Opinion Piece: Deaf Children in Developing Countries Are Getting Inferior Cochlear Implants

Opinion Piece: Deaf Children in Developing Countries Are Getting Inferior Cochlear Implants

Michele Friedner, herself an implant user, recently published this opinion piece in Scientific American giving the view that deaf children in developing countries are getting inferior cochlear implant technology. What do our members in developing countries think? Are there more issues to be considered? Read the article and give us your view at info@ciicanet.org



9 August 2021

3 Replies to “Opinion Piece: Deaf Children in Developing Countries Are Getting Inferior Cochlear Implants”

  1. Dr Monika Lehnhardt Goriany (Germany ) says:

    Thoughts on the article from the Board of the Lehnhardt Stiftung Foundation, from Dr Monika Lehnhardt-Goriany:

    She talks about “implanting behind” and “differential implantations” and “obsolete”.
    A “stripped down version” of the speech processor for developing countries was produced. This was never on the market in the US and Western Europe, correct
    Fact is, that manufacturers are constantly developing new models and the latest models are more expensive than the previous ones.
    Prices vary significantly !!! – the lowest I am aware of is below € 7.000 for the CI system in one of the ex USSR countries.
    In many there is tender business (and not only in Eastern Europe and ex-USSR) and the lowest offer is taken by the government.
    The lack of “quality” is not limited to CI, it starts with the lack of routine neonatal hearing screening, professional diagnostics.
    Provision of hearing aids and adequate rehabilitation
    This is the same in many other fields in the medical and pharmaceutical industry. Not everybody / every country can afford the top quality.
    Look at the situation with vaccination against COVID 19; it’s the same issue.
    Even in a “rich” country like Germany the insurance companies pay only a limited amount for certain aids (e.g. hearing aids) and if the client wants top quality he / she has to pay the difference. Not everybody can afford this.
    The same situation is also in the car business, a very simple Smart brings you from A to B like the super luxury top class Mercedes.
    It is a question of luxury.
    Let us not forget that we have many, many CI recipients with “obsolete” CI models and they show excellent results.
    So far a global ethic commission does not exist. Will CIICA take on this extremely difficult topic?

    Any more comments anyone?

    The Lehnhardt Foundation helps to open the way into the world of hearing
    for children; mainly in countries where there is no funding from the government or other institutions like insurance companies

  2. Michele Friedner (US) says:

    Hi, Dr. Lehnhardt-Goriany and your Board, you write: “The same situation is also in the car business, a very simple Smart brings you from A to B like the super luxury top class Mercedes.
    It is a question of luxury.” This is an argument that I have heard constantly throughout my work and it is interesting to me that a comparison is made between hearing technology and cars! My argument is that this is NOT an appropriate analogy– what about the Mercedes makes it more expensive? Is it about status? The seat warmers? The surround sound in the car? Research has shown that the more advanced processors make a difference in noise– in terms of what is heard, cognitive load, etc. Since we are talking about children and the “potential” of children, it seems especially egregious to implant behind. I think that you are right to point to the ways that this is similar to other technologies and the current vaccine inequalities as well. However, in relation to hearing technologies, I think we need to think about the marketing by the device manufacturers and the way they promote their latest iterations/the latest technology— marketing videos talk about “finer hearing” and how it is for parents who want the best for their children. Surely all people want the best for their children. I think we need to look at the larger political economy around this. And both nation-states and corporations, in addition to individual activists/advocates, have a role to play. Tender systems/structures are often a race to the bottom but at the same time if a nation-state is buying a large amount, they can ask for certain kinds of processes and specifications.
    But what is it with these car analogies???

  3. Robert Mandara (1st Vice-President, EURO-CIU) (Finland) says:

    I fully agree with Michele Friedner’s article but would like her to have picked up on the issue of lifelong commitment. Providing implants to children and then only committing to maintaining them until they become adults is irresponsible. Authorities need to learn and accept that implants require lifelong commitment.

    There is a potential that if costs are cut on the processors, there may also be cuts on rehabilitation, support, upgrades etc. That really isn’t a recipe for success. To see the best outcomes, you need to make the best investment. Success builds upon success.

    Making the comparison with cars is not a fair analogy. With cars, the customer is usually the end user. They can choose the right kind of car to suit their budget and needs. The key words are END USER CHOICE. Besides, in the car analogy, a more accurate choice would be between a new Tesla and a 15 year-old unreliable banger with no safety features. Processor technology which is two generations behind the latest tech can be as much as 15 years old. The end users of implants and processors are not in control of the purse. Even in developed countries, users can have startlingly little choice. Often the only real and informed choice is “What colour do you want?” – which has absolutely nothing to do with how the device sounds! With the current technology, I would say that colour is the only luxury that could be stripped away without harming users. Processors do not currently feature surplus useless luxury bells and whistles. Meanwhile, end users with disposable income usually do not have the option to purchase faster upgrades, bilateral implants or similar. Compromises and silly rules prevail everywhere, not just in the developing world.

    Ethically, I think it is wrong to offer a device to enable hearing if it doesn’t function optimally. If users are wearing hardware that features functionality, all of that functionality should be available by default. Recently we have seen hearing aid manufacturers start charging big money to simply flip a software switch to enable essential features such as streaming. In my opinion, that’s simply unethical. Returning to the subject of cars, I recently bought a new car and was disappointed to find that it did not have a feature found in higher-spec models. However, I discovered that I could attach a computer to the car and enable the feature that I wanted. Basically, the car features a whole lot of functionality which is deliberately locked away from the consumer. Who owns the car? The manufacturer or the customer?

    Don’t forget that producing “stripped down” processors costs money. They need to be developed, tested, certified, stocked, tooled etc. Then, once released, the brands need to provide long-term maintenance and support for a broader range of devices. Logic would suggest that it would make more economic sense to make a slim range of good devices in great quantities, rather than the alternative. Henry Ford had the right idea.

    The cost to make processors is a mere fraction of the list price- an eye-watering figure which has to incorporate all of the development, distribution, warranty and market costs, not to mention profits for the shareholders. The easiest way to get the list price down would be for the uptake of CI to be 20 times higher than it currently is. As production volumes grow, prices will tumble.

    I’m a bilateral user living in Finland – a cool, low-humidity country with clean air. Nevertheless, I have huge problems with sweat and moisture entering my supposedly water-resistant processors. I can only imagine how much bigger my problems would be in a hot, humid, dusty country! If anything, processors need to be ruggedised and even more effective rather than stripped down, to cope with conditions in developing countries.

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