[HN Gopher] Who pays the price when cochlear implants go obsolete?
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Who pays the price when cochlear implants go obsolete?
Author : PebblesRox
Score : 60 points
Date : 2023-05-23 21:08 UTC (1 hours ago)
(HTM) web link (www.sapiens.org)
(TXT) w3m dump (www.sapiens.org)
| TazeTSchnitzel wrote:
| Perhaps medical implants should be legally required to have open-
| source hardware and software.
| RajT88 wrote:
| It's interesting, because in some fashion the private industry
| has a practice which is designed to prevent against software
| obsolescence or the failure of their vendor company: Code
| Escrow.
|
| 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.
| skyyler wrote:
| Could something be done about "planned abandonment"?
|
| It's too tempting a profit source.
| Izmaki wrote:
| Have the authorities change the requirements for EOL. Hearing
| Health companies just follow the instructions, pretty much...
| ekianjo wrote:
| "security" by obscurity is the golden standard here. You don't
| want to see the massive incompetence at play if everything was
| open.
| Izmaki wrote:
| Auditing is a mess more so than security by obscurity.
| Source: employee.
| bombcar wrote:
| I think, as a society, we _do_ want to see it, slowly, over
| time.
|
| 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.
| rektide wrote:
| Allowing/affording society some ability to come in, to see,
| to form opinions seems so elemental to progress in general.
|
| _Pay no attention to the man behind thr curtain_ forever
| & ever, everywhere, does not seem like a great strategy for
| keeping & maintaining a society.
| bitwize wrote:
| Gonna go out on a limb and guess that it's enough to send
| shivers down anyone who's heard the Therac-25 story...
| rektide wrote:
| confidence through obscurity?
|
| actually a semi interesting argument, which seems likely to
| be widely accurate in many places.
| ajsnigrutin wrote:
| And spare parts and built for repairability.
|
| 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.
| sigstoat wrote:
| open source doesn't make modifications free. who is going to
| take the liability of distributing modifications for other
| people's medical devices even with a "no warranty expressed or
| implied" license? who is going to load "no warranty expressed
| or implied" software onto their kids brain implant?
| m00x wrote:
| A much better idea is to have the implant part require a
| standard connector, while the outside part could be upgraded
| later on.
|
| Medical devices take a TON of money to develop and license, so
| companies aren't going to open source them.
| Izmaki wrote:
| That is exactly how they work. The implant is incredibly
| "dumb" and very future proof.
| elzbardico wrote:
| Exactly. The problem is that the processor is absurdly
| expensive, up to 10 thousand dollars range in the US if you
| self-pay.
| Izmaki wrote:
| ...and the manufacturing price is so low it makes me
| physically sad to think about.
| m00x wrote:
| Nice, thanks for the info!
| pie_flavor wrote:
| R&D is financed by the profiteering. Having companies legally
| on the hook for abandoning their clients is a great idea, but
| demanding that they allow anyone else to manufacture their
| design is a great way of ensuring vastly fewer designs.
| elzbardico wrote:
| In practice, a lot, and I mean, A LOT of research and
| development in health is done by universities under
| government grants from the NIH.
|
| Like this https://twin-cities.umn.edu/news-events/university-
| minnesota...
| alvarezbjm-hn wrote:
| Yes, it would be convenient to treat prostetic devices as drugs
| and allow generics to be manufactured.
| Izmaki wrote:
| A lot of OSS is used in modern hearing aids, actually. A
| hearing aid is closer to a small computer these days than you'd
| think.
| firstlink wrote:
| The article barely touches on it but the real threat isn't from
| the manufacturers producing newer and better processors, but
| rather from insurers/single payers not covering the cost of new
| processors. I deliberately use the word "threat" to answer the
| question that several other comments ask, or rather point out
| it's the wrong one: "Why does the processor need to be replaced
| with a newer model?" In ideal circumstances, it doesn't. But if
| the insurer/single payer has declared they will not pay for a new
| one for some ridiculous amount of time like 10 or 15 years after
| the previous are bought, then the user is under the constant
| threat that the old ones will break but not be replaceable.[0]
| That is only tangentially related to old models being replaced
| with new ones, although this may be the excuse that
| insurers/single payers use not to replace lost or broken
| processors, e.g. by insisting that the old ones be repaired even
| though that's no longer an option (granted, this example would be
| a combined problem with the payers and the manufacturers).
|
| 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.
| LemonLeaf wrote:
| I wonder how companies go about retiring these sound processors
| on the technical level. Are those in need of continuous updates
| to keep working? Do they receive a final update one day which
| bricks them? Since the consequences seem so heartbreaking I would
| imagine that unofficial ways of prolonging the life time of this
| hardware do exist?
| Izmaki wrote:
| The firmware on most modern hearing aid devices can be easily
| updated. These updates may include updates for the sound
| processing as well, indeed. However, you can't easily "replace
| the chip" like you can just swap out an old SSD drive with a
| new, faster model.
|
| 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...).
| pkaye wrote:
| Probably it will still work but no replacements parts for
| repair at some point. I know regular hearing aids can be quite
| moisture sensitive (though new ones are getting much better) so
| I don't know if these sound processors are the same.
| Izmaki wrote:
| Here's the thing about cochlear implants that the article at
| first glance does not tell the reader:
|
| * 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.
| firstlink wrote:
| > 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
|
| 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.
| m00x wrote:
| Do you have a link to a processor with the price? It doesn't
| sound that complicated to make tbh. It might just all be FDA
| approvals.
| Izmaki wrote:
| The surgery _is_ the expensive bit. It 's a 10-to-1* kind of
| expense compared to the hearing device you attach to the
| head.
|
| * Rough guess based on the price of regular, high-end "in-
| the-ear-canal" hearing aids.
| floxy wrote:
| Does anyone have insight into the whole story here? There are so
| many unanswered questions.
|
| >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?
| bentcorner wrote:
| I think it could be something as simple as the rechargeable
| batteries no longer hold a charge and they don't manufacture
| the receiver unit anymore.
|
| 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-...
| floxy wrote:
| >I think it could be something as simple as the rechargeable
| batteries no longer hold a charge and they don't manufacture
| the receiver unit anymore.
|
| 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).
| TimTheTinker wrote:
| The iPhone 5 could stay out of obsolescence if Apple were to
| continue offering replacement parts and repair services for its
| current owners. It's not that the device would stop working on
| a pre-programmed day - it's that the iPhone 5's out there would
| all eventually need parts and/or repairst, and would have no
| way of getting them.
| floxy wrote:
| How often to these hearing aid type devices wear out? It
| seems like that is something that could last 10-20 years.
| sharkjacobs wrote:
| It seems that it is "just" a matter of dropping service support
| for devices
|
| > 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...
| alvarezbjm-hn wrote:
| The so called "Cochlear implant" by vendors is really a system
| with an actual implant and an external sound processor and a
| transmitter.
|
| 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.
| Izmaki wrote:
| I believe the "cocleah system" is guaranteed to function for
| that long, yes. The part inside of you is very simplistic and
| doesn't do much (or anything) besides translating data into
| electrical signals. It's the unit on the outside that gets
| replaced frequently.
| flerchin wrote:
| It's not explained in the article how these compulsory upgrades
| are being forced. These are not net enabled devices. Perhaps the
| idea is that the receiver is no longer for sale and cannot be
| replaced once it has eventually broken?
| elzbardico wrote:
| Your old processor needs a new battery. it gets damaged. But it
| was EOL'd a few months ago. No spare parts, no servicing. You
| need a new one.
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