First Opinion is STAT’s platform for attention-grabbing, illuminating, and perhaps even provocative articles in regards to the life sciences writ massive, written by biotech insiders, well being care staff, researchers, and others.
To encourage strong, good-faith dialogue about points raised in First Opinion essays, STAT publishes chosen Letters to the Editor acquired in response to them. You may submit a Letter to the Editor right here, or discover the submission type on the finish of any First Opinion essay.
“Sonya Massey’s demise: Learn how to stop extra killings of defenseless Black girls,” by Onyeka T. Otugo and Adaira I. Landry
Sonya Massey ought to nonetheless be alive. The cops who entered her residence in Illinois weren’t sufficiently ready to reply to a person experiencing a psychological well being disaster. As a member of a company that has been supporting New Yorkers with psychological well being considerations for the final 50 years, I can inform you that this has additionally been the case in New York, the place far too many individuals of coloration have been killed in encounters with the police. Since 2015, 20 New Yorkers have been killed, 17 of whom had been BIPOC.
No quantity of disaster intervention coaching can right a regulation enforcement tradition the place “command and management” ways are so deeply embedded.
The op-ed by Dr. Otugo and Dr. Landry rightly identified that there are individuals in lots of different occupations who’re higher geared up to reply in a method that doesn’t escalate the state of affairs and avoids lethal hurt in conditions like Sonya Massey’s. In 2021, New York Metropolis established a Behavioral Well being Emergency Help Response Division pilot, or B-HEARD, which responds to 911 psychological well being calls in choose precincts all through town with EMTs and psychological well being professionals relatively than police. However at the same time as New York Metropolis has taken some steps in the best route, important components are lacking from their method. Educated friends, individuals with lived psychological well being expertise, can play a key position in forming connections and assembly individuals in disaster the place they’re — decreasing the temperature of doubtless risky conditions.
There at the moment are greater than 100 alternate disaster response models working in cities throughout the U.S. Lots of them studying from the many years of profitable interventions by the CAHOOTS program in Eugene, Oregon, the place a non-police response — friends paired with EMTs — are dispatched to assist people in disaster. If such a crew had been obtainable in Springfield on the night time when Sonya Massey known as the police, she would possibly nonetheless be alive. Till extra municipalities acknowledge the pressing want for extra various disaster intervention response techniques — and implement non-police responses successfully and meaningfully — extra individuals dwelling with psychological well being considerations shall be killed in police encounters. We can’t settle for this establishment and demand higher from our techniques of care.
— Cal Hedigan, CommunityAccess.org
“Empathy ought to information responses to reported vaccine accidents,” by Kizzmekia S. Corbett-Helaire
This dialogue ought to embrace “shoulder harm associated to vaccine administration” (SIRVA). Based on the literature, SIRVA is an underrecognized, underreported, and extremely preventable harm inflicting any mixture of soreness, stiffness, losses of energy and vary of movement, numbness, and tingling. Accidents will be short-term (days, weeks, or months or everlasting. SIRVA may end up from the injection being too excessive on the higher arm.
I discovered about SIRVA from private expertise after a Covid vaccination was administered noticeably excessive on my arm by a well-intentioned younger nurse who clearly hadn’t discovered about SIRVA. I solely discovered about it when the standard one- to two-day soreness didn’t subside and different signs appeared.
I’ve since talked with medical doctors, nurses, and an epidemiologist who didn’t learn about SIRVA. Some M.D.s and nurses did learn about it. One M.D. mentioned she had questioned why her personal arm was stiff and sore for 5 months after a reasonably current vaccination. I used to be lucky my signs lasted “solely” 4 months.
A fast on-line search generates peer-reviewed articles obtainable from the Nationwide Institutes of Well being and credible journals. The Facilities for Illness Management and Prevention has a Scientific Immunization Security Evaluation Venture. The Well being Sources and Companies Administration has a Nationwide Vaccine Damage Compensation Program.
Everybody who administers vaccines ought to have preliminary and recurrent coaching about SIRVA, and persons are suggested to position three fingers on the prime of their arm (this measure might differ with the size of 1’s arm) and to talk up about SIRVA earlier than injections to make sure vaccinations are safely in the best place. I’m not a clinician, however from printed diagrams, the right injection website seems to be within the middle of the inverted triangle-shaped deltoid muscle.
— Skip Grieser, Colorado State College
“Useful neurological dysfunction just isn’t an acceptable prognosis for individuals with lengthy Covid,” by David Tuller, Mady Hornig, and David Putrino
At first, I used to be confused by this text, because the assertion that LC and FND are completely different diagnoses is apparent to anybody who treats them. Nevertheless, it was disconcerting to comprehend the intention of the article was seemingly to present validity to the lengthy Covid prognosis by diminishing the validity of the useful neurological dysfunction prognosis. Each are frequent debilitating problems and seen from the view of a affected person affected by FND or caring for them, this text reads as successful piece. It is usually very deceptive scientifically.
In fact they’re completely different, however not for the explanations listed. Like frequent migraine and FND, post-infectious neurocognitive problems like lengthy Covid contain a whole lot of mind community dysfunction. Arguably main despair has extra constant biomarkers than any of the others. And identical to diabetes, the entire above are affected by hostile childhood occasions (trauma), all contain psychological parts, and all are greatest handled with quite a lot of medical and behavioral well being interventions.
Lengthy Covid and FND are clearly completely different and anybody complicated them doesn’t perceive the subject. If somebody heuristically simplifies all cognitive affective situations right into a simplistic paradigm of “temper stuff” I may perceive their confusion. The most important distinction between lengthy Covid and FND isn’t the neurophysiology or the validity as diagnoses, it’s the stigma related to them and this text positively acts to widen that divide.
— Joshua Claunch
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I agree with this well-reasoned argument that FND is misapplied to sufferers with nonspecific signs who current diagnostic dilemmas to their medical doctors. I’m an autonomic specialist, and see many sufferers with power orthostatic intolerance associated to the triad of dysautonomia spectrum dysfunction — (inappropriate sinus tachycardia and postural orthostatic tachycardia syndrome, mast cell activation syndrome, and hypermobile spectrum problems). It’s common for these sufferers to have lengthy lists of signs, usually in extra of 30, associated to this triad of problems in addition to comorbid migraine, irritable bowel, generalized ache, small fiber neuropathy, fibromyalgia and different problems sometimes called central sensitization syndromes. This “symptom snowball” is just too usually interpreted as being totally attributable to a useful neurologic dysfunction. There may be usually a biologic set off that’s being missed: extreme venous pooling from collagen laxity, vascular extravasation from power allergy/irritation from mast cell activation, environmental triggers together with meals intolerances, medicine excipients, mould toxicity, and infections.
My method has been to acknowledge each the presence of an as-yet unidentified biologic set off in addition to the psychophysiologic dysfunction that attends any power unexplained sickness. When a biologic set off happens, the mind begins to work to resolve the issue. If the signs stay unexplained, the mind might develop into a symptom generator.
Whereas reassuring sufferers that we’ll proceed to seek for the biologic set off, I counsel them to cut back the cognitive misfiring via symptom reprocessing remedy, 4-7-8 respiration methods, and amygdala retraining (Guptaprogram.com or the ebook “The Manner Out” by Alan Gordon, and others). When introduced in a compassionate method, sufferers are much more more likely to embrace these methods whereas awaiting additional investigation and therapy.
— Laurence Kinsella, adjunct professor, neurology, SSM Well being St Louis College
“Mark Cuban’s firm received’t repair drug prices, however it could possibly nonetheless assist rectify America’s drug shortages,” by Ezekiel J. Emanuel and John Connolly
Thanks for publishing the essay, which is considerably correct. I take exception to at least one widely-circulated falsehood, particularly; “…excessively low costs incentivize corporations to outsource to Chinese language and Indian producers which lack stellar observe information on the subject of high quality.”
Web page 5 of FDA’s FY 2023 report on the State of Pharmaceutical High quality concerning passable FDA inspections of producing websites from China (95%), India (89%) and the U.S. (94%) don’t bear out this false declare. It’s promoted by sure U.S.-based insiders looking for authorities subsidies to “reshore” manufacturing.
— Vincent Andolina
“Medtech compliance — not regulation — is stifling innovation,” by Erez Kaminski
As a former FDA affiliate commissioner, I can attest to the risks of “White Oak Syndrome” — regulated corporations attempting to out FDA the FDA. In lots of cases (and never only for medical machine corporations), company compliance departments restrain their very own colleagues from actions that drive vital improvements due to their very own overly conservative studying of FDA rules. In the case of guiding their very own companies, they depend on one-dimensional readings of the regs relatively than a extra three-dimensional view of what’s there between the traces. Such practices act as sea anchors to innovation and the outcomes shouldn’t be blamed on the FDA however relatively on the dearth of inside danger tolerance. Lastly, no less than in my expertise over the past 20+ years, company compliance departments behave as if they’re secret societies, repeatedly refusing to debate and debate their positions with their R&D, advertising and marketing, and different company colleagues. Boldness is taken into account recklessness — however these phrases usually are not synonyms. There’s a distinction with a distinction.
— Peter Pitts, Heart for Drugs within the Public Curiosity
“Sponsored genetic testing packages are below fireplace, additional complicating life for individuals with uncommon ailments,” by Emil D. Kakkis
The state of affairs is extra perverse. Usually medication to deal with a uncommon genetic illness usually are not included within the formulary of a medical insurance plan’s pharmacy profit and usually are not lined. To acquire protection, a doctor must exhibit the medical necessity of the drug for which a genetic take a look at discovering would supply that help. By insurers proscribing protection of the genetic take a look at, the truth is what’s being restricted is entry to the medication which treats the genetic illness.
— Douglas Dachille
“The ‘Dangerous Analysis Evaluate Act’ would do extra hurt than good,” by David Gillum, Rebecca Moritz, and Gregory D. Koblentz
Any time I see a proposal to carry scientific analysis below the management of politicians, alarm bells begin ringing. What number of politicians have ample schooling to grasp what’s being researched? What number of are letting their spiritual beliefs stand in the best way of correct analysis?
— Linda-Claire Steager
“To get a good deal on Wegovy, shopping for Novo Nordisk won’t be Medicare’s worst possibility,” by Melissa Barber, Joseph S. Ross, and Reshma Ramachandran
I like the truth that severe public coverage researchers are figuring out choices similar to public manufacturing of prescribed drugs that usually are deemed too far off the charts. However there are a number of weaknesses within the article, the obvious being that Denmark is unlikely to permit a overseas takeover of Novo Nordisk, whose market worth exceeds that of the nation’s total GDP and which contributes probably the most to its company tax revenues.
One other downside is that Novo Nordisk is the dominant international provider of each insulin and GLP-1s and for nations which want these medication a Novo alternative topic to the general public coverage whims of a overseas authorities would doubtless be a nightmare.
And at last, the authors method the topic of a Medicare takeover of Novo Nordisk with a comparatively slender financial lens, bypassing any consideration of non-pharmaceutical interventions and even different drug therapy choices. That is shocking since a key contributor to weight problems is poverty and growing a extra upstream, public well being response to the implications of that — poor diet and dietary schooling, stress, and so on. — would possibly considerably scale back the quantity of people that would require GLP-1s. This method could be preferable not simply due to value, but additionally due to the recognized unwanted side effects of this class of drug — to not point out the unknown, potential long-term unwanted side effects.
A dialogue of public manufacturing is required, however we additionally want to speak about social determinants that are contributing to poorer well being usually, together with weight problems and sort 2 diabetes.
— Colleen Fuller
“Why aren’t philanthropists stepping as much as make nursing schooling free?” by Tracy R. Vitale and Caroline Dorsen
Regardless of current high-profile items and the heightened consciousness of the nursing disaster throughout the Covid-19 pandemic, personal giving for the nursing occupation stays alarmingly low, with just one penny of each greenback donated for well being care directed in the direction of nursing. This evident disparity in philanthropic priorities undermines the central position nurses play in advancing well being care high quality and fairness.
Nurses are uniquely positioned to drive well being care enhancements attributable to their direct affected person connections, intensive experience, and big selection of obligations. Their firsthand data of affected person wants and outcomes makes them very best companions for funders looking for to remodel the well being care system to serve everybody higher. Investing in nursing just isn’t merely an funding in people however a strategic transfer in the direction of less expensive, higher-quality, and extra equitable well being take care of all.
One of the important areas for philanthropic help is the transition of internationally educated nurses (IENs) into the U.S. well being care system, a trigger fervently championed by the Filipino Nursing Diaspora Community. IENs carry invaluable variety, representing varied nations and providing cultural and linguistic affinities with foreign-born sufferers. These nurses usually face vital challenges when transitioning to apply within the U.S. attributable to variations in tradition, language, and well being care techniques. Nevertheless, their contributions are immense and transformative.
Analysis reveals that models with extra internationally skilled nurses not solely have larger ranges of schooling—usually because of the requirement of a baccalaureate diploma for U.S. licensure—but additionally exhibit decrease turnover charges. This stability fosters collaborative environments amongst nurses, finally contributing to improved well being outcomes and diminished recruiting and hiring bills. Supporting IENs can considerably improve affected person care high quality and workforce stability. Furthermore, their various views and experiences enrich the well being care surroundings, making it extra inclusive and aware of the wants of a multicultural affected person inhabitants.
A shining instance of the facility of philanthropic help is the transformational present by Dr. Nancy Atmospera-Walch, a Filipino nurse chief, to her alma mater, the College of Hawaii Manoa Faculty of Nursing, in 2022. This contribution not solely underscores her dedication to nursing schooling but additionally elevates the satisfaction and recognition of IENs and Filipino nurses within the diaspora. Hawaii, residence to many Filipino nurses and a major variety of IENs, stands to profit enormously from this daring funding.
Dr. Atmospera-Walch’s present focuses on 4 important areas: bettering college well being for Hawaii’s keiki (youngsters), addressing the state’s nursing workforce scarcity, supporting future nurses, and growing early-career nursing school. This complete method ensures that nursing college students and school will profit from her generosity for a few years, fostering a strong and succesful nursing workforce and elevating the Faculty of Nursing on each native and nationwide phases. Her philanthropy exemplifies the profound influence of focused help on the nursing occupation and the broader well being care system.
By directing philanthropic sources in the direction of nursing, significantly in supporting IENs and academic establishments, we are able to create a extra steady, educated, and efficient nursing workforce. This, in flip, will result in higher affected person outcomes, diminished well being care prices, and a extra equitable well being care system. Investing in nursing, particularly within the help of IENs, is a strategic crucial that guarantees substantial returns in well being care high quality and fairness, benefiting society as a complete. Dr. Nancy Atmospera-Walch’s transformative present serves as a strong instance of the influence and significance of such investments.
— Jerome Babate, Filipino Nursing Diaspora Community
