This week on the Future Ear Radio podcast, I’m joined by Nancy M. Williams, President of Auditory Insight. Nancy sat down with me to discuss a variety of topics including her personal experience of living with hearing loss and wearing hearing aids since age 12, her love for piano, her motivation for starting her boutique consultancy, Auditory Insight, and some of the recent research notes published by Auditory Insight.
One of the big themes that we discuss throughout the conversation is the longstanding negative stigma associated with treating one’s hearing loss with hearing aids. As we discuss, the stigmatization of hearing loss is one of the major root causes of why so many people choose to delay taking action on treating their hearing loss.
We really hone in on Auditory Insight’s 2021 Q3 note, “Addressing Hearing Loss Stigma Within the OTC Context.” This was an absolutely fascinating research note that delves into the parallels between the way we stigmatize hearing loss and the glamorization of cigarette smoking prior to the anti-smoking campaigns. As Nancy points out during our conversation, nearly half of the US adult population had smoked a cigarette in the past week in 1954, but by 2019, that number was reduced to 15%.
As Nancy describes, the anti-smoking campaigns deployed three key communication strategies: issue a negative shock factor, create empowerment, and advance counter-narratives. So, as we discuss, the hearing health industry might benefit from adopting these same communication strategies in a concerted effort to effectively combat the stigma surrounding hearing loss.
In addition, we also discuss Auditory Insight’s 2022 Q1 Research note, “Barriers to Adult Cochlear Implantation.” Nancy shares some of the key insight about this note as well, rounding out our discussion by touching on multiple portions within the hearing loss spectrum.
-Thanks for Reading-
Dave
References mentioned during the conversation:
- Ebrahimi-Madiseh article reference: https://journals.lww.com/ear-hearing/Abstract/2020/11000/What_Influences_Decision_Making_for_Cochlear.30.aspx
- Expressed Barriers reference: 5 Balachandra S, Tolisano AM, Qazi S, Hunter JB. Self-Identified Patient Barriers to Pursuit of Cochlear Implantation. Otol Neurotol. 2021;42(10S):S26-S32. doi:10.1097/MAO.0000000000003376
EPISODE TRANSCRIPT
Dave Kemp:
All right. And welcome back to the Future Ear Radio Podcast. I am joined here today by Nancy Williams. This is going to be a great episode. So Nancy, tell us a little bit about who you are and what you do.
Nancy M. Williams:
Well, Dave, first of all, it’s a pleasure to be here. I’ve been a long time listener, and I should add, reader of Future Ear blog. I think I was one of your early readers of the transcript during my hearing loss. And I’m president of Auditory Insight. And we are a boutique management consulting firm that is focused on developing successful commercialization strategies for hearing healthcare, with a heavy emphasis on market development. And I know we’re going to get into that more during the session.
Nancy M. Williams:
We work across the entire vertical of hearing healthcare. So our clients include hearing aid manufacturers, cochlear implant manufacturers, as well as gene therapy and drug therapy companies. But having said that though, we focus only on hearing healthcare. So we have developed a real expertise in the area over the five years or so that we’ve been in business.
Dave Kemp:
Fantastic. Yeah, it’s really great to have you on. I was originally introduced to you by Andy Bellavia. So I know that we share that common connection and he just speaks really highly of you. And he was the first one to really turn me on to Auditory Insight. And as you described there, a lot of research around market development, which ties really nicely into the theme that we’ve been discussing on this podcast, which is the evolving landscape of the hearing healthcare market. It’s very much in flux right now, things that we can’t control, like the state of the FDA guidelines around the Over The Counter Hearing Aid Act, which has been just a prolonged process that continues to be dragged out.
Dave Kemp:
And so in the meantime, the market moves on. And so I think there’s a lot of really interesting things to unpack about what’s going on and how we should maybe be thinking about some of these things as it relates to both how we can be thinking about it from the history of this industry itself, as well as some anecdotal examples of other industries and areas that have experienced somewhat similar instances.
Dave Kemp:
So I also appreciate you mentioning the transcript and I just want to give you huge shout out here as you were one of the first people to really bring to my attention, the importance of having all of my episodes transcribed. So that for folks that have a hearing loss, it might just be a little bit easier to listen and read along with the transcript. So kudos to you for bringing that to my attention and creating the change that you wanted to see in the world. I really appreciate it.
Nancy M. Williams:
It was my pleasure, Dave, and kudos to you for responding so quickly. That was helpful.
Dave Kemp:
Awesome. Well, great. So let’s start with you. So you had mentioned that you do have a hearing loss. Do you mind sharing maybe a little bit of your backstory and then ultimately leading into Auditory Insight and how maybe living with hearing loss has shaped your view and ultimately, it all culminated into launching Auditory Insight.
Nancy M. Williams:
Sure. I’d be happy to. So today I have a moderate to severe hearing loss, but when I was first diagnosed at age six, my hearing loss was only mild high frequency. But we’ll hear in a minute that mild is a bit of a misnomer. It’s a misleading label. So in kindergarten I was singing too loudly on the big brag rug. Mrs. Quail, who was my beloved kindergarten teacher used to play the piano. That was one of the highlights of the day for me and … Well, I hope we’ll also talk more about my love for the piano and how that’s impacted my choice of careers with Auditory Insight.
Nancy M. Williams:
She recognized that there was something going on with my hearing. And I remember her turning around in the class and saying, “Somebody is singing too loudly.” And I looked around, I was like, “I wonder who that is.” And this little boy next to me nudged me and I was annoyed. I’m like, “Why is he nudging me?” And I nudged him back. But it became pretty clear that I did have a hearing loss that summer when I was taken to the University of Arizona’s ideology department, I grew up in Tucson and my dad was a professor at the U of A, for a hearing test. And I still remember being led into that sound booth and how scary it was as a little kid. And after the test, the audiologist recommended a hearing aid and my parents refused and they were doing the best they could because they felt that a hearing aid would be socially limiting.
Nancy M. Williams:
So fast forward to about six or seven years later and I’m in seventh grade, I’m struggling to hear my pre-algebra teacher when he turns his back to the classroom and he’s writing equations and he’s talking at the same time and I’m missing some of what he’s saying. And I was telling my parents about this. And up to that point, we had used accommodations like front row seats for me. And oftentimes during recess, I would go up to the teacher and say, “When you were talking about so and so, what did you say after that?” I was very motivated to try to get as much information as I could, which I think helped me, but that only last so far. But it wasn’t until I actually had a socially limiting experience that my parents finally got a hearing aid.
Nancy M. Williams:
So I ate lunch with this group of girls in middle school, and they loved to tell secrets, that’s a classic middle school girl thing to do. And so the secret train would get to me and I couldn’t hear these secrets at all. So they pretty much kicked me out of the group. And at that point, after I was ostracized, my parents broke down and got me a hearing aid. And so it turns out that not being able to hear is as socially limiting as a hearing aid. They both have real elements of stigma that as people with hearing loss, we simply need to address and handle as best we can. And once I got the hearing aid it was much easier for me, although I will say, even then, I was embarrassed because I felt like an other or somebody in a different group. And I think that’s the primary way the stigma can manifest itself for tweens and adolescents.
Dave Kemp:
Yeah. It’s so ironic almost, that they were almost trying to shield you from the stigmatization by preventing you from getting a hearing aid, which ultimately culminated in you having to get a hearing aid because you became ostracized within your peer group. So it’s like it came full circle that way.
Nancy M. Williams:
It is very ironic. And I will say, the silver lining is, my parents are now very aware of hearing aids. So as they’ve aged, they have gotten hearing aids themselves much earlier than their peers. I think that’s been a good thing.
Dave Kemp:
Yeah. Absolutely. Okay. So you have this pretty formative experience. You get fit with hearing aids at an early age. How has your experience been living with hearing aids, speaking to maybe some of the ways that either the technology has improved over the course of time, what it’s like now, compared to that first hearing aid device that you had as well as just, I guess, growing into the confidence and just comfort of the fact that this is a part of your life?
Nancy M. Williams:
It’s a really good question. And I think that every person with hearing loss has that journey to becoming comfortable with that part of themselves. So really, the name of the game when I was growing up was to hide my hearing loss. And certainly after I had that experience with those girls in middle school, even though I had a hearing aid, I felt that I wanted to hide my hearing loss as much as possible. And I went to Harvard Business School and the curriculum there was case based. So that a large part of your grade and really of your learning, most importantly, depended on these discussions of the cases with your peers. So we all sat in the same seat for the first year for every single class and the professors came to us.
Nancy M. Williams:
And it was a big struggle there because I am a lip reader. And so I would turn around the classroom with an amphitheater and try to hear people better. But other than requesting a seat in a certain area that gave me the most visibility of my peers, I didn’t really ask for any accommodations. I was really mainly just trying to manage as best I could. And then I remember, I went into the business world and I worked first in telecom and then in healthcare services. And at one point I was interviewing for a new job and I was sitting outside a senior executive’s office and my hearing aid battery went dead, which was very poor timing, but of course I’ve changed a hearing aid battery, thousands of times in my life.
Nancy M. Williams:
So I ripped out the battery immediately changed it, put the hearing aid back in my ear, just as the executive was walking out of the office. And for a long time, I congratulated myself on that. Almost like it was some slight of hand. But I think when I look back now, in a way that’s sad because it’s all part and parcel of not coming to terms with this part of my identity.
Nancy M. Williams:
So I mentioned the piano earlier, and that really was the part of my life that helped me come to terms with my hearing loss. So I played until I was 16, and then I took it up again when I was in my early 40s. And over the course of the years, I’ve become an amateur concert pianist. I think it was thought when I was younger, that I would never be a concert pianist because of my hearing loss. It was just viewed as the wrong disability for a musician. And I think a lot of musicians with hearing loss struggle with that.
Nancy M. Williams:
So I started a blog, it was really an online magazine in 2010 called Grand Piano Passion. And I began to realize that it was almost a bit hypocritical of me to be writing so much about music and sound without addressing my hearing loss. So that’s really when I came out, if you will, about my hearing loss and I became public with it. And that was a scary experience for me. I thought there would be some repercussion. There was, it was a good one. It wasn’t what I feared that I would somehow be ostracized all over again or thought of as less competent or less capable. So with that, I really became an advocate on nights and weekends and continued with my business career during the day.
Nancy M. Williams:
And then in, I think it was, I cannot forget it was 2016 because that was the cusp of the OTC legislation really, moving through Congress. Is I went to a career coach and I was interested in exploring my next step, and she looked at my background and she said, “Well, it’s great. You’re doing all this work and advocacy on nights and weekends, but why aren’t you in hearing healthcare professionally?” And I have to tell you, Dave, that the question actually surprised me. I didn’t expect her to ask that. And I think it was stigma all over again, like it was okay to keep my hearing loss tucked away on nights and weekends. But if I were to devote myself professionally to hearing loss and to hearing healthcare, would that be a safe choice? Would I be able to make it as a person with hearing loss?
Nancy M. Williams:
And I’ve since understood that, that’s part of what I bring to my client’s projects. So around the same time, and I think this was very lucky, great timing is, later that year, FDA came out and said, “We intend to create a class of over the counter hearing aids.” And then as you know, Congress took up the ball and we now are very close to having those regulations finalized later this year. And that really gave me, when FDA came out with that initial announcement, the courage and really the motivation to start Auditory Insight.
Dave Kemp:
Thank you for sharing all that. That’s such a cool story. And I think probably one that resonates with some of the people listening to this right now. I guess my first question would be, who is your favorite composer? Which line of piano do you like to play the most?
Nancy M. Williams:
Well, I hate to be predictable, but I adore Beethoven.
Dave Kemp:
That’s awesome.
Nancy M. Williams:
And I just really relate to what he must have gone through. Like me, his hearing loss started out in the high frequencies. And as you probably know, by the time he composed the 9th symphony, he was essentially profoundly deaf. So his hearing loss deteriorated much more quickly than mine. And I have performed some Beethoven. So perhaps one of the most memorable performances I ever gave was that the 2017 Hearing Loss Association of America’s National Convention. And I played the first movement to Beethoven’s Moonlight Sonata, which is very famous.
Nancy M. Williams:
And my teacher and I chose that because the main motif, the da-da-da-da, I can play the piano but I can’t sing. But anyway, I think people probably know what I’m talking about, but that repeats itself in many different octaves throughout the piano. So whether you have a low frequency hearing loss or medium or high, my hope was that at least at some point, that that main motif or that main famous melody would be audible to the people in the audience, which were really my people. And it was wonderful feeling, getting up and bowing after that. And I think there were maybe 500 people in the audience and just seeing all of those people who I shared so much of my life journey with.
Dave Kemp:
Yeah, that’s just so cool. What an awesome accomplishment and just how your life comes full circle like that. It’s funny too, whenever I think about Beethoven, I have this really vivid memory, my grandpa who passed away when I was just a kid, but one of the earliest memories I have of him was he would always do the Sunday crossword and he was obsessed with Beethoven and he called them Bates baby. And he’d just be listening to all Beethoven, just knocking out the crossword puzzle. And so I just have a lot of fond memories myself about Beethoven, but I just think it’s really neat too that in a way you’re carrying on a legacy in that regard where somebody that this incredibly talented composer who lived 500 years ago or however long ago who had debilitating hearing loss, but was still able to produce such a masterpiece body of work.
Nancy M. Williams:
It is. And there’s a fascinating book that I finished recently called Hearing Beethoven by Robin Wallace and his wife had a cochlear implant. He’s a musician and a professor at Baylor. And he talks about how yes, Beethoven was able to compose without the benefit of hearing his music. And he had a lot of accommodations including this big resonator that he put over his piano and the Wallace, his theory at least is that would bounce the sound back and help him absorb the vibration. And I think Wallace really hit the nail on the head when he said that “Despite all of this, despite all of his accommodations, it’s very hard for us to imagine the grief that Beethoven must have felt and not being actually able to hear his own music.”
Dave Kemp:
Yeah, I can totally imagine that. So with Auditory Insight, I feel like it’s probably after I’ve read some of your research notes, does a lot of your experience in your time at Harvard, does it translate over? Because you said that a lot of what you were doing at Harvard was all this case based stuff. And when I’m reading your notes, I’m recalling it’s like, that is how I perceive that is a lot of these are very much case based. It seems as if you were drawing upon that. And did you feel like a part of your Harvard portion of your career and your life is now an Auditory Insight is an extension of that portion of your career?
Nancy M. Williams:
Yeah, absolutely. And I would actually go back a little bit earlier in time because before I went to business school, I worked in Strategic Management Consulting first for the Boston Consulting Group and then for Marakon Associates. And I went down to Australia with Marakon and I helped them open their Melbourne office. So I worked for four years in management consulting and that was a great prelude to the program at Harvard Business School. So I think that the six year period taken together is really important. And Harvard really, along with my experience in consulting, gave me the ability to understand industry dynamics and the forces that are acting on all of the players. We specialize not only in the patient journey, but also in understanding what are the barriers and motivators for audiologists, both hearing aid and cochlear implant, general EMTs and neurologists. And all of these players together are stakeholders and constitute the market and are acting on it in different ways.
Dave Kemp:
Yeah. I think that’s really neat because it does seem like that makes sense. I didn’t know that you had the market research, that portion be leading into to the Harvard or actually following Harvard, but it makes sense in retrospect. And so when you had this career coach that you went to, did this immediately jump out at you that, “Okay, if I want to get involved in the hearing healthcare space, I want to do that line of work, but within this industry?”
Nancy M. Williams:
By opening a management consulting industry?
Dave Kemp:
Yeah.
Nancy M. Williams:
Yes. Yeah. And we do do some market research, but primarily we’re strategists. And we’re thinking about developing go to market strategy to help grow the market. Yes. It was interesting because around that time I also talked to my friends, some of whom were at the business school with me and had known me for years. And that’s such a great thing to do is to go back to people who knew you earlier in your life and ask them, “Well, what do I like? And what was I good at?” And I remember one of my friends who runs a business unit now for a conglomerate said to me, “You really seem to resonate with management consulting. That’s when you seemed happiest.” And so yes, she was right. It was, I think a great opportunity for me to be able to combine my interest in hearing healthcare in a consulting capacity.
Dave Kemp:
Okay. So let’s start to get into some of the research and market development that you’ve been looking at. So when I was reading through some of your past notes, the first one I want to start with is the Q2 2021 note. This is the one that’s really around adoption of hearing aids. And you wrote a lot about price and stigma within this. So let’s start just by you setting the stage a little bit and I guess giving a high level overview of what you were setting out to look at and examine with this particular note.
Nancy M. Williams:
We started with the question of what are the barriers to people more actively wearing hearing aids. And if you look at the market research, that’s publicly available, for example, market track and you group together, the reasons why people who are not currently treated are not pursuing hearing care. You come up with three main reasons and those will probably not be a surprise to you or your listeners. Price is number one, followed closely by denial. And then stigma is number three. And we really felt that the advent of OTC regulations will be a very interesting experiment on the issue of price.
Nancy M. Williams:
And so there’s a major market event that’s occurring in the near future with regard to price. But what about denial and stigma? Well, denial to some extent is present in every single healthcare category. And sometimes people combine now with apathy as well. There will always be a segment of people who are not going to seek care, but then there’s, in hearing healthcare and in some other healthcare categories as well, this issue of stigma. And so that’s what we decided to zero in on. And I will say by the way, feel that some of denial is probably fueled by stigma. People are so unwilling to talk about feelings of shame related to their hearing loss or to the prospect of wearing hearing aids that it could present to a market researcher as denial, but really is a fear of stigma.
Nancy M. Williams:
So it’s no surprise that the industry has been struggling with stigma for decades. It’s an entrenched phenomenon. So the first thing we did for this research note was we went to one of my favorite researchers, Margaret Wall Hagen, who has done some work on stigma in adults. And she identified three, if you think about it, pretty shocking stereotypes that people with hearing loss have regarding stigma. There’s three perception categories. And first of all’s that they’re not whole, they’re missing something. Secondly, that they’re disabled. And thirdly that they’re in some way, cognitively impaired. So people worry that by wearing hearing aids, by making their hearing loss more visible as they will signal one, if not all of those stereotypes or perceptions.
Nancy M. Williams:
So that’s pretty big nut to crack. And so we said, “All right, for whatever reason, we’re struggling as an industry, let’s look outside of the industry, what we would call an analog or inspiration.” And we alighted somewhat interestingly, on the idea of the smoking cessation campaigns. And I remember talking to some teammates and they’re like, “Wait a minute. Smoking cessation was all about getting people to stop smoking, and you’re trying to get people to do something, to wear a hearing aid, to start something, how does that work?” But what we realized is that the intensity with which society once glamorized smoking is similar to the intensity with which some members of society stigmatized hearing loss and hearing aids.
Nancy M. Williams:
And I do want to say too that, a lot of stigma is what we call internal. So it’s internally generated based on one or two experiences that people may have had with real external stigma in their environment. And in my case, for example I was banished from this lunchtime group of girls because I couldn’t hear secrets. And that was very formative. And I internalized that and it kept me from doing things in a certain way from really living my dreams for a long time. So when we talk about the presence of stigmas, it’s also within.
Nancy M. Williams:
So with that analogy in mind that the smoking cessation campaigns could be a useful model, we took a look at how successful they were and they’ve been extraordinarily successful as probably many people know. And I like to cite the fact that in 1954, and this was right before the US Surgeon General first warned American, that smoking could cause lung cancer, almost half of American adults had smoked a cigarette at least once in the past week. Whereas today, that number is significantly lower and it’s around 15% or so. And so these campaigns have been part of a larger social movement, as well as governmental action to help people understand the health costs of smoking.
Nancy M. Williams:
So when we analyzed these smoking campaigns, of course they were using some of the typical marketing strategies that you would expect, like targeting and testing and developing a call to action, but they also had what we thought were three innovative strategies using a shock factor, empowering people to quit smoking and finally, employing counter narrative. The other point that you made, Dave, that I wanted to pick up on was that it would be great if we could figure out a way to make it more societally acceptable, or even cool to protect your hearing and treat your hearing. I think that the biggest hope that we have for that happening right now, rests with Apple. And I know you mentioned them earlier as well. I think they’re really a potentially huge there’s a lot of potential there for Apple to have an impact on the market.
Nancy M. Williams:
What interests me about Apple is the hearing study is making data available to people on how much they’re actually exposed to dangerous levels of noise. And I also really like that the AirPods Pro have a protection plus customized amplification function wrapped in one device, which by the way, is perhaps one of the most socially acceptable devices to wear in your ear today. So I think both of those factors could potentially help normalize treating hearing loss in society.
Dave Kemp:
Yeah. I think that with everything regarding Apple, I think they’re such an important company to recognize as being the one that really did usher in the normalization of wearing in the ear Bluetooth devices. It could have happened regardless whether or not AirPods ever were a thing, but I’m not sure if it would’ve happened as soon as it has, because this is something, again, that I talk about a lot I write about is I think we under appreciate that point of, you go into any public place now that the pandemic subsided a little bit, it seems, and you look around at the airport or wherever, everyone’s wearing in the ear devices, it seems, or over the ear, Bluetooth headphones.
Dave Kemp:
And like it or not, it might come across for some as a little dystopian that we’re all walking around, plugged in all the time. But I think that for this specific aspect of our society, of the pervasiveness of hearing loss, and as you identified, the fact that this is already a two in one device that provides you with, that active noise cancellation is very much, that’s a hearing conservation tool. And the fact that you can then turn it back on into transparency mode and have hearing augmentation is quite an achievement.
Dave Kemp:
And this is why I think that Apple isn’t by any means the end all be all, but I think that they are very much setting the tone of what people are becoming accustomed to what these devices can do and what they can have. And I’ll go back to a comment that Andy made one time, Andy Bellavia about how awesome would it be if as efficacious as Apple’s ads tend to be, if they have an ad at some point where it’s a la the iPad when you had that really memorable ad in that hallmark ad of everybody was dancing around with the white headphones.
Dave Kemp:
I could see it being somewhat of a similar thing where it’s all around conversation boost and it’s highlighting this feature as we’re providing you with super power it’s that thing where a lot of it is about the way that we message this stuff. A way that the public is perceiving these things, rather than we’re going to treat some deficiency. It’s like the way that they speak about it. Even the name transparency mode is different than hearing the amplification. It’s all messaging in this realm of, do more with what you have. And I know these things seem small and trivial on the surface, but this is how you usher in new norms within society in the same way that the truth campaign and all these different smoking cessation campaigns, they actively combated the then prevailing stereotype that smoking was cool.
Dave Kemp:
So we have to have these big bodies that have the ability to really influence, I think, behavior that can in ways, normalize certain things, good or bad. I think that some people might argue again, that this is dystopian that everybody’s going to be walking around with AirPods in their ears, is that what you’re saying? Not necessarily, but I think that being more aware of the fact that these types of features even exist in providing people with exposure to that. To me, I think there’s just tremendous opportunity there when we’re talking about combating the stigma around treating hearing loss.
Nancy M. Williams:
Absolutely. And in the research note, we look specifically at some of the strategies that the smoking cessation campaigns utilized. And I mentioned already, some of them that were more innovative. I just wanted to zero in on this idea of creating empowerment. So there’s a smoking cessation campaign called Every Try Counts. And it acknowledges that people often require multiple attempts to quit smoking. And they had three primary vehicles that they used in that campaign. One was to provide people with factual information on the impact of smoking. The next one was to provide positive reinforcement. And then the third one was to create support programs. And even just by identifying, I think those three aspects of that campaign, we’ve now started to create a potential model for how hearing healthcare could emulate this type of campaign to create empowerment.
Nancy M. Williams:
And I’ll sum up this research note by saying that one of the things that we looked at is, particularly, how could a company create empowerment for people who are in the workforce? And our personal belief is that for adults up to say 75, the primary catalyst for getting treated for hearing loss is work. Our research shows that with people who faced poor performance reviews, missing critical information of work, or even potentially being fired, we’re finally motivated to get over the issue of stigma, which is very powerful and very real and seek hearing treatment. And there’s more people working in the older demographics than I think a lot of folks initially realized.
Nancy M. Williams:
So a third of people age 65 to 69 are in the workforce. They’re not all working full-time, some of them are part-time, but they are actively working. And for people age 70 to 74, that number goes down to only a quarter. So a quarter of them are in the workforce. Those are pre-pandemic numbers. We’ll have to see how once we get past the turmoil of these last three years, those numbers settle in, but they’ll probably be pretty similar if not even higher in terms of workforce participation. And so I think there’s an opportunity for the hearing healthcare industry to combine some of these techniques from the smoking cessation campaigns and zero in on specific use cases like people needing fields to be able to hear at work.
Dave Kemp:
Yeah. I love that, the whole theme of empowerment and you’re right, because that’s how you can normalize this. We don’t all have to be dependent upon something we can’t control like, what’s Apple going to advertise? Something like that. But as even down to the employee or the employer level, I think these are the things that you can see some meaningful change. And this is where I would challenge the audiologist to really enter into the fold here. Because again, as has been the theme on the podcast for a while now is like, in this new age of online retailers, big box retailers, new avenues of access that people can pursue OTC self fit, how does the professional channel meaningfully stand apart? And I think that it’s going to largely come down to recognizing that in the past, it used to just be that like here, the hearing aid is the end all be all, but we know that’s not really the case.
Dave Kemp:
If you work in a call center, for example, and you have to process orders or something like that come through the phone, is your phone set up in such a way where the audio through there is being configured to your hearing loss. That’s a humongous opportunity is to understand what’s your actual day to day look like? And where are ways that we can optimize that throughout your day? That’s so much more valuable than just come and see me and I’ll fit you with like one singular device. I think it’s understanding the individual and personalized needs on a patient by patient basis. That’s value centered care is really what I’m getting at.
Nancy M. Williams:
Yeah, I agree. And it’s interesting. I mentioned that before I started at Auditory Insight, I had a 25 year career in telecom and also healthcare services and the unifying thread across all of those was I was launching new products, services, channels, and then businesses. Always creating new things. And I think, part of what I learned during those two plus decades of work was that segmentation is really important. And so we already have five global companies who are providing a full suite of hearing aids for general purposes. And I do think that for new players into the industry, zeroing in on specific applications or market segments, is one way for them to make a dent. And in this challenge that we have of increasing adoption.
Dave Kemp:
Couldn’t agree more. Okay. So as we come to the close here, I had one other note that I wanted to touch on with you. We’ve talked a lot about the less severe cases of hearing loss and some of the ways that we can maybe address some of that. So I want to go to the opposite end of the spectrum and talk about the most severe cases of hearing loss and some of the ways that we can improve adoption on things like cochlear implants. So I know on your most recent note, Q1 of 2022, you talked a lot about cochlear implants and the adoption rates and some of the different ideas that you have in terms of how we can maybe improve adoption in that arena.
Nancy M. Williams:
Sure. So I think the prevailing wisdom in the industry for many people, not all, is that the primary barriers to more people getting cochlear implants. And that number by the way is about just a little bit over 5% of those who are indicated, is to address structural factors. One example that’s often given is that hearing aid audiologist may not be always referring their patients who are indicated for a cochlear implant for an evaluation. Either because they’re just not aware of the benefits of cochlear implantation or perhaps in some cases, they may not feel economically motivated to make that referral. But there’s some recent research that came out and here, I want to give us a shout out to Ebrahimi-Madiseh, I’m probably mispronouncing that, and I apologize paper, but Dave, you can hopefully link to it.
Dave Kemp:
I’ll link it. Yep.
Nancy M. Williams:
Okay, great. And this team analyzed a number of contributing factors to what motivates and prevents people from getting a cochlear implant. And they discovered that really, the patient was at the center of that journey. It’s the patient who is primarily making this decision on whether to proceed or not to proceed. So with that insight, we stepped back and we said, okay, well, about 95% of them are not electing to proceed. And clearly, some of that is because they don’t understand the benefits, but we wanted to know what else is on their mind. And as background to that question, we took a look at the outcomes for cochlear implantation. And what we discovered is that there’s a wide range of post operative speech perception scores.
Nancy M. Williams:
And I was delighted to co-author this paper with Dr. Aaron Schaeffer. She was actually one of the co-authors on this paper who produced these outcomes. And the median patient goes from a pre-op speech recognition score of 15% to 56% post-op, but there’s a tremendous amount of variability around those medians. The highest quartile of patients end up with speech recognition of 75% or greater. And that’s a beautiful thing for those people. They’re having a much positive experience, probably both professionally as well as personally, but the lowest quartile is at 40% or below speech recognition. 40%, by the way, is the cutoff for Medicare to approve a CI in the first place. So we’re seeing a lot of variation there, and that created for us a hypothesis that perhaps this uncertainty around outcomes is a barrier.
Nancy M. Williams:
So the next thing we did was we looked at the literature on what patients express barriers are to cochlear implantation. And in fact, the number one express barrier in this study that we footnote and link to in our study was that a cochlear implant “would not improve my communication ability.” So they’re concerned that they’ll go through the surgery and they won’t end up with any better ability to communicate than what they had before. And the before is not always a very good picture. It’s typically cobbling together a solution of hearing aids, captioning, sign language, lip reading, and what I call the W word, what. What was that you just said?
Nancy M. Williams:
So I empathize with what people are going through because they’re struggling to hear, and yet they’re not certain whether a cochlear implant will improve on their situation. Other express barriers, where the risk of surgery, of course, and postoperative recovery. And that included how much time they might have to invest in rehabilitation, which is understandable. But then the fourth and fifth barriers were, I’m concerned about losing music appreciation. And by the way, I think my hearing aids are just fine.
Nancy M. Williams:
So three of those five express barriers really are about hearing outcomes and the ability to communicate. So we hypothesize that some of this uncertainty about outcomes is driving some of these expressed patient barriers. And so there’s a whole host of implications that we don’t have time to get into now for cochlear implant centers, for cochlear implant manufacturers, and for companies who may be looking to come into this industry about how to address this, but clearly, starting to develop data, perhaps utilizing big data to analyze this is important to try to get a better handle on what people might expect based on their personal profile, including not only more standard factors like their age, how long they’ve had a hearing loss, whether or not they’ve been wearing hearing aids, but some of the softer factors like how willing and able they are to participate in mapping sessions and rehab.
Dave Kemp:
Yeah. I feel like this whole thing there is, like you said, there’s so much to unpack.
Nancy M. Williams:
Yeah.
Dave Kemp:
And we’ll table this for a part two down the line, along with some of the other research notes that you’ve had. But I wanted to just draw attention to that as just another example of the depth and breadth of the types of things that you’re covering, because just wanted to plug, Auditory Insight just broadly speaking as being a really awesome, well thought out market development forum for this research. And I know we spent a lot of time on the lower end of the market, like I said, or the lower cases of severity, but I wanted to just give you an opportunity to speak to some of the work that you did there, because … And there were a lot of takeaways that I had personally with this.
Dave Kemp:
I know that you had mentioned in there that a lot of this is like having the direct relationship with somebody that has had a CI and how important that is in terms of getting people to be willing, to “take the plunge.” So just so much there, so much to unpack. And I just thought that this whole conversation for me has been really awesome because I’ve felt like I’ve been reading and writing and podcasting about a lot of this stuff. And to talk to somebody that’s really done the work of the really deep research that you have on this and have a conversation about these topics. Who knows how this will all pan out.
Dave Kemp:
I have my own personal inclinations of some of the ways that I can see this all transpiring. And I know others have totally different ideas, but I think, what’s really important is that these discussions and all of these different thoughts and perspectives are part of the discussion. And we can all come to an idea of how we can try to make change in a positive way together.
Dave Kemp:
Here we are heading into the OTC era. And I just think that there’s a lot of things I think, to be pretty excited about, of what’s to come. And for someone like you, who is a long time hearing aid user, and this is a really personal issue that’s near and dear to your heart. I just can’t thank you enough for coming on and sharing your perspective and some of the key takeaways of the types of notes that you write.
Nancy M. Williams:
Thank you so much, Dave. I really enjoyed this, and it’s just a pleasure to be able to share what we’re working on and our perspectives. I know you have many listeners out there, so I hope this is the first of many podcasts that we’ll do together.
Dave Kemp:
Absolutely. So for the listeners who want to follow up with you, where’s the best place to reach you?
Nancy M. Williams:
Sure. So I’m on LinkedIn, I’m quite active on LinkedIn. People should feel free to message me on LinkedIn or send me a connection invite and then message me, I’ll be happy to hear from them.
Dave Kemp:
Awesome. Fantastic. Well, thank you so much, Nancy. Thanks for everybody who tuned in here to the end and we will chat with you next time. Cheers.
