Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.
Many readers responded to our data-driven coverage of how ethical and religious directives issued by the U.S. Conference of Catholic Bishops affect care options at Catholic and Catholic-affiliated hospitals in the United States. And we encourage other readers to share their feedback.
A communications specialist in Seattle stated her opinion bluntly in an X post.
— JoAnne Dyer, Seattle
The Right to Separation of Church and Care
At my most recent OB-GYN appointment, I was warned that our biggest hospital, Covenant Medical Center, is affiliated with the Roman Catholic denomination, as is its string of primary care and other clinics, Grace Clinics.
Attempting to regain some sense of control over my body, I decided to create an advance health directive to make clear I do not want to be taken to any medical facility associated with that denomination, to avoid my medical care being curtailed or impacted by ethical and religious directives, known as ERDs, issued by Roman Catholic bishops (“The Powerful Constraints on Medical Care in Catholic Hospitals Across America,” Feb. 17). To do this, I wanted to know which facilities are so affiliated. It is very hard to find that out.
First, I looked at Grace Clinic and Covenant Medical Center websites. No mention of affiliation with the church, or ERDs, or how ERDs limit the types of medical treatments a patient will be offered (or even informed of the existence of).
When I called Grace Clinic, they denied affiliation with the Catholic Church. When I called Covenant Medical Center, they also denied affiliation. They are owned by Providence, which is Roman Catholic, though you have to do a deep dive into the website to figure that out.
Either the employees are lying or are kept in ignorance so the patients will be kept in ignorance. How can a patient determine whether a hospital will deny them care because of religious beliefs, if the organization conceals its affiliation with said beliefs?
These hospitals have the right to believe whatever they want. It appears they currently also have the right to lie to patients about it. How can patients be informed health care consumers if they can’t access the information they need, and are affirmatively given incorrect information from the organizations?
I have contacted Providence through its website asking if it is affiliated with the Roman Catholic Church and, if so, where I can find a list of types of patients that won’t be treated in accordance with American Medical Association standards, as well as which treatments, procedures, and medications will not be provided or provided only on a limited basis because of that affiliation.
I’ve heard nothing.
— Helen Liggett, Lubbock, Texas
An assistant professor at the Cincinnati Children’s Hospital Medical Center also weighed in on X:
— Elizabeth Lanphier, Cincinnati
Life at All Costs Is Costly
One aspect of IVF that’s not being discussed is the discarding of embryos found to have serious medical defects (‘What the Health?’: Alabama Court Rules Embryos Are Children. What Now? Feb. 22). For example, a family may carry a devastating condition and wish to screen potential offspring, or defects may arise spontaneously. The Alabama Supreme Court’s decision suggests that these embryos, too, must be implanted.
The court’s decision also affects babies born with severe defects. How much support must be provided a baby born without parts of the brain and skull (anencephaly), which is not terribly uncommon? Or one born without kidneys? Or one with a most severe form of brittle-bone disease (osteogenesis imperfecta), where every touch can break bones? It sounds as though Alabama law now requires maximum support in every instance — in my opinion, this would be holier-than-thou sadism. How does the court define life? Merely a beating heart? I can’t imagine a nurse or doctor not leaving/quitting when forced to torture these babies. Then there’s the parents’ torment. This is godly?
— Gloria Kohut, Grand Rapids, Michigan
On X, an anesthetist and emergency medicine doctor promoted the “What the Health?” podcast episode that delved into the topic:
— David Moniz, Chilliwack, British Columbia
Distilling Statistics on Women’s Drinking
While the distilled spirits industry is opposed to excessive consumption by any segment of our society, it’s important to note that your recent article on women and alcohol failed to include federal data showing reductions in alcohol abuse among women in the United States (“More Women Are Drinking Themselves Sick. The Biden Administration Is Concerned,” March 28). For example, the most recent National Survey on Drug Use and Health data indicates binge-drinking among women 21 and older declined more than 6% in the past five years (from 2018 to 2022).
Additionally, claims in the article that the covid-19 pandemic “significantly exacerbated binge-drinking” are not supported by multiple federal data sources that indicate that the pandemic did not produce lasting increases in drinking or harmful drinking.
For instance, a 2023 study using federal data showed that, while sales did rise at the very beginning of the pandemic, this did not necessarily translate to increased binge-drinking or overall consumption in the months following. Rather, drinking decreased — both days per month drinking and drinks per day — as did binge-drinking. Moreover, the same federal NSDUH data referenced above indicates nearly 9 out of 10 U.S. adults 21 years and older (89%) say they drink the same amount or less than they did pre-pandemic.
The article also cites an outdated Global Burdens of Disease report published in 2018 to back up claims that “no amount of alcohol is safe” while ignoring the updated GBD report published in 2022. Importantly, this most recent GBD research concluded there are drinking levels “at which the health risk is equivalent to that of a non-drinker” and that “for individuals age 40+, drinking small amounts of alcohol is not harmful to health.”
Reporting on alcohol research provides important information for consumers, so it is imperative that such reporting correctly reflects the latest evidence on alcohol and health. We encourage all adults who choose to drink — women and men — to drink in moderation, to follow the advice of the Dietary Guidelines for Americans, and to talk to their health care providers who can help determine what is best for them based on individual factors and family history.
— Amanda Berger, vice president of science and health, Distilled Spirits Council of the United States, Washington, D.C.
A lawyer who specializes in fighting insurance denials recommended our March “Bill of the Month” feature in an X post:
— Scott Glovsky, Pasadena, California
Working Within a Broken Health Care System
Thanks to Molly Castle Work for the excellent article about the England family’s struggles with our broken health care system (“A Mom’s $97,000 Question: How Was Her Baby’s Air-Ambulance Ride Not Medically Necessary?” March 25). One avenue of resolution that was not noted in your excellent article is the California Department of Managed Health Care. I am a physician, and we had a different, but also very expensive ($90,000), health care bill. It took two years and two appeals to that department, but, ultimately, we were reimbursed by our insurance company. This is a resource that should be more widely known.
— Erica Buhrmann, Berkeley, California
An Unfair Burden on Those Most in Need
It is difficult to understand why those most vulnerable in society, who have difficulty purchasing health insurance, are required to pay more for services with the same doctors and facilities than insurance companies pay. Insurers benefit from “negotiated pricing.” Those with no insurance are required to pay the entire “inflated” bill for medical services. Most times, the difference between the amount a doctor or medical provider bills, compared with the actual payment doctors receive from insurance companies, is approximately 20% of the amount billed.
It is patently unfair to require uninsured patients to pay more than insurance companies pay. Uninsured individuals have an unfair bargaining power, compared with insurance companies. A good example is demonstrated in your article of the woman who received an uncovered emergency medical flight before her death, and her heirs were left with an outrageous bill of $81 (“Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight,” Feb. 27). If her family was told they were responsible for $81,000 for the air ambulance, the transport would not have occurred.
The practice of holding uninsured persons responsible for “entire” medical bills often, in essence, causes someone who does not have coverage — mostly because of affordability — to supplement the revenue of doctors and medical providers by being required to pay the full inflated amount billed for medical services.
Insurance companies defend this practice of “negotiated pricing,” when, in essence, it is used to force those who can least pay to supplement losses suffered by the doctors for discounted payments from insurers.
There needs to be regulation that prohibits medical providers from price-gouging the uninsured, forcing them to supplement doctors’ and providers’ income to make up for underpayments from insurers. Many times, uninsured individuals are already living at or near poverty levels before incurring unexpected medical obligations. Being hit with a surprise bill for an air-ambulance ride costing $81,000 is sufficient to cause the patient to file for bankruptcy. In the U.S., the No. 1 reason people file for bankruptcy protection is because of medical bills.
Our current system of administering health care and payments for such is broken and needs to be fixed. Once this disparate system of payments is rectified, health care should become far more accessible to the general public.
— Ronald B. Kaplan, Holbrook, Massachusetts
On X, a public health scholar shared our article about the side effects of the anti-vaccine movement:
— Jenn Kauffman, Washington, D.C.
Not Vaccinated? Get Schooling Elsewhere
I am a father and a primary care physician. I just read Amy Maxmen’s article “How the Anti-Vaccine Movement Pits Parental Rights Against Public Health” (March 12) and commend her for her balanced and fact-based presentation.
I feel that an important aspect is missing from such articles — that being the rights of the majority of parents who support vaccination to have their children in the safest possible environment in public schools. We know that no vaccine is perfect, and that our children are still at risk for measles, covid, and other diseases, despite taking advantage of the proven benefits of vaccines.
I believe that parents who exercise their rights to not have their children vaccinated should be required to homeschool, or to send their children to private schools having policies with which they agree. I am aware that only a tiny percentage of Americans would agree with me.
— John Cottle, Mendocino, California
Clinical psychologist Carl Hindy seemed inspired by our article on a costly new postpartum depression treatment:
— Carl Hindy, Exeter, New Hampshire
Tending to New Mothers’ Needs
It was heartbreaking to read that private health insurers have effectively delayed the availability of a revolutionary treatment for postpartum depression, a debilitating condition that makes it difficult for new parents to care for their families, work, or even get out of bed (“A New $16,000 Postpartum Depression Drug Is Here. How Will Insurers Handle It?” March 12).
As one of the 1 in 5 new mothers who struggled with this terrible illness when my own son was born, I can only hope zuranolone is made widely available very soon. As an advocate for the rights of pregnant workers, I hope that mental health care providers are aware that there is another new and revolutionary tool that is at their disposal today to support patients struggling with prenatal and postpartum mental health conditions. A new federal law, the Pregnant Workers Fairness Act, gives workers the right to receive changes at work needed for pregnancy-related mental health conditions. The Pregnant Workers Fairness Act, which applies to employers with 15 or more employees, requires they provide reasonable accommodations for pregnancy, childbirth, and related medical conditions, so long as it does not impose an undue hardship. For example, a new mother experiencing a perinatal mental health condition may be eligible to receive a modified schedule, time off to attend mental health appointments, a more private workspace, permission to work from home, or any other “reasonable accommodation” that will address their needs. Mental health care providers should support their patients by discussing their work-related challenges, helping to identify workplace modifications, and writing effective work notes to their patients’ employers.
Health care providers and their patients can access free resources from the University of California Law-San Francisco Center for WorkLife Law on workplace accommodations for perinatal mental health conditions at pregnantatwork.org. Health care providers or employees with questions can contact the Center for WorkLife Law’s free and confidential legal helpline at 415-703-8276 or hotline@worklifelaw.org.
— Juliana Franco, San Francisco
Fear of Needles Is Sometimes Unfounded
I read your article “Needle Pain Is a Big Problem for Kids. One California Doctor Has a Plan” (March 20). I can tell you from experience that the needle is not the source of the pain. After a bone marrow transplant from a donor, I had to get all those childhood vaccines and those for adults 65 and older. The needle stick can barely be felt; it’s the medication going in that is painful. The area you get the vaccine in is then sore for several days. That has been my experience.
— Patsy Rowan, Los Angeles
Radiologist Ian Weissman chimed in on X about pain-reduction strategies:
— Ian Weissman, Milwaukee
Informed on the Difference Between Mis- and Disinformation
First, I am grateful for your continued investigative reporting on covid-19.
Second, I am writing to share a perspective that I trust you can share with the writer of “Four Years After Shelter-in-Place, Covid-19 Misinformation Persists” (April 1). My focus is on the term “information” and its variants.
Specifically, I find it helpful to distinguish linguistically three variants:
- “Information” is information that one provides to others that the informer believes to be accurate.
- “Misinformation” is information that one provides to others that the informer believed was accurate, yet was provided information that indicates the information was less than accurate at some level. As such the informer issues an erratum and corrects the “mis” of the “mis-information.”
- “Disinformation” is information that one provides to others with demonstrable knowledge that this information is not accurate and shares with an intent to illicit thought and action for ulterior motives — motives that are often nefarious and may result in harm, such as increasing individual and/or population morbidity and mortality.
I find the conflation of “mis” and “dis” to be in and of itself harmful to those who convey “mis” and then correct as well as giving those who use “dis” for less-than-honorable purposes cover, a safe haven, and a “get-out-of-jail card.”
For example, it is well known that Fox News internally adhered to information based on scientific data and medical evidence during the covid-19 pandemic state of emergency. Concurrently, it parlayed information externally that can only be characterized as “dis.”
What I find surprising is the fact (I stand to be corrected should I be misinformed) that no one has found at least one individual who acted upon Fox News’ disinformation that resulted in morbidity and/or mortality — or wrongful death litigation.
Keep up the good work.
— Ed Shanshala, CEO of Ammonoosuc Community Health Services, Littleton, New Hampshire
A communications specialist outside Chicago called out disinformation in an X post:
— Michelle Rathman, Geneva, Illinois
States Should Not Spend Opioid Settlement Cash on Unproven Tech
Aneri Pattani did an excellent job reporting on the event in Mobile, Alabama, on Jan. 24, where the Poarch Band of Creek Indians presented a check for $500,000 from the tribe’s opioid settlement funds to the Helios Alliance (“Statistical Models vs. Front-Line Workers: Who Knows Best How to Spend Opioid Settlement Cash?” March 5).
Helios, which includes for-profit and nonprofit organizations, will use funds to build a proprietary simulation model to help leaders decide how to spend settlement funds. According to Helios, the initial system will not be completed before spring 2024.
As a digital product manager for the past 20 years, I understand the potential of technology to improve health care, but settlement funds should not be financing early-stage, proprietary technologies developed by private-sector companies. Helios’ pitch is: “… spend 5% [of settlement funds] so you get the biggest impact with the other 95%,” says Rayford Etherton, who formed the alliance. But given the nationwide settlement is $50 billion over the next 18 years, 5% means that $2.5 billion would go to a potentially proprietary solution.
While the promise of a new technology simulation model is exciting, it’s also high-risk. Moreover, while respected experts like Stephen Loyd are involved with Helios, there aren’t experienced artificial intelligence engineers, digital product experts, data scientists, or security experts listed on the Helios website.
Any technology developed using opioid settlement funds should be open-source and free to all states. More transparency from Helios is needed to describe ownership, user access terms, and licensing fees.
Settlement funds should be deployed to proven, evidence-based solutions. Given the opioid crisis has been raging for 20 years, health care experts already have data-driven insights on how to fix this: increase access to medication-assisted treatment; reduce barriers to physician licensing for buprenorphine, methadone, and naltrexone; increase education in schools; enhance social services such as employment and child care; and increase funding to law enforcement to fight illegal opioids (specifically, fentanyl).
Rather than putting large settlement investments into a not-yet-built simulation model, states should use a human-centered design approach based on research from patients, providers, family members, and community groups that have been battling the opioid crisis for decades to drive initial investments across the ecosystem of opioid crisis drivers. Once Helios has a working simulation product tested and in production, states can consider small investments to pilot usage and see if the product actually produces the desired outcomes.
The ongoing mantra of “public-private partnerships” is a great idea, but the public sector shouldn’t end up paying the bill and taking on all the risk.
— Kelly O’Connor, Washington, D.C.
A professor in Weill Cornell Medicine’s Department of Population Health Sciences shared insights on X:
— Bruce Schackman, New York City
