Prof David McAlpine at Macquarie University asks, do we need a cure or is what we have enough to solve the problem?
“I’m going to say that the answer is — we need a cure, and the reason is because there is much of hearing loss we can’t prevent — even so-called preventable hearing loss.”
If we look, or perhaps listen, to the future—is the future for hearing health ‘bright’—I hesitate to say ‘loud’? Will hearing health improve over time? Will hearing healthcare become ‘mainstream’? Can we deliver a national agenda for preventing hearing loss. Could we scale that up globally? Or are we on the path to declining hearing health? Is preventing hearing loss beyond us and do we simply have to accept the inevitable? What does our future sound like?
To help us on that one, we can look to the World Health Organisation’s 2021 World Report on Hearing. It confirms what we knew — hearing loss is a chronic health condition that manifests right across the life course in utero to late age. And it’s increasing globally at a time when vision loss is declining. It affects 1 in 6 of us, and will rise to 1 in 4 by 2050, a product of our ageing societies, yes, but also our life-style choices. The WHO also estimates the annual cost of untreated hearing loss is close to 1 trillion dollars in lost productivity and the like. And despite it being the most common sensory deficit — comorbid with other health issues in later life — hearing loss still has the status of an orphan disease in terms of ring-fenced research funding, public-health profile, and other initiatives. To date, its known consequences on speech and language, life-chances, cognition, mental health—have failed to shake the nation, and indeed the globe, out of its torpor when it comes to preventing hearing loss and protecting our listening abilities over the life course. Why is this the case? Are we not cutting through when it comes to messaging the dangers of hearing loss? Is anyone listening — communities, governments, healthcare systems, businesses, regulators? And what is our message on prevention? Are we trying to prevent hearing loss itself, or should we focus simply on preventing the consequences of hearing loss? More radically, might we better seek a cure for hearing loss — should we be trying to reverse it, say, through biological means? Are those lifestyle choices contributing to hearing loss ‘hardwired’, and therefore the only way forward is for us to develop ‘a pill for deafness’? And how does the concept of prevention work in the charge towards over the-counter, or OTC, hearing aids? Hearing loss is increasingly part of the business model for major tech companies. Will cheaper hearing aids — if they even are cheaper — get them off the hook for their negative behaviours when it comes to our hearing health?
We need a cure
Do we need a cure or is what we have enough to solve the problem? I’m going to say that the answer is — we need a cure, and the reason is because there is much of hearing loss we can’t prevent — even so-called preventable hearing loss. But finding, and funding, a cure won’t be easy. Therapies for hearing loss are a hard problem. We don’t have the diagnostic toolbox, or an effective delivery system for bringing drugs to the inner ear, though cochlear implants are an idea choice in my view. Importantly, we don’t understand the patient populations — their genetics or their phenotype — required to make effective therapies and make therapies effective. We also know that the money invested into the science of hearing and deafness is much less than is invested into other health conditions including vision loss.
We know that Libby Harricks — whom this oration honours — was a pioneering advocate for people with hearing loss, but we also know she died of breast cancer at the terribly young age of 52 in the late 1990s. At that time survival rates for breast cancer were not as good as they are today. What changed? First, prevention. You can’t easily prevent the onset of breast cancer, but you can prevent its progression through timely diagnosis — a combination of personal knowledge and behaviour and better diagnostic tools. Sound familiar? Second, the possibility of a cure. You can’t manage breast cancer, you must get rid of it — new drug therapies, new combination therapies, augmented by radio- and surgical interventions. People survive breast cancer today because their breast cancer— diagnosed in a timely manner — is eradicated, not because it is managed. The broader point I want to make is that once you have evidence of an effective therapy, money pours into that disease model. This kickstarts new diagnostics, changes behaviours, engages public health agendas, gets commercial, government, and clinical partners talking. And it doesn’t matter what the therapeutic intervention is going to be: it could still be hearing aids, it could still be a cochlear implant, it could be a combination of all these things — therapies, hearing aids, implants.
Success in finding a potential cure for hearing loss raises all boats. People take effective drugs for breast cancer and have radiotherapy and have surgery.
Australia is one of a handful of countries that could achieve the unity of purpose required to deliver a cure for hearing loss. So, I believe we should be working together to deliver the next generation of hearing therapies — genetic, biological, pharmaceutical. These will become effective tools in our armoury not just for curing hearing loss but informing the public, empowering them to take charge of their hearing health, driving prevention campaigns, and showing that prevention and cure, together, will transform the hearing health and the wealth of our nation and the globe.
David McAlpine is Distinguished Professor of Hearing, Language & The Brain, Dept of Linguistics, and Academic Director of Macquarie University Hearing.
Read David’s complete Libby Harricks Memorial Oration 2022 here.