Hello and welcome back for another episode of the Future Ear Radio podcast!
For this week’s episode, I had the pleasure of speaking with Dave Fabry – Chief Hearing Health Officer at Starkey and Host of the Starkey Soundbites podcast.
During this episode, Dr. Fabry and I discuss:
– His start as an aspiring Veterinarian, which ultimately exposed him to Audiology (training Chinchillas to “perform” an audiogram)
– Dave’s PhD, time at Walter Reed Army Medical Center, and Clinical Fellowship at The Mayo Clinic
– The ACHIEVE study and Dave’s big takeaways as both a clinician and researcher
– The emerging use cases for biometric and acoustical data sets that are being captured and logged by Starkey’s latest hearing aids
– The evolution from machine learning-based applications to deep neural-net based applications for hearing aids
– The case for why this is the most exciting time for Audiologists and Hearing Professionals broadly speaking, even with the existing and forthcoming challenges on the horizon
– Career advice and words of wisdom from Dr. Fabry
Thanks to Dr. Dave for kicking off the new year with me! I’m very much looking forward to ramping up the cadence of the Future Ear Radio podcast here in 2024 and want to wish all the listeners a very happy new year!
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp
All right, everybody, and welcome to another episode of the Future Ear Radio podcast. I am pumped today to be joined by Dr. Dave Fabry. So Dave, thanks so much for coming on the pod. How you doing today?
Dave Fabry, Ph.D.
I’m doing well. It’s my distinct pleasure to be with you.
Dave Kemp
Awesome. Well, we’re one podcast here to another. It’s great to have you on today. I’ve really enjoyed listening to the Starkey sound bytes podcast, I was telling you right before we started recording, you know, as like, part of the research of looking into who your guest is, and trying to kind of like, pull out some interesting nuggets. You go and you start reading or listening to some of their material. And I just have to compliment you that kudos on on that podcast, because it really is engaging. You’ve been interviewing some very interesting people from all different facets of the industry or on the patient side. So I’ve learned a lot and wanted to just give you a shout out right at the top of your podcast your podcasts are now. Well,
Dave Fabry, Ph.D.
thank you so much you can teach teach an old dog new tricks. I mean, I didn’t know much about podcasting before a little over a year ago. And thanks to the efforts of our team, we have an outstanding team here at started working on that. And I just get to be the guy that asked the questions and interviews the guests and I just sit back. And you know, I’ve had to learn one of my mantras My whole life has been we were born with two ears and one mouth so that we can listen twice as much as we think but one of the I think the secrets of learning to become an effective podcast host is to remember that adage and listen more than I speak because I don’t learn anything when I’m talking. I tend to learn more when I’m listening. And people tune into the Starkey sound bytes podcast to hear the guests and my job is to just help set up the topics and sort of shape the the conversation but thank you, you’re very kind to say so. Awesome.
Dave Kemp
Well, I wanted to kind of just get into your, your career and you know, your whole backstory and journey as an audiologist. So why don’t you just take us back to the top, from the beginning of how you came to get involved in this space and pursue the field of audiology?
Dave Fabry, Ph.D.
Oh, boy, how much time do we have? The I was not the traditional audiologist that found hearing through speech. But rather, I was the first person in my family to go to college, and I went so I was living in Wisconsin I grew up in in Green Bay. And many of my family members were farmers. And I also took an interest at an early age in animals and I thought I was gonna be a veterinarian, and ended up coming to the University of Minnesota as an undergraduate in animal science of all things, and began that journey, only to discover that I really didn’t like I’ve always liked collaborative learning more than competitive. I mean, you got to be competitive, you got to differentiate yourself, but I liked I didn’t like the pre vet focus at the time because it was at the time there were only 19 vet schools in the country. When I began my collegiate career, it was tougher to get into vet school than it was in med school in many ways on number one your patients can tell you what’s wrong with them easily. But you know, the competitive nature of it meant that a single B in a class could almost destroy your your chances, at least that with at the age of 1718. That’s what your you’ve got in mind. And I’ve always viewed learning as an opportunity. As they said, I was first in my family to have that privilege and opportunity to go to college. My dad was a laborer or work in a paper mill and I got a scholarship from that paper mill. And I was determined not to screw it up. And so I was trying to learn and it was a little disenfranchised by the fact that in classes kids would not ask questions in the class but rather rundown the rest of the professor at the end of the class so that they only they would get the answer to their question. And I was just like, this isn’t fun. And so I had the opportunity to take a class in animal science and start studying hearing from is an intro to audiology class just I took on a whim and suddenly became enamored with hearing and with audiology as an opportunity and I had my first job at the University of Minnesota as a chinchilla tester working in Dave Nelson and Dix Ward’s lab. Chris Turner was the person that hired me and became later became a fantastic friend of mine, but it was, for the first time it was this opportunity to sort of realize that I’m hearing and I immediately fell into the magic of this space of changing people’s lives through communication. And as I started working in this chinchilla that most of what we know about human audition is either from Guinea pigs or chinchillas. Because their their hearing mechanism is very similar to the human ear. And so they had me at that point, they were looking for a person who had experience with animals and behavioral training of animals. And Dix was in particular focused on looking at the research that ultimately became the basis along with others around the country for the damage risk criteria, or noise exposure. And the good news from my perspective as a person who loves and continues to love animals was that we were studying the aging impact of hearing loss and noise induced chinchilla. So we did not have to do traditional animal studies where we tested them and they this they were deceased shortly after we had many that lived a full life and became a became quite attached to a lot of them. But that was my entry point into audiology. And then I stayed at the University of Minnesota, got my master’s, I like to say I have three degrees below zero. I have a bachelor’s in psychology, a master’s in audiology during the time when the master’s degree was the first professional degree of audiology, and then a PhD in hearing science all from the University of Minnesota. I’m proud of that.
Dave Kemp
Okay, that’s actually really fascinating. So you literally by way of extension of what you were doing with the veterinarian side of it, you got exposed to what they were doing as like the caretaker of the animals. Yeah, and trainer,
Dave Fabry, Ph.D.
we were using training models to teach a chinchilla it’s very difficult to put a chimney in a booth and get them to raise their GPA two weeks ago, we had to have them jump back and forth when they heard sounds and we taught them how to do an audiogram using a Skinner box and, and so I had some behavioral animal training and had as well, like I said, growing up, I had run I my dog became an AKC champion for the American Kennel Club, in obedience. And so I had a little bit about shaping and behavioral shaping and animals but then I absolutely fell in love with hearing and in the environment. And, you know, then began what I thought was going to be a more traditional career. As an academic professor, I had outstanding training and preparation, I mentioned Dix Ward, Dave Nelson, my master’s degree was through working with Diane Van Tassel, who was my mentor, then also on my PhD, and, and I really thought My first job after I got my PhD, I went to Walter Reed Army Medical Center, as a research audiologist there and I really thought that I was going to go down that path, but something happened. After I got my master’s degree, I had the the opportunity to do a clinical fellowship here, which as you know, at the time, and back in the previous millennium, was required as part of the audiological practice leading to licensure was you have your master’s degree, and then one year see a fly. And I had the distinct privilege and opportunity to do a clinical fellowship year at Mayo Clinic in Rochester, Minnesota, and completed that first year. Unfortunately, my father passed away at that time, it’s the 40th anniversary of my father’s death this year, it really helped kind of shaped me into Matthew McConaughey spoke at one of the Starkey exploits a couple of years ago, he also lost his dad at a young age. And he said, you get to a point where when your hero dies, you’d have to be less impressed with accomplishments, what you’re doing what you’re trying to do, and more engaged. Because you’ve lost your safety net, you’ve lost that, that that hero that helps guide you. And so I, my dad died at the kind of in the middle of my first clinical fellowship year. And Darryl Rose, who has been a tremendous mentor to me over the years, offered me the opportunity to do a second year, which I did and jumped at it. And I became enamored not only with hearing at that point, but then audiological clinical care. And so that was then when I went back to my PhD and did research on hearing aids, in particular noise reduction, hearing aids that were just emerging at the time. The Zeta noise blocker, if you go back and look in the history books, was one of the first single microphone noise reduction strategies that use digital and analog strategies to reduce background noise. And so I really became interested in that area and fell in love with hearing aids and the way that they could help people communicate more effectively with each other and this bite them that first year at Walter Reed where I followed David Hawkins he had been in the role previously. And then I went and in addition to doing the research audiologist role, I said, I want to work in the clinic of it too. And, and that’s been something that has always been a part of my role, I’ve had the opportunity to do a lot of different things in audiology. But throughout all of that, I’ve always wanted to keep one foot planted in research, and one in clinical care. And I still see patients today on a regular basis, because I think it’s the only thing that in the Jim Collins sense, helps me keep my saw sharp, and make sure that I’m continuing to understand the impact of technology that I get to help develop, but on the patient, and really that patient driven technology is what really excites me, but I also love sitting across the booth or the room, from a patient and and really seeing in their face. The impact of that technology and seeing the changes over the last 40 years has been remarkable.
Dave Kemp
Right? Yeah, it’s, it is nothing short of remarkable to see the technology, you know, and just the advances that have occurred within this space, I think it’s really promising and exciting. I think that we’re in like the most exciting period we’ve ever been in just because, you know, you think back on, you’ve experienced this on the previous generations, and you just kept going back and all the shortcomings of the technology and all of the challenges that people were met with like it sort of systematically, I feel like the the industry, the manufacturers have just kind of slowly been chipping away at it to where now, you know, we’re at the point where I think a lot of the sort of like the old problems have been solved, or I think we have a line of sight on solving them, like background noise and speech and noise. You know, some of the different we can get into this system as the conversation goes, but like with what you guys are doing with the AI algorithms and in you know, having that like in the actual hearing aid itself. So going to the point, though, about where you are, as you’re kind of like moving in your professional career along the way. So you’re at Walter Reed and you go to Mayo Clinic, you get your and your during the phase when you know, was not a doctoral level degree, the AUD at that point, it was a master’s level degree. What was that period of like for you where, you know, before, I guess, like audiology had fully cemented itself and gone down that route, which I don’t think has been fully resolved yet. In terms of, you know, the audiologists having the the level of status that I think was originally sort of was hoped for. Yeah,
Dave Fabry, Ph.D.
well, you know, great comments. First one I want to comment on and I know a lot of your audience on the podcast are hearing care professionals, audiologists. And one of the things that happened interestingly, after I got my master’s degree, that was 1983. But then because of my father’s death, I didn’t graduate until early 1984. And one of my professors at graduation, who shall go unnamed, congratulated me on completing my master’s degree and transitioning to an audiologist. But they said, Boy, I’m just really glad I’m in my shoes and not yours, because I really don’t see much future for this profession. Wow. And and it was like, Wow, thanks. You know, and it was like, you know, someone who had just spent a lot of time and money and an education and, and so I always, you know, I think back on that now, now, from the benefit of 40 years of practice, I and I realized now I’m older than they were when they made that comment. And I don’t want to be that person. Because for me, I can genuinely tell you, your comment was what triggered the memory was, I think we’re in the most exciting time right now. I know there’s there’s threats, there’s always disruptions, there’s, you know, you name it, the disruption of OTC or the disruption of third party pay of a whole host of things that people are fearful of, especially, you know, 40 years ago, I’m embarrassed to say how little debt I carried coming out of my PhD. Because there were great traineeships and research programs and you know, during the commitment to education at that point in time, in the mid 80s, was different than today and tuition was much less expensive. But you know, so I didn’t have that burden of thinking about you know, what’s going on why did I choose this discipline and I’ve got all of this you know, average debt now, I think according to a recent audiology today, study public By Tish Gaffney was close to $200,000. And, you know, I didn’t have that burden, but every day, even 40 years in, I’m extremely excited to come into work. And I love doing what I do. And whether it’s and maybe because for me, there’s no typical day. And that was really an answer to your question coming back around to I have my master’s degree, did my clinical fellowship year plus one. But I knew I wanted to go back and get my PhD because I was really fascinated by research because I had grown up and cut my teeth. In Dix Ward and Dave Nelson’s lab and then working with diamond tassel. And I did a master’s thesis was really fascinated by the the opportunity to go in and study something really deeply. And and the first thing you learn is you don’t even know what you don’t know. I mean, I like to say I never understood anatomy and physiology of the ear better than I did in the intro class, the first level anatomy and physiology class, because the more you learn, more fascinated you are with the elegance of the auditory system. But you learn there are many more questions and answers even today, when you start thinking about the the neurological process, I don’t know. But so you know, I manage and I struggled to always try to keep that sense of awe and wonder of the auditory system in the way that it connects us. And so I knew I needed to go back and get my PhD and was never a doubt that I was going to do so. My dad had an eighth grade education. My family at times wondered if I was ever going to stop going to school, but But I looked at it as a luxury to invest in. In myself, you know, now it’s interesting benefit of hindsight and why I save with baby boomers. And my parents were concerned about cancer and cardiovascular disease. Baby Boomers, like myself, are worried about cognitive decline. And and so for me, you know, I’ve invested a lot in my brain is why I’m still now transitioning, you mentioned AI, mentioned neuroscience, you mentioned hearing aids, that begin to look at how it is that we can take some of the results from the achieved study that was published, you know, earlier in July this year, and consider how it is that we help do everything we can to keep people connected, keep people engaged, preventing people from being lonely, you know, hearing aids are not going to cure dementia, but if they can, indeed, show that they can slow down the progression of that horrible disease. That’s a great thing. And it’s something I’m I’m as passionate and committed to today as I was 10 years ago and 20 years ago. What
Dave Kemp
did you get your PhD in? Like? What was the dissertation it’s
Dave Fabry, Ph.D.
called? Hearing science. And again, what I did in particular with that was used a model an artificial intelligence, no AI back when it was the articulation index. So So I like to say I was doing AI in the 70s, when I started as a pre vet major, but AI was artificial insemination. Then I graduated in the 80s to work with articulation index, which is now known as the speech intelligibility index. Okay, and then now, AI is that consistent thread through in the 2020s, with artificial intelligence, but my dissertation was looking at an AI model, a computational model, and then measuring the impact of, of single microphone noise reduction circuits and their ability to improve the signal to noise ratio versus reduce the background noise, make ease of listening and comfort. And look at the the ability to evaluate that. Using devices. This was an early version of a single microphone, noise reduction hearing aid. And at the time, some were contending that you could improve signal to noise ratio, and therefore speech understanding with a single mic noise reduction system not independent of directional microphones. And so we wanted to use the AI model to verify that our hypothesis my hypothesis was that when you’re changing by reducing the low frequencies that a lot of noise reduction systems predominantly do because that’s where noise energy isn’t mostly present, that you would reduce speech and noise by equivalent amounts, and that it wouldn’t increase the audibility, but rather reduce the presence of background noise. It could reduce upward spread of masking, but in in really unusual cases where people had really broadened auditory tuning. And so it was a it at a practical application of confronting those who said that these noise reduction circuits that were being popularized in the mid 80s weren’t really improving speech, understanding and noise, but also making the point that they could improve comfort and listening effort and listening ease. And so that really then directed the my research career for the next decade or so, where I was working with write it by timing, timing is everything. And I was fortunate to come on when directional microphones certainly have been available in the 70s. But in the 90s, they started coming back again, because now we started to have really good behind the ear devices with two directional microphone systems rather than using a single mic port. And so I really started to look at and work with directional microphones as well during that time, but always with a clinical application in mind.
Dave Kemp
Yeah, that’s really interesting. I the the reason I was curious about that, you know, kind of like, piggybacking on what you were saying about the achieve trial, which you had a great episode on, I learned a little bit about about the results even that I, myself hadn’t gathered. So kudos to you. And I think it was Dr. Jamie Meyers seeing
Dave Fabry, Ph.D.
that, yeah. Jamie had Yeah, that was
Dave Kemp
great. And, you know, I think that I’m curious, as a researcher, you know, somebody that’s like, on, that’s kind of got both feet, like you said, you’re, you’re in the clinical application space with, you know, you’ve always tried to maintain that, but you’re also kind of a researcher at heart. This, I think, is like the epitome of those two worlds coming together as the achieve trial, because it, it has such I think, a relevant, like, place in clinic, you know, and it’s not to say that you should be leading or with, like, fear or anything like that. But to your point earlier, I think that, like, intuitively, people kind of understand this. And I think it’s become even more pronounced with the pandemic. And masks is like, how detrimental it becomes when you start to that, like the social fabric that so many people depend on starts to decay. And then like, it’s just very interesting to sort of see the results of that, coming off the heels of the pandemic, where it was so visceral, and then it’s like, you know, you kind of read through that. And you know, that, you know, even with the way that it’s kind of split into two different populations, the people that are at risk, and maybe the ones that aren’t, quote unquote, as at risk, I think the the undeniable thing that is, is something that everybody can relate to whether they’re in this industry, they’re a professional, or they’re just like a loved one. And somebody that you know, in your life is like, How challenging is it? When you can’t communicate with one another? Whether it’s because of the masks or you’re socially isolating? And then what are the like, secondary effects of that in everybody can kind of relate to that now is like, Yeah, it sucks. When you go a week at a time where you’re not really communicating. It’s, it’s like, well, yeah, your your mind is a muscle, we’re less than you. You’re you’re experiencing, like a sense of atrophy basically. So I just find that to be something that as a researcher, like, you would would probably just like eat up and say, this is absolutely fascinating to see the ramifications of that kind of like longitudinal study and what the implications of that then are for the profession moving forward.
Dave Fabry, Ph.D.
Yeah, I think you raised a lot of really interesting points. First of all, you know, you’re right, the pandemic really taught us all the importance of engagement. And when we were isolated from each other, we could converse on Zoom or team calls, like this. But with that incidental conversation that occurs between the meetings, the watercooler effect, and just talking about what else is going on in your life, other than the content that is focused on a given meeting, that we were stringing together during the pandemic, is what I think provides that engagement, that connection to other people. And so for me, you know, then you add a hearing loss, untreated hearing loss on top of that, and every clinical audiologist, I think, was hoping that the achieved study would show the main effect, and that was that hearing aids could help slow the progression of cognitive decline. And it didn’t show it for the main effect, at least now, they’re still looking and they’re doing additional studies after the initial findings were presented. But But I think that that group at risk of atherosclerosis, those who had elevated blood pressure and cardiovascular diabetes and cardiovascular risk factors, they did show a significant slowing in the progression by 48% versus the control group that had importantly, engagement about healthy living and things like that, but not hearing aids. But hiding in plain sight in the overall cohort was that every subject in the nearly in roughly 1000 participants, while divided in two said that on the metrics that they used, that they were less lonely when they were fitted with hearing aids. And I think that’s that that’s that’s a significant and very important finding that loneliness has been highlighted by everyone from the surgeon In general on down as a next big epidemic, and particularly in the aging population. And so I think that’s something we really should be focusing on instead of our disappointment, that the overall main effect in the study for the roughly 1000 participants wasn’t a positive link, a positive association between the use of amplification and reduction in cognitive decline, those individuals who were at risk for cardiovascular disease did show more preservation than the control group, there was no harm there, no one was killed by wearing hearing aids. So there’s no harm in trying it. There were no adverse effects. But I think that loneliness point is something that we should really attach ourselves to as well as use the cardiovascular risk factors to have conversations with primary care physicians, cardio cardiologists, about those patients, who that they’re seeing who have those risk factors and may have untreated hearing loss. And what the one thing I’m hopeful of, is that the phrase you’re hearing is normal for your age gets thrown out. Moving on that we’re not simply accepting that hearing loss is a consequence of birthdays, and rather, doing something about it sooner rather than later, particularly if you have those risk factors will help with cognitive issues and cognitive tests that they that they measure, they had, you know, 10 items, 10 different cognitive tests that they use, and then those loneliness measures that looked at the size and complexity of a person’s network. That is something that should say, don’t delay if you have a hearing loss, to do something about it, and to work with a hearing care professional, because the other thing that we should be really focusing on is all of those patients who participated in that achieve study were fitted prescriptively. So they had the benefit of working with an audiologist to get an ensure that the devices were adjusted optimally for their loss. Yeah,
Dave Kemp
there’s a couple of things I want to comment on there. The first is that, to your point, I think that I think what’s really encouraging and probably should be one of the main like talking points in that I was trying to kind of get at, with what I was saying earlier about, like the, you know, kind of this coming on the heels of the pandemic is like, you know, hearing aids alone might not necessarily be the reason why you’re warding off cognitive decline or something like that. But I think that it’s easier to make the leap to say that it helps to allow for you to engage socially. And we know that loneliness is really the culprit behind a lot of this stuff. Like that’s when like you start to socially withdraw, you’re not engaging, you’re not using your mind, which is not to go on off on another tangent. But I think one of the really, really interesting things about you guys hearing aids at Starkey and the route that you’re going, which is to kind of monitor that, I think is absolutely fascinating. Because I do think that it’s, I think a maybe more appropriate way to be positioning all this is to make that confrontation in people’s minds to say that this enables you to communicate and communication is actually at the heart of where a lot of these nasty secondary effects can come into play. And can’t we all kind of remember what it’s like when we were all quarantined from one another, it might not have been as pronounced for, you know, someone young like myself, but I definitely saw it with some of the older adults in my life like it looked like they were visibly aging, because I could tell that like that was such an important part of their cognitive fitness more or less. Well,
Dave Fabry, Ph.D.
and thank you for saying that. I mean, now we look like we were a bit prescient of the achieved study findings because in 2018, when we when we launched Livio AI was the our industry’s first product that had embedded sensors that were capable of monitoring physical activity the way a wrist worn device would, and and really was done with purpose because we already knew, I mean, there’s been a long standing association between cardiovascular disease, diabetes, risk of stroke, elevated blood pressure, and untreated hearing loss. And even back when I was at Mayo, I was working with a lot of the cardiologists who were colleagues and friends, and they often said in the aging individual hearing in the audiogram is a great indicator of overall cardiovascular disease. Just because the money blood supply that goes to the ear into the eyes. If there’s any interruption if there’s high blood pressure or a stroke or any interruption of blood flow to the eyes or the ears. That’s a good indication that they should check into cardio To vascular factors as well. And so, you know, we what we wanted to do was look at using that that step counting function, if you will to look at physical activity steps, exercise, and just simply getting up and moving around a little bit every hour as a means of ensuring musculoskeletal strength would be good in the aging population. But then the other part that you can’t get on the wrist at the time, was that social engagement piece and so we kind of cobbled together a metric that is proven to hold up quite well, in terms of using the acoustic classification systems. That’s one form of machine learning that has been used in hearing aids, or some time to be able to monitor the acoustic environment and say, Is this a quiet environment? Is their speech in quiet? Is it noisy? Is it machine noise? Is it windy, and the acoustic classification tells us something about whether a voice is present in that environment. So we could look at the number of minutes that a person is spending throughout the day when speech is present in those acoustic classes. And trying to maximize that engagement. Admittedly, it’s not saying your voice versus someone else’s voice yet. But but it is saying a voice is present. That’s a measure of engagement. And then also, the complexity and diversity of acoustic environments was another metric we put into this engagement score. If you’re going out and about going throughout your day to restaurants, work, places of worship, Jim, that means you’re probably more engaged, you’re less likely to be lonely, you’re less likely to be sitting at home, watching TV. And and then, you know, we really wanted to look at that beyond just hours of daily use, which was also a measure of engagement. If you’re, if you’re up and about, you’re getting up in the morning, putting your hearing aids in and going out through your day, that’s a good sign, then we want you talking to other people, and we want you going through varied environments. And we’ve really taken that social engagement metric, and built on it to where we are with current products. And really, we’re still just scratching the surface in terms of what AI has the potential to do for encouraging people to live, more physical activity, build lives that have more physical activity for all of the reasons we discussed with cardiovascular, but also that social engagement piece. And we really think that we need to think we’re not just fitting a pair of ears and measuring it. I’m a big fan of real ear measurements, and hitting targets and ensuring audibility in the individual patient is important thing. But we also need to think about the patient as a whole and how it is that they engage with their their world. And probably the most important thing that we do beyond the audiogram is really understand better what the patient’s concerns. Are these first time users for sure. What are their fears? What are their concerns? I find among baby boomers that were less stigmatized. I mean, for my whole career, we’ve talked about the stigma of hearing loss and is still a major barrier. But among younger patients with who have hearing loss, they’re less stigmatized by the use of of a hearing aid, but they have higher expectations for what hearing aids can do impact their life in a positive way.
Dave Kemp
Yeah, I would, I would agree with that. I think that that’s one of the most, again, if we’re kind of talking about the bull case for sharing healthcare, broadly speaking, and I think that’s a big part of it is I do think that there is a generational component to the stigma, where for whatever reason, it’s just like, the connotations that maybe the previous older generations had were sort of Geriatric, you know, the big beige banana kind of thing. And I think that now we’re getting into the boomers that are, you know, the ones that are really kind of the growth market here. And I think a lot of them are way more receptive of it. I mean, I can see it viscerally, just through my parents and all of their friends now, for the most part, have hearing aids. And so, and I think it’s just kind of like become totally normalized in a lot of different ways. Because I think people are starting to kind of pick up on some of these, you know, ancillary applications that again, I, this is a good segue, because this is what I wanted to talk about next, which is, you know, I want to kind of like thread two things together, which is the comorbidities. And there’s a discussion I want to have with you here, but then also the biometrics. So again, big kudos to you all in 2018 when you launched Livio, because I had been following the whole biometric monitoring space very closely at the time and I was really excited because, you know, back then there was sort of this like notion of like, well, what what can your your worn device do that? A wrist worn? device can’t, you know, with an Apple watch or a Fitbit or whatever. And so, you know, I think that like as time went on, and he kind of worked through, like what some of those different things might be, this was a very interesting application of using the microphones to basically detect the ambient environment, and then draw conclusions from that. And I think that like the stuff that you guys are monitoring, you’re right, it was very prescient, because now we know, much like it’s important to close your physical activity rings, if you’re, you know, into that, I think you can kind of be looking at the same thing here of like, this is your cognition score of the day. But I think that, you know, without like, getting into any of the future plans, with the product roadmap or anything like that, I just personally think this is going to be the biggest secondary set of use cases for hearing aids, in moving into the future is basically like the idea of using, whether it’s an Apple Watch, or it’s a hearing aid or using a, you know, a symphony of these different devices, and they all feed into a different data set, I think what we’re going to find is that, like, when you have a longitudinal data set that’s taking measurements on the minute on the hour, as opposed to maybe once or twice a year, when you go see the doctor, people are going to get incredibly more precise with what’s going on with their bodies. And I think that this is such an interesting opportunity for hearing healthcare is, if the ear becomes a hub for biometric monitoring, wouldn’t that sort of imply that then you would maybe start to be able to build inroads with the cardiologists, the nephrologist the different people that are your allied medical professionals that, you know, there are commonalities and you know, that you can be sort of a first responder of sorts to be detecting maybe some things that, like, I remember, I went and I saw Viktor Brae speak earlier this year, and Dr. Bray was talking about how sudden sensory and sensory sensory neural hearing loss is like a stroke in the ear. And, you know, basically, how he was describing it is that like, it’s the first indication that there’s something much bigger going on in your body and was drawing the connections between, you know, like kidney failure and stuff like that things that on the surface. For me, I had a hard time grokking. But for me, like, again, to kind of just bring this whole thing full circle is that is a really tantalizing future is one where the hearing healthcare professional becomes a liaison and a conduit for many other medical professionals. Because you know, you have this mutual patient, that you might be on the frontlines of detecting something that really does warrant a referral off and in, isn’t that a great way to like, start to build those inroads if you do want to kind of medicalize your your offering, in a sense,
Dave Fabry, Ph.D.
for sure, so much to unpack there. So. So first off, as you said, the ear is a remarkably good place to monitor and measure biometrics. And so we learned this very early on in terms of we had a, we had a device a number of years ago that had a heart rate function that could report our rate as you go throughout the day, the ear is a great spot to measure heart rate, temperature is another SPO, too, is another you start looking at things that you can measure in the ear with greater accuracy than in a lot of other places. And so that was one thing that intrigued us was this ability to use the ear as a hub for looking at an exploring other things. But I think the other point you raised is that long term biometric monitoring is far superior. And we’re we’re looking at novel ways to measure long term biometrics in ways that transform or transcend what occurs typically when a person goes and has an annual physical, or, or even does a stress test when they go in because they’re concerned about cardiovascular and we can start looking at the benefit of monitoring and all the patient has to do is wear their hearing aids and be connected to their smartphone. Now, you really look at being able to evaluate and think about things in a different way than what a traditional clinical care model provides. The challenge with that is now data. And data is the new oil. It’s been said, you know, and the issue is, is that when you have this ability to monitor all of this, you don’t have the capability of storing it on the hardware peripherally for forever. You run out of storage, and then you’re talking about cloud and and you know, Hate to break it. There is no cloud. It’s just someone else’s computer, right and it’s still There are limits to what cloud storage can do. And you end up with a really a signal to noise problem, if you will, of monitoring all of these data that much of it is probably not useful. But if for example, using the case that Victor gave, if you had the ability to monitor change, some minut change in terms of blood flow or odd audition, if you could, if you could do something with an OEE, or something like that, they could monitor a change in auditory function. And then if you could buffer 510 minutes or an hour before that those data might be invaluable. But the hours and hours leading up to it might not be as much. And I’ll segue a little bit into something that we’ve actually delivered since 2019. And a product and that was something that should be within the scope of practice of every audiologist you start, you start scaring people a little bit. Sometimes when you start talking about heart rate monitoring, and some of these things, they say, Well, wait, I’m not a cardiologist, I’m not a physician, and I get that. But hearing and balance, you know, is something that is within every audiologist scope of practice. And so we recognize the comorbidity with falls in the aging population. And falls really is not only for aging population, but people at risk for falls have a great concern about you know, their family members are equally concerned to the individual. And it often if you have a fall, it starts to begin this downward spiral of lack of independence because now your family starts worrying about you living alone, let’s say you lost your partner, and you’re living alone and your family is worried about your falling in the home. So we use those sensors, the the IMU, the inertial measurement unit sensors to detect a characteristic pattern, a physical pattern in XYZ plane of what a fall looks like. And so we did a lot of assessment of how people fall and there’s a gate disruption followed by physical contact, a slowing of that and then arousal after that, and then having two devices that can cross check, and really reduce false positives by having two devices or reduce the problem. If you drop one hearing aid. The other hearing aids still in place it knows Okay, by looking and coordinating the input between the two years that that was a false positive. But that feature of a fall detection feature that could then alert, three trusted contacts of the presence of a fall has been met very warmly, in the field by patients and especially by their families. Some a child who lives half a country away from their parent who is living alone can receive a text that says your loved one just fell. And if they tried to call them or text them and they don’t respond to even see on a map where they were so they can send over emergency personnel or if they’re in the vicinity, they can go over and check on them themselves. That’s been a great feature. And I like to say you know, a fall detection feature is great, but in many ways it’s too late. Because once someone falls and breaks their hip, it starts a downward spiral of health. My mother fell broke her hip had a hip replacement, and the fall itself didn’t kill her. But it really escalated a lot of other health concerns that led to reduced physical mobility, mental mental acuity and accelerated her demise. The following didn’t kill her. But the consequences of it ultimately terminated her life shorter than it would have had to have been. So what we’ve been engaged in more recently, is a research collaboration with Stanford, and the audiology and Otolaryngology and aging group there to look at ways that we can use those sensors to try to use it to assess fall risk, if you will, at least on exercises. The study protocol, the stopping elderly accident deaths and injuries protocol that is used by physical therapists and primary care physicians is something that we postulated. Right now it requires someone to go to your earlier point to go into a clinic and be monitored by a physician and audiologists a PT as they go through a series of exercises. For example, how many times in a period of time can they sit down in a chair without using the arms in 30 seconds? There’s standards norms and age based norms for that. Well, we thought the sensors could do that and scored automatically if they’re connected to the phone. There’s a timer there’s a clock and the motion SEC signatures. So we’re engaged in a multi year effort looking at ways that people can use this ongoing monitoring so that in the comfort of their own home ultimately, they could look at running through the study protocol tests. and see how they perform relative to normal to know whether they’re at an elevated risk of a gait disruption or strength is diminished or balance, and then try to see where we can go with this to ideally provide screening measures that can provide an indication or some confidence to say you should be working on this gait strength or balance exercise to try to help prevent falls, you know, hearing aid isn’t going to prevent a fall. But if we can provide screening measures that are established in the healthcare system for use in assessing fall risk, we think that that’s an interesting area moving forward, that can combine hearing and balance within the overall scope of practice. With a mild hearing loss, you’re at three times the risk of a fall, and once you suffer, one fall, you’re going to fall again, and providing really that peace of mind for the patient, their family members, and see what we can do and where we can go with that. So it’s an area that we’re actively engaged in, in this partnership with Stanford. And I also want to say that we’re talking about comorbidity and secondary effects, I mean, that the main drivers of of expectation for hearing aids from hearing aids by people with hearing loss remain relatively constant over the last decade, they are speech understanding, you know, hearing soft sounds, hearing well in noise, preventing loudness, discomfort, and interestingly, localization, spatial awareness, those are the top four drivers and have been for some time, we can talk about the secondary effects. But unless we’re excelling in the core areas, job one is always speech, understanding and quiet noise, preventing loudness, discomfort, and preserving spatial awareness so that when I put my hearing aids on, and I’m fitted by normally, that if a sound is over here, I hear that it’s present. And I know where the sound is. And so fundamentally, that’s always going to be what we’re focused on first. But then these other areas are really interesting. And where we’ve been working with a lot of the AI approaches machine learning, and even is starting to move in the direction of deep neural networks is for speech, understanding in quiet and particularly in noise, because that’s an area that is where people first begin to notice difficulty.
Dave Kemp
Well, it goes back to what you said earlier to with the expectations and the expectations being pretty high. And I think that, you know, I think this is like, it’s the whole notion that, you know, the last thing that you want is for people to buy hearing aids, and then put them in the drawer and not wear them. Like that’s the worst possible outcome that you can probably have even worse than people not even engaging with the whole system. Because it’s hard to salvage that person. And I think that, you know, if you can, if you can sort of nip that in the bud by providing an optimized experience. And I think that it’s critical that I mean, I’m very pro, hearing healthcare professional, I think that they’re a critical piece of this puzzle. I think the OTC market is interesting. And I, I’ve always just viewed that as a secondary market, I don’t think they’re the same market in any way I, but But you know, again, you get fit properly, you have that good first experience, and then the device just works. And I think that, in essence, like AI, though, my read on it is that it’s really ultimately going to just make things work more efficiently, unbeknownst to the user. You know, I think that many people that are going to be wearing something like the Genesis, and that’s their first hearing aid experience, you can attest to this, like that is so night and day different to, you know, what was around in the 90s in the early 2000s. And again, I think that kind of gets at, like, what’s so exciting about this space is that a lot of what had previously been I think a lot of the the challenge as a provider is being sort of circumvented at the, at the root. And so that’s what gives me a lot of hope. And I’d be curious to kind of get your take on like, say, you know, speech in noise, because that kind of seems to be the Holy Grail. Do you think that, like, how far away do you think we are to having, you know, devices that are more or less able to self tune themselves to where it just is complete? It’s adapting to whatever ambient noises there are, and it’s able to parse out speech from noise and it just feeds you speech. And it filters out the noise like, Are we there? How close are we to being there? I don’t personally know where we are with regard to that, but it feels like we’re closer than ever.
Dave Fabry, Ph.D.
Well, I can give you one person’s opinion. And you know, I think first of all, the you talked about the changes from the 80s 90s into today, I think as we transition from analog devices into digital, and really looking at that acoustic canvas, if you will, that is the the breadth of frequency response. And the breadth of intensity, the range of the input dynamic range, if you will, that is possible with hearing aids today is remarkable on this latest product, you mentioned Genesis, we have 118 dB input dynamic range. So that acoustically gives us a lot more range. And while speech understanding and noises is the area where people have the highest expectations, I’m also I think, the issue and Mead Killian was really is really someone that has promoted this for a long time, when is the inventor of the camp and really starting to lead us into the nonlinear amplification era that he talked about the importance of hearing for hearing aid users to hear different dynamics within the the intensity range, and you want to be able to when someone drops their voice and leans into to share a secret with you, you want to be able to get that nuance. And to be able to have a much greater input dynamic range helps mean that soft sounds or soft, moderate sounds or comfortable, loud sounds are never uncomfortable across as broad of frequency range, as the residual auditory area allows. Sounds simple, a lot harder to do in the technology today in the computational power, and the frequency response. And intensity ranges, critical to speech and quiet and that natural sound quality for the entire range of input levels and across all of the frequency response. Now, speech and noise that comes in terms of some of the areas where I would agree with you that OTC and state of the art prescriptive fitted devices are different. Because with a professional kind of understanding what the expectations are for the person, where do they want to hear what are their expectations for benefit helps guide them into the appropriate technology. But you mentioned it the first thing whether you’re going for OTC or whether you’re going for prescriptive, you want seamless technology as a baseline to capture the majority of people, they just want to put them in and not have to fiddle with them. And so certainly, we want that seamless technology. Because the the the easier you make it, the easier it is for the majority of people to accept it and use it on a regular basis. That being said, where we really started to move from machine learning into dnn was with this feature, secondary to automated acoustic environmental classification. You know, back in the 90s. If I wanted to fit someone with a directional microphone, I would they would have to engage a separate program to say, here’s your quiet program. Here’s your noisy program. Here’s your music program. And we had devices that could change channels like on a TV set. Little bit later, moving into the end of the turn of the millennium, we started to see automatic devices that could use that machine learning to classify on the basis of spectral temporal timing differences. You say this is quiet, this is noise this is windy and then only apply those features necessary to that environment. Problem with that is even the most sophisticated machine learning systems today are only about accurate 80 to 85% of the time. Why is that? That’s a question. Why Why would you say even if you if our goal is to have completely automated hearing aids that just go around and turn on directionality? Wind Noise management, a music program, our feedback make power one thing but what what else would say what would limit that from being 100% accurate so that if you were judging the environments that a hearing aid was changing to say this is quiet, this is noise, this is music, this is this? What prevents it from being 100% aligned with your assessment of an acoustic environment? Is
Dave Kemp
the 15% sort of ambiguous and you need to discern? Yeah,
Dave Fabry, Ph.D.
because music can be a stimulus of interest. Or it can be noise. If we’re in an elevator and we’re engaged in a conversation. And they’re playing music overhead in the in the elevator, I don’t want to hear that I want to hear you. But at other times I may want to enjoy the music. And so the the algorithms, the algorithms can’t discern what’s something of interest versus what what is noise. Similarly, speech can be a stimulus of interest. If we go out to a restaurant and we’re having dinner, and there’s a person at the table behind me he’s got a really loud voice, that the hearing aid has no ability to understand. Do I want to hear that? center do I want to hear you, it can do so on the basis using directional microphones assuming the person in front of you, but it’s not always the case. And so what we decided to do a number of years ago was come up with a feature we call Edge mode, which enables the individual to use their hearing aid in an automated fashion, go about their their day and let it just switch and apply that. But if they get into a really tough situation, let’s say, You’re a real soft talker, and I’m having trouble even with the the automated processing, and I want to apply a setting where I can double tap or press a button in an app to do an acoustic scan for your voice at that moment in time, because it’s really taking the automated processing plus what I would call listener intent to say right now what’s in front of me is what I want to hear, and I want to hear it better than I’m hearing in the automated program, I can tap or I can push, and it will do an acoustic adjustment and assessment to look at is their speech and noise present. And it will take whatever’s in front of me and apply additional offsets to either make it more clear and more audible. Or if I choose in an app, I can use Edge mode to either enhance clarity or reduce background noise more aggressively than what the automated program would be. It’s like having a Tesla with Ludicrous mode, or plaid or whatever, you know, to give outstanding acceleration when you want to show off to your friends, this is with a purpose to say right now I want to hear that person or that entity that’s in front of me more clearly. Or I want to reduce background noise in that environment. And I can select that. But no machine learning system is capable today of really assessing your listener intent. And I think even as we move into using deep neural networks, to enhance and optimize Signal to Noise further, in this type of situation, I don’t know for sure that we’re ever going to see completely automated systems overtake what the hearing aid even using dnn and and certainly machine learning can do plus listener intent to say right now, what’s in front of me is what I want to hear. And I want to I want to kick it up in turbo charge a little bit more.
Dave Kemp
Yeah, it’s such a good point I and I’m, I’ll be curious to see how they, how you and other manufacturers solve this. Because it is something where it’s just sort of, again, modern marvel that is our brain. You know, it’s like you’re constantly bombarded with so many different sounds. And you’re just so you know, naturally unknowingly just like, you know, toggling between which noises you want to hone in with. And I can imagine how hard that would be to replicate in some sort of machine where you don’t have the engine that is your brain that’s driving and telling it you know what to focus on?
Dave Fabry, Ph.D.
Absolutely, no, I mean, I think that’s really begging as we get more and more computational power at the ear level, either using some of the processing power that we have on a phone or some other system or ideally, just using what onboard processing we have at the ear to first consider the input dynamic range and the frequency response and make sure that we have signal processing that can handle all of those inputs and map it to the residual auditory area, but then start to think about computational power at the ear. We’re starting to see, you know, where chipsets are really capable of moving we have an onboard dnn accelerator that can now you know what I like to think of as the difference in machine learning where we tell it what the rules are. And then we see how accurately it can provide classification of auditory environments. I said, 85%. With dnn, we don’t give it the rules, we just say the goal is to pull speech out of noise, you figure it out, not encumbered by our biases. And you can go down some funny rabbit holes in a dnn model that is unsupervised. But at the same time, there I think are going to be breakthroughs that are provided by letting it try to work to enhance and pull out speech from noise. There’s always you can’t defy the laws of physics, there are still going to be things and limitations that prevent us from you know, taking a minus 10 signal to noise ratio environment and suddenly providing perfectly clear speech without being able to plug it into a wall. But But I think the more and more we think about neuroscience and neurological processing and trying to have automated computers and computer based hearing aids, mimic or exceed what the brain can do that that really has to remain. The singular goal is to think about how it is that we can apply this neuroscience to a hearing aid type system.
Dave Kemp
I think it’s so fascinating. I mean, it’s going to be very interesting to see, you know, you think that we’re sort of reaching the, you know, the horizon, and you realize that the horizon never ends, just keeps going and going and going. And you see, like, Okay, well, now that we’ve really gotten to this new threshold, and you know, hurrah, how do we get to the next like, 5%. So it is super interesting. I want to be conscious of your time, I can’t thank you enough for taking so much already. I want to close by changing gears a little bit. So I, I mentioned to you before, I think something that I really appreciated about you, every time I’ve had a chance to meet with you and see you is that I feel as if you proactively try to really impart wisdom on the next batch of professionals and pay it forward, more or less. So in that same vein, for people that are, you know, kind of feeling their way out in this space right now. I mean, I think that there is some false narratives and doom and gloom, when I personally think that this is one of the most optimistic times and to your point, maybe some of that is burdened with some of the realities of today, like student debt and grad school debt and whatever. But what would you say to to people that are, you know, kind of, like just getting their feet underneath them in this space? As a young professional that, you know, I guess it can be applicable to not just people in this space, but to to people that are young, ambitious, and wanting to, you know, I guess make the most out of their career, what what are some wisdom that you can impart on us young whippersnappers,
Dave Fabry, Ph.D.
young whippersnappers. Okay. Well, I think, you know, speaking from my own personal experience, when you finish with school, and you’re trying to establish there was a time when I still looked young, you know, and you’re trying to establish credibility with your patient, when, when they’re when you know, when they’re 75. And they’re looking at you like, you know, what’s, what’s this kid going to teach me that I haven’t already learned or know, the first bit of advice is that two ears one mouth, as I said, because I think patients don’t care how much you know, until they know how much you care sort of sums up, what I’m going to say in the next little bit here is that it becomes, I think, it becomes an issue where you want to try to impart to the patient that you know what you’re talking about. And so you’re going to try to talk more in technical terms and, and tell them, but I think you don’t learn by talking, you learn by listening. And so one of the first things is take a pause. And listen, particularly for the first time hearing aid users because you got to remember, if you’re working with hearing aid patients, they are at the very least in a an approach avoidance conflict, and maybe even an avoidance avoidance conflict, when they’re coming to you. They don’t like that they have a hearing loss. And they really don’t are not enamored with wearing hearing aids or spending money on something because of that stigma effect that we talked about. That’s somewhat changing. But But the issue is, you’ve got to remember that they’re kind of stuck in this cognitive dissonance over the fact that their family is telling them to be there. They’re afraid that their family is going to think differently of them if they admit that they have a hearing loss and do something about it. But your job is to really listen and demonstrate that you care beyond the audiogram. You know, you can’t be doing the Audiogram and immediately start thinking about which which device you’re going to fit with them which receiver which receiver sighs You got to stop for a minute. And because your secret sauce, I said you don’t know your patient until you know your patient. And you’ve got to invest that time in understanding what your patient’s concerns, fears needs expectations are AI is the ultimate in rule following. And it’s going to be able to determine what to do on the basis of the audiometric information and what the on the acoustic environments all that but to date, some, some may start to beg to differ that computers are capable of empathy. But today, that’s been the barrier that really separates us from the machine. And I think the combination of letting AI help you in the areas that it can do very well. Acoustic mapping of acoustic environments is a good example. But then using that empathy to help select the style, the form factor the features, the user app, or whatever is going to make that patient and streamline them to maybe they’re incapable of using a feature like edge ml but they want to just put it in their ears and go don’t only think about Rick styles because not all patients want that style. Don’t think about what’s the easiest for you. But think about what is going to get you to the, to the best solution for that patient. The other thing is, while many people complain about musicians and engineers and the difficult patients, the musical engineer is the most challenging patient. My experience in my history is I run into those patients, because musical engineer is capable of understanding technically, and aesthetically what they want to hear and what needs to be done. And they can often articulate their concerns better than the average patient. And if you can successfully meet them and fit them, and so that they understand you’ve provided the best solution, given the limitation provided by their hearing loss, they will become your best advocates. And I don’t think there’s anything to fear by AI or OTC because the engagement with the patient, it sounds like it’s a soft skill. And it is, but but that working with the patient to display empathy, to help understand where they are on their journey, and to meet them there, and then bring them to where you know, they need to go using best practice should be the goal, it’s easy to say a lot harder to do on a day to day basis when you got the pressure of patients. And you’ve got the pressures of ensuring that you’re economically bringing value if you have a practice or bringing value to the clinic where you’re working. But but I think I’ve always tried to focus and I learned this at Mayo, and I continue to learn it from the founder of Starkey, Bill Austin, when I’m with an individual patient, I’m giving them all my attention, I’m not focused on anything else other than them at that moment. And if you do that, the needs of the patient are the only interest that you’re pertaining to at that moment in time, you may lose a few battles along the way, but you’ll never lose the overall war against isolation and loneliness. And, and to me, that’s served as a good rubric for patient care. And it’s why I continue to want to work with patients and why I can see that the generational changes that are taking place, but don’t paint with too broad of a brush, you don’t know your patient until you actually get to know that patient and and listening more than hearing. And listening more than talking rather, is the best way to get and draw that out of a patient. Very
Dave Kemp
well said. And I agree that I think it’s it’s almost like these are the kinds of things that people almost tend to dismiss, because it seems so obvious. And it’s so simple. But I do think that there’s a ton of wisdom there is that don’t overlook the real true value that you’re bringing in that what differentiates you from every other avenue of access within the market is you. And I think that like, if I could kind of sum up this whole conversation, it’s like, you know, from the achieve trial to the capabilities that the technology now is providing, it’s like, ultimately, what that boils down to, in plain English is more ammunition for you to have a conversation with your patient, once you start to gather information from them about at the core of why they really came in to see you, you know, it’s not to necessarily just I need to hear better, it’s like a specific thing. It’s, I can’t hear my grandkids, and this is really eating at me, you know, so I just find this to be something where the the really encouraging thing about this is that I think that the medical professional has, you know, regardless of what the one guy told you back in the day, that you know, wow, like, I fear for this profession. I think that there, I think that the profession of audiology, and the whole spectrum of hearing healthcare is is in a really fortuitous position right now. Because I think a lot of roads sort of lead to Rome, Rome being the brain and like, the gateway to that is the year and so I think that, you know, it just it’s it’s exciting to know that you’re going to be more prominent in these broader discussions that involve a whole medical team. And it’s almost kind of like, I think in some ways, audiology has had a seat at that table in some capacity. But maybe it hasn’t. It hasn’t had the like presence that maybe audiologists know they should have. And I think if nothing else, what we’re kind of learning from all of these disparate things is that there is 100% a role for this specific medical professional. And I think that the way that you can sort of embody that is to be well read on all the different new trends that are happening, the new research and all that and then being able to like communicate that effectively. So yeah, it is kind of a soft skill, but in many ways, I think it’s just being able to distill down what you know, as a medical professional in plain English to your patients in a way that really resonates with them. And I think the only way that you can ever resonate with them is if you really can listen and understand at the heart of why they’re kind of coming through and seeing you today. Yeah,
Dave Fabry, Ph.D.
and I just want to add on to a little bit of what you said, because I think the most important thing is to never be closed minded that it to learning new things. When I became an audiologist, really, your measurements didn’t exist, auto acoustic emissions didn’t exist. Even at the world famous Mayo Clinic, we had one tympanometry room, that we would all line up to us to do admittance testing at the time early in my career, and a lot of the measures that we have available to us today, that didn’t exist. And I think there was, even maybe some of my mentors might be disappointed that I don’t do as much research now as I did at one point in time. But one thing that is always done is the PhD. You know, even the process of getting a PhD is to really get you to surrender to the fact that you don’t know all of the answers, and you will never know all of the answers. But what you can do is try to never, that should never deter you from trying to find all the answers and being open to different ways of doing things. And so when those new technologies inevitably will occur in your career, be open to looking at them don’t become enamored just because it’s another get a gizmo another widget, but look at how it is that it can change the course of of patient care and treatment and lead to better outcomes. And and remaining open to that I think is the second bit of advice I would get other than listing more than you speak, be open to different ways of doing things. And it’s never a weakness to admit that you don’t know something if the best parts of my career have been when I’ve been a part of an outstanding team, that we had different strengths. And we were willing to be vulnerable with each other to say, I don’t know what you mean, when you said that instead of just pretending and nodding. And I think that that’s the second bit of advice I can give is always remember that there’s more that you can learn no matter whether you’re old, like me or young like you. And I have a lot of mentors that are very young. You know, mentorship is not only something that comes with wisdom, I have mentors that are the same age as you and I have them through you always want to take advantage of what different gender I like to surround myself with young ins and old people. And and you can always mentors come in a wide variety of ethnic backgrounds. diversity of opinion is extremely important and age and gender. Yeah.
Dave Kemp
That’s really cool. Well, Dave, I can’t thank you enough for taking all this time. It’s been an hour and 20 minutes and I feel like we’re we could go for another hour and 20 minutes, but I don’t want to put you through that
Dave Fabry, Ph.D.
will put everyone to sleep too. So buddy, thank you so much. I appreciate it. Great. Yeah,
Dave Kemp
this has been a really great conversation. So thanks for everybody who tuned in here to the end. We will chat with you next time. Cheers.
