Clinician, student and faculty perspectives on the audiology-industry interface: implications for ethics education

Figures & data

Table 1. Participant profiles.

Country of practice	Primary role identification	Gender identity
USA	Clinician, hospital-based	W
USA	Industry, hearing aid manufacturer	W
USA	Industry, hearing aid manufacturer	M
USA	Industry, hearing aid and implantable device manufacturer	M
Canada	Industry, hearing aid manufacturer	M
USA	Industry, hearing aid manufacturer	W
Canada	Student, clinical	W
Canada	Student, clinical	W
Canada	Academic, university	W
Canada	Clinician, private practice	M
Canada	Student, clinical and research	W
USA	Academic, university	M
Canada	Student, clinical and research	W
Canada	Clinician, cochlear implants	W
Canada	Academic, university	W
Canada	Academic, university	M
Canada	Clinician, private practice	W
USA	Academic, hospital-based	M
Canada	Clinician, private practice	W
8 USA	5 Academic	12 women
11 Canada	5 Clinician	7 men
	5 Industry
	4 Student
	Years in practice: 0–30

Table 2. Grey literature sample.

Title	Year Published	Type of Publication	Source
Ethical practice guidelines on financial incentives from hearing aid manufacturers	2003	Practice guideline	Academy of Doctors of Audiology http://www.audiologist.org/ethicalpractice-guidelines
American Academy of Audiology ethical practice guidelines for relationships with industry for audiologist providing clinical care	2017	Practice guideline	American Academy of Audiology https://www.audiology.org/about-us/membership/ethics/ethical-practices-guidelines
Code of ethics	2016	Code of ethics	American Speech-Language-Hearing Association http://www.asha.org/Code-ofEthics/
Dilemmas for audiologist: Scenarios for ethical decision making	2018	Commentary	Audiology Online https://www.audiologyonline.com/audiology-ceus/course/dilemmas-for-audiologists-scenarios-ethical-28595
Ethical considerations in audiology practice	2018	Commentary	Audiology Online https://www.audiologyonline.com/audiology-ceus/course/ethical-considerations-in-audiology-practice-29641
Professional ethics: Making the right decision	2018	Commentary	Audiology Online https://www.audiologyonline.com/audiology-ceus/course/professional-ethics-making-right-decision-29236
Compliance, legalities and ethics in audiology today	2012	Educational material	Cavitt, K. (PowerPoint Slides) https://www.audiologyonline.com/files/content/06900/06968/10-15-12-cavitt-ethics.pdf
Compliance in audiology: The ethical and legal requirements of our profession	2015	Educational material	Cavitt, K. (PowerPoint slides) https://www.audiologyonline.com/files/event/26000/26061/slideshoethicscavitt6-8-15.pdf
By-law NO. 211-8: Code of ethics for the members of the college	2011	Code of ethics	College of Audiologist and Speech-Language Pathologists of Ontario http://www.caslpo.com/sites/default/uploads/files/LAW_EN_8_Code_of_Ethics.pdf
Ethics in audiology	2012	Educational material	Freeman, B.A. (PowerPoint slides) https://www.audiologyonline.com/files/event/21400/21496/freemanethics-handouts.pdf
Ethics: Application to the clinical, academic and corporate worlds	2011	Educational material	Freeman, B.A. (PowerPoint slides) https://www.audiologyonline.com/files/event/19700/19790/19790-ao-ethics-final-handout.pdf
Ethics in hearing healthcare, the basics	2012	Educational material	Lindsey-Henderson, S. (PowerPoint slides) https://www.audiologyonline.com/articles/ethics-in-hearing-healthcare-basics-11568
What social sciences research teaches about financial incentives from industry	2008	Essay	Margolis, R. H. https://www.audiology.org/sites/default/files/documents/SocialScienceResearch2008.pdf
Selling hearing aids: Ethical issues – Again	2012	Commentary	Staab, W. http://hearinghealthmatters.org/waynesworld/2012/conflictsturmoilantagonism/
Justifying conflicts of interest in medical journals: A very bad idea	2015	Commentary	Steinbrook, R. http://www.bmj.com/content/350/bmj.h2942
Ethical and legal aspects of paediatric audiology: What could go wrong	2016	Educational material	Windmill, I., Kettler, M. (PowerPoint slides) https://www.audiologyonline.com/audiology-ceus/course/ethical-and-legal-aspects-paediatric-27902

Figure 1. Summary of findings. Audiologists’ perspectives, stances, actions and systemic influences re ethical industry relations.

Table 3. How audiologists view and respond to potential ethics issues at the audiology-industry interface.

Participants’ views of potential ethical tensions at the audiology-industry interface	Participants’ associated responses or actions in relation to ethical tensions at the audiology-industry interface	Example interview excerpt
Hypervigilance	Avoidance of industry relations	I know that the relationship with the industry is part of selling hearing aids and having a good relationship with a manufacturer makes an independent clinic more viable. I had one placement in a hospital where we were not dealing with hearing aids and my supervisor there seemed to feel that we should be really careful taking anything from hearing aid manufacturers. And if you take free stuff from people, then you are biased. And he would not but he also did not actually work with hearing aid manufacturers. So that struck me as an overly rigid approach because you have to have a relationship with the manufacturers to sell hearing aids. Student (Georgia)
Tolerant awareness	Imagine systems change	But this is a legislative issue ultimately. I mean, this is something that should go beyond the health care system, or at minimally should be pervasive across the health care system. Is that if, for any reason your treatment options are limited by a business consideration, that that health care provider needs to disclose it. But, again, it would require legislation to mandate that. Industry-based audiologist (Carl)
Tolerant awareness	Enact individual change	When they could not afford [hearing aids], I tried to send them to the foundation […] that works with donated hearing aids so I tried to work with that as much as possible because a lot of times people are choosing between medications, food, and hearing aids. Of course, it was hard for me to try to get them to buy a $6000 hearing aid when I knew they were struggling financially. That was hard for me, and so I got yelled at for doing that as much as I did. I did not like it so I looked for another job. Industry-based audiologist who also works clinically (Francine)
Denial	Negate/deflect the call for change	You cannot create regulations or guidelines to protect against bad people. Bad people are going to be bad people. You cannot protect society against bad people just by having rules and regulations. There is always ways around it. You just have to hope that those people are found out, that somehow that that shines through. You also have to hope that patients, that eventually that catches up to a bad person and a bad clinician, if someone is doing things for the wrong reasons. You cannot legislate morality, that is basically an issue, you cannot legislate ethics, that is a personal decision. Industry-based audiologist (Dave)