Many people may well have trouble being part of the party at Thanksgiving dinner. That’s because a quarter of those over 60 and half over 70 have hearing loss, and noisy dinners are among the worst places to be. They really should be wearing hearing aids, or hearables, as I prefer to call them, but most don’t. There are a number of reasons for this, mostly to do with cost (the average pair costs about $4,600 and fancy ones cost more) and stigma — they worry that the devices will make them look old. President’s Council of Advisors on Science and Technology (PCAST), which normally advises President Obama on everything from climate change to cybersecurity, is on the case; Jason Karlawish in Forbes writes that things might change if he takes their advice.
The Food and Drug Administration and Federal Trade Commission can nudge the overly consolidated and stagnant hearing aid industry into 21st century innovation, and if they do this, options for quality hearing aids will increase and prices will drop. Older adults will no longer have to spend their time and money on expensive hearing aids they really don’t want to wear and that don’t seem to work. Congress might even authorize Medicare to pay for them.
The PCAST letter calls age-related hearing loss “a substantial national problem” and notes that it is associated with depression, dementia, inability to work, travel or be physically active. It’s also really isolating and hard on families.
They blame the high cost on the concentrated industry (just six companies control 98 percent of the business), a lack of innovation and a distribution setup that makes shopping for it difficult and choices limited. However even in countries where hearing aids are free, there's not as high an adoption rate as there might be.
Social stigma — the association of hearing aids with old age or infirmity — is a barrier. Public education can play a role in expanding use, and the the arrival of the Baby Boomers as new seniors with different attitudes, including greater familiarity with wearable electronics and greater use, may shift attitudes toward social acceptance. But, robust technology innovation could also be a potent force for wider use — with the introduction of devices that are simpler, better, and more fashionable.
PCAST is calling on the FDA to change the rules and make buying hearing aids more like buying glasses, allowing over-the-counter sales and simplifying regulation.
In summary, PCAST finds that the costs and risks of inaction with respect to untreated hearing loss in the aging U.S. population are large. PCAST finds that the unnecessarily high price of hearing aids for individuals and the conspicuously slow pace of innovation by their manufacturers compared with other consumer electronics are consequences of a concentrated and increasingly vertically integrated incumbent industry, operating in the context of longstanding Federal and State regulations that appear to discourage potential new entrants. PCAST recommends specific actions by FDA and FTC that would have the effect of opening up the market for innovative hearing technologies and increasing opportunities for consumer choice.
Which is all a long way of saying: Let’s make these things easy to buy, fun to use and full of new tech tricks. A good example of where this is all going is Eargo, a new hearing aid marketed online with humor and style — even the FAQ section is fun to read, with lines like “Don’t use hot air or a hair dryer to dry your Eargo devices. It might give them a stylish, carefree, wind-blown look, but it could also damage their internal electronics.” They are designed for standard boomer hearing loss, which is usually at the high end of the spectrum. Most people (like me) wear behind-the-ear hearing aids for this reason; the ear isn’t totally plugged up with plastic so that the bass sounds can get in naturally around the tip of the hearing aid.
But the Eargo design is particularly clever about this; it has a squid-like “flexi Fiber” design that allows an in-ear hearing aid (this way nobody can see it, avoiding the stigma) without blocking the whole ear. They are even rechargeable; just drop them on the induction charger.
They don't do all the fancy stuff; they don't connect to the Apple Watch. However they're also less than half the price of conventional hearing aids and a third the cost of the top-of-the-line ones that do the Internet. It's almost as if the PCAST letter had already been acted upon — a new company selling new hearable technology over the Internet directly to the public. Who would have thought.