— Timothy Ray, Cleveland
In your excellent interview with Dr. Rana Awdish, she discusses several "system" barriers to enhancing the patient-doctor relationship – such as productivity demands, the upkeep of electronic medical records, dealing with insurance. But she seems to separate physicians from the "system." Such separation is itself a significant barrier to the communication space that the doctor challenges her colleagues to create. Breaking down system barriers requires a system-wide effort, among physicians, nurses, aides, administration and information technology officials — even insurance carriers.
— Paul Shirilla, Traverse City, Mich.
How Hospitals Game The System
In regards to the "poor and sloppy reporting" from the Chicago hospital suing over a rating agency's contested grade ("In Era Of Increased Competition, Hospitals Fret Over Ratings," Dec. 11): Such scores do not reflect the quality of hospital operations. They reflect the ability of a person to write the best report. This can be compared to financial success of hospitals. The hospital that knows how to game the system — getting more money from the Centers for Medicare & Medicaid Services and insurance carriers by maximizing billing — beats the hospital that is focused on good care.
— Bob Schmidt, Atlanta
Dispense Your Words Carefully
I'm certainly not a fan of PhRMA but, in the interest of accurate reporting, Jay Hancock should choose his words more carefully ("Drug Industry Spent Millions To Squelch Talk About High Drug Prices," Dec. 19). An organization with a $220 million budget can hardly be said to "lavish" support on a group of organizations when it spends a total of $2 million across "scores of organizations," and the largest gift was $260,000. But the word "lavish" would be entirely appropriate when describing PhRMA's gift of $6.1 million to the American Action Network.
— Worth Gretter, Menands, N.Y.
The woman featured in your article "Opioids After Surgery Left Her Addicted. Is That A Medical Error?" (Dec. 11) was not "addicted." She was "drug-dependent." Yes, the docs should have educated her better, but you ought to be technically accurate.
— Sally Satel, M.D., Washington, D.C.
Missing A Killer App Opportunity For Painkillers
In reporting on the opioid epidemic, Michelle Andrews provided insight on her personal experience being overprescribed Percocet for a minor knee injury ("Doctor's Rx For A Stiff Knee: A Prescription For 90 Percocet Pills," Nov. 21). She noted how electronic prescribing systems make prescribing more pills simpler than prescribing fewer, as they generate the maximum prescription — in this case, 90 pills of Percocet, a relatively strong opioid for a minor knee surgery.
An automated prescribing system based on procedures would allow more accurate pain medicine allocation, while aligning with the behavioral workflow of physicians. Why not apply the sophisticated algorithms and big data — which Silicon Valley frequently capitalizes on — to the opioid crisis, by developing user-friendly software for physicians to quickly prescribe appropriate doses according to the procedure and weight of the patient?
— Ariel Cooper, Oakland, Calif.
Docs Not Inoculated Against Runaway Vaccine Costs
Prevnar's high price tag ("The Ratcheting Price Of The Pneumococcal Vaccine: What Gives?" Nov. 29) is only part of the problem. Its manufacturer, Pfizer, unlike other vaccine companies, refuses to offer a refund for expired doses of Prevnar if the 10-dose package has been opened (doses are in separate, prefilled syringes). So, the pediatrician who orders a large supply when Pfizer offers a couple of months' worth at the old price then gets stuck with unused vaccine ($1,000 worth this summer for me, for having six of 10 doses left in the second package — they had early expiration dates). I'm stuck with Prevnar, but I use Pfizer's competitors for all other vaccines now.
— PL June, M.D., Moultrie, Ga.
New Light Shed On Sickle Cell Disease
Thanks for the piece on sickle cell disease ("Sickle Cell Patients Suffer Discrimination, Poor Care — And Shorter Lives," Nov. 6). I remember hearing stuff on TV about sickle cell growing up in the '70s, but hadn't heard anything since biochemistry class in college. I'd assumed that, because of the earlier attention, treatments had become so good that it was no longer an issue. I guess that was naive, given the ensuing deterioration of our health care system in general.
— Linda Wilson, Georgetown, Texas
I wanted to thank the Kaiser Health News team for writing a story about sickle cell disease. My older brother, Marqus, has sickle cell disease. The story echoed our lives and managed to capture over 100 years of discrimination.
The good news is that Marqus survived his seizures and the two of us started a nonprofit to try and improve policy efforts and quality of life for sickle cell patients. We even went to the Food and Drug Administration last year and testified about the need for drug development, ultimately aiding in the FDA approval of a sickle cell drug. Thank you for validating our cause and shedding some light on disparities for sickle cell disease.
— Ashley Valentine, co-founder and president of Sick Cells, Washington, D.C.
Help For Millennials Peering Over Insurance Cliff
Your recent article reporting that millennials are struggling to enroll in health plans ("Challenges Abound For 26-Year-Olds Falling Off Parental Insurance Cliff," Dec. 8) profiled one young woman who found a plan after consulting a health insurance broker. More first-time enrollees should consider following her lead. Eighty-four percent of consumers who sought guidance from health insurance agents and brokers when shopping on the exchanges found them helpful — a higher satisfaction rating than any other source of assistance.
— Janet Trautwein, CEO, National Association of Health Underwriters, Washington, D.C.
Weeding Through Facts On Marijuana
It's interesting that the article "Teaching Teens The Perils Of Pot As Marketplace Grows" (Nov. 29) completely left out the federal study released in September 2017 showing that "in 2016, rates of marijuana use among the nation's 12- to 17-year-olds dropped to their lowest level in more than two decades, according to federal survey data released."
— Jason Barker, LECUA Patients Coalition of New Mexico, Albuquerque
You guys keep pushing reefer madness articles to NPR. You published an article about a teenager who was speculating that legal marijuana makes it harder to talk to teens about marijuana. Maybe instead of what some random kid thinks, look at the numbers that show usage dropping among teens.
And your article on cannabinoid hyperemesis syndrome ("Wrecked And Retching: Obscure Vomiting Illness Linked To Long-Term Pot Use," Jan. 2) is nothing more than a scare piece. What are you afraid of, dropping opioid deaths? This condition, which is stated in the article to be rare, goes away once the person ceases use. Get with the times. Your coverage is the same old only-negative drug war nonsense.
— Chad Spratt, Austin, Texas
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.