Guest Post from Dr. Randall Bock M.D.

Hearing Aids Versus Reading Glasses
Guest Post from Doctor Randall Bock M.D.

Hearing aids cost thousands of dollars. In my early dotage ;-) currently 53 years old, I recently found imperfection in my near-vision (as we all do, over time). Probably I was laboring for a year or so before caving in: purchasing reading glasses. I am using them right now and they have made all the difference.

In the space of a few months, this year, I went from no reading glasses to seven pairs. I bought all seven online together as a package recently, for the grand sum of $10.00. That comes out to less than $1.50 per pair. As a result I keep one set by my bedside, one in the kitchen, one at my office, one in the car etc.; always at hand.

Not so long ago, reading glasses would have been "fitted" by an optometrist much like prescription glasses would have cost potentially hundreds of dollars each pair, but the wisdom of the market prevailed, under the implicit acknowledgment that the vast majority of cases of people needing reading glasses doesn't require prescription-fitting. Pretty much everybody gets nearsighted in the same manner, albeit differing in gradation; so it's just a matter of finding the right amount of correction in purchasing the new reading glasses. You can try one pair and then another until you are comfortable. There's the possibility that one eye's visual correction need is different from the other 's, and for those people optometrist consultation might be in order; however for nearly everybody else, off the shelf reading glass purchases are adequate, after trying different diopter-gradations of the eyeglasses.

Age-related diminishment in near-visual acuity is a result of change in the shape of the eyeball, essentially the drying out of the intraocular gel. This is nearly uniform although some of us get it earlier than others. Because the problem is pretty much the same for everybody, although differing slightly in degree, the solution is nearly the same for everybody. As a result , there is a great economy of scale, and eyeglass-fitting for hundreds of millions if not billions of people just a matter of choosing a correction-level and finding a nice style, really no harder than buying a pair of gloves and probably easier than buying a pair of shoes.

Along the same lines of losing our near vision gradually, pretty much much we all lose our hearing, or more harshly said "go deaf" in the same manner as each other (with aging that is).

If we can fit gloves, reading glasses, or shoes so easily: usually for relatively little indentation into our pocketbooks, why then do hearing aids cost thousands of dollars? I recently bought a replacement Bluetooth earpiece, and it cost me all of $20. This Bluetooth coordinates with a variety of telephones and computer and other devices. It is tiny and extremely complicated. It has volume adjustments, battery-saving mode and probably a bunch of other features that I have not figured out yet.

Why is this purchasing paradigm so different from that of hearing aids'? I know that a hearing aid has to augment sound yet not overdo it in case a loud sound occurs whereupon the hearing aid 's amplification could damage the eardrum. But really how much more complicated is a $2000 hearing aid than a Bluetooth earpiece?

I think the pricing has much more to do with lack of access on the part of the consumer to a free open market for same. Everyone is funneled through the audiology offices.

There was apparently some interpretation of a federal statute by FDA making hearing aids prescription devices. This apparently was a misreading of statute and the market is now opening up. Once this occurs we should be able to obtain hearing aids for prices similar to the more complicated Bluetooth devices, and maybe get more features too. Wouldn't it be nice if one could remotely control hearing aids; add GPS or item loss-prevention; replace them for tens of dollars rather than thousands?

Remember when contact lenses cost hundreds of dollars per pair? That market has totally turned inside out. We need to open up the market for hearing aids. I'm somewhat surprised that organizations supposedly advocating for the elderly, e.g. AARP, have not been more proactive in this area. The AARP wants its members to have hearing aids, promotes the benefits of hearing aids, but does not appear to have done very much to open the market. They have tried to promote a tax credit for hearing aids, but this only transfers the cost, the high cost, of hearing aids to other taxpayers effectively.

It would seem to me that the highest benefit from the current approach accrues to audiologists. Similar situations obtained previously vis-à-vis contact lenses for ophthalmologists, orthotic shoes for podiatrists, reading and other eyeglasses for optometrists, teeth whitening fittings for dentists, antisnoring mouthpieces for ENT's or dentists.

We have to flip this model inside out so that the greatest benefits accrue to those with the problem: in this case hearing loss. I have so many patients with hearing loss who can't afford to go the hearing aid route. When they can purchase these items freely, try them on, and choose openly between brands, prices will drop. The free-market rules!

See Doctor Randall Bock's blog here:

http://doctoringtheevidence.blogspot.com/2010/07/hearing-aids-versus-reading-glasses.html