far-reaching will this disruption become? How will the industry adapt?

Let’s address these questions. The Direct to Consumer (DTC) revolution for hearing instruments is underway and gaining traction. The U.S. Food & Drug Administration (FDA) mandate to specify the terms under which the new class of over-the-counter listening devices will become available will, of course, be a game changer. There is already plenty of evidence that such devices are available at retail and via the Internet.

Turning, potentially tipping, points like this have affected many industries and the variety of responses is instructive. Some enterprises have been sluggish and ended up disappearing. Others have been more agile and adaptive, changing their proposition and continuing to thrive. Whether the hearing aid segment of the hearing health landscape remains dominated over time by relatively few players is open to question. There is little doubt that others, in some cases, with much larger scale and far greater reach, will enter the arena.

This juncture creates an opportunity to consider deeply what should happen (a values question) as well as the size of the stakes (an economic question). We have argued for some time that hearing loss is the largest untreated chronic health condition in our society, and that the numbers typically quoted–37 million plus in the United States–are significantly understated (NIH, 2016). For example, a recent study (Sawyer, et al 2020) from the United Kingdom (UK) found that 40% of adults between the ages of 50 and 89 years have a measured hearing loss, but do not report any difficulty with their hearing (Sawyer et al 2020). These figures, from the US and UK, indicate hearing loss and its long-term consequences are not taken serious by the public. Indeed, data collected by my company, Summus Hearing Solutions, supports this fact: The public is generally unaware of the debilitating effects of hearing loss.

Regardless of the precise number, there is no question that many more individuals are left out of the assessment and treatment process than are accommodated by it. And, given what we now know about the hazards of ignoring hearing loss and the problems of late diagnosis, that abandonment (a word deliberately chosen to underscore my point) should be considered unacceptable. As practitioners with the most experience in dealing with hearing issues, audiologists should be cultivating ways to overcome this indifferent, “so many on the sidelines” conundrum.

Why not begin by thinking boldly? Assume there are at least seventy million people in the U.S. and Canada with self-perceived communication difficulties and/or varying degrees of permanent hearing loss - sensorineural patterns within the normal range through profound degree of hearing loss. How might they be tested and empowered to take control of their hearing health?

Too often, the industry starts with a solution - a device, usually with a number of services bundled with it. Compare that with what the contemporary consumer wants: An accessible, reliable and private way of measuring their hearing. When it comes to other types of self-assessment, however, most of us have become suspicious of providing personal information before the need is evident and the service provider is trusted.

A credible self-screening tool must not only be easy to use and reliable, but audiologically valid – that is, the consumer is informed about his or her hearing status and the implications for any next steps that are warranted. Some of the basics include establishing the interpreted result as a baseline, informing one’s family physician and maintaining a vigilant stance for the future.

Finally, to the extent that a product or service could be helpful, such advice can then be offered. A minority (our data sets indicate that an average of 30% of those 45 years of age or older) will test with a sensorineural hearing loss, the more advanced of whom (including many “mild” and “moderate”) should consider a remedial device, such as a quality PSAP or starter hearing aid and many of those are becoming aware of some degree of hearing change. Another 15%-20% will have indications of a conductive change where, if the condition is persistent, their pharmacist and doctor are obvious sources of medical support. Most will display normal patterns and levels where coaching about frequent updating is appropriate.
Figure 1: The help seeking journey for the person with hearing difficulties in Medicine 3.0


Figure 1 describes the paradigm of test → interpretation → implications for action → potential solutions. It is the essence of Health Tech and personalized medicine and represents an enormous shift towards Medicine 3.0. For those unfamiliar with the term, Medicine 3.0, it is a health-related extension of the concept of Web 3.0 whereby the users’ interface with the data and information available on the web is personalized to optimize their experience. A primary goal of Medicine 3.0 is to use consumer technology, such as social media and smartphone-enabled apps, to actively engage persons with hearing difficulties in their ability to self-direct their own care.

The meta issue, directly related to the application of Medicine 3.0 within the profession of audiology, can be stated quite simply: How can tens of millions more consumers become engaged in the hearing health process? There is not one answer, but rather a constellation of related steps involving a number of players and technologies. The outcomes remain speculative as the process, by definition, will be incremental with learning and adjustments required at each step.

A good starting point is to ensure that the overriding message is consumer, rather than product oriented – focused on how to create value by providing timely information, education and guidance rather than a “fix” via a hearing device. Sensorineural changes can begin at birth or be acquired at a relatively young age (particularly now with the “gaming and earbuds generation”) rather than suddenly appearing at age 60 or older. Even when exacerbated by noise, ototoxic medications and/or one or more disease states, such changes usually worsen gradually. Pattern recognition algorithmic routines can detect early changes within the normal range thereby identifying younger a well as older people that are entering their “hearing journey”. The cohort of those who should be concerned about their hearing sensitivity is very broad and will benefit from early identification. We do this with sight and blood pressure; why not hearing?

We have found a receptive audience among this much larger target group. When testing is provided in an accessible, efficient, and private fashion with no strings attached, most people regardless of their age, are interested in participating. This receptive audience is prepared to take guidance, providing it is well explained and not biased towards a particular solution. When adequately prompted, there is often an appreciation of the widespread nature of the problem. Those with signs of hearing loss appreciate they are in good company – there is nothing unusual or abnormal about acknowledging and dealing with the condition.

Another key involves recognizing that the industry as it stands now cannot alone solve the problem of poor uptake of treatment options and lack of awareness that hearing loss is a consequential problem, if left untreated. Even if concerted action was taken by every audiologist and hearing instrument specialist, the proportion of those impacted would fall well short. Natural biases and business-traditional imperatives, among many, and the dominant brick-and-mortar distribution infrastructure, with limited reliance on the Internet, assures that the problem of poor uptake and lack of awareness among most of the population will remain unresolved. Adding thousands of family physicians and pharmacists would clearly help, although a continuing campaign with enough incentives would need to be created to sustain their efforts. Existing hearing health providers will need to evolve and receive help from other healthcare professions if the goal of greater awareness among the public is to be entertained.

Reducing regulations and creating an environment where individuals are empowered to seek knowledge as well as what next steps make sense is vital. The industry, with more of a 21st century face, can provide an important part of that engine, providing much greater reliance on the Internet is assumed. Adoption of hearing health as a priority by governments and public health agencies is also essential. Greater testing of school-age children, for example, with educational extensions for parents about their child’s and their own well being would be additive. Leveraging corporations and their insurers is also part of the mix. The influence of new players, those offering less expansive hearing devices and including at least a few of the FAMGA (Facebook, Apple, Microsoft, Google, Amazon) technology group, each with a stake in healthcare can be enormous, as well.

Some of these drivers are already underway, although most are motivated by appeals to their audiences or members to acquire product. Whether the net effect is to turn on or off most consumers, receiving these messages remains to be seen. What is certain is that awareness of hearing and hearing health issues is increasing and will likely continue to do so.

Making it simple for consumers to test themselves reliably and follow the Health Tech process to a logical conclusion is also a requirement. There are many tests available, most via the internet, beyond those provided by in-house by industry professionals. Many of the protocols followed are of dubious quality and almost none, if any at all, offer reliable interpretation. The presence of “Click-Bait” (i.e. You’ve been tested and need a (expensive) hearing aid!) is all too evident, even with some of those that offer “professional” intervention along the way.

What is needed is a simple application widely available on the Internet via thousands of websites that can be accessed with a browser or QR code, using any connected device, any time from anywhere, particularly from home. Such a medium would provide an interpreted test and explanatory report for the user at a minimal, if any, cost. A further comfort would be the assurance that personal information required to report would not be stored, much less shared, unless the user wished it to be for follow-up evaluation or support. We can anticipate such an innovation to become available soon.

So, what else might we do short of letting market forces alone confront the problem as important as those forces can be?

The industry itself can provide part of the solution. Adopting more of a counselling stance (and likely charging for it), partnering with physicians and pharmacies, and using the Internet to a much greater extent to extend reach are all part of the equation. So is offering more devices at a wider range of prices as is unbundling and making related services transparent to clientele.    
Terry Mactaggart is the President and CEO of Ultimate Kiosk Inc. and Summus Hearing Solutions Inc., AI-enabled software companies with proprietary technologies aimed at capitalizing on opportunities in international hearing health. He has substantial experience with private venture creation, financing and growth as an investor, consultant, director, chairman and president of a number of companies – both privately owned and publicly traded – as well as of a private equity fund. A broad international perspective has been gained from these activities as well as from his leadership of The Niagara Institute and his time with the World Bank. Terry has a BA (Political Science and Economics) from the University of Toronto and an MBA from Stanford University. He can ne reached at terry.mactaggart@bell.net.
References
National Institutes of Health Quick Facts About Hearing. December, 15 2016. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing. Downloaded February 25, 2020.

Sawyers, C, et al (2020) Biopsychological classification of hearing health seeking in adults aged over 50 years in England. Ear and Hearing. Published-ahead-of-print.