What readers have to say about long Covid, FDA and diversity, and more

First Opinion is STAT’s platform for interesting, illuminating, and maybe even 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.

“Long Covid feels like a gun to my head,” by Rachel Hall-Clifford

As someone living with chronic illness, I just want to a) applaud the author and everyone else out there who continues surviving and fighting for answers about long Covid and other post-viral syndromes and b) want to provide a bit of a public service announcement:

It’s well known amongst the community of people living with postural orthostatic tachycardia syndrome (POTS) at this juncture that long Covid is largely a trauma/virus induced dysfunction of the autonomic nervous system (aka dysautonomia), specifically POTS. Many of us have lived with the symptoms of “long Covid” long before there was Covid. Folks genetically predisposed to autoimmunity and other precursors to POTS were extremely likely triggered by the coronavirus. It pains me that this is still not common knowledge for sufferers. Please seek out help from a POTS specialist and continue digging into your underlying condition, when you have the energy, so that you can eventually regain a fuller life. It’s not easy and takes a tremendous amount of time and will. But it will be worth it. Be as well as possible!

— Sandra Ivanov

“FDA: Don’t rush publishing your diversity guidance plan. Take your time and do it right,” by Tamei Elliott and Maria Vassileva

“Equity” in clinical trial participation doesn’t mean that trials “look like America,” but rather that they “look like the therapeutic population.” But it’s got to be more than just about clinical trial participants. What’s equally important is that we must also expand diversity in clinical trial designers, recruiters, principal investigators, FDA review teams, and advisory committee members — and not just patient representatives. This isn’t the end, it is only the beginning, and the goal mustn’t be diversity for diversity’s sake, but to facilitate better trials leading to better data, better agency reviews, better and more precise labeling, resulting in and better patient options and outcomes.

— Peter Pitts, Center for Medicine in the Public Interest

“AI and rural health care: A paradigm shift in America’s heartland,” by Bill Gassen

I found some of AI’s potential cures misleading. While the article states AI does not save clinician time reducing cognitive burden, the burden of responding to patients is not lifted by text prompts. And those fully transcribed clinical encounters have to be fully reviewed. Without knowing the why of higher rates of later-stage cancers, risk calculators and reminders may not deliver on their supposed promise. Much of what AI promises is to repair the unintended consequences of the last great idea, electronic health records.

Can AI make inroads into the disparities of care for our rural citizens? Perhaps. But this, like many other articles, is more about vested interests looking at the newest shiny object that promises to “move fast, break things, and apologize later.”

— Charles Dinerstein, American Council on Science and Health