The Report…
I finally forced myself to read the PCAST report on assistive hearing devices that was released last week. Given how grumpy I was about the video summary of the study which I discussed in my last column, I knew it was going to be a difficult read – and I was right. It’s hard to know where to begin and it’s also hard to know how an expert panel could get so much wrong.
After reading a report published by the Consumer Electronics Association (CEA 2014 Personal Sound Amplification Products (PSAPS): A Study of Consumer Attitudes and Behavior), it became clear that the PCAST recommendations mirror those of CEA.
CEA is a member organization representing more than 2,000 consumer electronics companies who develop, manufacture and distribute audio, video and mobile electronics products and include many of the manufacturers of PSAPS. According to its website, CEA’s mission is to “grow the consumer electronics industry” and to influence Congress as well as federal and state agencies to protect the business interests of its member companies.
The Recommendations
Both PCAST and CEA consider PSAPS a suitable and inexpensive alternative to hearing aids for individuals with mild to moderate hearing loss (PCAST). The President’s Committee managed to both emphasize the tragic consequences of untreated hearing loss while simultaneously minimizing any concerns that inappropriately fit devices could cause any damage to the user. PCAST states:
“Untreated hearing loss is statistically associated with higher risks of social isolation; depression; dementia; falls with injury; and inability to work, travel, or be physically active,” but then insists that “for hearing aids needed for age-related hearing loss, however, an inherent failure of the product to perform does not provide an increased health risk to the user.” How can both statements be accurate?
There is no clear definition of what constitutes a “mild to moderate” hearing loss, nor is there any recognition of the variability in overall communication function of individuals with certain patterns of hearing loss. Self-test items generally consist of pure tone stimuli with no provisions for testing speech recognition abilities.
The Eye Thing
The PCAST report makes repeated comparisons between vision disorders and hearing disorders and between eyeglasses and hearing aids with no recognition that the vision and hearing disorders and their treatment bear no resemblance to each other.
PCAST recommends that the FTC “should require audiologists who perform standard diagnostic hearing tests and hearing aid fittings to provide the customer with a copy of their audiogram” as well as something called the “programmable audio profile”.
Audiologists are already required by law to provide copies of test results to patients; secondly, there is no such thing as a prescription for a hearing aid.
They recommend that the President work with Congress to develop bipartisan legislation to instruct the FTC to issue rules for hearing aids and PSAPS that are similar to the eyeglass and contact lens rules – again confusing a refractive prescription with hearing aid fittings.
DIY Hearing Aids
Finally, PCAST recommends that the FDA create a category for something called a “basic hearing aid” and approve it for over the counter sales without requirement for consultation with a “credentialed dispenser”. They also want the FDA to approve tests for both online and in store use that allow people to self diagnose, self fit and self adjust these devices.
Both the devices and the “diagnostic” hearing tests used to fit these Class 1 devices, says the report, should only be regulated by the standards for quality appropriate for the consumer electronics industry.
The underlying assumption throughout the report (in the absence of any data whatsoever) is that these recommendations will result in an explosion of innovative hearing aids, drastically lowered prices, and increased numbers of individuals with hearing loss entering the market who will know how to self treat their hearing loss.
Advice from the Crabby One
Here’s what I think. I saw no evidence in the PCAST report that this group had any real understanding of what it takes to help someone with hearing loss. There is no evidence whatsoever that flooding the market with PSAPs advertised as do-it-yourself solutions to the problems caused by hearing loss will improve the situation for most people with hearing loss.
I think there will be more misinformation, not less.
The report underscores the commoditization of the whole process. It is based on the notion that a cheaper product is the solution to the problem of millions of people with untreated hearing loss. I think PSAPs will add to wasted expenditures that people make before they get to where they should be in the first place: in the office of an audiologist.
I also think audiologists become part of the problem when they behave as if they are selling products instead of the audiology services that will ensure the devices work for the individual.
Thoughtful audiologists will explore the PSAPs available, choose a few good ones, and add them to their armamentarium, verifying and validating in the same way as any other product.
It is important for audiologists to demand far more from manufacturers in terms of price and in terms of solid evidence for recommending the technical advancements they advertise in their products. Why do we so willingly accept the necessity for charging private practices $1500 for a product sold to box stores for $300?
That Great PR Agency In The Sky
What is that Great PR Agency In The Sky all about? It’s my never ending hope that as a profession we will someday fund a public relations platform and strategy to inform the public about audiologists.
This PCAST group, like so many panels before it, did not see audiologists as separate from commercial dispensers and they certainly devalued our services.
We need a commitment from practitioners to change that image–which takes money…which brings me back to that yearly waste of millions of dollars thrown into the certification dumpster…. Hmmm….
*images courtesy Wikimedia Commons
In a dream world everyone would be able to walk into an audiologist a office carrying a limitless credit card.
We don’t live in that dream world.
Even in the UK where the NHS provides free, audiology services and very functional hearing aids, all is not totally rosy.
The reality is cost is only one thing that prevents people seeking hearing help, stigma,convenience and a need to feel in control get in the way too.
Anyone familiar with the UK NHS will know that when your GP (general practitioner our family doctors) refers you for further treatment the letter disappears into an mysterious fog. Appointments do eventually emerge, and you are then at the mercy of the hospital.
I don’t know about US hospitals, but UK ones are mostly large, confusing and almost impossible to park at. They are pretty stressful places, that work according to their own inpenitrable set of rules.
You never know who you will see, how long you will wait or when or if there will be follow up appointments. Because your not paying you don’t want to ask too many questions or use too much of anyone’s time.
Thus even though hearing aids are free (and my hospital audiologist lovely) many people, both busy working people and seniors would happily pay a few £100 for an off the shelf hearing solution that they feel in control of and avoid the whole NHS merrygoround.