STAT readers on what human health care can learn from veterinary medicine and more

STAT now 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.

“Dental care is in crisis. But it’s also a moment of opportunity,” by Steve Pollock

It is time to put the mouth back in the body. In 1973 two things happened that emphasized the problem and the solution. In his last race before the Kentucky Derby, the future champion Secretariat faltered, losing a race he was expected to win. It turned out that before the race, a veterinarian had discovered an abscess in the horse’s mouth, but that information wasn’t passed along to the jockey.

In that same year, the ongoing problem reared its ugly head. I was a medical student doing an advanced rotation at a Harvard Hospital in Cambridge. I was asked to see a woman with a high fever and stiff neck who was drifting into coma. Her physicians were concerned about meningitis, but couldn’t find a source. I was back in medical school as part of a new dual degree program for Harvard dental medicine graduates doing oral and maxillofacial surgery that began in 1971. I naturally examined the mouth and found an infected impacted maxillary left molar. The patient went on the make a moderate recovery but became one of the first high-profile malpractice cases in the state.

Our primary care physician shortage requires veterinarian solutions: dual degree education and training for leadership, change in state practice acts, or passage of dental therapists laws to permit non-dentists to treat more patients.
— Bruce Donoff

“The Philips CPAP nightmare exposes shortcomings in medical device regulation,” by Kushal T. Kadakia, Joseph S. Ross, and Vinay K. Rathi

The 510(k) system has inherent flaws, as seen here and in a number of other recent, high-profile cases. In the EU, under the Medical Device Regulation, the Post-Market Surveillance system is much stronger with new post-market clinical follow-up requirements, and may — not definitely, but may — have picked this up. Maybe it’s time for a degree of trans-Atlantic harmonization, going beyond the proposed quality management system regulation requirements?
— Eamon Doherty, Revvity

“Why I left the editorial board of the prestigious scientific journal NeuroImage — and helped start something new,” by Shella Keilholz

I am deeply moved by the action of this editorial board. A potential solution is for the scientific and medical institutions to band together and offer a new set of journals, not to showcase their own work, but to replace the for-profit company journals. Subscription costs would cover costs and institutions would not pay the current onerous fees currently incurred. Putting aside institutional competition would to accomplish this would be beneficial for all.
— Mark Kupersmith, Icahn School of Medicine at Mount Sinai

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The fundamental flaw is the requirement that authors pay to publish. That has corrupted the entire industry and generated the multitude of useless journals. Readers should pay as in the past, with multiple positive effects, such as fewer journals but more quality journals. The author payment has turned the entire industry into a money-making machine that fails to fundamentally support the science on which the efforts of researchers depend in the final analysis. Readers should pay, as in the publishing industry in general.
— Albert Gjedde, University of Copenhagen

“A year in, the U.S. is still not taking advantage of lower-cost biosimilars for Humira,” by Juliana M. Reed

Juliana Reed is probably right, that the U.S. drug channel doesn’t have strong enough incentives to realize the full potential savings from biosimilars. However, her use of gross price is at best, misleading, and at worst, disingenuous. AbbVie’s U.S. net sales of Humira declined 45% year-over-year in the latest quarter (Q4-23). If Humira hasn’t ceded significant market share, how is that possible? The only reasonable answer is that the price of Humira has come down (via higher rebates) in response to biosimilars. There are real problems of skewed incentives in the U.S. drug channel, but pointing to gross price as an indicator doesn’t help.
— Craig Dauer

“The health care system is ignoring world’s most promising approach to preventing cardiovascular disease,” by Arthur L. Kellermann

Although a new and interesting approach, still it is like working on consequences rather than on the causes of hypertension. Teaching people the benefit of a more active lifestyle and better nutrition will help much more to keep blood pressure within healthier levels. People living in rural areas and with more physical activities as a lifestyle and with no junk food (or less) live longer and healthier. There’s enough research about this. The larger the city, the more unhealthy are lifestyle and food habits and higher the prevalence of cardiovascular diseases. We need to make our cities much friendlier to walk and use bikes to go to work.
— Ronald Rodríguez

Correction: A previous version of one of the letters misstated the story behind Secretariat’s oral injury.