STAT readers weigh in on gun silencers and ENT surgeons
First Opinion is STAT’s platform for fascinating, illuminating, and provocative articles in regards to the life sciences writ massive, written by biotech insiders, well being care staff, researchers, and others.
To encourage sturdy, good-faith dialogue about points raised in First Opinion essays, STAT publishes chosen Letters to the Editor obtained in response to them. You possibly can submit a Letter to the Editor right here, or discover the submission type on the finish of any First Opinion essay.
The story
“I’m a surgeon. My society waded into gun regulation — and selected politics over science,” by Aru Panwar
The response
We learn with puzzlement Aru Panwar’s First Opinion alleging political shenanigans on the American Academy of Otolaryngology-Head and Neck Surgical procedure and abandonment of its scientific ideas. As two of the seven co-authors of the academy’s place assertion endorsing firearm suppressors, we want to set the file straight. Fortunately, neither of those dire judgments is the case. Firearm suppressors are the very definition of a profitable public well being intervention. They’re a confirmed methodology for major prevention of an irreversible incapacity: noise-induced listening to loss. Their use by hunters and sport shooters in Europe is broadly accepted and uncontroversial, and that’s more and more the case in america.
We’re each life fellows of the Academy, and Cueva is a previous president of the American Otological Society, the premier educational society of ear and cranium base surgeons. 4 of us seven board-certified ENT surgeons are additionally fellowship-trained neurotologists — subspecialists in ear and cranium base surgical procedure. We converse as properly for our different co-authors, one in every of whom (Matthew Department, M.D.) authored a peer-reviewed academy journal report of unique acoustic analysis on suppressors — one in every of a number of citations that Panwar nebulously dismisses as “extremely problematic.” The academy’s listening to committee and its Board of Administrators reviewed Department’s work and our different scientific references and didn’t share Panwar’s evaluation.
We had been additional bowled over by Panwar’s insinuations that we’re motivated by politics. Sure, suppressors have been unfairly demonized as instruments of the prison underworld, and a part of our public well being initiative is to dispel the Hollywood myths about them.
However all seven of us have seen innumerable sufferers with everlasting, mainly untreatable sensorineural listening to loss from firearm noise. All of us share the identical frustration in our incapacity to assist them, and worse, within the information that their listening to loss was fully preventable with the assistance of suppressors. We discover it disheartening and downright merciless that some policymakers, and sadly a few of our fellow physicians, consider anybody who places a muffler on her firearm ought to be prosecuted, see her life ruined, and be thrown in jail. However extremely, that’s the regulation in eight states and the District of Columbia.
The essential analysis on noise-induced listening to loss is a long time outdated and universally accepted in our specialty. The efficacy of suppressors in decreasing muzzle blast impulse noise has been totally studied and documented. We stand behind the scientific references we submitted for evaluation to the academy in assist of our place assertion. And if, as Panwar accuses, we’re responsible of some political motivation, it’s our agency perception that defending your listening to shouldn’t be against the law.
—Roberto A. Cueva, M.D., and Timothy W. Wheeler, M.D.
The story
“If Kennedy doesn’t resign, physicians ought to take into account happening strike,” by Richard L. Kravitz
The response
Physicians have wanted to take a stand in opposition to the travesties affecting our occupation for years. This example, the place 1000’s of lives are at stake, warrants the drastic measure Kravitz advocates. For years I’ve talked about what an moral strike would appear like. In my discipline, pediatrics, it’s actually fairly simple. One continues to offer care as earlier than — sick care, follow-ups, physicals, and (if there are any left) immunizations. The strike half comes when individuals ask for this or that type to absolve faculties, athletic services, and different entities of all duty for something. Name it a “note-out” or a “form-out,” however the lack of a bureaucratic paper path would flip entire communities the other way up. “Uncle,” within the type of “get RFK out,” would occur shortly. Lives could be saved, and we’d be capable to reestablish our position as a world chief in well being analysis and coverage.
— Stanley Sack, M.D., P.A.
The story
First Opinion publication for Sunday, Sept. 21, by Torie Bosch
The response
The latest First Opinion publication calling for a ban on the phrase “lived expertise” displays a troubling misunderstanding — an imposition and an assault. Linguistic censorship, which restricts how individuals and communities describe themselves, is dangerous, significantly in well being care.
We acknowledge the editor is entitled to her opinion, and language does evolve. However who will get to determine the phrases people select to self-identify, significantly given the well being and social realities of psychological sickness, disabilities, homelessness, or different circumstances? As advocates for psychological well being care, remedy, and providers, our perception and understanding is serving as a champion for these with “lived expertise” is essentially a well being justice crucial.
Our concern is the hurt imposed on individuals with psychological well being circumstances, irrespective of which phrases are used. Id is solely on the discretion of the person. Thus, omitting “lived expertise” can inadvertently silence illustration and neutralize voices that should be heard beneath the guise of a selected type choice.
The editor’s unilateral critique that the terminology of “lived expertise” is “lifeless” misses the purpose. For a lot of, “lived expertise” carries weight and dignity in settings the place total tales can’t be adequately shared. When a person states, “I’ve lived expertise with melancholy,” “lived expertise with dependancy,” or “lived expertise of being unhoused,” it’s clarifying and empowering. Psychological Well being America is obvious that using language is crucial to making sure a recovery-oriented and person-centered strategy, and that persons are seen first as individuals and never seen as their psychological well being situation.
Thus, banning phrases corresponding to “lived expertise” not solely compromises self-identity but additionally serves as a car to “chill speech,” finally harming the flexibility for people to reclaim their identification and position in their very own therapeutic course of.
Using “lived” or “dwelling” expertise is interchangeable as a result of each honor the reality for advocates, friends, and caregivers, who acknowledge that the journey for remedy and care is significant, seen, and heard.
Whereas one might dislike the phrase “lived expertise,” when a journalist declares a group’s self-chosen language “banned,” it crosses from choice into energy. Phrases like “ban” should not impartial and problem our sensibilities round freedom of speech. As Jimmy Kimmel returned to air on ABC, the visibility of this reality is much more prevalent. Phrases carry the burden of authority. Our collective duty is to not determine “who” will get to be seen, heard, or recognized.
Communities are always renegotiating language that finest captures their realities. If the phrase “lived expertise” upsets the ears of privilege, so be it. Lived expertise was by no means meant to consolation, however as a substitute to assist the self-identity of those that have been lengthy ignored, forgotten, dismissed, and marginalized.
— Courtney Lang, J.D., board director of Psychological Well being America and founding father of Langco + Companions, and Annelle Primm, M.D., M.P.H., former deputy medical director for the American Psychiatric Affiliation
The story
“Make statins accessible with out a prescription,” by Vishal Khetpal
The response
Narcan went over-the-counter. Everybody rejoiced that entry had elevated. What occurred? The worth skyrocketed to $40+ a pop. Insurances not cowl it as a result of it’s OTC. So you’re basically suggesting we kill entry to statins by permitting insurance coverage corporations to get round masking it and permit producers to extend pricing. I do know you’ve got the perfect of intentions, however that’s the truth of our Nice American Healthcare System. The MOMENT one thing goes OTC, cost peaces out.
— Bernadette Goncharova
The story
“Trump’s well being and the medicalization of American politics,” by Eric Reinhart
The response
As a doctor with expertise bridging medical drugs and coverage work at each nationwide and worldwide ranges, I learn Eric Reinhart’s latest opinion piece with nice curiosity and located his evaluation significantly insightful and well-reasoned.
I want to add one necessary consideration to the dialogue. Whereas I agree with the core ideas Reinhart outlines, I consider there may be room for nuanced examination relating to non-physician public figures who routinely supply medical opinions and interact in intensive public discourse. Such people, by means of their very own option to enter the medical commentary area and their sustained public presence, might exhibit behavioral patterns that warrant accountable skilled statement and dialogue.
This angle finds assist in latest clarifications from Allen Dyer, a psychiatrist who was instrumental in creating the Goldwater Rule. In October 2024, Dyer emphasised that the rule’s unique intention was by no means to function an absolute prohibition on all skilled commentary. Relatively, he famous, it mustn’t preclude considerate, accountable dialogue of observable public behaviors when carried out inside applicable skilled and moral boundaries. I consider this distinction — between distant analysis and accountable behavioral statement — represents an necessary evolution in how we strategy the intersection of psychological well being experience and public discourse.
— Robert C.J. Krasner
The story
“A $100,000 charge for H-1B visas will devastate U.S. well being care,” by Geeta Minocha
The response
The plan I’ve managed for 15 years serves 1000’s, many dwelling in rural and medium or small cities in California, Oregon, Washington, Arizona, Texas, New Mexico, and Nevada, with smaller numbers in large cities. In lots of hospitals and clinics in cities like Bakersfield, Calif., a really important share of the medical doctors and different medical professionals have come right here from India in addition to different international locations. When my spouse had severe coronary heart points a number of years in the past, the vast majority of the cardiologists that handled her — even at world well-known hospitals like Cedars Sinai in Los Angeles — had been of Indian origin. The identical is true in locations like Fresno and Stockton, Calif., or Portland or Spokane or Las Vegas. Most of the hospitals in these areas depend on overseas medical employees, and this new coverage will hamper them considerably. This is only one extra instance the place the present administration is severely undermining well being care on this nation.
— Patrick Pine, Robert F. Kennedy Farmworkers Medical Plan
the response
After working 30-plus years in each crucial and emergency departments, I can guarantee you the individuals engaged on H-1B visas and giving well being care to our plenty can by no means be matched by anybody else. They’re essentially the most educated and proficient minds we might ever get pleasure from. Why would you wish to cease this a lot wanted expertise from us? These medical individuals fill a a lot wanted void in our system in analysis, training, care, and extra.
— Catherine Hamilton
