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042 – Dr. Nick Reed – The Significance of Johns Hopkins’ ACHIEVE Trial

Today’s episode of the Future Ear Radio podcast features Dr. Nick Reed, Assistant Professor in the Department of Epidemiology at Johns Hopkins Bloomberg School of Health. In addition to working in the field of epidemiology, Nick’s also a clinically trained audiologist which led him to focus on the intersection of audiology and epidemiology. The question that Nick’s team is trying to solve, is whether hearing aids can have a positive impact on reducing the rate of cognitive decline, and possibly even dementia.

We kick off our conversation with one of the key findings from the recent Lancent Commission on Dementia prevention, intervention and care. As you can see in the image below, the second bullet point speaks directly to the audiology industry:

As a lay person, I look at this finding and think, “well, that’s about as black-and-white of a statement as can be.” Why, then, isn’t there some sort of broad call-to-arms for mass screening of hearing loss in our aging population? As Nick tells me, the primary reason why this is not as straightforward as it seems is because there’s a lack of hard evidence on the treatment side to motivate the US Preventative Task Force to calling for widespread testing. The fact of the matter is that there’s not sufficient clinical data that definitively links hearing aids with stunting cognitive decline.

So, while we think that there’s a strong likelihood of the two being linked, the ACHIEVE trial is designed to actually prove it. ACHIEVE is a randomized control trial led by Dr. Frank Lin at Hopkins’ School of Epidemiology. It’s a blind, longitudinal study of roughly 1,000 people aged 65 – 90 years that includes de novo participants and also folks from a study that has been going on since 1987. That means that the study effectively spans a 30 year trajectory, and is designed to look at each participants cognitive decline by checking in and testing them every year or so.

The key to the ACHIEVE trial is to isolate hearing aids’ effect on the slope of decline, to appease the notion that, “causation does not equal correlation.” As Nick describes, the team working on the trial have gone through great lengths to ensure that they’re parsing through all of the other potential factors that might also have an impact on blunting the rate of decline (i.e. wealth, education, smoking, etc). Again, going back to the Lancet findings, the whole goal here is to back that claim up with hard data to persuade the US Preventative Task Force to call for action.

As we discuss, the ACHIEVE trial results won’t be out for another 3 years and since it’s a blind study, we can’t really take a peak behind the curtain to even see what the data might be suggesting today. However, as Nick points out, there was a six-month pilot study conducted before ACHIEVE, to make sure the logistics are sound and to work out any kinks. While the pilot trial was not intended for any kind of statistical inference, the findings from it were hard to ignore. The participants who were given hearing aids seem to have responded strongly and the slop of their decline appeared to have noticeably leveled off. These findings will have to be re-affirmed when ACHIEVE finishes, but it’s hopeful nonetheless.

Finally, I ask Nick what his ultimate hope is for the ACHIEVE trial. It’s here (around the 30 minute mark), where Nick unloads one of the most insightful bits on the podcast to date with his response. Not only would the findings of this research potentially lead to more calls to action from large governmental tasks forces around preventative measures, but it also might allow for a much more persuasive political argument around insuring these devices. If we can begin to make the argument that hearing aids are effectively an upfront cost that would mitigate MUCH larger costs down the road due to the cost of the linked comorbidities, it suddenly might become politically advantageous to lobby for hearing aids to be better insured by things like Medicare.

For now, we’re in the midst of the waiting game, but there’s certainly a lot to be optimistic about. Nick’s team at Johns Hopkins might ultimately be working on some of the most significant research applicable to the audiology industry. Here’s to hoping for results that can lend hard evidence behind the findings from sources like The Lancet.

-Thanks for Reading-

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