Who pays the price when cochlear implants go obsolete?
sapiens.org
sapiens.org
>Their child’s current processor—a “basic” model designed for the developing market—was becoming “obsolete” and would no longer be serviced by the company. The family would need to purchase another one, said to be a “compulsory upgrade.”
...from the quote above, it doesn't sound like there is anything wrong with their existing hardware. And it doesn't seem like the existing hardware is broken. It sounds like a pushy sales department is trying to scare these people into upgrading to the latest-and-greatest version? Or is there some supposed medical reason you need to adjust the parameters of the device on a regular basis?
>In one especially devastating case, a father lamented that his daughter, who had been doing well with her implant, could no longer hear since her device had become obsolete.
Is there a timer in the existing hardware that is shutting things off after a certain amount of time? Or it phones home somehow, and gets instruction from the mother ship that it should stop working? Is there more than this one case? I guess the article keeps using the term "planned obsolescence", but I need some more evidence to go on here. Could it be that in this one case, the kid dropped the external processor in the river, and now it doesn't work? And the article also keeps mentioning continued maintenance, but seems to be conflating maintenance with upgrades. Maybe these people are showing up at the audiologist for a "check-up", and the audiologists are bricking the devices in the name of upgrades?
If you clicked the link [1] in the article, it sounds like designing them to survive regular day-to-day usage is important. Components will wear down over time and replacing them is inevitable.
[1] https://www.indiamart.com/proddetail/cp-802-sound-processor-...
If that was the case, then the author missed a big opportunity use this one sentence to spell this out and lend a whole lot of credibility to the article (that the article is currently missing).
> Companies like Cochlear Americas stop providing parts or service for old processors, essentially forcing people with cochlear implants to upgrade to newer versions. A new processor isn't covered by the Saskatchewan health plan.[1]
> The typical replacement timeframe is once every five to seven years, or the lifespan of the sound processor. [2]
> After March 31, 2023, you will no longer be able to purchase parts and accessories for all Nucleus 6 Sound Processors and Cochlear will no longer be able to repair them.[3]
[1]https://www.cbc.ca/news/canada/saskatchewan/costs-to-maintai...
[2]https://www.saskhealthauthority.ca/your-health/conditions-di...
[3]https://www.cochlear.com/us/en/campaign/product-retirement-2...
https://media.arkansasonline.com/img/photos/2015/07/13/cochl...
The "external sound processor and transmitter" is an electronic appliance, like a phone, which the patient removes and puts on, like glasses. It can be lost or damaged.
The reason that the external device is abandoned by the manufacturer is the same for abandoning phone software and batteries: market strategy.
My personal opinion is that the most basic product line must guarantee quality and two or three decades of support. Part of the product is INSIDE of the patient. State of the art devices for people who can afford them are another matter entirely.
However, sometimes the difference between Basic and "State of the art" in medicine is non existent, and the patient only pays for it because they don't know better. Most of them don't like it when they get the full story.
Folks with cochlear implants regularly (i.e. once a year) meet with audiologists to tweak the parameters of the device that feeds the implant, called a "processor." The tweaking process is referred to as "mapping."
The processor is a very small, delicate piece of equipment. Over time, various parts wear out and have to be replaced. Rechargeable batteries stop holding charge, microphone elements putter out from exposure to sweat and dead skin, etc. If the company no longer offers parts/service, then when something stops working, there's not much to be done.
In defense of the manufacturers: a cochlear implant and accompanying processor are very specialized pieces of electronic equipment. The hardware, algorithms, etc. are all being improved over time. So it's not totally unreasonable to try to move folks unto the newer models.
I think the issue is the period of support. I think these need to be designed to last 10 or even 20 years. And this needs to be clear before the surgery like informed consent.
The other issue is optionality. It’s nice that there’s a new model and that businesses want to move people on to it. It’s not nice that the old model is unnecessarily, from an ops standpoint, turned off to require patients to upgrade.
If I had to choose for my 4 year old between deafness and an implant that worked for 4 years and then cost my family 10x my annual pay every four years, although I’d be heartbroken, I’d have to choose deafness.
I also think the initial price must include the price of surgical extraction so this kid isn’t stuck with a non-functioning implant in his head for life.
For comparison, a pacemaker battery lasts 5 years and can be replaced in an outpatient clinic [0]. But pacemaker recipients typically only live 5-15 years so it’s quite different than putting this in a kid who will have it for 70-80 years.
[0] https://www.hopkinsmedicine.org/health/treatment-tests-and-t...
* you undergo a VERY expensive surgery.
* in the surgery you get installed the actual cochlear implant.
* the implant itself is VERY basic and is designed to work with future models of the hearing aid (the one behind the ear).
It is therefore, unlike what the article seems to suggest at first glance, not the case that families spend money (a lot of it - upwards $50,000 per ear iirc), only to be told later that they have to go through it all again. I bet what this family experience is a sales department telling them the very real situation that hearing aids - just like smart phones - improve over time and that old models reach an end of life date eventually. There's nothing new here although hearing aids are arguable much more expensive than smartphones - not that they had to be, Hearing Care Professionals make a lot of money per hearing aid.
But that's a story for another time.
You make it sound like the surgery is the expensive bit, but as you pointed out, the implant is very basic electronics. The medical procedure is certainly expensive, but the processors are the truly expensive physical product.
* Rough guess based on the price of regular, high-end "in-the-ear-canal" hearing aids.
This guess completely missed the point. Cochlear implants are not audio amplifiers like hearing aids are. They must convert sound into electrical impulses which are sent more or less directly at the user's sense organ, via a relatively dumb implant. Now, on the one hand you could say, "yeah well that's just a Fourier transform" but that would also miss the point. A cochlear implant only creates impulses at a limited discrete set of points, and the way those points map to frequencies is not going to obey a nice consistent function. This means the processor must be programmable to adjust the mapping of desired frequency (which may not be the input frequency) to electrodes, which already puts us into needing a rather fancier microprocessor than a hearing aid needs.
Moreover, the limited set of frequencies causes a massive loss of signal-to-noise ratio. The processor has to compensate for this intelligently filtering the sound to make the result useful. For example, it may need to detect and filter background noise. It is not really even attempting to replicate natural hearing because that's impossible; it may be more helpful to think of it hijacking the user's aural sense to do something almost totally different with it, but staying just close enough to natural hearing that the brain has a fighting chance of making sense of the inputs.
Sound processors are around NZD7-8k a pop and have an expected replacement cycle of 5-7 years.
This seems like something that ought to have a reasonable social venture develop an open source model with a very long lifecycle and good repairability.
It's too tempting a profit source.
Perhaps requiring they be open sourced after a point in time or to be eligible for medicaid, etc. Maybe only new ones - but eventually we need to clean this up; as we're creating a digital superfund site each time, only covered up by people disposing of them or dying.
Pay no attention to the man behind thr curtain forever & ever, everywhere, does not seem like a great strategy for keeping & maintaining a society.
actually a semi interesting argument, which seems likely to be widely accurate in many places.
I would love to see a nonprofit/NGO/TLA dedicated to getting such defunct tech open sourced. I am sure lots of great stuff gets archived in hopes of selling/licensing the IP later, and then it never sees the light of day again. To the extent such things get archived at all.
This came up in another thread here the other day in fact. And before the same guy chimes in to suggest that governments ruin everything they take on because of corruption: You're still wrong, and you can take that defeatism elsewhere.
Batteries are practically guaranteed to degrade after a few hundred charge cycles, and totally fail after a few hundred more... with daily charging, that's a timeline of a few years.
And with all the breakthroughs in technology, we've gone from replacable batteries everywhere, even with waterproof devices, to impossible or very-hard-to replace batteries, even in large, non-waterproof stuff such as laptops.
Medical devices take a TON of money to develop and license, so companies aren't going to open source them.
Like this https://twin-cities.umn.edu/news-events/university-minnesota...
They do quite a lot, actually. They typically have 4 settings that the wearer can opt for. Some are "smarter" than others. The one I described is one of the more advanced functions.
To the best of my knowledge (first hand experience from the industry), they receive a final update one day and will then only be updated in extreme situations, like, say, imagine you plug in your devices one day and suddenly get a max volume high pitched feedback screech in your ears (this should never happen, ever, mind you). But I'm only guessing here.
However, just like my old trusty iPod Touch 1st Generation, they are due an upgrade eventually if you want to use the latest features (my iPod still works, it's just not very fancy anymore...).
Apparently the upgrade threat is such an issue that the way even exceptional insurance avoids the issue (per my family's experience) is to purchase the user an extra processor at the same time as the processor is first purchased (or, eventually, upgraded): a preemptive replacement/backup unit. This way presumably the payer doesn't have to have on the books a difficult-to-quantify liability from needing to replace a lost/damaged processor with an unknown future model.
[0] Critical context: Unlike a hearing aid, the process of getting a cochlear implant physically destroys any residual hearing the user may have had. When the processor is not present and functioning, the user is completely deaf. And that's little-d deaf, which is the problem: cochlear implant users have explicitly chosen not to enter the big-D Deaf world (which largely rejects implants anyways), and so are completely dependent upon their devices functioning correctly.
Also, all designs, software and patents should be open sourced/released to the public domain if the company goes bankrupt or the product line gets sunsetted.
This is surgery, these are peoples lives. These are their organs. People that make executive decisions like this are subhuman scum.
What if we decrease the regulation on things that do not harm the patient when they fail, so they can but a device for $100 on Amazon rather than $10k at the hospital?
If your product needs to be surgically installed in a patient, if you can't afford to support it for the lifetime of the patient the product isn't viable and shouldn't be brought to market.