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
“Doing more cancer screening won’t reduce Black-white health disparities,” by Adewole Adamson, Vishal Patel, and H. Gilbert Welch
the response
The op-ed unfairly and dangerously diminishes the value of cancer screening in reducing health disparities. As the writers acknowledge, numerous, complex factors contribute to poorer outcomes for Black patients than for white patients. Long-standing problems — like structural racism, poverty, lack of health insurance, and reduced care access — lead to poorer health and outcomes. Medtech innovators have forcefully advocated for Medicare, and other, policies to facilitate patient access to technologies, both established and emerging — including cancer screening — and are developing devices that are faster, more accurate, and more accessible than before. Cervical cancer screening kits for home use are in development. AI-enabled medtech devices are achieving more accurate diagnoses and helping clinicians find appropriate care pathways.
These devices have tremendous potential to reduce the number of tests needed for accurate diagnoses and to direct patients to the best care. Early detection can directly impact patient outcomes, treatment options, and financial burden. A patient whose cancer is detected early may have a better prognosis and may require less aggressive and/or less lengthy care. Longer care can be especially financially debilitating for under-resourced patients. Equal or higher rates of screening for Black patients relative to white patients is a positive development. It reflects years of dedicated advocacy toward getting patients what they need.
Of course, the work is far from over. For example, women with dense breast tissue need screening beyond mammograms, and access to supplemental screening is inadequate. Addressing health disparities in cancer diagnoses and care requires a comprehensive approach, and screening plays a vital role.
So rather than cast screening as the enemy, we should promote it alongside the necessary steps preceding and following it. Maybe screening gets an under-resourced patient in the door. If there’s a cancer diagnosis, the next step should be ensuring access to appropriate treatment, not devaluing the screening that led to the diagnosis.
The authors would have patients question the value of screening. Will that accomplish better health? Instead of dismissing cancer screening, which has been shown to work, those with a voice in health care debates should continue promoting equal access to all the resources that improve patient health.
— DeChane Dorsey and Deidre Washington, AdvaMed
the story
“Why you may not need a checkup every year,” by Daniel Morgan
the response
Dr. Morgan describes a health care philosophy embraced by many physicians. We are cogs in a medicoeconomic system that pays no heed to the interests of the patient. The chaos is united in only one central concept: financial gain. Any practicing physician must acknowledge this reality. Dr. Morgan gives more voice to those in the profession who have grown weary of the inherent conflicts of trying to practice good medicine, while at the same time being inundated with perverse incentives which feeds the bottom line.
— Walter Bortz
the story
“To stop mpox from becoming the next pandemic, we must address global vaccine inequities,” by Wilfredo R. Matias
the response
“Have we learned nothing from Covid-19?” That’s the right question, but Dr. Matias reaches the wrong conclusion. The real lesson is not to rely on the World Health Organization to look after the needs of developing nations. In the case of mpox, there isn’t a vaccine shortage. Both Bavarian Nordic (the manufacturer of the adult vaccine) and KM Biologics (manufacturer of the mpox vaccine for children) are ready and willing to ship their products to nations such as the Congo. What’s standing in their way is the unwillingness of the WHO to “precertify” that these products are safe and effective. Now the WHO says countries can begin to negotiate pricing before their process is complete. The WHO is in over its head. It is neither staffed nor financially resourced to undertake a thorough review of vaccine data — unlike either the European Medicines Agency or the Food and Drug Administration.
The WHO should step aside and let the expert judgment of gold standard global regulators expedite delivery to the Congo and other nations in Africa and elsewhere. Vaccine “prequalification” is a joke — a dangerous one — and a lesson we should have learned from the WHO’s debacle during the Covid-19 pandemic.
— Peter Pitts, Center for Medicine in the Public Interest
the story
“Health care price regulation is undemocratic,” by Ge Bai
the response
A for-profit health care system is immoral and amoral. It matters not that price regulation is undemocratic, it’s just necessary.
— Bruce Saunders
the response
In general I agree with this opinion. However, in order to have competition, the consumer/prospective consumer needs to have adequate understandable information regarding the likely cost between providers, and there needs to be a bare minimum of providers competing with each other. In many nonurban areas, there is no real competition due to a shortage of providers for many services — and for some specialties there is no real competition even in major metros. These situations exist with or without any price regulation or incentives. And in order to have real competition, providers must be more transparent than they are — for most services there is little true transparency even after the recent transparency requirements were imposed. So if we are going to back off of pricing regulations, we will need a corresponding improvement in true transparency for competition to become a reality.
— Patrick Pine, Robert F. Kennedy Farmworkers Medical Plan
the story
“A harm-reduction approach to eating out,” by Sophia Hua
the response
Portion control is a key factor in achieving and maintaining a healthy weight, so the author’s exhortation to restaurants to offer two size options is sound. For those with just a bit of willpower, however, there’s another alternative: the doggie bag. When the plate of food arrives, just divide it all in half and take home the leftovers for tomorrow’s dinner. This limits calorie intake and proves a better bargain when the check arrives.
— Alison Sneider
