Readers respond to essays on hospital taxes, ADHD in girls and women, and more

STAT 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.

“Hospitals that make profits should pay taxes,” by Marty Makary

Why didn’t Dr. Makary’s article cover educational institutions, which do not provide free services to whoever shows up in one of their departments. Like getting a medical appointment, try registering for class at a “not-for-profit” school without paying tuition. Universities also hide their profit centers (see Athletics) with accounting maneuvers.

— Joel Simon

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Don’t look now but we are Medicare for All. Taxpayers are footing the bill for the entire medical industrial complex. The only problem is we didn’t vote to spend our health tax dollars on middlemen. It’s time for a refund or free care.

— Paula Muto

“I saw the promise of diversity efforts in health care. A moment later I saw its critical gaps,” by David Velasquez

Congratulations to Dr. Velasquez. I know some young Black/Hispanic doctors who have paved the way for you. I am sure they have stories similar to yours. Welcome to the world of health care and medicine in the USA. Do not be disheartened and know that you will definitely make a difference in every single life that you touch. I am a retired nurse from NYC. I did bedside nursing for 41 years. I am happy to say that I witnessed the change in the racial landscape as I saw more and more of “my people” joining the profession and rising in the ranks while never losing their identity and making a difference. In addition, more non-Hispanic doctors spoke fluent Spanish. They knew that working in an urban setting, command of Spanish would be necessary. I say God bless you and forge on. Be great. Do great things. Save lives. All the while let them see you in all your black, beautiful, Hispanic glory!!!

— Ana Amaro

“ADHD is often overlooked in girls and women. They need help, too,” by Michael Morse and Kathleen Nadeau

Excellent First Opinion piece by Michael Morse and Kathleen Nadeau. I was pleased to hear voices from the mental health research and treatment community speaking common sense about expanding treatment for women with ADHD, a condition that is highly treatable with safe and effective medications.

I commend the authors for this gloves-off criticism of the FDA/DEA: “To be sure, misuse of stimulants is a serious problem in certain populations. But so is undertreatment of ADHD. Tight production quotas produce predictable medication access issues that are disproportionately discriminating against disadvantaged people. We call on the DEA and FDA to directly and forcefully address the inequitable negative consequences of these regulations.”

I would like to add that these agencies are not in any way acting in opposition to a longstanding and highly coordinated federal/state public health policy consensus dedicated to obstructing access to stimulant medication across the board and purposefully stigmatizing people with ADHD/ASD.

And the CDC is by no stretch of the imagination less guilty of overestimating the harms of prescription stimulants.

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Alongside NIDA, the CDC has worked diligently to reinforce the DEA’s opioids/stimulants false equivalency narrative, and in partnership with the DOJ, it continues to promote misuse of the interconnected 50 state prescription drug monitoring program to stigmatize ADHD treatment, red-flag patients getting stimulants, and obstruct access to safe medications under the guise of “SUD detection” and “diversion” control.

— Michael Doran

“To rebuild trust in public health: Better communication, fewer mandates, and small wins,” By Tom Frieden

Tom Frieden’s article underscores the importance of rebuilding trust in public health, but overlooks the critical role of mandates. Public health mandates save lives. If federal agencies and public health authorities did not establish quarantine or mask mandates during the Covid-19 pandemic, negative health outcomes experienced in the United States could have been exponentially worse.

It is important to note that mandates are rarely a first-line approach to public health emergencies. Nancy Kass, a professor in health policy and management at Johns Hopkins, notes that while mandates are not the first choice, they become necessary when initial strategies fail. With Covid-19 vaccines, initial efforts focused on educating the public about safety and effectiveness, and ensuring the vaccine was readily available without a high cost. Only when these measures proved insufficient to reducing Covid-19 rates and hospitalizations, did mandates become a consideration.

While local leadership should be empowered to make decisions on behalf of their communities, large-scale public health mandates can be essential in emergencies. Balancing mandates with individual freedoms is challenging but crucial for effective public health policy. Building trust in authorities is also vital for the acceptance of mandates, focusing on transparency in decision-making.

— Sheena Sharifi