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
“Former surgeon general: Vaccine-preventable diseases are still a major threat,” by Jerome Adams
The response
Adams’ op-ed discussing concerns over reemerging diseases in the era of rising vaccine hesitancy are correct. But with the pending confirmation of RFK Jr. to lead HHS, I also felt that perspectives of a rural public health officer were needed for a robust debate to understand the “why.”
My patients have shared with me a newfound mistrust over the safety of all vaccines since the Covid vaccine mandates were forced upon them. Many patients/parents are becoming “partial-/un-vaxxers” rather than rolling up their sleeve. Like it or not, Kennedy is a spokesman who addresses their concerns, and frankly might be the only nominee many in America would trust to restore confidence in pharmaceuticals, food, or environmental issues since he has a history of crusading on each of these. Outside the ivory towers of academic centers, many people view Kennedy as an honest broker who will be able to look behind the curtain on many issues, including vaccine safety. To fail to engage him would be detrimental to public health efforts.
Good physician-scientists should boldly and continually re-examine dogma. Rigorous, but respectful, debate is healthy for our process. Rather than marginalize MAHA proponents, let’s hear their concerns and engage them. There is surely much common ground: Who doesn’t want a safer version of a medication, or cleaner food and environment?
We need to admit an uncomfortable truth: Covid vaccine mandates just unwound a century’s good work of public health and communicable disease prevention. Without those mandates, Kennedy would not have the platform he will presumably hold at HHS. Adams correctly worries about the future effects of a growing hesitancy toward vaccines, but I would propose his word choice of “deeply misguided” and “misinformation” fail to attribute the correct root cause of this skepticism that is becoming mainstream. Much work and newfound humility is needed to restore the confidence our patients used to have in us.
Now is the time for medical professionals to acknowledge the reasons for MAHA, and to meet our patients where they are. If RFK Jr. is confirmed, we need to work with him to truly make vaccines safer, and worthy of the public trust once again.
Views expressed are my own, and not necessarily those of any institution I am affiliated with.
— Daniel M. Hesler, M.D., health officer, Fountain County (Indiana) Health Department; adjunct clinical professor of anesthesia, Indiana University School of Medicine
The story
“The infamous ‘Cutter vaccine’ changed my family forever — but we still support vaccination,” by Laurie Maffly-Kipp
The response
I also caught polio from my 2-year-old daughter who had been vaccinated with the Cutter vaccine. I was left with a paralyzed right arm, a weakened left leg, and damaged lungs. I fortunately have made it into my 90s with not much damage other than difficulty breathing. This article absolutely reflects my thinking, which is why I’m writing you to commend the author.
— Sally Hanes
The story
“Will PBM reform save pharmacies from closing?” by T. Joseph Mattingly II and Kelly E. Anderson
The response
Will fixing reimbursement keep community pharmacies from closing? No one can say for sure. What we can say with confidence is the negative impact on patients if local community pharmacies continue to close, and the critical need for regulatory changes that can help keep these accessible health care hubs open.
In many cases, pharmacists serve as the first point of contact for patients entering the health care system. They provide essential services like medication management, vaccinations and health screenings, and play a crucial role in managing chronic conditions like diabetes and hypertension. Beyond clinical services, pharmacists offer a compassionate ear and trusted advice, often forming deep bonds with our patients. In Gallup’s recently released annual report on America’s most trusted professions, pharmacists ranked higher than medical doctors for the first time in 10 years.
And yet, pharmacists are the only health care providers that are not reimbursed for all of their clinical services beyond dispensing a drug. Let me be clear, pharmacists are not merchants. As a third-generation community pharmacist, this is personal for me. Pharmacies are closing at an alarming rate — most of them, including Walgreens, independent from PBMs — due to unfair reimbursement practices by a few large, vertically integrated conglomerates. As pharmacies close, pharmacists and pharmacy technicians are also becoming increasingly harder to find as pharmacy schools have seen decreasing enrollment. The writing is on the wall, and patients will need to look elsewhere for health care services if the industry doesn’t take a close look at making meaningful changes to pharmacy reimbursement. This includes health plans and employers pushing for reform and alternative partnerships in order to protect access for the people they represent.
I believe patients should have the freedom to choose the pharmacy and pharmacist that best meets their needs — available nearby within their community — not one that aligns with a PBM’s financial interests. If fair compensation is not achieved, then yes: Pharmacies will continue to close, and surrounding communities will lose access to vital services. Together, we as an industry need to acknowledge our current flaws and work together with the new administration, Congress and state leaders to pursue meaningful reforms that create a more effective and integrated health care system that ultimately benefits the patients and communities we’re meant to serve.
— John Colaizzi, Walgreens
The response
After reading this article, it is clear both authors have been in academia for far too long and have lost touch with what is currently happening to the pharmacy profession. I implore both of you to take a field trip to local pharmacies and speak to the pharmacists who work there. Sit for one day and look at the current reimbursements offered for medications and services provided on each prescription. Look at the contracts offered to local and chain pharmacies by the major PBMs and ask yourself how much longer pharmacies can keep their doors open. You mention retail revenue streams. When selling products that can compete with prices from Walmart or other large retailers, the margin of profit is extremely small and not enough to sustain the losses on dispensing prescriptions. Many of the points mentioned make sense, but a lot of your article suggests you have lost connection with what has been happening to the profession.
— David Valentine
The story
“Allowing ICE in hospitals is a public health catastrophe in the making,” by Eric Reinhart
The response
As a family physician caring for Cleveland residents, I share Eric Reinhart’s fears of how the Trump administration’s actions will gravely threaten the health of my community and my patients. ICE raids on health care facilities, and the terror such raids will generate among those seeking care, is only part of the damage this administration will cause. The impending imposition of burdensome work requirements on some Medicaid enrollees has already been shown to cause disenrollment and decreased access to care. Potentially ending the enhanced federal matching dollars for Medicaid expansion, a provision of the Affordable Care Act, will force states to limit enrollment, cut benefits, cut provider reimbursements, or some combination of all three. Letting enhanced ACA premium subsidies expire at the end of this year will cause private marketplace insurance costs to skyrocket. Together, these actions will increase the ranks of the uninsured by tens of millions, which in turn will lead to higher overall health care costs and needless, avoidable suffering and premature death. Like Dr. Reinhart, I believe that we health care providers, and the institutions that employ us, must do all in our power to oppose these threats, and to advocate for the health of our communities and our patients.
— James Misak
The story
“The U.S. should reform the WHO, not leave it,” by Ashish K. Jha
The response
I am writing to respectfully rebut several claims made in your recent editorial about the World Health Organization.
1. The editorial claims the WHO mismanaged the emergence of Covid-19. It is critical to recall that the WHO’s decisions were made in real-time as information about the novel virus was rapidly evolving. By early January 2020, the WHO began collaborating with global experts to assess the emergence of this novel respiratory pathogen. On Jan. 30, 2020, the WHO declared Covid-19 a public health emergency of international concern, weeks before many countries fully grasped the gravity of the situation. During this critical period, the WHO urged member states to prepare for containment by implementing measures such as active surveillance, early case detection, isolation and case management, contact tracing, and prevention of onward spread infection. It also emphasized the importance of full and transparent data sharing from all member states with the WHO. Furthermore, the WHO provided comprehensive guidance on key aspects of the response. Criticism of the organization’s actions must be framed in the context of the immense uncertainty and limited international coordination that characterized the early stages of the pandemic.
2. The assertion that the WHO has refrained from criticizing China while frequently targeting the U.S. is factually incorrect. The WHO has repeatedly called on China to release critical information about the origins of SARS-CoV-2, share data transparently, and provide access to international experts. At the same time, the editorial’s claim that the WHO disproportionately criticizes the U.S. is unfounded. On the contrary, the WHO has worked closely with stakeholders in the United States before, during, and in the aftermath of the Covid-19 public health emergency as well as numerous other outbreaks and health concerns. Criticism of specific actions or policies — from any country — should not be conflated with bias but seen as part of the WHO’s mandate to provide evidence-based guidance to member states.
3. The editorial implies that the WHO operates without accountability. This misrepresents its structure and governance. The WHO is, in fact, held accountable by its 194 member states, which set its agenda and approve its budget through the World Health Assembly. Member states play a central role in evaluating the WHO’s performance, and any perceived missteps are a reflection of collective global governance rather than the organization acting in isolation. Furthermore, reforms to enhance transparency and accountability are actively underway.
It is imperative to evaluate institutions like the WHO with nuance and a recognition of the complex circumstances under which they operate. Criticism can drive improvement, but it must be grounded in fact and context.
— Krutika Kuppalli