Letters to the Editor is a periodic characteristic. We welcome all feedback and can publish a range. We edit for size and readability and require full names.

Many readers responded to our data-driven protection of how moral and spiritual directives issued by the U.S. Convention of Catholic Bishops have an effect on care choices at Catholic and Catholic-affiliated hospitals in the US. And we encourage different readers to share their suggestions.

A communications specialist in Seattle said her opinion bluntly in an X publish.

“Increasingly girls are working into boundaries to acquiring care as Catholic well being methods have aggressively acquired secular hospitals in a lot of the nation.”Faith is harming healthcare. https://t.co/O4L9mIzP5K

— JoAnne Dyer (@7Madronas) February 27, 2024

— JoAnne Dyer, Seattle

The Proper to Separation of Church and Care

At my most up-to-date OB-GYN appointment, I used to be warned that our greatest hospital, Covenant Medical Middle, is affiliated with the Roman Catholic denomination, as is its string of main care and different clinics, Grace Clinics.

Making an attempt to regain some sense of management over my physique, I made a decision to create an advance well being directive to clarify I don’t wish to be taken to any medical facility related to that denomination, to keep away from my medical care being curtailed or impacted by moral and spiritual directives, often called ERDs, issued by Roman Catholic bishops (“The Highly effective Constraints on Medical Care in Catholic Hospitals Throughout America,” Feb. 17). To do that, I wished to know which amenities are so affiliated. It is extremely arduous to search out that out.

First, I checked out Grace Clinic and Covenant Medical Middle web sites. No point out of affiliation with the church, or ERDs, or how ERDs restrict the forms of medical therapies a affected person will likely be supplied (and even knowledgeable of the existence of).

After I known as Grace Clinic, they denied affiliation with the Catholic Church. After I known as Covenant Medical Middle, additionally they denied affiliation. They’re owned by Windfall, which is Roman Catholic, although it’s important to do a deep dive into the web site to determine that out.

Both the workers are mendacity or are stored in ignorance so the sufferers will likely be stored in ignorance. How can a affected person decide whether or not a hospital will deny them care due to spiritual beliefs, if the group conceals its affiliation with stated beliefs?

These hospitals have the best to consider no matter they need. It seems they at the moment even have the best to deceive sufferers about it. How can sufferers be told well being care customers if they will’t entry the knowledge they want, and are affirmatively given incorrect info from the organizations?

I’ve contacted Windfall by means of its web site asking whether it is affiliated with the Roman Catholic Church and, if that’s the case, the place I can discover a checklist of forms of sufferers that gained’t be handled in accordance with American Medical Affiliation requirements, in addition to which therapies, procedures, and medicines is not going to be offered or offered solely on a restricted foundation due to that affiliation.

I’ve heard nothing.

— Helen Liggett, Lubbock, Texas

An assistant professor on the Cincinnati Kids’s Hospital Medical Middle additionally weighed in on X:

Vital reporting from @KFFHealthNews on the affect of Catholic hospital care together with their ethics evaluation course of:https://t.co/0k2mJpPhY0

— Elizabeth Lanphier (@EthicsElizabeth) February 19, 2024

— Elizabeth Lanphier, Cincinnati

Life at All Prices Is Pricey

One facet of IVF that’s not being mentioned is the discarding of embryos discovered to have severe medical defects (‘What the Well being?’: Alabama Court docket Guidelines Embryos Are Kids. What Now? Feb. 22). For instance, a household could carry a devastating situation and want to display potential offspring, or defects could come up spontaneously. The Alabama Supreme Court docket’s resolution means that these embryos, too, should be implanted.

The court docket’s resolution additionally impacts infants born with extreme defects. How a lot help should be offered a child born with out components of the mind and cranium (anencephaly), which isn’t terribly unusual? Or one born with out kidneys? Or one with a most extreme type of brittle-bone illness (osteogenesis imperfecta), the place each contact can break bones? It sounds as if Alabama regulation now requires most help in each occasion — in my view, this might be holier-than-thou sadism. How does the court docket outline life? Merely a beating coronary heart? I can’t think about a nurse or physician not leaving/quitting when compelled to torture these infants. Then there’s the dad and mom’ torment. That is godly?

— Gloria Kohut, Grand Rapids, Michigan

On X, an anesthetist and emergency medication physician promoted the “What the Well being?” podcast episode that delved into the subject:

Take a look at the most recent episode of KFF Well being Information’ “What the Well being?” podcast, the place the Alabama Supreme Court docket’s ruling on embryo rights sparks a nationwide debate. Plus, doable abortion bans and Catholic hospital care. Pay attention at: https://t.co/4hrsEaWXVb#well being, #healthpolicy, …

— David Moniz (@DrDavidMoniz) February 22, 2024

— David Moniz, Chilliwack, British Columbia

Distilling Statistics on Girls’s Ingesting

Whereas the distilled spirits trade is against extreme consumption by any phase of our society, it’s necessary to notice that your latest article on girls and alcohol failed to incorporate federal knowledge exhibiting reductions in alcohol abuse amongst girls in the US (“Extra Girls Are Ingesting Themselves Sick. The Biden Administration Is Involved,” March 28). For instance, the latest Nationwide Survey on Drug Use and Well being knowledge signifies binge-drinking amongst girls 21 and older declined greater than 6% prior to now 5 years (from 2018 to 2022).

Moreover, claims within the article that the covid-19 pandemic “considerably exacerbated binge-drinking” are usually not supported by a number of federal knowledge sources that point out that the pandemic didn’t produce lasting will increase in consuming or dangerous consuming.

For example, a 2023 research utilizing federal knowledge confirmed that, whereas gross sales did rise on the very starting of the pandemic, this didn’t essentially translate to elevated binge-drinking or total consumption within the months following. Fairly, consuming decreased — each days per 30 days consuming and drinks per day — as did binge-drinking. Furthermore, the identical federal NSDUH knowledge referenced above signifies almost 9 out of 10 U.S. adults 21 years and older (89%) say they drink the identical quantity or lower than they did pre-pandemic.

The article additionally cites an outdated International Burdens of Illness report printed in 2018 to again up claims that “no quantity of alcohol is secure” whereas ignoring the up to date GBD report printed in 2022. Importantly, this most up-to-date GBD analysis concluded there are consuming ranges “at which the well being danger is equal to that of a non-drinker” and that “for people age 40+, consuming small quantities of alcohol is just not dangerous to well being.”

Reporting on alcohol analysis gives necessary info for customers, so it’s crucial that such reporting appropriately displays the most recent proof on alcohol and well being. We encourage all adults who select to drink — men and women — to drink sparsely, to comply with the recommendation of the Dietary Pointers for Individuals, and to speak to their well being care suppliers who will help decide what’s greatest for them primarily based on particular person components and household historical past.

— Amanda Berger, vice chairman of science and well being, Distilled Spirits Council of the US, Washington, D.C.

A lawyer who makes a speciality of preventing insurance coverage denials really helpful our March “Invoice of the Month” characteristic in an X publish:

All too typically insurance coverage suppliers declare medical remedy is just not medically needed. This text explains a #Cigna denial. #healthinsurance #medicalnecessity https://t.co/rpMwsSOOup

— Scott Glovsky (@ScottGlovskyLaw) March 25, 2024

— Scott Glovsky, Pasadena, California

Working Inside a Damaged Well being Care System

Due to Molly Fortress Work for the wonderful article in regards to the England household’s struggles with our damaged well being care system (“A Mother’s $97,000 Query: How Was Her Child’s Air-Ambulance Trip Not Medically Obligatory?” March 25). One avenue of decision that was not famous in your wonderful article is the California Division of Managed Well being Care. I’m a doctor, and we had a unique, but additionally very costly ($90,000), well being care invoice. It took two years and two appeals to that division, however, finally, we have been reimbursed by our insurance coverage firm. It is a useful resource that must be extra extensively recognized.

— Erica Buhrmann, Berkeley, California

An Unfair Burden on These Most in Want

It’s obscure why these most susceptible in society, who’ve problem buying medical insurance, are required to pay extra for providers with the identical medical doctors and amenities than insurance coverage firms pay. Insurers profit from “negotiated pricing.” These with no insurance coverage are required to pay all the “inflated” invoice for medical providers. Most instances, the distinction between the quantity a health care provider or medical supplier payments, in contrast with the precise fee medical doctors obtain from insurance coverage firms, is roughly 20% of the quantity billed.

It’s patently unfair to require uninsured sufferers to pay greater than insurance coverage firms pay. Uninsured people have an unfair bargaining energy, in contrast with insurance coverage firms. A superb instance is demonstrated in your article of the lady who obtained an uncovered emergency medical flight earlier than her dying, and her heirs have been left with an outrageous invoice of $81 (“With out Medicare Half B’s Defend, Affected person’s Household Owes $81,000 for a Single Air-Ambulance Flight,” Feb. 27). If her household was informed they have been accountable for $81,000 for the air ambulance, the transport wouldn’t have occurred.

The apply of holding uninsured individuals accountable for “whole” medical payments typically, in essence, causes somebody who doesn’t have protection — principally due to affordability — to complement the income of medical doctors and medical suppliers by being required to pay the complete inflated quantity billed for medical providers.

Insurance coverage firms defend this apply of “negotiated pricing,” when, in essence, it’s used to power those that can least pay to complement losses suffered by the medical doctors for discounted funds from insurers.

There must be regulation that prohibits medical suppliers from price-gouging the uninsured, forcing them to complement medical doctors’ and suppliers’ earnings to make up for underpayments from insurers. Many instances, uninsured people are already dwelling at or close to poverty ranges earlier than incurring surprising medical obligations. Being hit with a shock invoice for an air-ambulance trip costing $81,000 is ample to trigger the affected person to file for chapter. Within the U.S., the No. 1 purpose individuals file for chapter safety is due to medical payments.

Our present system of administering well being care and funds for such is damaged and must be fastened. As soon as this disparate system of funds is rectified, well being care ought to turn out to be much more accessible to most of the people.

— Ronald B. Kaplan, Holbrook, Massachusetts

On X, a public well being scholar shared our article in regards to the unwanted effects of the anti-vaccine motion:

A TN regulation now means they foster dad and mom, social staff & different caregivers can’t present permission for childhood vaccines — an important a part of well being care for youths. We have to take antivaxxers critically as a result of they’re critically harming public well being. https://t.co/6jX7ltNq4i

— jenn kauffman ✨ (@jennaudrey) March 12, 2024

— Jenn Kauffman, Washington, D.C.

Not Vaccinated? Get Education Elsewhere

I’m a father and a main care doctor. I simply learn Amy Maxmen’s article “How the Anti-Vaccine Motion Pits Parental Rights In opposition to Public Well being” (March 12) and commend her for her balanced and fact-based presentation.

I really feel that an necessary facet is lacking from such articles — that being the rights of the vast majority of dad and mom who help vaccination to have their kids within the most secure doable surroundings in public colleges. We all know that no vaccine is ideal, and that our youngsters are nonetheless in danger for measles, covid, and different illnesses, regardless of profiting from the confirmed advantages of vaccines.

I consider that oldsters who train their rights to not have their kids vaccinated must be required to homeschool, or to ship their kids to non-public colleges having insurance policies with which they agree. I’m conscious that solely a tiny proportion of Individuals would agree with me.

— John Cottle, Mendocino, California

Scientific psychologist Carl Hindy appeared impressed by our article on a pricey new postpartum melancholy remedy:

[Instead of gender reveal parties, we can have Pharma baby showers 😢] A New $16,000 Postpartum Melancholy Drug Is Right here. How Will Insurers Deal with It? – KFF Well being Information https://t.co/1CVZEX7yf8

— Carl Hindy, Ph.D., HSP, Scientific Psychologist (@DrCarlHindy) March 18, 2024

— Carl Hindy, Exeter, New Hampshire

Tending to New Moms’ Wants

It was heartbreaking to learn that non-public well being insurers have successfully delayed the supply of a revolutionary remedy for postpartum melancholy, a debilitating situation that makes it troublesome for brand spanking new dad and mom to care for his or her households, work, and even get off the bed (“A New $16,000 Postpartum Melancholy Drug Is Right here. How Will Insurers Deal with It?” March 12).

As one of many 1 in 5 new moms who struggled with this horrible sickness when my very own son was born, I can solely hope zuranolone is made extensively accessible very quickly. As an advocate for the rights of pregnant staff, I hope that psychological well being care suppliers are conscious that there’s one other new and revolutionary software that’s at their disposal at present to help sufferers scuffling with prenatal and postpartum psychological well being situations. A brand new federal regulation, the Pregnant Staff Equity Act, offers staff the best to obtain adjustments at work wanted for pregnancy-related psychological well being situations. The Pregnant Staff Equity Act, which applies to employers with 15 or extra staff, requires they supply cheap lodging for being pregnant, childbirth, and associated medical situations, as long as it doesn’t impose an undue hardship. For instance, a brand new mom experiencing a perinatal psychological well being situation could also be eligible to obtain a modified schedule, time without work to attend psychological well being appointments, a extra personal workspace, permission to earn a living from home, or every other “cheap lodging” that may deal with their wants. Psychological well being care suppliers ought to help their sufferers by discussing their work-related challenges, serving to to establish office modifications, and writing efficient work notes to their sufferers’ employers.

Well being care suppliers and their sufferers can entry free assets from the College of California Regulation-San Francisco Middle for WorkLife Regulation on office lodging for perinatal psychological well being situations at pregnantatwork.org. Well being care suppliers or staff with questions can contact the Middle for WorkLife Regulation’s free and confidential authorized helpline at 415-703-8276 or hotline@worklifelaw.org.

— Juliana Franco, San Francisco

Concern of Needles Is Generally Unfounded

I learn your article “Needle Ache Is a Massive Drawback for Youngsters. One California Physician Has a Plan” (March 20). I can inform you from expertise that the needle is just not the supply of the ache. After a bone marrow transplant from a donor, I needed to get all these childhood vaccines and people for adults 65 and older. The needle stick can barely be felt; it’s the treatment entering into that’s painful. The realm you get the vaccine in is then sore for a number of days. That has been my expertise.

— Patsy Rowan, Los Angeles

Radiologist Ian Weissman chimed in on X about pain-reduction methods:

Researchers have helped develop a 5 step plan to assist forestall what they name “unnecessary ache” for kids getting injections or their blood drawnhttps://t.co/mCi8Tx6ILn

— Ian Weissman, DO (@DrIanWeissman) March 29, 2024

— Ian Weissman, Milwaukee

Knowledgeable on the Distinction Between Mis- and Disinformation

First, I’m grateful to your continued investigative reporting on covid-19.

Second, I’m writing to share a perspective that I belief you’ll be able to share with the author of “4 Years After Shelter-in-Place, Covid-19 Misinformation Persists” (April 1). My focus is on the time period “info” and its variants.

Particularly, I discover it useful to differentiate linguistically three variants:

• “Data” is info that one gives to others that the informer believes to be correct.
• “Misinformation” is info that one gives to others that the informer believed was correct, but was offered info that signifies the knowledge was lower than correct at some degree. As such the informer points an erratum and corrects the “mis” of the “mis-information.”
• “Disinformation” is info that one gives to others with demonstrable information that this info is just not correct and shares with an intent to illicit thought and motion for ulterior motives — motives which might be typically nefarious and will lead to hurt, reminiscent of growing particular person and/or inhabitants morbidity and mortality.

I discover the conflation of “mis” and “dis” to be in and of itself dangerous to those that convey “mis” after which appropriate in addition to giving those that use “dis” for less-than-honorable functions cowl, a secure haven, and a “get-out-of-jail card.”

For instance, it’s well-known that Fox Information internally adhered to info primarily based on scientific knowledge and medical proof through the covid-19 pandemic state of emergency. Concurrently, it parlayed info externally that may solely be characterised as “dis.”

What I discover stunning is the very fact (I stand to be corrected ought to I be misinformed) that nobody has discovered at the very least one particular person who acted upon Fox Information’ disinformation that resulted in morbidity and/or mortality — or wrongful dying litigation.

Sustain the nice work.

— Ed Shanshala, CEO of Ammonoosuc Group Well being Providers, Littleton, New Hampshire

A communications specialist outdoors Chicago known as out disinformation in an X publish:

Disinformation is public well being enemy 1. Those that begin it and unfold it are poisonous for our society.

— Michelle Rathman 🟧 (the actual one) (@MRBImpact) April 1, 2024

— Michelle Rathman, Geneva, Illinois

States Ought to Not Spend Opioid Settlement Money on Unproven Tech

Aneri Pattani did a superb job reporting on the occasion in Cellular, Alabama, on Jan. 24, the place the Poarch Band of Creek Indians offered a examine for $500,000 from the tribe’s opioid settlement funds to the Helios Alliance (“Statistical Fashions vs. Entrance-Line Staff: Who Is aware of Finest How you can Spend Opioid Settlement Money?” March 5).

Helios, which incorporates for-profit and nonprofit organizations, will use funds to construct a proprietary simulation mannequin to assist leaders resolve learn how to spend settlement funds. In response to Helios, the preliminary system is not going to be accomplished earlier than spring 2024.

As a digital product supervisor for the previous 20 years, I perceive the potential of know-how to enhance well being care, however settlement funds shouldn’t be financing early-stage, proprietary applied sciences developed by private-sector firms. Helios’ pitch is: “… spend 5% [of settlement funds] so that you get the most important affect with the opposite 95%,” says Rayford Etherton, who shaped the alliance. However given the nationwide settlement is $50 billion over the subsequent 18 years, 5% implies that $2.5 billion would go to a doubtlessly proprietary resolution.

Whereas the promise of a brand new know-how simulation mannequin is thrilling, it’s additionally high-risk. Furthermore, whereas revered consultants like Stephen Loyd are concerned with Helios, there aren’t skilled synthetic intelligence engineers, digital product consultants, knowledge scientists, or safety consultants listed on the Helios web site.

Any know-how developed utilizing opioid settlement funds must be open-source and free to all states. Extra transparency from Helios is required to explain possession, consumer entry phrases, and licensing charges.

Settlement funds must be deployed to confirmed, evidence-based options. Given the opioid disaster has been raging for 20 years, well being care consultants have already got data-driven insights on learn how to repair this: improve entry to medication-assisted remedy; scale back boundaries to doctor licensing for buprenorphine, methadone, and naltrexone; improve schooling in colleges; improve social providers reminiscent of employment and baby care; and improve funding to regulation enforcement to battle unlawful opioids (particularly, fentanyl).

Fairly than placing massive settlement investments right into a not-yet-built simulation mannequin, states ought to use a human-centered design strategy primarily based on analysis from sufferers, suppliers, relations, and neighborhood teams which have been battling the opioid disaster for many years to drive preliminary investments throughout the ecosystem of opioid disaster drivers. As soon as Helios has a working simulation product examined and in manufacturing, states can take into account small investments to pilot utilization and see if the product truly produces the specified outcomes.

The continued mantra of “public-private partnerships” is a superb thought, however the public sector shouldn’t find yourself paying the invoice and taking over all the danger.

— Kelly O’Connor, Washington, D.C.

A professor in Weill Cornell Drugs’s Division of Inhabitants Well being Sciences shared insights on X:

Fascinating article. On the one hand “Knowledge doesn’t save lives. Numbers on a pc don’t save lives,” vs the town has an obligation to make use of its settlement funds “in a method that’s going to do probably the most good…as an alternative of merely guessing.” https://t.co/w4QJ7zOkgM

— Bruce Schackman (@BruceSchackman) March 6, 2024

— Bruce Schackman, New York Metropolis