First Opinion is STAT’s platform for interesting, illuminating, and provocative articles about the life sciences writ large, written by biotech insiders, health care workers, researchers, and others.
To encourage robust, good-faith discussion about issues raised in First Opinion essays, STAT publishes selected letters to the editor in response to them. You can submit a letter to the editor here, or find the submission form at the end of any First Opinion essay.
The story
“Trump deserves the Nobel Peace Prize for Operation Warp Speed’s global impact,” by Marc Siegel
The response
Maybe if he didn’t turn against the vaccine, lie to the public, hold a super-spreader event, have Herman Cain die from Covid after attending an indoor rally, cause vaccine rates to drop, and hire vaccine skeptics to his new administration. His HHS secretary is against the Covid vaccine and just canceled a $500 million mRNA contract. The complete history should be evaluated. He doesn’t deserve it.
— Bruce Young
The response
This article may be provocative and well-intentioned, but it is also ludicrous. We all know (or should know) that Trump is an established anti-vaxxer, which is one of the reasons he appointed Robert F. Kennedy Jr. to be his Health and Human Services secretary. I also think we need to keep in mind that Trump launched Operation Warp Speed in a desperate bid to cling to office in 2020. This is the same president who mused publicly about whether the U.S. government should slow down testing people for Covid-19 in order to keep the number of infections down. Yes, OWS did amazing things, and harnessed the talents of many amazing scientists and logistical experts across multiple sectors, including industry. And I’m not knocking mRNA vaccines; in fact, I’ve lost count of how many Covid-19 mRNA vaccine doses I have received since 2021.
But no, we should not give the Nobel Peace Prize to such a polarizing figure — particularly when he wondered out loud, in front of the world’s media, if people should inject themselves with disinfectants like bleach to inoculate themselves against Covid-19. It’s well-documented that some unfortunate souls actually followed this advice. There were many genuine heroes in the pandemic – Tony Fauci among them. Let’s honor them, instead.
— Gavin Hart
The response
Just …no. Brett Giroir deserves some credit. Trump created or greatly worsened the public health crisis that necessitated these heroic measures.
— Melanie Wasserman
The story
“Doctors sometimes fake CPR — and they should,” by Jason Adam Wasserman and Parker Crutchfield
The response
As a potential frail or terminally ill patient (aren’t we all?) as well as a bioethicist, I am dismayed but unfortunately not surprised to read about doctors who fake CPR on “frail or terminally ill patients” whose “odds of surviving CPR are dismal.” What this overlooks, of course, is that CPR is generally performed only when the odds of surviving without it are zero. Whether low odds are better than zero odds is not a decision about which medical professionals have medical expertise. It is a moral decision to be made by each patient through an advance directive, or, failing that, by the patient’s family. “Humane, patient-centered care” means respecting each patient’s priorities. The “deeper dysfunction in how we manage death and dying in America” is that many health professionals don’t respect patients whose priority is to stay alive no matter what. I think death would be far more “brutal” than CPR, so my advance directive says, “Keep me alive as long as possible by any means necessary.” I fear that this will be overridden by ableist medical personnel.
— Felicia Nimue Ackerman, Brown University
The response
As someone who’s worked in health care for 37 years and is now retired, I found this article to be so true. When I first started working, I heard about a slow code. I didn’t understand it until I found myself participating in one. I asked the doctor why he didn’t try harder. He explained to me the patient was so frail that it would’ve caused her death anyway. I went home at night and thought about it. After I had been there a while I understood. I started thinking: What if it was my mother, grandmother, or even myself? For some reason all made sense. Thank you for the article.
— Sue Johnson
The response
My mother is a complex heart patient who is now 82 years old on her third automatic implantable cardioverter defibrillator, likely fourth next year. The excellent medical care she has received over the last 22 years has saved her life more than once.
But the one thing she has not wanted since the age of 70 is to be dependent upon others. I would like to say her doctors had a frank discussion with her about what “heroic interventions” meant, but it wasn’t. It was me, her daughter. We talked about ribs being broken, how sometimes people can’t be extubated successfully and have to stay on ventilators (and how sometimes they successfully self-extubate). She made a decision to accept any medication that could revive her, any electrical shock, or “moderate” procedure that could return her to the life she enjoyed she wanted. But CPR and intubation were not wanted. I think there is a fear to be frank about what it means to “extend life” versus “quality of life.” Unfortunately we do live in an age of misinformation and that only makes it more difficult to talk honestly about the reality of what certain interventions have in the body, despite our best intentions.
— Kim Wright
The story
“Kennedy’s case against mRNA vaccines collapses under its own evidence,” by Jake Scott
The response
Good fact-based article, but the people who need to be convinced don’t care about facts. They’ve built their political base on lies and conspiracy theories, so no amount of factual information will deter them from their successful political strategy. The irony is that many of the same people who claim to support “life” are supporting policies that will result in more unnecessary deaths.
— Dan Rogerson
The story
“Why Silicon Valley should demand clinical trials for its medical AI,” by Olivier Elemento, Cora N. Sternberg, and Sean Khozin
The response
I support this call in principle, but there are some issues:
1. The title implies that someone is stopping AI vendors from pursuing randomized controlled trials, but that is not the case — they can conduct RCTs if they choose to.
2. A real issue is lack of incentives. As an example, OpenEvidence achieved significant adoption and an astronomical $6 billion valuation without any trials at all, let alone RCTs. Why would they incur the major cost and risk of RCTs?
3. Also worth mentioning is that the situation is different for generative AI vs. non-generative AI. For NAI, the incentives do exist, in the form of reimbursement. For GAI, there are hardly any.
— Ljubomir Buturovic, Inflammatix Inc.
The story
“Make statins available without a prescription,” by Vishal Khetpal
The response
Vishal Khetpal argues statins should be made available over the counter as a means of increasing access to these important cardioprotective medications. While removing barriers to receiving statins may have many benefits, as Khetpal discusses, policymakers should consider potential unforeseen consequences of such a move. Namely, modification of how patients perceive statins as a drug class and the downstream implications of divorcing mental association of these drugs from tailored physician advice.
The consumer studies literature — the branch of marketing that studies the psychological underpinnings of individuals’ choices — may offer some guidance. In the International Journal of Consumer Studies, Amanda B. Bower, Stacy Landreth Grau, and Valerie A. Taylor write that consumer behavior is based on the cognitive construct of “schema”: “functional ways of organizing information based on prior knowledge.” Applied to the medical context, patients have different perceptions of drugs based on whether they are prescribed by a physician or are readily accessible OTC. Consequently, patients may behave differently with regard to adherence and other considerations depending upon which schema they apply to a particular medication. Bower, Grau, and Taylor tested this hypothesis empirically. Specifically, they found evidence that patients have statistically significantly more positive attitudes toward compliance with drug instructions for prescription drugs than OTC drugs.
Adapting this finding to our question of statins, if patients begin perceiving that statins are minor enough of a drug class to be relegated to OTC status — in the same cognitive schema as ibuprofen and vitamin C supplements — they may (consciously or unconsciously) begin to adapt their behavior toward these drugs. In other words, if patients begin seeing statins less as serious medical interventions addressing underlying disease, and more as drugs not important enough to rise to the level of physician prescription instead, then they may become less adherent and appreciative of the value that these drugs can provide for reducing cardiovascular risk.
Ultimately, the question of whether statins should be made available OTC must rely upon a balance between diffuse increase in access and altered patient behavior. This question has considerable implications for public health, as Khetpal discusses. However, rather than an immediate change to medical guidance, policymakers and academic researchers should first consider an empirical study of patient behavior in both schemas. Perhaps statins should be “in the water,” but if you’re surrounded by a freshwater lake, do you value water as much?
— Manav Midha, USC Schaeffer Center for Health Policy & Economics and Icahn School of Medicine at Mount Sinai
The story
“Dental care is increasingly under threat in the U.S.,” by Melissa Burroughs
The response
I live in Boise, Idaho, which at present has fluoridation. I, however, lived in an old house still on a natural well. Guess what? After 25 years my teeth are almost completely gone. The few that are left have cavities and other issues. I am a prime example of what can happen without fluoridation.
—Bruce McMurtrie
The story
“Hospice was meant to offer dignity in death — but it fails the most marginalized,” by Christopher M. Smith
The response
I am truly grateful for the perspective the writer provided me. I’m grateful for the call to check my privilege in what should be a fundamental, universal, ubiquitous, “no matter who you are” guarantee to all people: a dignified death. I just walked through the peaceful passing of my boss’ 102-year-old mother, who lived happy and healthy all her days and was assisted by compassionate hospice professionals up to her final breath. I walked this same path with my maternal grandmother 10 years ago. I can’t imagine anyone approaching their end without these resources — and yet, entire swaths of marginalized people are systematically denied this dignity. I intend to find ways to volunteer this care and compassion to underserved neighbors. Until this care is for everyone everywhere, I will make people uncomfortable with these truths. Death is such a consuming fact, it’s easy to be self-centered about it … we don’t get to do that. Not anymore. Thank you for this perspective. My heart is broken, and now I can get to work doing something about it.
— David Stanley
The response
Thank you for this op-ed! I agree so much that every human being deserves dignity and respect in their health care in life and most importantly in death. I’ve been a nurse 33 years with a long focus in home care before my palliative career. I too struggled with care inequities. Our health system very broken. I hope this message is seen by many and voices are heard to intact change to include all no matter their circumstances.
— Deborah Cowart, R.N.
