What STAT readers think about JPM’s locked lactation room, covering weight loss drugs, and more

STAT now publishes selected Letters to the Editor received in response to First Opinion essays to encourage robust, good-faith discussion about difficult issues. Submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.

“Pumping milk at JPM was a nightmare. It’s part of a bigger problem in the industry,” by Tara Bannow

As always, Ms Bannow nails it. As a male physician, I was completely oblivious to the difficulties inherent in our society for breastfeeding mothers, despite my advocacy for this practice among my patients for decades. It was only when I observed reality through my wife’s and daughters’ experiences that it really dawned on me how profoundly simple the solutions to this problem can be. It requires a modicum of consideration and common sense. The article explains succinctly what women endure all too frequently, still, in our supposedly enlightened nation.
— Robert Kline, ABCCM Medical Clinic

***

Thanks for writing this piece and bringing attention to a real equity issue for lactating people. I have written previously about access to lactation spaces in endurance sports for Women’s Running and Trailrunner magazines. While not the same as the workplace, not having space for lactating people in sports is also an equity issue. I just wanted to mention &mother, an organization seeking to change the norms in sport around lactation spaces and parenting, and also Mamava, a company that sets up lactation pods so people have a private space to breastfeed or pump. Maybe JPM can look into that next year instead of relying on the hotel room with limited access.
— Chrissy Horan

“I went on a mind-boggling journey to get my son’s ADHD medication covered by insurance — twice,” by Craig Idlebrook

As a physician I was always dumbfounded by the ridiculous denials of care my patients would receive. The ProPublica article on the Cigna system of mass denials in 1.2 seconds without review of the record was eye-opening for me. I have no idea how a physician could deny care for 60,000 patients and not review a single medical record. Thank you for sharing your story and best to you and your son.
— James O’Leary

“Cost isn’t the only reason Medicare doesn’t cover Wegovy,” by Daniel Weiner

This is an excellent article. Change in insurance practices with respect to obesity drugs is long overdue, whether in the public (Medicare and Medicaid) or commercial sectors. While blanket coverage of the new wave of obesity treatments is unlikely, select patient subgroups who fit the profile of clinical trial participants in, say, the SELECT study, should be able to access these products. Nevertheless, many privately insured people cannot, and such products are off-limits to all Medicare beneficiaries. As someone who’s evaluated Medicare’s prohibition on obesity medications as well as other (what used to be considered) “lifestyle” medicines, I believe the author’s point is well taken. Severe restrictions on coverage reflected cultural attitudes at the time. These perspectives have changed.

The oft-reintroduced Treat and Reduce Obesity Act currently has more momentum than it did when it was first proposed 10 years ago. And this is precisely for the reasons laid out in Weiner’s article. Views on obesity have evolved from it strictly being a lifestyle issue to a disease for many. However, now the problem is budgetary. And it’s not just the CBO report, which the author cites. Other recent studies have demonstrated that covering obesity drugs poses substantial budget challenges to payers, particularly in the short term. And because of the high degree of churn or enrollee turnover, U.S. payers tend not to consider longer-term clinical- and cost-effectiveness. This myopia applies to insurers in the public and private sectors. I’ve researched and written about these issues for more than 20 years, including this piece on the uphill struggle facing the Treat and Reduce Obesity Act.
— Joshua P. Cohen, Ph.D., independent health care analyst

***

This is a wonderful, illuminating article explaining the political history leading to unreasonable restrictions on medications with cardiovascular and psychological benefits. They just may increase the quality of one’s life and just might enhance longevity.
— Arthur Papas, Massachusetts General Hospital

“What Congress must do next to fight the opioid crisis,” by Sen. Maggie Hassan

I wish I could endorse the SUPPORT Act, because 90% of its common-sense regulations and requirements seem to be worth renewing. But I will have to urge my representatives not to renew it because it contains provisions for expanding prescription drug monitoring programs (PDMP) data sharing beyond regional state borders and calls on the CDC to fund “enhancements” to PDMP systems. That latter means continuing funding for “Narxcare” and other fraudulent “substance use disorder detection” algorithms. These algorithms are designed specifically to stigmatize people like me who need medication for ADHD. And that they certainly do effectively. The other thing that they have done effectively is make the epidemic of opioid addiction and overdose worse every year since states have been coerced into adding them to PDMPs by the Justice Department and since the CDC issued ham-fisted prescribing guidelines.
— Michael Doran

“Addressing the Black youth suicide crisis requires a new approach to licensing clinical social workers,” by Janelle Goodwill

This article is on point. This needs to happen in New Jersey. The board and legislators need to develop an alternative plan for [master of social work] social workers. I graduated with a masters of social work in 2012 and still am not a licensed social worker. There are hundreds in my same situation.
— Rodney Herring