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.
The story
“Rise of anti-science rhetoric has fundamentally changed the relationship between doctors and patients,” by Krutika Kuppalli
The response
I sympathize with Dr. Kuppalli’s dilemma as I encountered the same skepticism. As a bedside nurse in several departments over the years, I’ve had similar conversations with patients and their families. I couch the “vaccine talk” as a risk/benefit decision, not minimizing their fears of vaccines while describing the diseases prevented and sometimes even delving into the mechanisms of action. I received much less resistance when I acknowledged their concerns and augmented it with more knowledge. Much of vaccine resistance is founded on genuine concerns of people with less scientific education and analytical reasoning. Their risk-benefit assessments are based on stories they heard. Our conversations require expanding their thought processes, not just content. It takes time, understanding, and communication skills, something most medical staff do not have time for. We are paying the price for this.
— Mary Van Siclen
The story
“I’m a physician who went to the anti-vaccine movement’s biggest gathering. More of my colleagues should, too,” by Craig Spencer
The response
In his recent article, Craig Spencer offers a good prescription for his field of study: “Public health needs to reclaim that same moral authority: to be seen as standing for truth with equal courage and clarity.” Sadly, in the very next sentence, he makes clear that his real goal lies not in pursuing truth but in defeating his enemies: “By the time I left Austin, I knew more of my colleagues should be in those rooms — not to agree, but to understand exactly what we’re up against.” If he attended the Children’s Health Defense conference with an open mind, he might discover what its attendees know that he does not, and reform his field from the persecution of heretics to the practice of science. In the meantime, those of us dissidents who have not already had our lives upended by his followers will remain in the shadows.
— Thomas Coffee
The response
Thank you for this insightful summary of a conference that none of us attended except for a brave and committed physician. What Dr. Spencer described is connection, bonds of respect, communication, and unity of purpose. In my experience, data rarely motivated patient compliance or habits, but rather it was the more human aspects of community, meaning, belonging, and feeling genuinely listened to and cared for that mattered most in the end. What he described are the same principles applied in a group. It is a unique and invaluable contribution to public health’s moving forward at this time. Many thanks to Dr. Spencer!
— Mary Silverman
The story
“It’s past time to update the rules intended to slow the FDA’s revolving door,” by Lee Rosebush and Marc Wagner
The response
Shocked and saddened to see STAT publish a scurrilous attack on the integrity of dedicated civil servants who spent their careers with FDA, many of whom were terminated by cruel and unnecessary DOGE staff cuts. As someone who worked for FDA-inspected, FDA-approved legitimate drug manufacturers for 45 years, seeing this attack from an outsourcing spokesperson, at the fringes of drug manufacturing, is deplorable. Perhaps that segment is upset that the gravy train of GLP-1 agonist “compounding” has run dry (since they are no longer in shortage), and I assume their attempt to replace it with unapproved minor variations of approved GLP-1 products under the guise of “compounding” is not as lucrative.
— Vincent Andolina
The story
“We wrote the HHS review on treatment for minors with gender dysphoria. We hope our critics actually read our report,” by Evgenia Abbruzzese, Alex Byrne, Farr Curlin, Moti Gorin, Kristopher Kaliebe, Michael K. Laidlaw, Kathleen McDeavitt, Leor Sapir, and Yuan Zhang
The response
The authors of the Department of Health and Human Services’ final review on pediatric medical transition make a well-reasoned defense of their work. The question now is how medical societies will respond. As many doctors can attest, our professional associations have largely avoided debate on this issue, despite the evidence and dissatisfaction among their members.
Several medical societies’ lack of participation in the peer-review process of the HHS review is not a heartening sign. The Endocrine Society and the American Academy of Pediatrics (AAP) refused to critically analyze it, indicating a general unwillingness to defend their current support for pediatric gender transitions. They could easily have followed the example of the American Psychiatric Association, which did submit a peer review. Such open debate and recourse to evidence is precisely what this issue demands.
Instead of ignoring the HHS review, medical societies should look to meaningfully engage both the evidence and their members. The AAP, despite its decision to conduct a systematic review of the evidence, has yet to produce on this promise. Nor has any medical society solicited its members’ thoughts on either the HHS review or pediatric gender transitions more broadly.
The de-emphasis of discussion has even permeated state professional associations. This fall, the House of Delegates for the Pennsylvania Medical Society went so far as to block studying a resolution I drafted on ending pediatric medical transition of minors in the Commonwealth. It’s one thing to block a measure supporting such restrictions; it’s quite another to block an exploration of the evidence, especially after all of 10 minutes of debate.
In light of the HHS review, national and state medical societies should seek to foster open and respectful debate on this issue. They should encourage vibrant discussion at annual conventions, hold dedicated panels for medical professionals with a diversity of views, and solicit feedback from their members regarding their support for pediatric gender medicine. My organization was recently denied the ability to run a booth at the American Academy of Child and Adolescent Psychiatry’s national convention — precisely the suppression that needs to stop.
What medical societies cannot do is pretend the HHS report either doesn’t exist or doesn’t matter. That document earnestly grapples with the evidence — an obligation that medical professionals and our respective societies share. Neglecting that duty is an affront to patients and families, who expect and deserve medical care grounded in science.
— Kurt Miceli, Do No Harm
The story
“How to keep commercial surrogacy from getting banned,” by Arthur Caplan
The response
Caplan wrote, “those implementing or calling for bans don’t acknowledge a key ethical value — the right to have a genetically related child.” Rich men throughout history have too often fancied themselves as having a right to a genetically related child and rationalized the abuses that such a right would entail. Because of this fancied “right,” for millennia, rich men have sought to control women’s bodies for their own reproductive purposes.
Surrogacy contracts are their latest attempt. Having a child requires access to a female body for gestation. If there is a right to have a genetically related child, there is a right to impregnate a female’s body and control that person’s body during gestation to optimize the likelihood of a live birth. That males do not have a right to impregnate or control the bodies of females is fundamental to feminism. There is no right to a child, in part because no one is owed access to the female body.
In addition to no right to a child, there is also no right to buy body parts or processes from any human being. When a society allows people or companies to risk other people’s health and buy body parts (e.g., kidneys) or bodily processes (e.g., pregnancy), even from willing sellers, the result is exploitation. (This can be seen from comparing the United States’ unpaid blood supply and paid plasma supply.) In a society that cares about human rights, the human body’s parts and processes are not for sale.
— Amy Simpson
The story
“I’m a doctor, and I believe in medical miracles,” by Marc Siegel
The response
I’m also a doctor who believes in miracles. The “millimeters from death” stories highlighted by the author? No person, physician or not, would argue those are miracles. The problem is that we fail to appreciate the everyday medical miracles: insulin for diabetes, antibiotics for pneumonia, CT scans and clot-busting drugs for strokes. Those of us who’ve grown up prescribing or using these treatments don’t know the time before them, when life — and doctors’ offerings — were severely limited by their lack. A person able to walk their child down the aisle or to simply walk out of the hospital because of these treatments — these too are miracles we should pause to celebrate and appreciate.
That’s not to say we’ve figured it all out. Medical treatment still falls woefully short in places. Take Parkinson’s, my area of expertise, for example. The disease upends lives. There is no cure. There is no way to slow progression. Yet there is much we can do to help our patients live well: lifestyle tools like exercise and nutrition, technological solutions that improve the day-to-day, and a growing number of medications that ease symptoms.
Spirituality, though — another key in supporting our patients — remains on the outskirts of holistic, whole-person care. That’s not just religion, which is, of course, important to many. Religion is a set of beliefs or teachings specific to a God or god(s) that a person may or may not ascribe to. Whereas religious affiliation is decreasing, spirituality is growing. Most Americans describe themselves as spiritual, with about a quarter saying they are spiritual but not religious. Spirituality means different things to different people: It could be believing in a soul, connecting to something bigger than oneself, or searching for and finding meaning and purpose in life. Spirituality can be practiced in many ways — spending time in nature, meditating, creating art, or following a faith tradition. It’s something all of us — physician or patient, religious or atheist, ill or healthy — experience in one way or another.
Not bringing spirituality into medical care, or limiting it to only religion, risks not seeing the full person beyond the disease, not supporting every patient as well as we can, not easing suffering as well as we can — it even risks turning to palliative care or hospice too late.
— Rachel Dolhun, M.D., Michael J. Fox Foundation for Parkinson’s Research
The story
“Doctors need to ask patients about chatbots,” by Saneha Borisuth and Nina Vasan
The response
In their recent opinion piece, Nina Vasan and Saneha Borisuth asked doctors of all specialties to screen patients for mental health issues regarding their patients’ use of chatbots. Primary care providers are all too familiar with such requests. The plea is always the same: “As a primary care physician you are uniquely situated to screen for XYZ, and doing so will take only a minute or two of your time.”
Here is an incomplete list of nonmedical screening topics suggested by various organizations over the years: domestic violence, human trafficking, child abuse, elder abuse, gambling addiction, internet addiction, housing instability, food insecurity, financial distress, religious/spiritual distress, social isolation, caregiver burden, immigration status, discrimination, bullying, work-related stress, marital discord, legal issues, mood disorders, and transportation issues.
What the authors of the article appear unaware of is that virtually every patient these days in primary care starts their visit with forms asking about depression, anxiety, and social determinants of health. Medicare patients during their annual wellness visit have eight more pages of screening questions to answer, and even more if we are to discuss advanced directives. This is all in addition to screening for actual medical conditions like diabetes, hypertension and various cancers, and before there is time to address known medical issues like heart failure, diabetes, and chronic kidney disease. All to be done in 20 minutes or less, and assuming they have no additional concerns they’d like to address.
The authors are from Silicon Valley, where the motto is: “Move fast and break things.” The unspoken assumption is that while billions flow into the coffers of AI developers, the repair bills are left to the individuals. Indeed, the authors of this article suggest that it is up to us to identify and repair the mental health problems Silicon Valley executives have unleashed via their AI chatbots. Would it not make more sense to not break things, rather than repair the damage later? The irony in this situation is unmistakable. I ask the authors this little favor: As a Silicon Valley executive psychiatrist, you are in a unique position to screen for and identify chatbot creators that damage mental health. It will take only a minute or two of your time.
— Paul Delaney, Wake Forest University School of Medicine
