STAT is now publishing a selection of letters to the editor received in response to First Opinion essays to encourage robust and honest debate about difficult issues. Submit your letter to the editor here or find the submission form at the end of the first opinion essay.
“Dentistry is in crisis.But it’s also an opportunitywritten by Steve Pollock
It’s time to put the mouth back into the body. Two events occurred in 1973 that highlighted his problem and solution. First Secretariat won the Triple Crown, the Nobel Prize of horse racing. It is achieved by very few people. It consists of three races: the Kentucky Derby, the Preakness, and the Belmont Stakes. After winning his first two races, Secretariat became lethargic and poorly trained, reducing his daily hay intake from 23 bales to a few bales. Something was wrong. A veterinarian was called to examine him. Believe it or not, when he looked inside his mouth, he found a very soft swelling in the horse’s jaw, an abscessed tooth. He manually drained her, gave her antibiotics, and Secretariat won the Belmont by 31 lengths.
In the same year, ongoing issues reared their ugly heads. I was a medical student doing an advanced rotation at Harvard University Hospital in Cambridge. I was asked to examine a woman who was in a coma with a high fever and stiff shoulders. Her doctors were concerned about meningitis, but they couldn’t find a cause. I returned to medical school as part of a new dual degree program for Harvard School of Dentistry graduates in oral and maxillofacial surgery that began in 1971. A spontaneous examination of the mouth revealed an infected upper left molar. Although the patient continued to make a slow recovery, this was one of the first high-profile medical malpractice cases in the state.
Due to a shortage of primary care physicians, a veterinarian solution is needed. It could be dual-degree education and training for leadership, changing state medical practices, or passing the Dental Therapist Act, which allows doctors other than dentists to treat more patients.
— Bruce Donoff
“Philips CPAP nightmare reveals flaws in medical device regulationby Kushal T. Kadakia, Joseph S. Ross, Vinay K. Rati
As seen here and in many other recent high-profile cases, the 510(k) system has inherent flaws. In the EU, under the Medical Devices Regulation, the post-market surveillance system has been significantly strengthened with new post-market clinical follow-up requirements, which may have been adopted, although it is not certain. Perhaps it is time for some harmonization across the Atlantic beyond the regulatory requirements of the proposed quality management systems?
— Eamon Doherty, Levity
“Why I left the editorial board of the prestigious scientific journal NeuroImage — and why I helped start something newwritten by Shera Keilholz
I am deeply moved by the actions of this editorial board. A potential solution is for scientific and medical institutions to come together and offer a new set of journals to replace for-profit corporate journals rather than showcase their own research. Subscription fees cover costs and institutions do not have to pay the high fees they currently incur. Putting aside internal competition, achieving this will benefit everyone.
— Mark Coopersmith, Icahn School of Medicine at Mount Sinai
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The fundamental flaw is that authors must pay to be published. It corrupted the entire industry and created a plethora of useless journals. Readers will still have to pay as before, and there will be fewer journals, but there will be multiple positive effects, including more high-quality journals. Author payments have ultimately turned the entire industry into a money-making machine that fundamentally fails to support the science on which researchers’ efforts depend. As with the publishing industry in general, readers have to pay.
— Albert Jedde, University of Copenhagen
“One year later, the U.S. still hasn’t taken advantage of Humira’s low-cost biosimilarby Juliana M. Reed
Juliana Reed is probably right that the U.S. pharmaceutical channel does not have strong enough incentives to realize the full potential savings from biosimilars. However, her use of total price is misleading at best and dishonest at worst.abbvie usa Net Humira’s sales were down 45% year-over-year in the latest quarter (Q4-23). How is that possible if Humira isn’t giving up significant market share? The only reasonable answer is that biosimilars are driving down Humira’s price (due to higher rebates) . There are real problems with lopsided incentives in the U.S. drug channel, but pointing to gross prices as a metric is unhelpful.
— craig duration
“Health systems are ignoring the world’s most promising approach to preventing cardiovascular diseaseby Arthur L. Kellerman
Although a new and interesting approach, it still addresses the consequences of high blood pressure rather than its causes. Educating people about the benefits of a more active lifestyle and better nutrition will further help keep blood pressure at a healthier level. People who live in rural areas, have a lifestyle with more physical activity, and eat no (or less) junk food live longer and healthier lives. There is enough research on this. The larger the city, the more unhealthy the lifestyle and diet, and the higher the prevalence of cardiovascular disease. We need to make our cities easier to walk and cycle to work.
—Ronald Rodriguez
