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.
A chronic-pain patient advocate, who has been featured previously in KFF Health News coverage, spoke out on the social platform X about our “Payback: Tracking the Opioid Settlement Cash” project:
Oh, look an entire investigation, of course partly by shatterproof, looking at where the settlement funds are going, and where they should go. Not one mention of pain patients as forgotten victims. Because we’ve actually been erased from the entire thing. https://t.co/LsHFs9tFwu
— Bev Schechtman🇮🇱 (@ibdgirl76) December 17, 2024
— Bev Schechtman, Clayton, North Carolina
Rooting Out the Root Cause of the Opioid Crisis
I read with interest your detailed coverage of how states are spending billions of funds from the opioid crisis (“Payback: Tracking Opioid Cash: How Are States Spending Opioid Settlement Cash? We Built a Database of Answers,” Dec. 16). The bigger story is health advocates and policymakers need to march upstream if we are to beat the “illness industry” players in illicit drug-making, distribution, and sales on our streets.
What should not be overlooked by those interested in solving this public health crisis (legislators, health department officials, and law enforcement and court system leaders) is that such downstream efforts, even when supported by unimaginable funding, does little to prevent those pushing our citizens into the quicksand of individual, family, and community destruction and death. Certainly, such mitigating and treatment programs and services are needed, but little attention is given to rooting out the root cause of the opioid/fentanyl epidemic.
It is easy and popular to damn the corporation, but it takes courage, real work, and much risk to confront Mexico’s drug cartels, Mexico’s government officials, the Chinese Communist Party, and any of their ostensible “leaders.” Furthermore, it is embarrassing to have to confront our own public officials, from the president on down, to stop aiding and abetting this carnage!
If no serious action is taken to work on upstream causes of our opioid crisis, no amount of lifeguarding and posting of warning signs will prevent bodies from struggling in this rip current of drug addiction. The silence and omission of any action from those who have taken the oath to defend and protect the public is creating a moral hazard for all citizens. Consequently, many more people will die, with nary a word against who is pushing them to such destruction.
— Stephen Gambescia, Philadelphia
A retired assistant surgeon general and epidemiologist weighed in on X about an article on the nation’s shortage of primary care providers:
Misdiagnosis. Young people choosing not to become primary care physicians after leaving med school will not be fixed by free tuition for the highest paid profession in America. Fix govt incentives about graduate medical education & reimbursementhttps://t.co/tPgeFVrzql
— Dr. Ali Khan (@DrAliSKhan) January 14, 2025
— Ali Khan, Omaha, Nebraska
Osteopaths Have Big Hand in Filling Primary Care Needs
I appreciate Felice J. Freyer’s insightful Jan. 13 article, “Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline?” As an osteopathic physician and medical educator, I can confidently answer this question with a resounding “Yes!” Osteopathic medical schools have long been at the forefront of this issue by emphasizing core principles of primary care as they train future physicians, a mission embedded in our philosophy since 1874.
Osteopathic medicine is founded on four key tenets that emphasize the interconnected nature of the body, mind, and spirit and the importance of whole-person care. These tenets have guided many of this country’s nearly 150,000 DOs (doctors of osteopathic medicine) into primary care roles. More than half of DOs enter residencies in the primary care specialties of family medicine, internal medicine, and pediatrics.
As mentioned in the article, “Many medical students start out expressing interest in primary care. Then they end up at schools based in academic medical centers, where students become enthralled by complex cases in hospitals, while witnessing little primary care.” This is a major part of the problem. Most Americans, more than 80%, will never be treated in a large academic medical center. Osteopathic medical schools have flipped the script.
Osteopathic medical schools, as well as some newer MD-granting schools, employ a community-based distributed education model, training students in settings such as rural clinics, community health centers, and physician offices where they will encounter underserved populations benefiting from primary care treatment. Training in underserved areas makes medical students almost three times as likely to stay in those areas to practice, and four times as likely to practice primary care in those locations.
I thank Freyer for shining a spotlight on the essential role of primary care and the contributions of osteopathic medicine. The osteopathic medical education community remains committed to working to ensure that underserved communities receive the care they deserve, and that primary care continues to thrive as the backbone of our health care system.
— Robert A. Cain, CEO and president of the American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
A family doctor and teacher shared the article on X:
The answer is that they can, but they won’t try. Financial and public good incentives for schools are not there. Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline? https://t.co/REsfJtfmmh via @kffhealthnews
— John Frey (@jjfrey3MD) January 14, 2025
— John Frey, Grayslake, Illinois
On Immunity for Vaccine Makers
When discussing vaccination in general (“Childhood Vaccination Rates, a Rare Health Bright Spot in Struggling States, Are Slipping,” Jan. 16), please address the federal legislation surrounding this topic.
According to 42 U.S. Code § 300aa–22, vaccine producers have immunity in civil court. It reads: “No vaccine manufacturer shall be liable in a civil action for damages arising from a vaccine-related injury or death associated with the administration of a vaccine after October 1, 1988, solely due to the manufacturer’s failure to provide direct warnings to the injured party (or the injured party’s legal representative) of the potential dangers resulting from the administration of the vaccine manufactured by the manufacturer.”
And there is only one federal National Vaccine Injury Compensation Program, also known as “vaccine court,” to hear all vaccine-related injury cases involving children. And its case backlog is at least a decade long.
In everything else, when a product or service causes harm, there is accountability through the process of civil suits. What other manufacturer of a product has such legal immunity?
The issue with this is there is no true measure to create accountability with vaccine products. And vaccine makers aren’t required to display ingredient labels. So, we may be injecting our children with unknown substances, from a manufacturer who has no judicial accountability if harm results from the use of the product.
Now, what parent wants to subject their child to this? This is a big deterrent to parents vaccinating their children. Emotional appeal will not dissuade parents, but correcting this legal fallacy will.
— Alesia Wright, Tulsa, Oklahoma
An Indiana dad expressed his opinion on X:
Indiana’s childhood vaccination rates have dropped significantly since the pandemic too.Some people are just going to have to learn the hard way, apparently. Sad that the only way that happens, however, is by gambling with their kid’s health.https://t.co/S9UgXAlAc6
— Steve Garbacz (@Steve_Garbacz) January 14, 2025
— Steve Garbacz, Fort Wayne, Indiana
As a retired primary care physician, I was often frustrated that my management of complex medical conditions was reimbursed at lower rates due to a required treatment code (“Perspective: Removing a Splinter? Treating a Wart? If a Doctor Does It, It Can Be Billed as Surgery,” Dec. 13). Blaming the physician for the discrepancy is inappropriate. The Centers for Medicare & Medicaid Services has strict regulations on billing. We are mandated to code per the regulations. We cannot give “discounts” for procedures. To do so would be problematic in the bizarre catch-22 world of Medicare billing. We are mandated to report our services accurately using only the codes available. To do otherwise is considered fraud by Medicare. When a physician is accused of fraud, he/she is presumed guilty and pays significant financial penalties until innocence is proven. Even a murderer or thief has more rights in the judicial system.
Medicare determines the lowest reimbursement rate; the other carriers pay a higher rate based on that rate. If an individual physician accepts Medicare, he/she must accept that rate. Only a non-participating physician (not accepting Medicare) can offer a lower rate. The exception is if the service is provided at no cost. Should the patient demand the service be provided free?
I’m reminded of the plumber charging $100 to replace a washer: 10 cents for the washer and $99.90 to know how to replace it.
— Robert Sullivan, Adairsville, Georgia
On X, a New England surgeon summed up his views:
We have lost “caring” – “How Everything Became Surgery” from The Washington Post. Read on @Doximity https://t.co/msHja8wsg5
— Rafael Grossmann, MD, MSHS, FACS 🇻🇪🇺🇸 (@ZGJR) December 20, 2024
— Rafael Grossmann, Bangor, Maine
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. A chronic-pain patient advocate, who has been featured previously in KFF Health News coverage, spoke out on the social platform X about our “Payback: Tracking the Opioid Settlement Cash” project: Oh, look an entire investigation, of course partly by shatterproof, looking at where the settlement funds are going, and where they should go. Not one mention of pain patients as forgotten victims. Because we’ve actually been erased from the entire thing. https://t.co/LsHFs9tFwu — Bev Schechtman🇮🇱 (@ibdgirl76) December 17, 2024 — Bev Schechtman, Clayton, North Carolina Rooting Out the Root Cause of the Opioid Crisis I read with interest your detailed coverage of how states are spending billions of funds from the opioid crisis (“Payback: Tracking Opioid Cash: How Are States Spending Opioid Settlement Cash? We Built a Database of Answers,” Dec. 16). The bigger story is health advocates and policymakers need to march upstream if we are to beat the “illness industry” players in illicit drug-making, distribution, and sales on our streets. What should not be overlooked by those interested in solving this public health crisis (legislators, health department officials, and law enforcement and court system leaders) is that such downstream efforts, even when supported by unimaginable funding, does little to prevent those pushing our citizens into the quicksand of individual, family, and community destruction and death. Certainly, such mitigating and treatment programs and services are needed, but little attention is given to rooting out the root cause of the opioid/fentanyl epidemic. It is easy and popular to damn the corporation, but it takes courage, real work, and much risk to confront Mexico’s drug cartels, Mexico’s government officials, the Chinese Communist Party, and any of their ostensible “leaders.” Furthermore, it is embarrassing to have to confront our own public officials, from the president on down, to stop aiding and abetting this carnage! If no serious action is taken to work on upstream causes of our opioid crisis, no amount of lifeguarding and posting of warning signs will prevent bodies from struggling in this rip current of drug addiction. The silence and omission of any action from those who have taken the oath to defend and protect the public is creating a moral hazard for all citizens. Consequently, many more people will die, with nary a word against who is pushing them to such destruction. — Stephen Gambescia, Philadelphia A retired assistant surgeon general and epidemiologist weighed in on X about an article on the nation’s shortage of primary care providers: Misdiagnosis. Young people choosing not to become primary care physicians after leaving med school will not be fixed by free tuition for the highest paid profession in America. Fix govt incentives about graduate medical education & reimbursementhttps://t.co/tPgeFVrzql — Dr. Ali Khan (@DrAliSKhan) January 14, 2025 — Ali Khan, Omaha, Nebraska Osteopaths Have Big Hand in Filling Primary Care Needs I appreciate Felice J. Freyer’s insightful Jan. 13 article, “Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline?” As an osteopathic physician and medical educator, I can confidently answer this question with a resounding “Yes!” Osteopathic medical schools have long been at the forefront of this issue by emphasizing core principles of primary care as they train future physicians, a mission embedded in our philosophy since 1874. Osteopathic medicine is founded on four key tenets that emphasize the interconnected nature of the body, mind, and spirit and the importance of whole-person care. These tenets have guided many of this country’s nearly 150,000 DOs (doctors of osteopathic medicine) into primary care roles. More than half of DOs enter residencies in the primary care specialties of family medicine, internal medicine, and pediatrics. As mentioned in the article, “Many medical students start out expressing interest in primary care. Then they end up at schools based in academic medical centers, where students become enthralled by complex cases in hospitals, while witnessing little primary care.” This is a major part of the problem. Most Americans, more than 80%, will never be treated in a large academic medical center. Osteopathic medical schools have flipped the script. Osteopathic medical schools, as well as some newer MD-granting schools, employ a community-based distributed education model, training students in settings such as rural clinics, community health centers, and physician offices where they will encounter underserved populations benefiting from primary care treatment. Training in underserved areas makes medical students almost three times as likely to stay in those areas to practice, and four times as likely to practice primary care in those locations. I thank Freyer for shining a spotlight on the essential role of primary care and the contributions of osteopathic medicine. The osteopathic medical education community remains committed to working to ensure that underserved communities receive the care they deserve, and that primary care continues to thrive as the backbone of our health care system. — Robert A. Cain, CEO and president of the American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland A family doctor and teacher shared the article on X: The answer is that they can, but they won’t try. Financial and public good incentives for schools are not there. Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline? https://t.co/REsfJtfmmh via @kffhealthnews — John Frey (@jjfrey3MD) January 14, 2025 — John Frey, Grayslake, Illinois On Immunity for Vaccine Makers When discussing vaccination in general (“Childhood Vaccination Rates, a Rare Health Bright Spot in Struggling States, Are Slipping,” Jan. 16), please address the federal legislation surrounding this topic. According to 42 U.S. Code § 300aa–22, vaccine producers have immunity in civil court. It reads: “No vaccine manufacturer shall be liable in a civil action for damages arising from a vaccine-related injury or death associated with the administration of a vaccine after October 1, 1988, solely due to the manufacturer’s failure to provide direct warnings to the injured party (or the injured party’s legal representative) of the potential dangers resulting from the administration of the vaccine manufactured by the manufacturer.” And there is only one federal National Vaccine Injury Compensation Program, also known as “vaccine court,” to hear all vaccine-related injury cases involving children. And its case backlog is at least a decade long. In everything else, when a product or service causes harm, there is accountability through the process of civil suits. What other manufacturer of a product has such legal immunity? The issue with this is there is no true measure to create accountability with vaccine products. And vaccine makers aren’t required to display ingredient labels. So, we may be injecting our children with unknown substances, from a manufacturer who has no judicial accountability if harm results from the use of the product. Now, what parent wants to subject their child to this? This is a big deterrent to parents vaccinating their children. Emotional appeal will not dissuade parents, but correcting this legal fallacy will. — Alesia Wright, Tulsa, Oklahoma An Indiana dad expressed his opinion on X: Indiana’s childhood vaccination rates have dropped significantly since the pandemic too.Some people are just going to have to learn the hard way, apparently. Sad that the only way that happens, however, is by gambling with their kid’s health.https://t.co/S9UgXAlAc6 — Steve Garbacz (@Steve_Garbacz) January 14, 2025 — Steve Garbacz, Fort Wayne, Indiana As a retired primary care physician, I was often frustrated that my management of complex medical conditions was reimbursed at lower rates due to a required treatment code (“Perspective: Removing a Splinter? Treating a Wart? If a Doctor Does It, It Can Be Billed as Surgery,” Dec. 13). Blaming the physician for the discrepancy is inappropriate. The Centers for Medicare & Medicaid Services has strict regulations on billing. We are mandated to code per the regulations. We cannot give “discounts” for procedures. To do so would be problematic in the bizarre catch-22 world of Medicare billing. We are mandated to report our services accurately using only the codes available. To do otherwise is considered fraud by Medicare. When a physician is accused of fraud, he/she is presumed guilty and pays significant financial penalties until innocence is proven. Even a murderer or thief has more rights in the judicial system. Medicare determines the lowest reimbursement rate; the other carriers pay a higher rate based on that rate. If an individual physician accepts Medicare, he/she must accept that rate. Only a non-participating physician (not accepting Medicare) can offer a lower rate. The exception is if the service is provided at no cost. Should the patient demand the service be provided free? I’m reminded of the plumber charging $100 to replace a washer: 10 cents for the washer and $99.90 to know how to replace it. — Robert Sullivan, Adairsville, Georgia On X, a New England surgeon summed up his views: We have lost “caring” – “How Everything Became Surgery” from The Washington Post. Read on @Doximity https://t.co/msHja8wsg5 — Rafael Grossmann, MD, MSHS, FACS 🇻🇪🇺🇸 (@ZGJR) December 20, 2024 — Rafael Grossmann, Bangor, Maine
