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 received 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.
“Doing more cancer screening won’t reduce Black-white health disparities,” by Adewole Adamson, Vishal Patel, and H. Gilbert Welch
The authors’ claim that increasing access to cancer screenings will not reduce Black-white disparities in cancer mortality and mainly serves the interests of the healthcare system is incorrect. Their claim ignores a large body of evidence demonstrating that increasing access to cancer screening is an effective strategy to reduce, or eliminate, the racial disparity in cancer incidence and mortality between Black and white individuals. For example, a previous study published in the New England Journal of Medicine found that increasing colorectal cancer screening rates among Black and white members of the Kaiser Permanente Northern California health plan eliminated the disparity in colorectal cancer mortality between Black and white adults. Moreover, in Delaware, implementation of a statewide colorectal cancer screening program led to marked increases in colorectal cancer screening rates and declines in colorectal cancer mortality, nearly eliminating the disparity in colorectal cancer mortality between Black and white Americans. Similar findings have been reported for other cancers, including breast and cervical cancer. These studies directly refute the very premise of this article — that increasing cancer screenings will not reduce disparities in cancer mortality.
Furthermore, the authors do not appear to recognize the broader public health impact of cancer screening. Numerous randomized trials have shown that cancer screening leads to significant reductions in cancer mortality. Outside of clinical trials, the widespread adoption of cancer screenings has been shown to significantly reduce cancer mortality at the population level. Increasing cancer screening rates is thus an important public health strategy to reduce cancer mortality among all people at risk for cancer, irrespective of race. Dismissing cancer screening as simply serving the interests of the health care system is to dismiss decades of high-quality evidence supporting the effectiveness of cancer screening in reducing cancer mortality and to dismiss the hundreds of thousands of lives saved thus far as a result of cancer screening.
The article has the potential to damage the public perception of cancer screening, prevent individuals from getting screened for cancer, and — ironically — further widen the disparity in cancer mortality between Black and white individuals. We must recognize that improving access to cancer screening is a powerful and evidence-based strategy to eliminate the disparity in cancer mortality between Black and white Americans and prioritize efforts to increase access to cancer screening among all people at risk for cancer.— Priyanka Senthil, executive director, American Lung Cancer Screening Initiative
“Mask bans disenfranchise millions of Americans with disabilities,” by Kaitlin Costello
Nassau County’s mask ban is unenforceable. If an individual is wearing a mask while committing a crime, there are already enough reasons for them to be arrested. If they are wearing a mask prior to committing a crime, how is the police officer going to divine that information? The leadership of Nassau’s law enforcement and judiciary should have to explain how they intend to enforce, prosecute, and judge individuals identified as having broken the law — this is just more virtue signaling.— Charles Dinerstein, American Council on Science and Health
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Indeed — a very fine line between unmasking potentially violent people and protecting a citizen’s right to medical countermeasures. However, hyperbole isn’t helpful. It’s important to note that Covid-19 is no longer considered a pandemic. Dr. Costello makes many important points. There’s no need to either exaggerate or misinform. Let’s let the facts speak for themselves.— Peter Pitts, Center for Medicine in the Public Interest
“Can AI help ease medicine’s empathy problem?” by Evan Selinger and Thomas Carroll
The authors correctly identify a root cause of the “empathy problem” as “ever-increasing pressures” resulting in burnout, but I worry that AI is ultimately a stop-gap solution. Ideally, technology would go hand in hand with solutions aimed at addressing these root causes. In practice, I would be concerned that resources spent by institutions adopting an AI-based communication platform, training staff, implementing the platform, and monitoring its effects would ultimately be zero-sum with resources that could alleviate actual burnout including longer visit times, more staffing, or reduced paperwork. The empathy problem is one symptom of pervasive burnout, which reaches beyond communication quality to negatively affect other critical aspects of patient care such as medication or procedure safety, provider turnover, and interpersonal teamwork. As a medical trainee, my hope is that the field will invest in solutions, AI-powered or otherwise, that not only give my patients the perception of empathy, but also replenish or protect the bandwidth I have to connect with patients and avoid personal burnout.—Daniel Park
