Innovation Science

Things That Suck: Wired Magazine's Fact-Checking

A little over two years ago, CNN named modern hearing aids among the top 25 technology innovations of the past 25 years. Last year, Wired gushed over the latest hearing aid technology, saying that new hearing aids “make your Bluetooth gear look like junk.” Wired also reported last year on research that the center I run did with UC Berkeley on how hearing aids reduce the effort that the brain expends understanding speech in noise. And just last week, CES awarded a hearing aid its Best of Innovations 2008 Design and Engineering Award.

Which is why I was so surprised to see the latest issue of Wired magazine whose cover story on Why Things Suck includes a scathing and poorly informed attack on hearing aids. Hearing aids? Suck? Am I back in the 1980s world of distorting peak-clipping analog hearing aids?

This categorization is, frankly, astounding. Hearing aids have made incredible advances in technology over the past decade that rival anything out of Apple, Intel, or Microsoft. The response I constantly receive from other industries when discussing hearing aid technology, such as as when I met with researchers at Yahoo or researchers at a UC Berkeley engineering research center, is one of astonishment over their current level of sophistication and technical challenges that have been solved.

Hearing aids may whistle (although even that is becoming a thing of the past), but the do not in any way “suck.”

Many of the facts stated in article were either clearly wrong or bad interpretations of the state of technology today. Anyone familiar with hearing aids at all will immediately dismiss the story for some of its stunning inaccuracies.

What is surprising to me is that the reporter actually interviewed me about hearing aids two months ago before the publication of this piece. Anyone who knows me (or has read this blog, or read my publications, or heard my presentations), knows that that I am a fairly strong proponent of the current state of hearing aid technology and the benefit to the hearing impaired that they provide. This reporter was clearly filtering whatever information she received from me to use in her assignment on hearing aid suckage.

What’s unfortunate is that Wired didn’t do any fact checking on this story, and that neither the reporter nor the magazine checked with me (or apparently anyone else knowledgeable) on whether the facts were accurately represented in the story (I also now know why the reporter didn’t reply to my e-mail asking about the purpose of the article).

Rather than provide a point-by-point correction to the article, I will simply highlight and correct a few of the more obvious errors.

The article starts with the ubiquitous inaccurate comparison to eye-glasses, which have the near-perfect ability to compensate for optical distortion of the lens of the eye. Hearing aids address a much more difficult-to-solve medical ailment of neural damage. The strawman of “why aren’t hearing aids as good as glasses” has been beaten to death and this fallacious question is a fore-shadowing to the inaccuracies that follow.

The reporter rightly points out that hearing aids consist of highly specialized technology that does not benefit from off-the-shelf components used in other products—Dell will never be getting into the hearing aid business. Would one raise the same complaints about other high-tech medical devices? Would someone really complain that pacemakers or spinal implants don’t use the same components as an XBox 360? Why should hearing aids cost the same as simple ground-glass holders? Does anyone honestly think that the R&D behind complex electronic medical devices matches the work necessary to develop and produce contact lenses?

The reporter correctly identifies that the hearing impaired are more exhausted listening in noisy environments. Hearing loss has even been proven to cause poorer memory due to the increased cognitive demands caused by hearing loss. Research conducted at UC Berkeley in collaboration with the center that I direct, however, suggests that hearing aids can help to reduce cognitive load. Contrary to what the reporter insinuates, hearing aids can reduce the concentration to understand speech in noise, not cause it. In fact, Wired even reported on the benefit to listening effort provided by hearing aids last year! I think that this commenter to one of the online Wired pieces last year summarizes this benefit of hearing aids nicely:

When I don't have my hearing aids, I spend most of my time trying to make sense of what people are saying. This leads not only stress and fatigue, but also miscommunication. The longer you go trying to understand, the easier it is to make mistakes in translation. On top of that, when you are constantly asking people to repeat themselves... it gets increasingly annoying for the speaker and the listener. Too much focus is on the translation of sounds into logical words and not on understanding the point or participating in the conversation.

Later in the sucks story, the reporter strangely suggests that bulk is a critical issue when using directional microphones in hearing aids. Bulk is not only non-critical, it is a non-issue. Few audiologists would suggest that directional microphones are not beneficial to patients, fewer still would even recognize bulk as consideration, and no patient has ever complained about the bulk of the directional microphone.

I have to assume that these and other mistakes are honest misinterpretations of what this reporter heard from the people she interviewed (including me). If so, the fact that Wired did not check the accuracy of what they wrote is unfortunate because it does a disservice to those who could experience real benefit from hearing aids but who might not seek hearing assistance because of the article.

The psycho-social consequences of hearing loss suffered by the hearing impaired are serious: depression, anxiety, fatigue, social isolation. These are details that I made available to the reporter by e-mail. Because of the possible deterrent effect this article could have to someone with these symptoms, I can’t simply shrug this article off with an, “Is she having a laugh?” dismissal—my only response is, “For shame.”

The Challenges Facing the Hearing Aid Field

The latest issue of the Hearing Review features seven papers from a research summit that I organized and my company hosted in January of this year in Napa, CA. The goal of the two-day meeting, attended by many of the nation’s thought-leaders in hearing aid research and key decision-makers within my company, was to set guidelines for the next 5 years of progress in our field.

The outcome of the meeting was consensus statements on the top issues facing our field today. I’m very pleased with the quality of the papers that resulted and, more importantly, with the value of the guidance that was developed at the meeting and expressed in the papers. I believe that years from now these papers will be seen as important guideposts, if not watersheds, for the direction that our field takes over the next decade.

The following is from my overview paper and provides the motivation for organizing this meeting:

The hearing care field is at a fascinating point in its history. Technological developments are accelerating almost too quickly to follow, and paradoxically, our science has matured to the point where only now do we recognize the vast number of research questions that still remain to be answered. The size of the hearing-impaired population is about to explode, and its demographics are changing in a way that will test our current products, services, and delivery models…this turbulent sea of change in which we find ourselves will have to be navigated with the precision that comes from careful planning, analysis, and dedicated problem solving. Ideally, a course must be charted that everyone can navigate.

The charted courses are provided by the accompanying papers that represent consensus statements from some of the nation’s top researchers, each one summarizing the challenges that our field currently faces and outlining guidelines for how to address these challenges. The issues addressed in the six papers are detailed in my overview as follows:

• [Clinical Validity] Why does hearing aid benefit measured in the clinic often differ from benefit experienced by hearing aid wearers in the real world? Can we align the two to better meet the needs of the hearing impaired?
• [[Individual Differences] How can we better comprehend individual differences in speech understanding ability and subsequently provide improved individualized hearing solutions based on measures of cochlear damage, psychoacoustic performance, and cognitive function?
• [Evidence-based Practice] How can our field implement evidence-based practice and evidence-based design such that dispensing professionals can more effectively meet the needs of their patients?
• [Wireless Technology] What are the challenges that must be addressed for wireless technology to reach its full potential for patient benefit?
• [Aural Rehabilitation] How can our field optimize its use of aural rehabilitation in the hearing health care process?
• [Future of Hearing Health Care Delivery] What challenges from changing patient demographics, changing technology, and changing market expectations are faced by the hearing health care delivery model?

This overview doesn’t begin to hint at the depth of thought provided in the papers, however, so if you are in the least bit interested in any of these topics, I recommend that you read the corresponding papers.

They key to successfully creating such an impressive collection of insight, of course, is to include an impressive collection of people who can develop and debate the ideas and then elegantly crystallize the discussion into the few critical points. I will probably post in the future on other key elements of hosting conferences such as these.

Thinking About Sound

A complementary article on the research that our research center is doing on cognition and hearing was recently published at HealthyHearing. Part of the research is being conducted by Tassos Sarampalis and Erv Hafter at UC Berkeley—I wish the reporters had interviewed them as well.

Here are some passages from the article:

Engineering has taken hearing aid technology to its current high standards. However, even though 91% of all hearing devices are digital, offering improved sound quality, Edwards is quick to point out that hearing impairments still lead to slowed speech communication, diminished access to the environment and others, limited hearing and interpretation of non-speech sounds, the loss of spatial hearing and selective attention issues that impact cognitive development.

Thus, there is a need for hearing science to take a more active role in the development of the next generation of hearing aids – devices that not only improve hearing, but also better facilitate the cognitive processes once sound input is delivered to the brain.

Indeed, hearing aid technology has made major strides in the past decade and we can anticipate that improvements to existing devices will continue to be made. We can also look forward to technological advancements that improve cognitive activities in hearing impaired individuals.

WSJ, Hearing and the Looming AAAS Conference

The Wall Street Journal today mentioned a conference session for which I am both a co-organizer and speaker. The WSJ article has an interview with Stefan Heller, a professor at Stanford University who is one of the invited speakers in the session, on the damage to hearing caused by such popular products as the iPod—a topic that I’ve posted at length on before. Dr. Heller’s research is on the use of embryonic stem cells to restore hearing to those with sensorineural hearing loss. The WSJ article simply discusses the potential for damage from current audio products and the fact that people don’t know that they are causing damage to their hearing until it’s too late:

WSJ: Can you actually kill some cells just from listening to a single CD on an iPod at top volume?
Heller: There probably are some people that can turn the volume of their iPods up to the limit and never have a problem. But other people might do it once and wipe out their high frequencies. And once that damage is done, it will get progressively worse. But you can only know which group you are in after you've lost your hearing.

The conference at which both Dr. Heller and I are speaking is the annual meeting of the American Association for the Advancement of Science, the organization that publishes Science Magazine, which is possibly the most cited scientific publication in the world. The meeting is in San Francisco from Feb 15–19, 2007. The theme of the conference this year is Science and Technology for Sustainable Well-Being, and the session that I am co-organizing with Dr. Steven Greenberg is titled Hearing Health—The Looming Crisis and What Can Be Done. (For you loomers out there who found this post after googling “Loom”: Welcome. Please link to me on your Looming site.) Looks like the conference will be an interesting one, see the bottom of this post for a sampling of session titles.

I believe that we’re going to be reading a lot more about prevalence of hearing damage and attempts at hearing conservation over the next few years. A small startup is addressing these issues with their recently launched iHearSafe earbuds that have hearing protection built right into them. This accessory to the iPod and other audio products appears to be designed with a more rigorous approach to hearing conservation than the iPod firmware upgrade last year that purported to address similar concerns about hearing conservation. As further evidence, over 150 scientists and intellectuals responded to web magazine Edge’s new year’s inquiry, “What are you optimistic about? Why?” and among such responses as Nathan Myhrvold’s “The Power of Educated People to Make Important Innovations,” Jared Diamond’s “Good Choices Sometimes Prevail,” and Steven Pinker’s “The Decline of Violence” was David Myer’s optimism towards benefit from hearing aids.

Back to the AAAS meeting: I’ll be speaking at the Hearing Health session about the application of hearing science to hearing technology. Due to an AAAS embargo on releasing presentation material before the session, I won’t be posting my talk or providing details from it until after the conference. This is done to ensure that the conference receives maximum press coverage, I suppose.

The program at the conference is extensive and incredibly diverse. As an example, below are listed the symposia that will occur on Friday at 8:30am:

• Achieving and Sustaining a Diverse Science Work Force
• Addiction and the Brain: Are We Hard-Wired To Abuse Drugs?
• Research Competitiveness Strategies of Small Countries
• Communicating Climate Change: Strategies for Effective Engagement
• Science, Society, and Shared Cyberinfrastructure: Discovery on the Grid
• Smart Prosthetics: Interfaces to the Nervous System Help Restore Independence
• The New Mars: Habitability of a Neighbor World
• Tinkerers and Tipping Points: Invention and Diffusion of Marine Conservation Technology
• The Crime Drop and Beyond: Explaining U.S. Crime Trends
• Dynamics of Extinction
• Achieving Sustainable Water Supplies in the Drought-Plagued West
• National Innovation Strategies in the East Asian Region
• Mixed Health Messages: Observational Versus Randomized Trials
• Education in Developing Countries and the Global Science Web
• Food Safety and Health: Whom Can You Trust?
• Numbers and Nerves: Affect and Meaning in Risk Information
• Teaching Sustainable Engineering
• Anti-Evolutionism in Europe: Be Afraid, Be Very Afraid, or Not?

See you there.

I'm Back...

Well, I guess my prediction of little blogging activity in August was accurate. You may recall that I stated four reasons why my posts would be infrequent in August:

1. Writing a paper. I was asked to write a paper on the future of digital hearing aids that was due three weeks ago. Here’s a copy of the draft that I submitted. The journal is targetted to both clinicians and researchers, so this paper is written for a broad audience. The final version will be modified from this after it goes through a peer-review system.
2. Family reunion. Lots of fun, drinking, eating. Good to see all of my relatives. Spent evenings on a farm and heard coyotes howling at night—sounded like escaped lunatics laughing maniacally.
3. Co-chairing a conference. The most significant conference in my field takes place every two years at Lake Tahoe. A beautiful location for inspired discussions (the photo here is of Eagle Lake, a short hike up from Lake Tahoe). I was pleased to see several presentations on cognition, a relatively new topic to this field. I’ve posted before on the growing prominence of cognitive science in a variety of fields, and it’s certainly starting to be the case in my field. I even spend a significant part the paper I recently wrote talking about how cognitive science will impact hearing aid technology (starting on page 15 of the paper linked above).
4. Corporate strategic retreat. Obviously, I can’t say much about this, but I can note that being a vegetarian in northern Minnesota is a test of mental and physical endurance (not for me, for my colleague). I can also state that it’s good to be tall when playing beach volleyball.
5. Buying a house. After signing our names two thousand times, my wife and I are near to closing on a house in SF. Phew. Now what do I do with all of my college furniture?

Not Gone, Just Busy

Not blogging with much frequency right now. I’ll be posting in August, but there won’t be many analytical posts until September. Here’s why:

• Week 0: am writing an invited paper due this week on the future of hearing aid technology;
• Week 1: am traveling to a big family reunion in one week;
• Week 2: am co-chairing the world’s biggest hearing aid conference in two weeks;
• Week 3: am preparing for a yearly corporate strategic retreat that is in three weeks;
• Weeks and weeks: am trying to buy a house in San Francisco.

Speaking of which, let’s talk about a deviant variation of innovation: since when is an offer at the asking price of a house with no other bidders countered by the seller at 10% above asking price? Innovation or perversion? Well, given that this is San Francisco, I guess the latter fits…

Brain Games

Playing games to improve one’s mental capabilities is becoming an increasingly popular pastime. Research has shown that doing crossword puzzles regularly can help counteract Alzheimer’s. I suspect that part of the popularity of Sudoku is the assumption that daily mental exercises is probably a good thing.

Nintendo games that are intended to exercise gray matter have become popular among adults in Japan. Dr Kawashima’s Brain Training game for the Nintendo DS handheld platform has sold nearly 2 million copies in Japan over the past year and has received attention by the BBC and the most recent podcast of CNet’s This Week in Technology (TWiT). Apparently the game has just been released in the US, so don’t be surprised if you start seeing adults playing with Nintendos on your next flight instead of watching Big Momma’s House II—the commentators on TWiT say that the Brain Training is fairly addictive. One of the tasks in the game is a classic cognitive task: identify the color of a word when the word spells a competing color, e.g., the word “green” appears on screen in the color orange and you have to answer "orange" and not "green". The person playing has to speak the color of the letters (not what is spelled) into the Nintendo microphone for scoring.

This idea of of intelligence-preserving software exercises has made headway outside of the game world. NeuroTone, a startup in the Bay Area founded by the people who started the dot-com-era digital audio company Liquid Audio, has developed a similar type of “brain training” system for new users of hearing aids. Most hearing aid wearers are older and have been listening for years to deteriorated speech through their impaired auditory system. They haven’t heard sounds normally for a long time and their neural plasticity has probably readjusted to respond to distorted sounds. When a hearing aid is first worn, the brain likely needs some training to readjust to the reception of normal sounds again.

Neurotone’s software, LACE, contains speech understanding tasks and cognitive tasks that help with such functions as memory. It runs on the person’s own PC and connects to their audiologist through the internet so that their audiologist can monitor their progress. LACE also adapts to the ability of the hearing aid wearer: as the person does better, the tasks become harder so that the person is always challenged. Given the interest in keeping one’s mental ability “fit”, I wouldn’t be surprised if LACE becomes popular with normally-hearing people as adults look for ways to develop their own “brain training” regimen.

One interesting aspect of LACE from a hearing aid company’s perspective is that not only is LACE innovative as a product in itself, but it proposes an innovative business model for companies that integrate LACE with their products. The software training program provides a connection between the audiologist or hearing aid company with the hearing aid wearer long after the time of purchase. It makes wearers excited about using their aids—actually looking forward each day to the “brain training” exercises that help them better use their aids.

Imagine if other products could create that kind of connection and dedication from their users. People don’t read manuals, and if they do they have usually become an annoyed customer. Imagine if you could teach your customers how to optimally use your product with an interactive game. Or turn a moderately satisfied customer into a passionate user. Creating that kind of dedication towards one’s product is something that most companies don’t even try to imagine, but here’s a system that allows users to get excited about becoming better users of a product, and obtaining improved benefit from the product as well.

With LACE, some audiologists are actually setting up PCs in their lobby so that patients who don’t have PCs at home can come in every day and obtain their mental exercises. In the consumer product field, who wouldn’t want to give their customers a reason to return to the point of purchase? Of course, audiologists are providing LACE as a part of a best-practices approach to providing benefit to their patient. In other product areas, however, the LACE business model is an example of how to  better engage with one's customers. People should be searching for similar ways to get their customers excited about learning and becoming better users of their products.

How can the “brain training” model work for your customers and inspire them to improve the benefit they receive from your product?

(Full disclosure: I’m friends with the founders of Neurotone and the renowned audiologist who developed the tests. My company gives away licenses to LACE with every one of our high-end hearing aids. These do not alter the fact that this approach to customer satisfaction is an innovation that can be adapted to other industries.)

The Value of Outsider Perspectives

An article that I wrote was just published in an industry trade journal called The Hearing Review. The article focuses on how the hearing aid industry is perceived by those outside of the industry and what we can learn from that perception.

I wrote the article after having listened for years to the opinions of people in the Bay Area and around the world on the hearing aid industry. While many of their perceptions were incorrect or out of date, they still revealed to me what we as an industry were doing wrong. I also thought about what the implication of these misperceptions were for our industry—we should not simply ignore them for being wrong and irrelevant because those opinions they have indirect consequences for the growth of our industry.

One of the main messages of the article is that evidence-based product development by companies and evidence-based practice by audiologists can help spur the development of new technology. If companies provide clinical data on patient benefit for their products and audiologists use that data in their decisions on what technology to give to their patients, entrepreneurs will be more motivated to develop new technology for the hearing impaired. This is because they will have confidence that demonstating patient benefit with their technology will result in success in the marketplace and a profitable return on their investment.

A side-bar in the article discusses how to realistically assess the potential market size of the hearing aid industry, a topic that I discussed relative to any industry in a previous post called How Big Is Your Potential Market.

Here are a couple clips from the article:

Despite all of these positive indicators that our industry is healthy and growing, many people outside of our industry still look upon the hearing aid business as if it were small, antiquated, and uninteresting. These outside opinions affect future customers by influencing their opinion of hearing technology and the process of obtaining a hearing aid. It also affects our industry in more subtle ways: Top university graduates may not be attracted to work in our industry, technology innovators may not be interested to contribute to our industry, and high-tech companies may be reluctant to pursue business opportunities in our arena. These influences can only have the effect of dampening the growth potential for dispensing professionals and companies in the hearing aid industry.

---

We can embrace the aspects of other industries that are likely to bring about positive change and that promote the integrity and quality of its products and services. Valid clinical data that demonstrate product benefit should become a part of product development industry-wide. This clinical data should be made openly available to audiologists and other dispensing professionals, and these professionals should embrace the evidence-based practice approach. Hearing care professionals should know what benefit new products provide to patients, should demand supportive data from manufacturers, and should be cautious when they see claims that are vaguely worded with no supporting data. This approach is understood by everyone outside of our field, and by embracing these standards industry-wide, we can only increase support for our industry among government, health insurance companies, health care professionals and potential patients.

Squidooing

I’m trying out this easy-to-create-website service called Squidoo (created by Seth Godin, business writer guru). They call their modular webpages “lenses,” and lenses are supposed to be on a specific topic of expertise of the lens creator. Here’s how they describe themselves:

We have built an online platform that makes it easy for anyone to build lenses on topics they are passionate about. These lenses help you find a unique, human perspective on things that interest you... fast. Not only can Lensmasters spread their ideas, get recognized for their expertise, and send more traffic to their Web sites and blogs—they could also earn royalties.

The concept is that you can easily create a page on a specific topic that contains several modules consisting of links, text, photos and several other preformatted entries. My lens is on hearing aids, but my lens is pretty green since I just created it a few days ago. To see more established and interesting lenses, check out these on Arrested Development, Trader Joe's, and Frequent Fliers.

I'm curious to see how much traffic I get on this and whether it shows up on Google when people search on hearing aids. It's so easy to create a page, not much is lost if it doesn't turn out to be useful.

How Big Is Your Potential Market?

So you’ve got your (relatively) new company making online to-do lists for mobile phones that you can tag and share, or perhaps it’s an electric toothbrush that you can access remotely with Bluetooth connectivity to your PC. You need to calculate the market size for your product, after which you will assume a market-capture growth from 1% to 10% over your first five years to predict revenue.  The market size for the first hypothetical company is everyone who owns a mobile phone that also creates to-do lists, while for the second company it’s the number of people who brush their teeth and also have an internet-connected PC. Those numbers are huge, your market is huge, and your 1% capture will result in millions of dollars in revenue right off the bat. Right? Um, right?

The error the above market analysis should be obvious, but the same error is not so obvious with more common products. This error, in fact, is one that lives in my industry and has created a misperception that impacts the industry in many ways.

Most people in the hearing aid industry, and most outside who have bothered to do “due diligence” on the industry, believe a misinterpretation of data that seems to tell an intriguing aspect of the hearing aid industry’s potential market. Approximately 10% of the US population is hearing impaired and of those only 20% have purchased hearing aids. The numbers seem straightforward: 30 million hearing impaired, 6 million with aids, and 24 million impaired without aids. The conclusion is that the hearing aid industry has only been successful in capturing 20% of the potential market, and 80% of that market is waiting there for some company to develop the perfect technology for them to buy. Right? Um, right?

There have been a couple straightforward but ill-founded conclusions that have resulted from this faulty analysis (I'll tell you why it's faulty in a bit). The first is that the hearing aid industry is doing a terrible job because it has only captured one-fifth of the customers that want hearing help. This causes every executive who enters the industry to have the “I’m going to school you on how to do business” swagger, thinking that people in the industry are, shall we say, inadequate. The second result is that entrepreneurs and investors look at the 24 million unsatisfied potential consumers as a potential bonanza for the right product. Why would you design a product for the traditional marketplace of 6 million consumers when 24 million are sitting and waiting for the right product?

The problem here, as with the hypothetical companies in my intro, is that the analysis identifies the population that meets the base requirements to be a customer, but does not identify how many in that population have a need and desire for the product. Not all bald men are viable customers for hair plugs, only those who dislike being bald so much that they would spend the money and time for a quality hair implant. When Palm Pilots hit the market, their potential market was not every adult who keeps a calendar, contact book or to-do list (i.e., everyone), it was those who had a need for and who would spend a few hundred dollars on a portable electronic device that synched with their PC. Palm ended up in 15 million households in the US out of a total of 108 million households. Their percentage of market capture was not 13%, however, because their viable market was much smaller than 108 million households--most of those 108 million households had no need for what Palm was selling. And no one would say that Palm (at their peak) was a failure at customer capture.

In the same way, not all 24 million hearing impaired without aids have a need for any hearing help. An analysis of how many of those 24 million actually have a significant amount of difficulty with their hearing is approximately 7 million people. So, the hearing aid industry has succeeded in capturing about 46% of the viable market--not bad. And the untapped hearing impaired market no longer looks so attractive given that they will be difficult to reach and are no greater in size than those who actively seek out hearing help.

So, what is your potential market? Like most things, it’s going to take work to figure out, because it’s not simply the number of people who meet your minimum requirements—you have to determine how many of that group actually have a need for what you have to offer. Marketing 101, perhaps, but I have met many savvy business analysts and VCs who have made this simplest of mistakes.