Shepard Fairey Gets It.

ICYMI: Reasoning is not what you think. It’s biased to promote cooperation. Authority has no inherent wisdom. Consumer culture makes it worse. You’re on your own if you’re hearing impaired.

Personal hearing health is connected to big issues – public health policies and institutions, communication technologies, social anthropology, evolutionary neuroscience, and cognition. This post connects those dots in the reverse direction, starting with how we use our brains. 

The evolution of human reasoning and cooperation.

Humans evolved to thrive on social understanding required for cooperation. It is our biggest advantage over all other species, but it comes with an ironic twist. Cooperation can prioritize group cohesion over truth. We prefer to get along by going along. We prefer to align with the group and avoid thinking critically if it sets us too far apart from the flow of those with whom we choose to affiliate.  

Human brains are much bigger than other species. The adult human brain has about eighty-six billion neurons, about three times the size of a chimpanzee brain, for example [1]. We are good thinkers, capable of complex problem-solving and abstract reasoning required for making inferences. In general, however, since we like to get along more than we like to think, human decision-making is driven not by facts or reason but by opinion. As Elizabeth Kolbert writes. “Reason developed not to enable us to solve abstract, logical problems or even to help us draw conclusions from unfamiliar data; rather, it developed to resolve the problems posed by living in collaborative groups…. Reasonable-seeming people are often totally irrational” [2]. 

Research validates the cognitive tendency in human decision-making to be influenced by opinions and group norms rather than hard evidence, a tendency that requires less mental effort but does not necessarily translate to better group outcomes [3]. Aldous Huxley observed this tendency and imagined the negative outcomes in his 1932 dystopian novel Brave New World.

Shepard Fairey and the art of questioning obedience.

As an art student, Shepard Fairey created the original "Andre the Giant Has a Posse" sticker in 1989. The sticker project evolved into the Obey project and endures today. Fairey writes, “The concept behind Obey is to provoke people who typically complain about life’s circumstances but follow the path of least resistance, to have to confront their own obedience” [4]. In a word, Fairey distilled our preference for social belonging over critical thinking. Obeying may make our lives seem easier, but obeying doesn’t necessarily contribute to cultural improvement, and it can harm the common good.

Culture as entertainment: A fundamental shift in communication.

Neil Postman illuminates the mental effort problem by reviewing the history of communications in his 1985 book Amusing Ourselves to Death. Communication methods have evolved from oral to handwritten, then printed, and most recently to electronic methods throughout history. Postman observed, “[I]t is in the eighteenth century that science – the preeminent example of the analytic management of knowledge – begins its refashioning of the world” [5].

Postman and Marshall McCluhan before him famously suggested that the medium becomes the message in communications. Postman warned that the newest electronic communication method, notably television, carried big risks for messages, amplifying and sensationalizing emotion, transforming communication into entertainment, and creating large gaps between public perception on the one hand and facts on the other, complicating efforts to sustain the mental effort required to sustain thoughtful dialogue, the traditional anchor for many previous centuries of cultural development.

Postman also observed that it was in the eighteenth century that “capitalism is demonstrated to be a rational and liberal system of economic life.” That fact powers the concept of the 1996 version of Andre the Giant sticker. Fairey wrote, “...people don’t realize they’re slaves to consumerism because everything is glossy on the surface…people can be manipulated just by a stylistic approach – style over substance.” 

The multiverse makes it worse.

The shift from content to style carries vast implications for communications. Television has evolved into today’s online multiverse predominantly comprised of digital publishing platforms that compete for our attention and money with emotion-biased content. For evidence that Postman was correct, look no further than the notifications on your phone’s home screen, so-called reality TV shows, political advertising, or challenges to liberal arts education. 

Fact-based communication is marginalized in our multiverse era. “Breaking through the noise” does not mean telling the truth. It means getting attention, like blowing against the wind, as Paul Simon sang [6]. The multiverse breeds “truthiness”, as comedian John Stuart said, or bullshit, as moral philosopher Harry Frankfurt famously explained in his 2005 New York Times bestselling book by the same name [7], or as Steve Bannon infamously said, ‘flood the zone with shit” because the real enemy in political communication is the media [8]. 

In television, as explained by artists Richard Serra and Carlota Fay Schoolman in their 1973 video titled “Television Delivers People,” you are not the customer, you are the product. [9]. Paraphrasing Postman, the world we experience represented on screens seems natural, not bizarre. Incoherence seems sane. We are living with a most disturbing consequence: the institutions we established long ago to promote group cohesion using carefully deliberated civil discourse seem not to fit our times, but we believe it is the institutions, not our perceptions, that are disordered and strange. 

Reasoning in American culture has been declining for some time as show business mentality has permeated public discourse, and spectacle is favored over substance. The shift has subverted reasoning’s evolutionary purpose to navigate the complexities of community life by relying on problem-solving dialogue and printed messages that can be read aloud in formal speech. 

The Big Sort and the loss of dialogue.

Increasingly, fewer Americans appear inclined to sustain the mental effort required to strengthen institutions. Instead, Americans are moving, relocating to communities of like-minded individuals in a trend called “the Big Sort,” reinforcing ideological echo chambers, reducing the cognitive dissonance often associated with encountering opposing views and the commitment to critical thinking that comes along with it [10]. Symbols like brand affiliations and yard signs that convey simplified messages of tribal allegiance function as shorthand for dialogue — “hooray for our side,” as Buffalo Springfield’s 1960s protest song “For What It’s Worth” described [11]. This behavior validates affective polarization theory, which postulates that humans prefer emotional loyalty to one’s group over the desire for civil discourse and problem-solving, contributing to the erosion of social cohesion and productive civic life [12].

Attention and knowledge become consumer products in the multiverse era.

In the multiverse, attention is a valuable and measurable commodity with a business model, and paying attention gets a new definition. Multiverse ‘users’ often pay to contribute to the manufacture of attention, then pay again to purchase the product from multiverse platforms, most recently from AI companies. To see how this works, let’s look at the business models of politics, health, and, finally, hearing health. 

Economics is defined as the branch of human knowledge concerned with the production, consumption, and transfer of wealth. However, in 2010, the U.S. Supreme Court’s Citizens United decision declared that corporations are human and have First Amendment free speech rights [13]. That decision has reshaped politics and political candidates into consumer products funded by billion-dollar advertising campaigns, with much of the money going to multiverse platforms. “In 2016, just under $3 billion was spent on political ads. In 2020, that figure had climbed to $9 billion. This year [2024], it’s estimated we’ll burn through $10.7 billion—a new record for our country and, quite likely, the world” [14]. The 2024 presidential election was a large-scale natural social experiment that confirmed decades of cognitive research: reasonable-seeming people tend to behave irrationally when messages are emotionally biased. 

Health and hearing health are marginalized in the multiverse era.

Let’s now consider the impact of the multiverse on health and hearing health. Health is defined as the state of humans being free from illness or injury. However, health is now defined as healthcare, a very large industry with a robust business model, the third largest U.S. industry. In 2023, total U.S. healthcare spending was $4.5 trillion, 17.3% of U.S. GDP [15]. Every American spent $13,493 on healthcare, about double the amount spent per person in comparable countries [16].

We can agree that hearing is fundamentally important to social engagement, and hearing impairment hinders social engagement. Those two facts would seem to suggest institutions structured to support hearing health, but that is not the case. Hearing health care remains virtually unknown. Environmental noise is the major cause of hearing impairment, but institutionally mandated noise restriction ordinances are rare. Hearing has evolved into a global industry called audiology that generates global revenue of about $10 billion, primarily from selling hearing aids. Surgically implanted cochlear devices for the profoundly deaf generate an additional $1.5 billion. Initial costs range from $50,000 to $100,000. Lifetime costs are difficult to estimate. The devices do not bring back normal hearing. 

Compared to other disabilities, institutional support for hearing research is tiny. Hearing research is focused on developing future hearing regeneration drugs to be administered and monitored by physicians. Meanwhile, sales of noise-canceling earbuds and headphones are increasing five times faster than hearing aid sales, adopted for personal listening and coping with environmental noise exposure, generating 2022 sales of $72 billion.

How we got here: A short history of the NIH.

The National Institutes of Health (NIH) is one of thirteen operating divisions of the U.S. Department of Health and Human Services (HHS) [17]. Within the NIH, the National Institute of Deafness and Communication Disorders (NIDCD) is responsible for hearing research. The NIDCD was established in 1988 as the twenty-second research institute of the NIH. 

The NIH got its start in 1798 as the Marine Hospital Service caring for seamen at about the time European researchers made the important discovery that microorganisms cause diseases. The Marine Hospital examined arriving passengers to prevent cholera and yellow fever epidemics from spreading into the U.S. Cholera is caused by bacteria in drinking water, but a cholera antibiotic wasn’t developed until 1948. Water sanitation largely eradicated it by the late 1800s [18]. Yellow fever is caused by a virus carried by mosquitoes. The virus was discovered in 1927, and the first vaccines were developed shortly thereafter, in the 1930s.

The Marine Hospital was renamed the Public Health and Marine Hospital in 1902, and a decade later, the name was shortened to Public Health Service, the PHS. At the time, the PHS mandate was expanded to include non-contagious diseases, a mandate that continues today, which is important for hearing research because hearing loss is not contagious and is not a disease.

Response to the Pellagra epidemic of 1914 is an example of how the PHS implemented its mandate. Pellagra is a potentially fatal nutritional deficiency disorder. PHS conducted public health research that identified the lack of niacin – vitamin B3 – in the diet as the cause. Pellagra was rampant in Southern states where the diet was primarily corn, which doesn’t contain vitamin B3. The PHS implemented a public health program that cured Pellagra inexpensively by providing brewers’ yeast, which was inexpensive, readily available, and rich in niacin, as a dietary supplement. 

Federal government legislation in 1930 renamed the PHS as the National Institute of Health and its mandate was expanded to include grants to support medical researchers investigating biological and medical problems. The NIH name became plural in 1948, with two institutes. There were ten NIH Institutes by 1960, and 15 by 1970. As mentioned, the NIDCD became the twenty-second Institute in 1988. Five more NIH institutes and research centers have been formed since then [19].

Medical research supported by the NIH has expanded from preventive care to drug treatments. Over time, pharmaceutical treatment has come to dominate health care. Pharmaceutical companies, insurance companies, health systems, and private equity firms are the main beneficiaries of this approach. Meanwhile, the NIDCD receives scant financial resources. The 2024 NIDCD budget is $534.3 million, 1.1% of the total NIH budget of $47.1 billion [20]. The 2024 NIDCD biotechnology lab research budget is zero [21].

Hearing researchers have faced the headwinds of poor institutional support for decades, and their community remains small as a result. The few who obtain grant funding to support their labs and develop potential hearing therapeutics, which typically takes a decade or more, face even longer odds attempting to move discoveries from their labs to clinical practice using the clinical trials process called translational research. Translational research often takes more than a decade and typically costs many hundreds of millions of dollars. The 2024 NIDCD budget for clinical research support is $34 million, or seven-tenths of one percent [ibid 20].

The upshot: Hearing health is a costly unmet medical need in America and the world.   

The NIDCD and the Centers for Disease Control and Prevention (CDC), another HHS division, are responsible for monitoring hearing health among Americans. Their reports rely on statistics from the National Health and Nutrition Examination Survey (NHANES), conducted by the National Center for Health Statistics (NCHS) at the CDC [22]. The epidemiological data are directional but imprecise. A 2023 analysis of NHANES hearing data concluded that about 15% of Americans over the age of 20, roughly thirty-eight million, suffer some degree of hearing loss, and hearing loss goes untreated for 85%, or roughly 32 million, roughly 10 percent of the total U.S. population [23 ].

Globally, roughly 1.5 billion suffer some degree of hearing loss. The World Health Organization estimates the global unaddressed costs of hearing loss to be around $1 trillion annually, including health care and education ‘hard costs’ and under- and unemployment ‘soft costs’. More than half the total costs are borne by people in low- and middle-income countries [24].

There are no hearing preservation prescription drugs. Hearing regeneration drugs are many years away, and they are unlikely to effectively respond to the need if and when any arrive. As Melanie Challenger writes, “[I]t’s a savvy move to present biotechnology as being a wonderful opportunity for those who have been marginalized…. But it’s most likely that it will be only the few and the powerful that will profit” [25].  Recent evidence that unaddressed hearing loss in midlife is the leading risk for dementia, for which there is no cure, further underscores the urgent need for hearing preservation therapeutics [26].

The bottom line: You’re on your own if you have hearing loss. 

Those with chronic, incurable hearing loss have four options. Do nothing. Purchase hearing aids. Undergo cochlear implant surgery if the disability is profound. Take so-called hope-in-a-bottle dietary supplements, lightly regulated under permissive DSHEA law by the Food and Drug Administration, another HHS agency. We said more about dietary supplements, DSHEA, and the FDA in this post. 

ACEMg is a rare exception to the fourth option, the first clinically proven hearing preservation dietary supplement to reach the market since the establishment of the NIDCD, and the only product of NIDCD-supported hearing preservation research to do so. The ACEMg project was continuously supported from 1988 to 2017 by NIDCD research grants totaling about $22 million, representing less than three-tenths of one percent – 0.00275% of the roughly $8 billion in total hearing research grants awarded by the NIDCD during that time [27], [28]. In 2012, the European government stepped in with a €5 million medical innovation grant to bring ACEMg to the entire European community, enabling ACEMg to become Soundbites. 

References 

Shepard Fairey images used with permission of his team.

1. Pittella JEH. The uniqueness of the human brain: a review. Dement Neuropsychol. 2024 Apr 15;18:e20230078. http://doi.org/10.1590/1980-5764-DN-2023-0078. PMID: 38628563; PMCID: PMC11019715.
2. “That’s What You Think:” Why Facts Don’t Change Our Minds, Elizabeth Kolbert, The New Yorker, February 19, 2017
3. The Enigma of Reason, Hugo Mercier, Dan Sperber, Harvard University Press, 2019, ISBN 9780674237827
4. Shepard Fairey, Obey, Supply and Demand, The Art of Shepard Fairey, Gingko Press, 2009, ISBN 978-1-58423-349-7; reissued April, 2018, Rizzoli, ISBN 978-0-8478-6172-9
5. Amusing Ourselves to Death, Public Discourse in the Age of Show Business, by Neil Postman  ISBN 9780143036531
6. https://www.paulsimon.com/track/i-know-what-i-know-3/ “Who am I/To blow against the wind?”
7. On Bullshit, by Harry G. Frankfurt, 2005, ISBN 9780691122946
8. “Flood the zone with shit: How misinformation overwhelmed our democracy”, by Sean Illing, Vox, updated Feb 6, 2020
9. https://www.youtube.com/watch?v=LvZYwaQlJsg
10. “Millions of Movers Reveal American Polarization in Action”, New York Times, October 30, 2024 [Paywall]
11. https://www.youtube.com/watch?v=gp5JCrSXkJY
12. Druckman, J.N., Klar, S., Krupnikov, Y. et al. Affective polarization, local contexts and public opinion in America. Nat Hum Behav 5, 28–38 (2021). https://doi.org/10.1038/s41562-020-01012-5
13. https://www.brennancenter.org/our-work/research-reports/citizens-united-explained
14. https://newrepublic.com/article/186735/inside-2024-political-ad-machine-expensive-dubious
15. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data
16. How does health spending in the U.S. compare to other countries?
17. HHS Organizational Charts Office of Secretary and Divisions
18. Tulchinsky TH. John Snow, Cholera, the Broad Street Pump; Waterborne Diseases Then and Now. Case Studies in Public Health. 2018:77–99. doi: 10.1016/B978-0-12-804571-8.00017-2. Epub 2018 Mar 30. PMCID: PMC7150208
19. National Human Genome Research Institute (NHGRI), 1989; National Center for Complementary and Integrative Health (NCCIH), 1999; National Institute of Biomedical Imaging and Bioengineering (NIBIB), 2000; National Institute on Minority Health and Health Disparities (NIMHD), 2010; National Center for Advancing Translational Sciences (NCATS), 2011.
20. National Institutes of Health (NIH) Funding: FY1996-FY2025
21. Major Changes in the Budget Request
22. National Health and Nutrition Examination Survey
23. U.S. Population Data on Hearing Loss, Trouble Hearing, and Hearing-Device Use in Adults: National Health and Nutrition Examination Survey, 2011–12, 2015–16, and 2017–20
24. The impact of unaddressed hearing loss
25. How to be Animal: A New History of What It Means to Be Human, by Melanie Challenger, 2021, ISBN 9780143134350
26. Hearing impairment and risk of dementia in The HUNT Study (HUNT4 70+): a Norwegian cohort study, Lancet Discovery Science, 2023.
27. NIH History of Congressional Appropriations, Fiscal Years 2010 – 2019
28. NIH History of Congressional Appropriations, Fiscal Years 2020 - 2024