Digital Therapeutics in Hearing Healthcare: Interview with Nancy Tye Murray and Chris Cardinal of Amptify

Amyn Amlani 0:10
Welcome, my name is Amyn Amlani and I have the privilege of serving as your host. Since we began this video webcast series a few months ago, this Week in Hearing has brought viewers information from a vast array of areas such as technology updates, innovation, updates, service delivery considerations, changing market dynamics and legislative issues. Today, I’m joined by two members of the leadership team from Amptify Nancy, Tye Murray, and Chris Cardinal. So welcome to the show.

Nancy Tye Murray 0:41
Thank you. Delighted,

Amyn Amlani 0:43
appreciate you guys taking time to be here. And I know our viewers are really interested in understanding what’s happening with Amptify. And so before we get started with that, Nancy, if you wouldn’t mind, and I, your reputation precedes you. I know, many of us have studied your work over the years. And for those who don’t quite know you. Well, would you mind sharing a little bit about yourself?

Nancy Tye Murray 1:05
Absolutely. So I’m a professor at Washington University School of Medicine, where I run an Aural Rehab laboratory, we’re very interested in aural rehab interventions, as well as audio-visual speech perception. I’m also the CEO and founder of Amptify, formerly known as clEAR, I with some co founders started the company in 2015. And it all started because somebody at a conference came up to me and said, hey, you’ve been talking about this stuff for 25 years, when we know you going to make it available to the general public and take it out of the ivory tower. And that was the impetus to start the company.

Amyn Amlani 1:46
Wonderful, wonderful. So you recently brought Chris on when I say recently, within the last couple of years, and Chris Cardinal is the president and COO. So Chris, welcome and if you would share a little bit about yourself, please.

Chris Cardinal 1:59
Well, hello, everyone. And as you said, Amyn, I’m the president and COO of Amptify, and my background really is in the digital health space, and specifically in the digital therapeutics space. So prior to serving with with Amptify, I was the co founder and CEO, CEO of a company called well to do and at well to do our goal was to develop digital therapeutics for a suite of chronic diseases. And our primary product was called migraine coach, migraine coach was a leader in the migraine space, a leading migraine application for a number of years, running had some pretty cool features, which I won’t go into here. But that company was successfully acquired in the third quarter of 2018. And now I am excited to be here to bring some of the technology and the learnings from the digital health space and from those other digital therapeutics that are out there in the marketplace, into the hearing health space for the first time.

Amyn Amlani 2:57
Well, you know, we’re moving in that direction. So Chris, your, your insights, and your expertise will certainly help us as a profession move forward in that arena. So before we get started with, you know, this, this paradigm shift in hearing health that you just talked about, let’s get off the table, this new company restructure that was just announced not too long ago, where as Nancy pointed out, we you started out as clEAR, and now you’re rebranding under Amptify. So can you guys talk about that a little bit?

Nancy Tye Murray 3:28
When did that start, and then I’ll pass it off to Chris. So we started out taking our research about auditory brain training and gameify it and making that available, and we learned a lot from clEAR, we learned that the games had to be a lot more interactive and entertaining. But importantly, we learned that one of the the secret sauce of clear was the ongoing support from an in house audiologist, people with hearing loss are socially isolated, and many are older. And you can’t just hand them a computer, say go home and play games. They need to know someone’s paying attention. They care about how they’re doing, they care about their progress. So I wanted to be kind of a cheerleader that made me fertile ground for when I met Chris, I heard Chris talk about a digital therapeutic at a conference that we were co presenting it. And after he finished talking, I went over to him and I said, we need you we need to convert what we’re doing into a digital therapeutic. And I don’t know if our listeners are familiar with a weight loss program called Noom, which provides a social group a coach in a daily curriculum, but that that was our model, and there are a lot of imitators coming trying to catch up with us but we’re a step ahead of them in that we have been 10 years of research to support what we’re doing. So we’re really hitting the ground running. So that’s it where I am, and then Chris can talk a little bit more about the decision to kind of pull the trigger at this point in time.

Chris Cardinal 5:07
Yeah, as Nancy had mentioned, you know, with clEAR and with the auditory training games, there is a lot of power and having efficacy, especially in the digital health space around these type of innovative products that maybe aren’t something that a consumer is really used to seeing, or hearing or even, you know, thinking about, it’s stepping back and saying, you know, you know, video games, how are those going to help me hear better? Well, you know, a lot of people can talk about that, but it’s in one ear out the other. So with with the clEAR auditory training, and then taking that and rebranding that and putting that making that a feature of what the Amptify digital therapeutic is, was a very powerful move. However, it was only a small piece of some of those learnings that we’re bringing from that traditional digital health space over into hearing health. So Amptify, as everybody knows it, it’s really the Amptify DTx, right, the Amptify digital therapeutic, which has those auditory training games, the curriculum, the hearing, health coach, the group, the group, and so on, right. But Amptify itself is more of a platform, a platform that services, clinical audiologists, and a platform that is able to service employers who want to offer a hearing health benefit to their employees, and also just consumers who want to come on to amplify to be able to access our products discount service, as well as the Amptify DTx. And it was just important for us to move past that idea in the marketplace that clear or amplify was just those auditory training games, and to really hold on to the innovative brand that amplify is so that we can expand the Hearing Health industry’s understanding of what Amptify and the Amptify platform truly is. Well, that’s

Amyn Amlani 6:58
interesting. And I’m going to read a quote that you have online on one of your web pages. And I think it really tells the tale of what both of you have just shared about where we were and where we’re heading. And then we’ll dive into some of the other pieces as you talked about. So I’ll read the quote here. And Chris, I believe your your the the author of this quote, “never has aural rehabilitation taken a mobile first approach been paired on a hearing health coach trained engagement and included an interactive curriculum and manage peer community. The hearing health industry has been stuck with this idea that implementing oral rehabilitation doesn’t work. But what they are really saying is that they tried auditory training a subset of aural rehabilitation, and it wasn’t clinically feasible. They are right. The auditory training programs of the past, were boring, half baked and half supported. Amptify is unlike anything that the hearing health industry has ever seen, and has created a paradigm shift.” And so this then lends to the services and these things that you’ve talked about as you shifted from one but from one strategic initiative into this other. So let’s dive into this a little bit. Let’s talk about the services that you offer, and how they help not only the patient, but also these clinicians

Nancy Tye Murray 6:59
and I’m glad you divided up patient and clinicians on the other side. And I’ll start with the clinician. So what we are doing is we’re providing them an easy way to outsource aural rehab to experts. You know, every audiologist I’ve ever talked to, when I talked to them says I wish I had the time or the wherewithal to provide ongoing or a rehab. But you know, frankly, it’s not cost effective, and it’s not feasible. So what we are doing is having a platform with just one click, you can outsource oral rehab in quality research backed or rehab. Secondly, for the clinician, we are providing remote monitoring of their patients. So they can hop on their platform at any time and see how their patients are doing. And this creates a bond and a sense of loyalty between patient and clinician. So that’s what we’re offering the clinician for the patient, we have an interactive curriculum. And what that is, is every day they they can log on to their phone or their tablet or their computer and have lessons that range from things like managing communication breakdowns to engineering the environment for listening to nutritional tips to prevent additional hearing loss and we’ve made this very colorful, entertaining very, we work hard to convey a proactive since you’re not a poor me, I’ve got hearing loss, but rather I’m in I’m managing this thing. I’m in charge of your strategies. So that’s a curriculum. We have ongoing support from a hearing health coach, as I said, That’s the secret sauce knowing somebody cares this social support groups. So we put people into social support groups that are and the people are both homogenous and heterogeneous. So to, they can share ideas and solutions. And this social support group is coached by hearing help coach. So it’s it’s led and, and discussion is birthed by input from the coach. And finally, the auditory brain training games. And so we work on developing speech discrimination, word recognition. But importantly, we work on developing those cognitive skills that are important no matter what you’re listening to. So auditory working memory, auditory attention, and auditory processing speed. And that’s had great appeal with our patients, because they’re reading the New York Times and learning that hearing loss is linked with cognitive decline, and they want to do something about it. So that’s, that’s the exciting package that we’re offering to clinicians, and we’re offering to patient

Amyn Amlani 10:58
that’s amazing. I mean, as you pointed out, you know, you’re you’ve got this Noom type package in the hearing healthcare space. I have some friends and some family members that have used Noom. And it’s done wonders for them when they weren’t able to lose weight previously, you know, with all the COVID stuff going on in the sedentary activities now and Noom has really helped them because it reinvigorates them. It allows them to be self efficacy, about their processes. And it gives them a for lack of a better term, a carrot in order to meet the next goal. And then a pat on the back when they get there. And bring your dad into this space, I think is absolutely what’s needed.

Nancy Tye Murray 11:43
Beautifully said, you know, we’re kind of a Johnny-come-lately to this space. You know, this was first proven, the effectiveness of the digital therapeutic was first proven diabetes, and then weight control with new diabetes, ADHD with children. And by grades as Chris did.

Chris Cardinal 12:02
Yeah, that’s right. So yeah, and kind of just to kind of round this all out with a digital therapeutic side, I just want to throw out there that I have lost 50 pounds on Noom. I don’t know if I’m going to share before and after pictures on this podcast or this video, but I thought my family thought I was melting. And so in the digital therapeutic space, though. So there’s something called the Diabetes Prevention Program. And it was a longitudinal study that looked at what are the elements of a successful behavior change program, right. And that was a very successful study. And those elements that we see in a number of digital therapeutics, like the ones that Nancy and has mentioned amongst a number of others there, there’s the Digital Therapeutic Alliance, you can go check out some more of those that are available, as well as the Consumer Technology Association, which I serve on the health and wellness committee at the Consumer Technology Association, have we just released as an industry a list of the standards for what defines a digital therapeutic and naturally amplifies what falls inside of that. And so if you’re judging whether something is a DTx or not, there is a definition for that now that is accepted within the digital health industry that you can go and you can look up, and you can see exactly what outlines that and Amptify is one. And so it’s it’s not we’re not completely carving new ground, right, we are bringing something that has been successful in other health on other health indications, to change people’s behavior. And we’re bringing that over into hearing health and what is very powerful, especially about the Amptify DTx is not only those auditory brain training games that have been developed in the lab at Washington University, and have been adapted, and we have redesigned and turn into a new product within Amptify. But also it’s that curriculum, it’s that information that educates, educates and inspires and motivates and helps those individual set goals. And I will use one prop and there’s no better person than Nancy timer to put together a curriculum like that for these patients to be able to, to learn those self management techniques.

Amyn Amlani 14:21
Yeah, well, so you brought up this book, and and I was a student at Purdue, and I got my Master’s back in the early 90s. And I started I got the I had the fortune of studying with Dr. Carl Binnie and Dr. David Goldstein. And we would read Nancy’s work when when we were there. And you know, aural rehab was a big part of the things that we did back in the 90s. Because the technology wasn’t that great now that the technology has improved. We’ve kind of pushed aside the rehabilitation. I’m going to get Nancy to come in and talk about well, even though the technology is better, the adoption rates have not really improved. So there’s still a need for the oral rehabilitation and I’ll go back to a conversation than I had with both Dr. Binnie and Dr. Goldstein during my education, and that was the hearing aid is not the silver bullet, it’s not going to cure hearing loss, you not only have to have the device, but you have to have the training that goes with it. So what do you tell our fellow providers about the need to merge these two pieces together as they provide services for this population?

Nancy Tye Murray 15:23
Well, I start by saying you are a hearing healthcare professional. And hearing healthcare consists of diagnostics, treatment in the form of say, hearing aids or implants, and then therapy, and what we’re missing right now, as we nail those first two, but we’re missing that third one. And so that’s where I start the conversation, then I point out some of the research where we’ve shown that auditory brain training can reduce perceptual effort, which as the name implies, the amount of mental effort or cognitive effort it takes to recognize words, enhances speech discrimination, increases listening competence, and improves, decreases listening challenges. So that in a nutshell, is great. Secondly, that patients will begin to see you as salespeople if you just hit, you know, selling my hearing aid and you send them on their way. If you if you provide ongoing rehabilitation and coaching and support, then you are perceived as a hearing healthcare professional that you are. And finally, just the needs of patients, you know, what is it? Only about 30% of patients who need hearing aids, get them and then we get the hearing aid in the drawer syndrome? And I can – there are wild numbers out there about how many ended up in the drawer, but sometimes up to 50%. I’ve seen reports. So something’s not working, something’s not working, you know, people aren’t getting hearing aids that should be getting them people who do get them are using them. So something’s not working with the current model. And that’s what we’re trying to disrupt.

Amyn Amlani 16:57
Yeah, yeah. No, I love, I love what you’re doing. Again, I call it old school that comes from the old school mentality of, of having these – this type of support. And I love what you guys are doing with this Noom-like, model. And I think it’s really going to allow for folks, particularly as we start to see some of these legislative issues come to light, they’re not there yet. But once they come to light, reimbursement rates will increase. And then of course, as we were talking before, this, this recording here, you know, there’s also the whole self fit component. And we know that at some point, those individuals will get frustrated and hopefully come back to the provider and say, I need something more you are the hearing healthcare provider that that Nancy detailed and allow them to come back on and use something like an Amptify in order to better train themselves to position themselves in the right room to get those trainings that they need in order to lessen some of the issues that they have and be successful with these products. So I asked the question earlier of, of, what did I ask

Nancy Tye Murray 18:02
why don’t I just pick it up about what I said about OTCs? Okay. Okay. So with OTCs, coming, soon becoming widespread and available, it still will be the case that many, many patients will still need to consult with an audiologist about how to insert them, care for them, program them and adapt to them. So there’s still a huge role for us to play in the OTC market.

Amyn Amlani 18:31
Yeah, no, absolutely. And I’m also understanding from looking at your website that amplify has a marketplace. So you it’s a one stop shop, not only do you get the services, but there are some products that are available there, too. Am I correct?

Chris Cardinal 18:46
Yes. And so I think that, really, when you think about Amptify, you really want to, or at least it’s our goal, to be able to truly comprehensively treat hearing health, right, not just hearing loss. I think that’s a very important distinction, right? I always like to say that hearing health doesn’t start when you get hearing loss and hearing loss doesn’t stop at the ears, right. And so we are working on positioning ourselves and making sure that with the amplify platform with the Amplify DTx. With our audiologists, and with this marketplace, we are able to service those individuals, not just patients who are interested in hearing conservation, and interested in working with a hearing health professional like an Amptify audiologist, to be able to learn techniques and strategies to maintain their current level of hearing. And then as they progress throughout life, they will always have a resource and a platform that they can go back to that is hopefully covered by their employer as a benefit or by health plans to be able to get consistent trustable verifiable information about what is best for them, their current stage in life, what products and services are available to them out there in our marketplace and in the general marketplace, so that they can better manage their hearing health, not just hearing loss.

Amyn Amlani 20:09
I love it. I love it. I absolutely love it. I mean, the opportunity for folks to engage with a provider, maybe they don’t need a device, going back to the whole rehab, you know, sitting in the right place, the inverse square law, you get closer, it gets louder. The critical distance, you don’t want to be in all that reverberant noise, you move forward. And, you know, the signal to noise ratio, the signal to reverberation ratio changes. So all of these things that I was taught back in the day, are coming back to fruition, they never left, we just thought the hearing aid was going to do it for us. And the fact that you guys are providing this service, this platform and these opportunities, I think it’s absolutely phenomenal.

Nancy Tye Murray 20:48
Well thank you. And there’s kind of a nuance in what you just said, many people who are beginning to have hearing loss aren’t ready to buy hearing aids. And so what we are doing, not only are we providing good support, support for those people who do but we’re giving a treatment for somebody who’s not ready for hearing aids, but needs help, instead of just sending them away and say, Come back when you’re ready for hearing aids. An audiologist can say “I’ve got just the thing for you.”

Amyn Amlani 21:17
That’s wonderful. Are there any other bells and whistles that I haven’t covered? That you would like to share? What lesson did

Chris Cardinal 21:26
you know, I think you I think you’ve done a pretty good job. I mean, really, we are serving patients, we are serving clinicians, and we are serving serving? Well. I will say that that one unique thing that we haven’t necessarily talked about is that if your clinic is a member of a network, like Fuel, or Consult YHN, we also have relationships with those entities to be able to allow you to provide Amptify to your patients, and to refer them to it at a discount rate. And then I would also add that if you are on some of the leading practice management systems like CounselEar, or like Blueprint that we are integrating and have integrated with some of those, which will be announced in the coming weeks or via this this interview right now. And so you will also be able to seamlessly integrate the outsourced our rehabilitation through the Amptify DTx to your patients without disrupting your workflow and be able to offer that gold standard of aural rehabilitation through your practice. That’s

Amyn Amlani 22:33
fantastic. Those are all great things for folks to know as they’re viewing this. And then the last thing that I’m going to touch on is I know that you all have embarked on some research. I know. You’ve got a couple things here. So Nancy I’ll start with you, again, the auditory and cognitive training, and you touched a little bit on the whole cognitive component that’s starting to surface in the profession. Can you talk a little bit about how rehabilitation might temper some of the cognitive issues that people are facing with hearing loss?

Nancy Tye Murray 23:04
Yes. So there are many hypotheses as to why this cognitive decline is occurring, but a couple of them are one is because you’re not stimulating the auditory regions of the brain. Either those regions are dying or are captured by other parts of the brain. Another one is that because you’re not socializing with people, because of hearing loss, you’re beginning to experience cognitive decline. And a third one is other areas of your brain are being stimulated, such as the memory areas or the attention areas. And so we are taking a multi-pronged approach. So first of all, we’re, we’re exercising the, the auditory temporal, the temporal region of the brain, per se, but also the memory and attention in areas with the games. But something else we’re doing is part, as part of our curriculum, we integrate many lessons about the importance of socialization, getting out there, we integrate, we have lessons about balance activities. So we’re not just about listening, you know, nutrition and whatnot. So we take a multi pronged attack against cognitive decline, which includes balance exercises, auditory brain training, socialization, we even have a metric to follow how often they socialize sort of thing. So it’s a comp, complex problem, cognitive decline, and we’re taking a complex solution approach.

Amyn Amlani 24:37
That’s wonderful. And, Chris, I know there was a recent article about a clinical trial, and I know that there’s some confidentiality components here that you’re not allowed to speak to, but can you talk a little bit about clinical trials, are you if you can share anything about the one that you did with Intriccon? That would be great. And then are you looking for other partners potentially for clinical trials for products and offerings that you have,

Chris Cardinal 25:04
yeah, so I can talk a little bit about the the Intricon study that is currently ongoing right now. And by the way, we are in the midst of recruiting and probably still will be when this is going. So if you go to hearingtrial.com if you have patients or family members who want to be enrolled in this study, they get free hearing aids, they’re able to complete the study, and they have just basically a battery of questions that they’re asked, anyways be that study, the initial one with Intricon was just basically it’s called a summative study. So it was a usability study where we were investigating the actual experience of unpackaging. And going through and putting on the self-fitting device and actually fitting that device and that was a successful study, we were able to have findings to show that this is this is a viable, and that allows us essentially to move on to the next step that study which is a clinical trial of essentially the self fitting against a professionally fit device. So when it comes to that study, in our relationship there really, you know, again, coming back to the platform mentality of Amptify, we are always interested in working with partners who are looking to bring cutting edge devices to the market, whether they be self fit, or whether they be specifically software, another DTx and, and working with them to to get those to market with our expertise and our resources that we have available. Because we believe that ultimately the consumers need, again, a trusted resource for these types of devices and services, that and software that is available out there on top of the ones that we offer ourselves. And we also want to make sure that the individuals that they’re getting consultations from are those audiologists, and aren’t just a technical support person who’s going to be answering your questions about you know, about how to power down or power up a specific device or anything along that front, right. So we want to make sure that that those licensed professionals are actually who they’re getting support from him, that’s who you get support from, when you are interacting with Amptify. And so as you had mentioned, through our marketplace, we do have opportunities for other manufacturers and or developers who are interested in gaining access, essentially, to the pool of, of customers that we have coming to us through a number of different channels. And I will say not through the clinic channel. If you’re a clinic, and you’re bringing your patients on to Amptify and you have your patient panel, they will always be your patient panel. But we I mean, people just find us on the app store, right? I mean, just they find it on the App Store, and they download it. And so we want to service them. And if they do have a severe hearing loss, we want to be able to refer them to one of our partners, as we do right now. But then there’s also the employee relationship. So that was a little too much. But yes, yes, is the answer. We are always open to partnerships. And we believe we keep an open approach to what the future looks like. And we want to be working with those change makers and innovators ultimately.

Nancy Tye Murray 28:07
So very briefly, two things that are really important. And what Chris just said, number one is we’re big believers in research and we know how to do it, you know, whether it’s aural rehab techniques or listening devices. And number two, we have tremendous respect for the professional, the AuD audiologist, the PhD audiologist, and they’re the backbone of our company. So those are two take home points.

Amyn Amlani 28:34
Oh, well said you guys are certainly busy and lots of things happening. And, you know, it’s it’s wonderful to see the evolution of the profession. I’ve been in it almost 25-30 years now. And we continue to grow and Amptify is helping push that agenda along. And as we come to the end here, last couple of thoughts here any future developments that you want to share that you are any final thoughts that you might have?

Nancy Tye Murray 28:57
You know, this is a very exciting time in hearing healthcare. You know, I mean, I’ve been in it for 25-30 years, too, and I’ve never seen a more exciting time. I know lots of audiologists are kind of nervous about change, but I always say to him, you know, there are 40 million people with hearing loss in this country in roughly what 17,000 practicing audiologists – there are plenty of customers and our job is to make sure they get the best possible care possible.

Chris Cardinal 29:26
And and I will just carry on to that, you know, the individuals with hearing loss are ultimately under diagnosed and undertreated. And we are creating and have created a platform that allows those individuals to get the treatment that they need, and the services that they need in an efficient way that allows us to scale essentially, what we are able to and how many people were able to treat or hearing loss and with that scale, we need more audiologists, right. And so I will end on you know, if you’re If you’re interested in working with Amptify, as an audiologist, I will direct you to a website, which will be put on the screen hopefully, at this point, because I don’t have a prop for that. And and, you know, go go fill out that form, essentially. And we can start having a conversation about how you can work with Amptify on the future of hearing health

Nancy Tye Murray 30:23
either within the company or as a contract worker.

Chris Cardinal 30:26
That’s right. Yeah. Yeah.

Amyn Amlani 30:28
I love what you guys are doing. Again, I come from that old school mentality. And I think this is the backbone of the future as it relates to how people are going to benefit from this technology. I know I’m preaching to the choir here, and I really like what you’re doing. Hopefully, we can get you guys back on here and maybe, you know, several months to see how you’ve moved along and some things that are happening. I wish you guys the best of luck and happy holidays and we look forward to engaging soon again.

Nancy Tye Murray 30:56
It’s been a pleasure.

Chris Cardinal 30:58
Thank you

Nancy Tye Murray 30:58
Thank you so much.

Amyn Amlani 31:00
My pleasure.