The Last Resort

When radio talk show host Rush Limbaugh announced to the world that he had lost his hearing, many of his listeners and supporters were understandably saddened. Today, Limbaugh’s recovery resulting from his cochlear implant is cause for celebration, not only among the listening public, but the neural prostheses community [see article, this issue].

But as we revel in the success, it’s worth reflecting on the intervening events that occurred between the onset of Limbaugh’s hearing loss and the restoration of his hearing. The circumstances reveal some of the greatest challenges confronting the neural prosthesis industry in the years ahead.

Before Limbaugh could even be considered a candidate for a cochlear implant, he went through months of “traditional” therapy with drugs aimed at treating or reversing his auto immune inner ear disease. Limbaugh himself described his attitude about treatments on the air October 8:

“I’m popping pills [and] I’m shooting up stuff. I’ve never done stuff like this before. If this stuff doesn’t work, then there is one other option that is relatively new, but it’s not something that has been done enough to where a pattern has been established to say that it’s acceptable. There’s always the last resort—the cochlear implant. It’s the last thing they do, because it’s irreversible.”

Limbaugh’s early perception of cochlear implants—as opposed to his current praise for the technology—is consistent with that of other recipients of neural prostheses. At the NIH Neural Prosthesis Workshop last October, a panel of users shared their experiences. The panel included a deaf person who had received a cochlear implant, a person with Parkinson’s disease who had received a deep-brain stimulator, a quadriplegic who had received the FreeHand hand grasp stimulator, and a paraplegic who had been implanted with an experimental standing prosthesis.

Each of the four reported a similar feeling prior to deciding to go ahead with their implant: they were concerned that a cure for their particular disease or disorder was imminent and that implanting a prosthesis might interfere with that cure. They also felt that neural prostheses represented a form of rehabilitation, not a cure. And they reported that clinicians were sometimes hesitant to recommend the procedure because of reimbursement or other financial issues. In many cases, it was difficult to even find information on neural prostheses because the respective patient communities were often in the dark.

After receiving their implants, however, each of the panelists expressed extreme satisfaction with their devices and regretted not opting in sooner. Even if a cure were to be found tomorrow, they would still feel that it was worth the effort they expended to receive their implant, recover from surgery, and undergo training.

The notion of neural prostheses as the “last resort” overshadows almost all of the technical and engineering challenges confronting the industry. There’s nothing wrong with the idea of searching for a drug or compound that will cure neurological diseases and disorders. But if the clinicians, manufacturers, and funding organizations supporting that strategy do so while shunning neurotechnological approaches that work today and will only get better in future generations, those individuals must be held accountable to the patients they have failed to help.

James Cavuoto
Editor and Publisher