A holistic perspective on hearing technology

In this episode, Brent Edwards from NAL and Stefan Launer from Sonova take us through their careers and share lessons and perspectives on the development of hearing technology. We discuss how the development of technology become more holistic, design thinking,  standardization and what's needed to get to new service models and innovation.

Time index of content:
Early career learnings - 3:20
Factors important for career success - 6:40
Hearing healthcare trends over past 30 years - 9:10
Design thinking and unmet needs in hearing - 14:00
Barriers to adoption of hearing innovation - 19:05
Hearables and alternatives to conventional hearing aids - 25:15
Hearing health data ownership, sharing and privacy - 28:50
Hearing manufacturer ecosystems and harmonization - 39:40
Threats and opportunities with OTC hearing aids - 44:50
Final points - 55:55
Advice for people early in their career - 57:05

Transcript

0:15

Welcome everybody at this third episode of the computational audiology network podcast. And today I have Brent and Stef in our virtual studio for the first time, welcome Brent and Stef! Um, let me further introduce them briefly. Brent Edwards is director at the NAL in Sydney. He studied electrical engineering, obtained a PhD at the university of Michigan Ann Arbor and worked for various companies in the hearing aid industry, including Resound, Starkey, Earlens. He's author of the innovation blog. And you produced also several NAL soundbites. Um, and I believe Brent, we have met once before in Europe in Oldenburg during a hearing aid developers forum long time ago, almost 10 years ago when, uh, I think the topic was music processing in hearing aids. And I remember you were talking about this with a lot of passion and fun, and I thought, well, with your long-time experience, that would be a great way to look at all these developments now around, over the counter hearing aids and yeah. How to treat no to mild hearing losses and to the left or to the left of Brent. Right. For the people viewing is Stefan Launer, he's working as a head of science and technology within Sonova. Uh, you studied a physics and did your PhD in. Gottingen at and Oldenburg, I believe you've been working down with, uh, Volker Hohmann and later you joined Phonak in 1995, and you've always been working for a Phonak since that time? Yes. Throughout the time when they changed the name or when the Phonak holding changed the name to Sonova. Company man company, man. Yeah. but you know, the industry throughout. And, important as a background for this episode is last year, the WHO reported 1.5 billion people with disabling hearing loss, and I think a really big global burden of hearing loss to treat. Um, and what we see now is a lot of new developments, for instance, in terms of consumer electronics, that Apple has produced AirPods that can function as hearing aids, Bose that just left this market, but also have of course changed a lot of, perspectives on how to, help and support people with hearing loss. That's WhisperAI, hearX well, numerous others. So a lot of exciting developments in recent years. And I only know this field since early 2010, but I wondered how is this in the long-term perspective? So let's start early nineties when you were both doing your PhD. Brent, could you introduce your younger self when you were. Working in Michigan university? Yeah. So, you know, I got into hearing by applying signal processing to auditory nerve signals and doing some psychoacoustics at the university of Michigan with Greg Wakefield. And I gotta say that was formative in terms of understanding, hearing and getting a passion for hearing. But I think what was really transformative for my career was my subsequent post-doc in psychology at university of Minnesota with Neil Viemeister, because I feel that Michigan, I learned about hearing science, but in psychology, I learned how to think like a scientist. Whereas engineering is about building and solving problems. Being a scientist is about asking the right questions and figuring out the best way to get answers. And that's a lot more of what interests me. I'm more interested in the unknown in asking really interesting questions and figuring out, uh, ways of getting answers that are meaningful for people. And then I can let someone else do the building, like Stef here, although I'm useless at building because I'm a physicist. So, and I'm often being told that I'm absolutely useless for really developing and implementing solutions. So I'm unfortunately the scientist who theoretically knows everything and practically doesn't get done anything. So, so that's the only challenge. but how did you then do you, were you able to have successful products or teams? What was there then key, if you say I'm not able to build it, so you need others to do this. See I think this is a really good and interesting question. And while Brent was talking, I was also thinking what on top of what Brent said was, um, transformative in my PhD thesis. And the one thing I think I also learned being part of team was to be part of an interdisciplinary team. I'm a physicist and I had to learn to talk to psychologists. They use a different language. They have a different approach. I was working in a clinic with the ENT doctors, very different environment for the first couple of years. So I had to learn to speak different languages to work interdisciplinary, to bring people together. Uh, to be respectful, to take their perspectives. And I think that was extremely helpful and transformative for me. And, and, I think that's part of then being part of a bigger team. So I bring a lot of basic knowledge and I also bring a lot of clinical knowledge how to test these devices. I know how to ask the questions the others built. And so we form a team where everybody brings strengths and weaknesses to the table and contributes. Uh, and I think that's a major part that I also learned in my PhD thesis. Maybe I laid the ground work, uh, that I could apply it afterwards, going to industry. so for both of you curiosity, asking questions was really important. Um, other factors that motivated you to work in this field or that you think are important characteristics to do work in your positions. well, I'll just emphasize something that Stef said, cause it's the same with me. And I think part of the strength that, that I brought to the field and then I leveraged was the ability to work with many different disciplines. So my first job was at resound in 95 in Silicon valley when it was headquartered there. And I immediately took over the audiology group, the signal processing group, electro-acoustic worked with marketing, worked with education and training and there's there's, there were very few people there that could take com the complexity of the technology that we were developing and translate it into layman's language. So that the marketing people could understand it and talk to customers about it. And so the audiologists could figure out how they were going to test it with patients and what evidence, what data was necessary in order to bring back to R & D that either they built it right. Or they had some problems that need to be fixed. Yes. So an ability to build bridges and to listen to each other and to ask the right questions and to also yeah. To build bridges and to accommodate different skills, strength, uh, and so on. So I think that's a, that's an, an important part and the field. I mean, I'm super passionate about hearing when I was a teenager, you know, my, my father and uncle worked in division research. So I was more on the vision side but I never found a position there and accidentally because. Uh, the uncle of my girlfriend, I ended up in, in hearing and I thought, whoa, that's also a cool sense. So why don't I go? I go there and I think it's a super meaningful field to work in. Uh, and we, I think so more today than even in the past, if I think about hearing in it's important for daily life communication and for our wellbeing, I think it's a super meaningful field to be in. And that's a major motivation for me too. And have you done seen in these years from starting working at Phonak differences in these trends of what was important, then maybe the transition from analog to digital and how we are now looking to all these trends? so, yeah, I think I have seen lots of changes. But I think for, in terms of the skills, the passions, the, feelings, you know, I think it hasn't changed so much. The technology is the tools have changed. What I find remarkable is that when I left my PhD, my perspective on hearing was the outer hair cell. And maybe to some extent, also we thought about the inner hair cell, but that was the perspective we had about hearing in the early nineties. It was all about the active cochlear, our compression and so on and so forth. But in the course of time, when we, you know, we realized, oops, there is a nerve there, and then there is perception there. And, and so I think we expanded our perspective on hearing and what other relevant fields and dimensions are significantly in the past 20 and 30 years. So I think today we have a much more. Uh, holistic perspective than what we had, uh, almost 30 years ago. It's actually exactly 30 years ago that I started my PhD old man. And when you ask what was different, I think, um, Brent had even far less gray hair than it is today and me too So what you've mentioned is a holistic approach from hair cell to auditory cortex. I guess it's also this holistic view of people being in an environment with a lot of different devices that need to integrate. I don't know if Phonak considers itself as only a hearing aid manufacturer or that this also has now a broader scope. Well, for us, it has completely changed. Um, first of all, we have this strategic. Dimension from healthy hearing to healthy living and also, you know, to expand more into, um, getting people into, uh, the channel, the process far earlier than, um, what we see today. So the scope of Sonova definitely has expanded and not only, I think that's not only true for us on over. That's true. I think for the entire industry, the perspective of the industry, uh, in my view has significantly changed and and also expanded. And I also think we put hearing today in a much broader context. I mean, 30 years ago, it was also all about speech intelligibility, but today we also look at other aspects of cognition processing Uh, situational awareness and the importance and relevance of hearing in daily life communication. Okay. And Brent, I saw you wanted to also add something, I think before I put my question, well, I was just thinking about your question about the past 30 years, you know, we've seen major disruptive changes in technology, you know, analog to digital, the introduction of wireless and connectivity. I think we're probably on the cusp of machine learning, uh, affecting that, but you know, what has also revolutionized our field has been non-technological aspects of hearing loss. You know, the thinking about the impact of cognition on auditory function. And the impact of importantly hearing loss itself on cognitive function. So back in 2004, I think I that's when I really started talking quite a bit about hearing loss, affecting cognitive ability, and there were very few believers, let's say that this theory was true and it took several years of, of collaborative work with UC Berkeley to get the evidence that it was. And now of course it's a given, so that's, that was transformative. But I think Steph would, would agree that the interesting, some of the interesting innovation happening now is not in technology. It's in the service delivery it's in, who is the kind of person that has the need. And how do you match the need to the personalized, uh, individual? So it's beyond technology now it's about the service. It's about the delivery channel. It's about the whole business of how you help people who have. Can I rephrase it? I think this is a great point. I just thought maybe we have finally realized that there is a patient or a, a person in need and we try to far more consider what the needs really are. And in the past we were really technology driven. It was all about the technology, the features. And today we still focus a lot on improving hearing performance and functionality of the devices, but totally agree with Brent. We also think far more about, um, how can we change the service delivery, understand the person's needs and provide services that really match these needs. Yeah. And you know, one learning that I've had in my career, and this gets talked a lot about in Silicon valley, you know, a lot of 90% of startups fail and a big reason for that is people develop cool technology. Then try to figure out who. And unfortunately the answer is a lot of times nobody wants it, but it's cool technology. So instead, what you should do is start by thinking of and discovering the unmet needs of people, focus on understanding the needs deeply, then start figuring out how you can solve and provide solutions to meet those needs. And if you take that approach you're increasing the likelihood that you're going to be successful, because you're almost guaranteeing someone's going to want what you produce if you're successful in developing it. But I think, you know, the unmet need, everybody always says that. And I totally agree. I just would like to maybe emphasize that from my perspective, sometimes people have a need and they don't even know that they have this need. So just to bring one example, At some point we introduced this really sound function to mimic the pina in the hearing instrument. And when you talk to hearing aid dispensers also to hearing impaired people, they could never voice that they had this problem. When we introduced it, all of a sudden people started saying, oh, I can hear and distinguish front from back again. So we had solved a problem nobody had before, but we knew it must be a problem simply because of the physics and some anecdotal evidence and observations. Um, so I think solving the unmet needs is the big thing. The question for me is how do you identify what an unmet need is? And this is why design thinking was created to create a systematic way of understanding needs. You know, Steve jobs said, customers, can't tell you what they want. You have to show it to them. And I see that here at NAL and other research organizations. They think if you ask a bunch of audiologists or ask a bunch of people with hearing loss, is this some, you know, do you want this? People may say yes, they may say no, but that doesn't mean they're actually going to use it. Oh, Or well, what if they say no, it doesn't mean they are not using it. Yeah. Yeah. So you can't just ask people cause they only know what they have experienced with. You have to demonstrate it to them. You have to get them to use it and see if they will use it. And that's the only way you're going to learn. So you learn something by asking people, but you've gotta, you gotta build it. You gotta do it and you gotta test it quickly. And that's what the lean startup principles are about as well. Are these also you're using the Silicon Valley approach that you mentioned that demonstration and trying to elicitate the needs of. users? Yup. Uh, unmet needs. And then you do a build measure, learn process where you keep testing and iterating on ideas to see if you're right. You're not testing. Does the technology work you're testing? Does anyone want my idea? And so the trick is how can you do that with, with minimal expense and minimal investment? Yeah. And I just wanted to bring one example where we adopted exactly this procedure. And for me, it's one of the successes and one of the failures, you know, when I look at remote support, uh, we built it and we learned very quickly that people don't want it unless they tested it and then they loved it and they thought it's great. However when we then introduce it in the market, the adoption is medium, with all of these internet tools, remote fitting, there is quite some adoption in the meantime, but it's by far behind what I would have expected and what I would like to see. So for me, it's an interesting, even if we have these approaches of design thinking and learning how to apply it and scale it in a larger market, sometimes still is a challenge. And for me in, in all this, uh, also computational audiology and in the future of this field, how do we, leverage new channels, new opportunities still is an unresolved topic. And, and the major issue for me to work on. and what are then the possible barriers that this adoption of this tele audiology in self fitting is low, because you said you expected more enthousiasm maybe? See I think there are probably a number of simply technical issues. You know, usability might not be good enough stability of the internet availability of wireless connectivity, but I think then sometimes also the time has to be right or the time has to be mature as we say it, it has to be the right time. And, um, and people might not be simply ready to adopt the solutions. This is really a question I have and I don't know the exact answer. Um, but it's really something to discuss and to work on. What are the barriers? What are the. Uh, and where are we with adopting these new means and tools for me, to a large extent, it also has to do with readiness, maturity, and mindset of the different stakeholders, the clinicians in the process, as well as the patients. And, you know, I guess the way I think about it is it's human nature to reject change. People like stability. They like continuity 90% of the people out there. And I'm making that number up is probably what 90% of people out there don't like change 10%. Yes. Like me and you thrive on change and trying new ideas. We had uh, a visitor from Google here last week. And one of the things that he said, uh, you know, around, around change is, um, that, uh, you know, you have to keep you here. Here's what he said. If you told me that this technology was 10%. That's not enough to motivate me to change. Cause I'm comfortable with, with what I'm using. Tell me it's 10 times better, then I'm motivated. So you've got a mode that has to be a reason, a real strong motivation to get people to change. And a lot of inventors think, oh, this is cool. It's 10% better. Everyone's going to love it. Yeah, I'm fine with my own solution. Thanks very much. And so that's what we face in our field. Audiologists do a pretty good job with, with what they have, uh, patients do pretty well with current hearing aids. How do you motivate them to do things differently? There has to be a compelling need. And I think that's, what's happening with tele audiology. COVID produced a need, the need. Isn't really there anymore. So people are reverting back to what they were comfortable with. What is the compelling need for someone to use remote fitting? It's very true, you know, but you could argue, you could offer more and different services and I would have a couple of examples. Um, for that but then people have to go through the process of also advertising it and changing their procedures in daily life. And sometimes, you know, you said an interesting thing sometimes even if something is 10 times better, the question is what is the effort to get there? It's not only the end result, if it's 10 times better, but it takes me two years and a lot of effort to get there. How do you apply it in the medical field in the sense of you need FDA approval, CE marking, et cetera, that I think leads to incremental changes. Which are maybe too small to motivate people to set this next step. What you're now suggesting this factor 10 sounds to me like a radical change. Yes, but you know, radical changes. You have to know when to apply a radical change. And basically the way we look at introducing all these tools is more or less trying to build them into the current systems and evolve the current system and not, to be disruptive. And I think, uh, from my end, that's also the right approach. But I think the question is, um, how do you implement that and integrate that? And I think we also have to appreciate that it takes time that you have to educate a lot of people that you may be also have to wait, um, until you have, uh, uh, audiologists who bring in, uh, maybe new tools who are familiar with new tools used to using new tools already because they grew up with it. So I think it's also a cultural and generational. Um, difference in evolution and change process. It's interesting to look at the hearing aid field and look at at changes that have taken a while to get introduced. How long were Ricks on the market before they became ubiquitous? There are on for years. That's true. Uh, before, you know, companies and audiologists decided to switch from BTEs what took them so long, RIC saw a much better product there. They're happy. They're comfortable. What's what's the burning platform to cause the change. If you look, you mentioned whisper AI earlier, they've got a really interesting different approach to hearing aids. Can you convince someone that this is enough of an improvement to, to switch and change your behavior? That's I think why they're starting small. They're trying to build that case and build the evidence so that they can convince the community at large. And I don't know what the answer is going to be. That's what you got to do if you really want to revolutionize, uh, any field, actually, I think, but you know, also with medical devices, I think it's okay to take a little bit of slower approach and not as fast as with consumer goods. I mean, at the end of the day, if headset, I don't, I don't like that much. I can, I can throw it away. It's not a medical condition and it has much less impact or with medical devices in general. I think it's, it's good to take a little bit of slow approach to have a little bit higher hurdles and maybe to introduce disruptive changes a little bit slower so that you are sure you're really provide benefit in the entire, um, clinical pathway and service delivery. Okay, but now let's imagine your clinician having this holistic approach, and there's a patient in front of you with a ski slope, ski slope, hearing loss. And so you know, the conventional hearing aids, well, that's difficult. A cochlear implant is also. Maybe a question is what would these hearables do since maybe the lower frequencies are better, um, audible with these systems than the conventional hearing aids. How could a clinician then address this question? Because to my knowledge, there are not many comparisons of this consumer electronics, hearables versus more the traditional care so we we've actually done that recently with air pod AirPods pros and, uh, other hearables. And Steph mentioned earlier that, um, You know, it's not just about here audibility and hearing. It's also usability. Yeah. Um, comfort fit, ease of use. How long is the battery going to last all of these kinds of things. And so part of it and stigma, of course. And so part of it is, is this. So I w what I believe is not everyone's different. And right now we're really good at addressing a certain segment of the market who accept hearing aids. We'll use them and we'll accept the help of an audiologist. So a whole bunch of other people out there who, who could use help, but are rejecting that, but may accept AirPods pros or a hear bowler or something else. How do you, how do you get to them? If they're refusing to go see an audiologist in the first place, because they have different needs. Yes, I agree. And that's also what you're talking about in your soundbite about the no, to mild hearing loss. I said that you see this big group that by the traditional field is not served. Yeah, but, but you know, maybe I would like to also, um, point out that we always talk about different devices, like the AirPods, the hearables, and the hearing instruments. And it's as if they were completely different categories. If you take a step back, you know, and you put them in front of somebody and you show the ingredients and the bill of materials, probably a person not knowing and having no information. This is an AirPod. This is hearable, this is a hearing instrument. They would say, well, I guess they are all the same. Isn't it? And, and functionally, they have differences and whatnot. The point I want to make is maybe we should stop thinking of strict different categories with strict silo boundaries, and think more of continuum of solution, including a continuum of solutions of service and care delivery. If we keep talking about these different devices, then there is no transition from one or the other, you know, maybe a person in need of some communication, some devices for communication support in specific conditions. At some point needs more support needs, more features, needs the most sophisticated hearing instrument. And then it would be nice if we don't have to throw away the first hearable and buy a hearing instrument. But if we could kind of continue and support and add features. So, uh, let's think in the future more in terms of continuum of care and continuum of solutions and solution offerings, instead of strict categories. I really like this idea. And for instance, how I would envision is this, is that a person would now maybe use, uh, the airports to monitor, hearing and get some audio gram, maybe with a lower, uh, certainty than normally. But if you do this like five years in a row, it could be that the airports would detect, Hey, your hearing loss. Um, getting worse, maybe you should visit a clinician and, or it's getting out beyond the reach of this product and in the continuum and you should go to the next one. Uh, and then I think for the clinician, it would be really helpful if that person was able to, um, download all these previous measurements and use this to see, okay, what was the rate of decline of your hearing? And can we maybe, use this for future comparison? Which is, I think for now really difficult because it's all different silos. Um, everybody, or every company, um, has its own database. Um, so do you think this would be possible that we somehow by standards or by other collaborations, we are able to that all these different players use, common platforms or something so that you can really provide care along this continuum? So you were a little bit interrupted. So I don't know whether you, um, whether I grasp the sense of your question, um, correctly. You know, I think when we talk about data, we also have to understand the data is a very, very important, good and currency today, and very important. It's kind of advantageous to have. Uh, and own data and learn from them. So I don't know whether everybody of us, whether we all would want to share all the data that we have, but I think we definitely should come to a more standardized ways of also leveraging, um, data and making them available for, um, analysis also to the research community. I think that's a, that's a big field. I think in that field, we also have to be super considerate about, um, data, privacy, consent and whatnot. So sharing data is a pretty tricky thing and we have to be very careful that we protect data privacy and also all the regulations that are in place here. Yes, you know, people are getting used to measuring their own health metrics uh, with wearables, you know, five, 10 years now, that's going to be commonplace. And then it's going to be commonplace that your health data will sit on your smartphone and you will own it. And then you will share it with the healthcare provider, uh, when necessary, the hearing aid industry tends to lag some of these other fields in, in these approaches. So I think people will be comfortable with this and other modes of healthcare before it becomes a comfortable and commonplace thing in hearing. Yeah. And I mean, to this point, you know, in general, I think it's not only the question about, for the hearing aid industry. It's a, it's a general question where should health data reside, who should own them and who should have access to them. And. I'm always a proponent of saying, Hey, the person, the patient themselves should own the health data and they should be hosted by kind of an independent, independent, and neutral organization. And maybe to a lesser extent by a commercial organization. oh, I also agree here, but do we think that this will develop or emerge spontaneously? Because I guess it will be really important for all the stakeholders then to think about how to design this environment where this data exchange is possible, that data indeed can travel when the owner had the patient, for instance says, okay, I want to share this with my clinic, or I want to share that. Uh, and not a new company that previously I got service from this, uh, service provider or company, and I want to relocate it to another one that there's interoperability, for instance, to make this happen. Um, while on the other side, there is this maybe conflict of interest in the terms of data is also like a currency or something of value that if you have a large amount, you can find patterns that others maybe cannot, or it can provide you an advantage. I think it's going to be driven by the users and, and, you know, um, innovators that are providing these solutions. Here's, what's going to happen 10 years from now. Someone's going to go to their GP and say, doc, I have hearing problems. Why do you think that? Well, look at this app, I've been measuring my hearing every year and you can see it's declined and here's my audio gram. And the chatbot on the audiogram tells me that I've got a, you know, a mild hearing loss and I should get a, a solution of some sort it's it's it's happening already with, with other, uh, aspects of health. It's going to happen in here. And it's just a matter of when, and I don't think the, the big hearing aid companies are going to facilitate it. I think it's going to come from a non-traditional source. and is this different than from the time that HIMSA was established and the NOAH, platform where I assume that has been collaborations or thoughts about common interests, that it would be good to have a shared database? Is that something, uh, Stef you could maybe do You know, more about that development Actually you're going to get in trouble if he answered it. I don't know. You know, HIMSA was established before I joined Phonak. So I really don't know how. Uh, created in, in, in too much detail, but as far as I recollect, you know, it wasn't an idealistic and we think this is the right thing to do type of approach. It was more like everybody had developed their own solution. And the acoustic, the, the hearing aid dispensers, the audiologists were screaming and yelling and shouting at the industry for the miles of cables. They had hanging around in their offices instead of having, you know, like, um, a single cable with a standardized, uh, interface and also a standardized interface then to all the emerging software. So I think it was a little bit more, they were forced to collaborate. Yeah. Um, Well, it's how I look at it. And I think, um, I don't know what it was, but, but that's my, uh, my recollection, I hope with data, we can really be more pragmatic and be more open, but I think it's also something that's not only a discussion within the industry that's beyond our industry. And that should also include other stakeholders. I mean, I know a couple of cities where the city took the lead to provide the electronic health record for all the inhabitants. And I think a public organization, uh, at some point really should take the lead and drive. I think it's more likely that government is going to mandate it. Then the companies are going to decide to do it Hmm. Yes. And have a broad, um, record. I mean, uh, I also have to admit, I see the challenges. Building all these data pipelines in a company. It's, it's a hell of a job, especially when considering all the data privacy regulations, uh, we have to comply with. And especially with all the data privacy regulations in all different countries, in all different cases, that's a, that's a nightmare, um, to, to consider and to control. Oh, well, thank you for your honest reply. And I guess it's probably the most realistic case how it went. And what I'm afraid of is that in the, this next, uh, level of these different clouds for audiologists, it will be the same problem. Like instead of many different cables, it will be different clouds. Like, oh, you go into the Sonova cloud with maybe, a video link to the patient. Uh, information about the settings of the device, et cetera, et cetera. But then for the next patient, you need to go to another cloud. So I can imagine that for clinicians, that will be difficult. You can also wonder what's then the position of clinicians in this, new constellation where maybe patients are directly, communicating with the company, a service provider. Um, do you think there's, uh, enough, uh, pressure by for instance, clinicians or interest to be able to unify make universal solutions in this cloud space? Maybe we have to rephrase that and maybe, you know, maybe today. There is not enough pressure, but maybe it's because we are not far enough and the clouds don't exist today. And so there is not yet a need to do so, but maybe we should take a different approach because I think what has changed in the past 30 years is thanks to HIMSA. We have a good understanding that there are certain topics where it's best to collaborate and to address them as an industry and to be reasonable about it. And I think what would be extremely helpful potentially is maybe to take a proactive role and drive this and avoid different clouds to exist in the first place. And maybe to start a discussion on what should and could be standardized, what should be shared in, in a cloud, um, and, and have this discussion, um, before, uh, Everything is it's done. Before it gets forced on them by governments. Yes. Yeah. And another problem could be just having this standard measure. For instance, now we have the audiogram or that you measure speech audiometry, uh, the way you define it in your clinic. So you have your own way to evaluate a system, but in a future, everything is streamed. Then you depend on the protocol. That's of course the, um, company has chosen, I guess, to implement and also there standards would be important. I mean, if it's to the benefit of all companies to do this, then they'll do it, but it's going to take a lot of effort to work together. So it's gotta be everyone benefits from this, like they did with Noah. Um, yeah, but if they don't see that everyone's going to benefit. You know, it's to their benefit to a little bit, to make it difficult, to move from one provider to another. So, right. So you don't necessarily want to remove all as that's why every fitting software is different and they're all designed differently. It's very difficult for a clinician to move from one fitting software to another, which means it's very difficult for a clinic to, to switch which hearing aids they're providing. Yeah. Well, it, it, it is absolutely fair, but I was just thinking, you know, this is something that is a, uh, generic, um, trend. I mean, look at apple, they, they have an ecosystem and it's super difficult to get to get out there. Um, and, and to leave this ecosystem once you are, uh, caught in it. Um, so, so I think, I mean, you probably see that in many different. Uh, parts of our lives that you have, these organizations kind of offering you end to end solutions and not only a part of it with the objective to to capture, um, people, customers in their network and in their environment and, and to keep them to motivate them also to keep them, of course, customers do make the choice because it makes their lives. It makes my life easier to be caught in Apple I'm not caught. I choose, I choose to take advantage of their ecosystem. Yeah. Yeah. See, it's a benefit to you to be part of this ecosystem. That's the point I also wanted to make. I mean, we don't only want. Uh, catch people in our ecosystem because we are evil. I mean, we really tried to offer good solutions, good services and drive innovation forward and not capture them and not be able to release them. It's really, wasn't your Roger system, a good example of that Roger system? Like it all worked well together. Yes. That's a perfect example because it's really optimized. It provides a lot of benefit. Yes. And once you have it, it's probably also difficult to get to another system, but that's a very specific solution for specific problems and it's highly optimized for that, for that use case. And if we look at this, the global burden of hearing loss, do you think that this, um, different ecosystems, would that be a threat or would it, and would that be a motivation to, um, better collaborate so that there's more efficient use of resources? Have you seen the stock prices of the major hearing aid companies? I don't think there's much of a threat from OTC or anything else. Yeah, it's the constant up and down, uh, at the moment. Uh, I think, I don't know. Um, but, but it's a, it's a good, um, question, you know, is it a major threat? I see it as a major, um, opportunity. I don't know whether we would have to standardize everything, but I think there are a couple of things where we should at least discuss, um, when harmonisation and maybe we don't have to standardize everything. I think first of all, to agree. if we look at the global burden of hearing and we wanted to provide everyone in need of a hearing, uh, of a hearing aid with a hearing aid, we probably wouldn't have the resources today to do that, uh, worldwide. Um, if we would offer and include other models, like we call it omni-channel models, which are basically, uh, models that allow us to move from one path, an online path do it, yourself, OTC paths to the model where you have a healthcare professional in the process, uh, that's for me the right way to do, and to accept that, um, these omni-channel solutions really provide good solutions, uh, with meeting certain quality criteria. I think that's important. And one part that is really important for me is to think of. Uh, quality of care and what are the quality standards we need to meet and also with OTC and whatever devices, uh, in, in the outcomes and the caretaking of the people, I think that's an important discussion to have what are the quality standards we want to, uh, we want to meet and how do we assess them and assure them? Because I really see also a risk that if we have a poor quality OTC device, uh, and it doesn't provide benefit, that it really puts a negative, uh, sheds a negative light on, on hearing instruments as well. So I'll disagree with you strongly on that. Okay. Then we have a point to and here's where's why a cheap,y good hearing aids have been available on the internet for the past 20 years type type into Amazon today, hearing aid, and you can get a $300 hearing aid delivered to your doorstep. Uh, that has had zero impact on people's perceptions of Phonak and Oticon and resound hearing aids. You still do very well through the professional channel. There are some people who want cheap and they want, and, and by the way, consumers, no, you get what you pay for. So cheap clothing stores, don't put out a business, the high end clothing stores, pizza people know if they, if, if they want the best hearing, they can get, it's going to cost them some money. But if hearing's important to them, then they go see a healthcare professional. It's not so important to them. You know, they just want to test it out a few hundred bucks there. That's not going to, in my opinion, that's not going to stigmatize, um, the traditional healthcare market. And it's also not my opinion. I should say. The hearing industry did some research quite a while ago with psap before the term hearable. Personnel sound amplification products and surveyed consumers on their perception of psaps versus hearing aids. And lo and behold discovered consumers realize there are different product. There are different category. They're not the same thing. And that if a psap is, is bad, that doesn't mean hearing are bad. I think that's a, it's a very good point, Brent, but I would still, I don't want to say I disagree, but I, I think in the fashion business here, we have two clearly separated, um, levels and people are well aware and they are well aware if one works, if one doesn't work, it doesn't mean the other one works. I think in the hearing aid field, we are not, um, at that point yet. And I would say that today, very few people are even aware that they can buy hearing instruments at Amazon. So, so I think simply it didn't have an effect. Because hardly anybody is doing it or is aware of that and is putting it in the same category. If we now really drive OTC products and they become super present, and we don't really distinguish that this is a different, um, or slightly different category and it has specific shortcomings potentially, then people might put it in the same class as the hearing instrument. That's what, I'm what, where I see a risk, maybe down the road, 10 years from now, it's an established thinking that this is one category of a product. Here is another category of a product, and they have a clearly differentiated, um, performance level. Then it might again, not be a problem, but in the transition period, when we talk about now, all of a sudden selling, hearing instruments, OTC on the internet and they are not good quality, then I of see a certain risk that at least in the transition period, it might harm I think the important part is to really make it entirely clear upfront. First of all, that, I mean, I think we owe it also to the patients that we have good quality OTC products to talk about what their benefits, their strengths, but also what their limitations are and to offer a fallback position so that we don't leave a person alone when they buy an OTC, they have some benefit, but they hit some limits to, to have a path that they could follow afterwards. I think that's the important part for me to avoid that. well, and Brent, you've also looked, I guess, the quality of these OTC solutions. And do you think, is there harmonization possible for so that customers can decide, ah, this is a high quality OTC compared to a low quality OTC? Yeah. How do new people or people new to the, uh, products get an idea of what's best for them? well, I think if they're not going to go to a healthcare professional who will advise them on, on, and only give them good quality products, so they're going to do it themselves. It's like everything else, consumers buy, you're going to have to do your own research. There will be some equivalent of consumers, consumer reports on hearing aids that will say this brand. Good quality. Good sound good. Good battery life, you know, this brand, you know, and there'll be, they'll, they'll have a bunch of features and they'll rate them from, you know, one star to five stars in each and the consumers will decide, and I do think marketplaces sort themselves out, and this will become a consumer marketplace where the bad products will die and the good products will survive, but there will be price, competition, and consumers have the choice, you know, I'll take like I do when I buy a TV or a stereo or a car, I'll say, look, I'm, I'll pay less. And I know the quality is not as good, but I'll, I'll accept a poor battery life for half the price. And you know, why not give them that choice, but they, but they're doing it with their eyes open yeah. With the eyes open. And well-informed you think? I think that's right. But I would, I would say for me, because it's something related to health and healthcare and it has such an important impact on quality of life and. And, uh, and also beyond a person alone, it's important for society. Um, I think as opposed to the TV example, if I buy a poor TV, bad luck, it's my problem, you know, but it, it doesn't matter for the rest, but for hearing, I think it's different. And so if I buy a poor TV, it's my problem. But if I buy a poor hearing instrument or it doesn't meet my needs, then I should have a pathway to get a good, uh, a good support and a good service and a good device. I think that's important to build in the process upfront. This is where I see a difference in the medical field than in the consumer field. And you know, this is one reason why I think OTC is not going to really cannibalize the traditional market because ultimately we're talking about healthcare and the people right now are choosing to go to see a healthcare professional, because hearing is important to them and they know it's a health. It a health issue and they don't want to make a mistake. Yeah. Um, and that's, that's not gonna change people's people's attitudes towards health is not going to change, but the people on the sidelines right now who are choosing not to, for whatever reason, they're not going to have a different opportunity, uh, to help their hearing. But they're taking the risks of it's do it. Yeah. And there's maybe the risk of what we discussed before that unmet needs, that people are not aware of, that it can get better because what I think is the big difference with the TV, people may be able, I guess, to assess, oh, this is a poor TV or smaller than my neighbors. But with hearing aids, I often see people in a clinic and then they were never aware of. Yeah, they had just a poor outcome due to a wrong settings, or there was so much more potential of what you could read. Do you see ways to somehow make people aware of this or that? Um, quality assessment, warning people? Oh, a warning. Um, uh, maybe somehow making people aware of this shortcomings shortcomings of, um, potential shortcomings of OTC also, um, uh, general devices. I mean, for me, uh, it's always important to have, um, a good education and also to set expectations, right. And to give them tools at hand, to assess whether they benefit from the devices or not. And to give them the right tools and discuss what are the benefit dimensions and how can they kind of. Self-assessed that with themselves or their families, spouses, friends, um, together, how can they find out whether they have a good solution or not, and where could they seek help? Um, if, if they don't think, and I think, yeah, there are solutions, especially today with all the smartphones and whatever we have, you know, you can give them diaries, you can ask them questions, you can give them a number of tools at hand to really assess their performance, uh, reasonably well. So, you know, I think in the future, there's going to be no difference between OTC hearing aids and professionally fit ones. It'll be the same product. There's going to be no difference, really in the technology, the differences in the service that you get. And there's a lot of people who need help to be successful, whether you're hearing aids. There's a lot of people who want to help to make sure that they're getting. Solution for them. There's, there's several examples that we can look into other aspects of health care. If you're a runner and you pronate, and you've got an issue with your form, you can try to go online and buy some inserts and figure out what the right shoes are. A lot of people do that, or you could pay money and go see a professional. Who's going to look at how you run and we'll make very specific recommendations for a shoe just for you. And it depends on your level of concern about if you're a marathoner, you're going to go pay money to go see the professional. If you're just a casual runner, maybe you'll just try it yourself. And I had a sore knee for a long time. I never saw a professional. I rubbed it with some oil. I got into chemist. You know, I try to bandage and, um, you know, if it ever, if I ever got to a certain level of concern, I would see a professional. And I think hearing is no different than other aspects of healthcare. Okay. Yeah, I think that's a good way to wrap it up in the sense that, um, we are hearing field and not different from the others and that we may expect that it further integrates, uh, in the future. Uh, like a lot of the insights you shared. And I wonder how we going to find this, um, external, uh, um, pressure maybe for, um, developing this field further in the things that are beyond the scope maybe of the companies are there, um, maybe last things you want to share or think, oh, that's important for the audience to know. see. I think, you know, maybe to, to revisit the point, I hope we don't have to wait for an external pressure, uh, you know, um, to drive these new things. Also a community like the one that you are trying to establish the computational audiology network can help and integrate with other existing communities to, um, to motivate the community, the industry, other stakeholders, to collaborate on these topics by bringing up good examples and benefits, why it would be very worthwhile to drive harmonization integration, um, forward. So this is where I see quite a bit of, um, potential, uh, moving forward. So take a proactive role and be present at various stakeholder meetings and keep talking and exploring the benefits of these new approaches around computational audiology. Thanks. That sounds like a good piece of advice. and then maybe as a last word for me, I'll go back to the conversation right at the beginning, for some of the people who are earlier in their career. So, you know, one is, it's very tempting to just start building a technology. Cause it's really cool and put a lot of effort into that without spending time to understand, are you really meeting a need? Is anyone going to want a, what you create? So start, you know, change the world. Steve jobs says, put it, I want to put a ding in the universe. You'll put a ding in your community, figure out what that ding is. And then, and then, you know, figure out how you're going to ring that bell. So, you know, that's one and then the other is, as you heard from both of us, you know, multi-disciplinary collaboration, don't just stick in your silo. That you're really good at. Uh, get involved with people in other areas that maybe you're uncomfortable with because there's value in those connections. And you're going to discover new ideas and new ways of doing things beyond just what you can bring. So if you're a technologist, talk to a clinician and talk to someone in, in marketing and sales and figure out, you know, what's the whole solution here that we can innovate on. Um, yeah, so collaborate, collaborate. And, and, and if I may add one last topic from my end, be persistent and don't give up too quickly. I mean, I was thinking, when did we start looking into all this stuff? And we started collecting data on a large scale, 2006, we started to build the first remote fittable hearing instrument in 2008. And so don't give up, keep working. New ideas sometimes take a while until they are really mature enough and make an impact. So be persistent and be in it for the mid to long run. It's not a sprint yes, it's an infinite game. Isn't it? Try to invite people, make these conversations from different disciplines. And I'm really glad that in this computational audiology network, we see engineers, innovative clinicians, researchers together. And I hope that just by conversations that may lead to collaboration by also lessons we learned from people experience like you, that will collectively bring the field forward. So thanks again for, for your time and for this conversation. and thank you for driving it. Yeah. Thank you. This is terrific.