Letters to the Editor is a periodic characteristic. We welcome all comments and can publish a range. We edit for size and readability and require full names.
Glucose Screens Can Profit All Sorts
I disagree with the destructive tone of a current KHN article about whether or not steady glucose monitoring (CGM) helps non-insulin-using folks with Sort 2 diabetes (Sort 2s) (“‘Painless’ Glucose Monitors Pushed Despite Little Evidence They Help Most Diabetes Patients,” March 16).
As a board-certified endocrinologist, I’ve seen firsthand important advantages of CGM for folks with diabetes, together with Sort 2s not utilizing insulin. This know-how offers helpful real-time details about the consequences of varied meals and actions on glucose ranges. CGM additionally reveals the right way to keep away from harmful hypoglycemia, which is usually a facet impact of sulfonylurea medication, often prescribed for non-insulin-using Sort 2s. A lot worldwide analysis on this inhabitants, not talked about within the article, reveals advantages of CGM, together with improved A1C ranges and decreased hospitalizations and emergency room visits.
Whereas no device is correct for everybody, Sort 2s who wish to study what impacts their glucose ranges and are prepared to make use of info to alter their conduct will typically profit considerably from CGM.
— Dr. David Klonoff, College of California-San Francisco
We speak about #valuebasedcare rather a lot, however we’ve got to outline worth. Is it comfort, peace of thoughts? Or precise higher #clinical worth per greenback? So typically there’s a grey space, however too typically we take the most recent & best as a result of it’s simply that.https://t.co/vGwBnUMKER
— Dr. Christopher Chen (@DrChrisChen) March 31, 2021
— Dr. Christopher Chen, Miami
Medicare and most different well being insurers will likely be pleased to study “a number of finger sticks, which value lower than $1 per day …” Not even near being true!
As a 75-year-old with Sort 1 diabetes (for 14 years, the final three utilizing CGM), I might agree along with your fundamental premise however for the comfort. CGM is one other step nearer to the factitious pancreas that can hopefully save prices and lives.
My CGM system doesn’t alert (sleeping or awake) for low blood sugar. It has additionally left my A1C unchanged (but it surely was already acceptably low). The month-to-month value of CGM vs. a mean of eight finger sticks a day, mandatory for my severely reactive Sort 1, is relatively low.
It might be much better for reporters and diabetes sufferers if diabetes weren’t the endlessly difficult illness that it’s.
— Phil Murray, Elk River, Minnesota
13/n Within the spirit of sharing all viewpoints, listed here are counter-arguments to what I’ve shared above about #CGM in #T2D: https://t.co/XHSbg6zUlK
— Aaron Neinstein, MD (@AaronNeinstein) March 24, 2021
— Dr. Aaron Neinstein, San Francisco
You place one thing in your story about CGMs that’s deceptive. Whereas a Dexcom CGM doesn’t check a selected A1C, it does maintain data which are shared along with your endocrinologist that define a mean A1C, which for me has been off by 0.5 factors, greater or decrease. I’m a Sort 1 diabetic; however I can inform you that Sort 2 diabetics can profit from this in the event that they watch and reply to the numbers they’re getting. They’ll have a transparent glimpse into all that causes their glucose to rise and fall: Stress releases a hormone known as cortisol that raises glucose, whereas anxiousness burns power and may drop it quickly. Even espresso with no cream and sugar raises glucose.
My A1C earlier than my CGM was all the time within the excessive 6s. My final one and the one earlier than that? 5.6 and 5.7, which is mainly a standard A1C. The CGM isn’t doing this for me … however due to the CGM, I’m able to define what precisely causes my glucose to rise and fall and the way to answer it.
Checking glucose 3 times a day is just not an efficient strategy to handle diabetes in any respect. It’s far costlier to observe sugars the best way that they’ve historically been adopted. We have to equip diabetics with higher instruments to watch the place their numbers are going in order that they’ll turn out to be empowered to handle this illness successfully.
— Rhonda Ronsman, Milwaukee, Wisconsin
Initially, public notion was that kids wouldn’t be contaminated with the #coronavirus. As a father or mother, I would not wish to threat #covid issues for my son. I like to recommend kids take related wellness precautions to cut back their threat for MIS-C. https://t.co/ofCqtitT9c
— MeiLan Han (@meilan_han) March 5, 2021
— Dr. MeiLan Han, Ann Arbor, Michigan
A Quick Course on Treating Lengthy Covid
Right here’s some recommendation for individuals who deal with folks with lingering issues attributable to the coronavirus (“Children’s Hospitals Grapple With Young Covid ‘Long Haulers,’” March 3). Main care physicians and pediatricians seeing sufferers with signs subsequent to covid-19 infections, generically known as “lengthy haul” covid, ought to try to tell apart between these signs which are the identical as these of myalgic encephalomyelitis/persistent fatigue syndrome (ME/CFS) and people which are distinctive to Lengthy Covid. For these much like ME/CFS, the well being care supplier ought to avail themselves of the symptom administration developed for ME/CFS, at the least as a primary method. Signs lasting past six months of the acute an infection might fulfill the standards of ME/CFS and that analysis must be thought-about. Grownup and pediatric ME/CFS primers can be found each on-line and in exhausting copy for each well being care supplier and affected person.
— Dr. Kenneth Friedman, Plantation, Florida
Lots of people dashing to reopen faculties are ignoring that kids are harmed by Covid too. Many youngsters are getting #LongCovid. #LongCovidKids“Kids’s Hospitals Grapple With Younger Covid ‘Lengthy Haulers'” https://t.co/MS3IKp3Mzg by way of @khnews
— Myra desires everybody to #GetVaccinated (@myrabatchelder) March 24, 2021
— Myra Batchelder, Brooklyn, New York
A Revealing Narrative
Thanks for bringing Paloma Marin-Nevarez’s story to us on Reveal (“‘Into the Covid ICU’: A New Doctor Bears Witness to the Isolation, Inequities of Pandemic,” March 1). I used to be most struck by her insightful response to your query relating to what she thinks about well being care employees being thought to be heroes. I’m a doctor, too, and have by no means felt snug with this hero meme, however couldn’t put my finger on why. The concept that designating another person a hero excuses the designator from doing one thing themselves, like carrying a masks or not consuming in a restaurant, is spot-on. As Paloma stated, “What the f*** are you doing?” It’s the identical with our pressured hero worship on these within the army. Positive, many within the army do remarkably heroic issues of their line of labor and threat their well being, however so do miners and fishermen and oil rig employees and loggers. However what if we have been extra prepared to sacrifice by not utilizing as a lot fossil gas or giving extra of our cash to worldwide help? May that avert a number of the mandatory sacrifice of these within the army? It’s simpler simply to say they’re heroes and transfer together with our lives. Thanks for making me assume.
— Dr. Gerald Gollin, San Diego
Clinicians in coaching have needed to study the exhausting approach this yr that expert communication with sufferers & households is an intervention that requires coaching and follow – educating applications ought to hearken to them: https://t.co/pZZ1IA0j0g
— Brynn Bowman, MPA (@BrynnBHealth) March 9, 2021
— Brynn Bowman, New York Metropolis
Deciphering Billing Codes
Isn’t a part of the problem the Medicare Benefit Plan and their protection (“Her Doctor’s Office Moved One Floor Up. Her Bill Was 10 Times Higher,” March 26)? I discover the code J10140 is for 80 milligrams of Depo-Medrol, which has an N standing indicator on the Facilities for Medicare & Medicaid’s Addendum B (that means no separate cost and no copay). The CPT code for the injection is 20610, with a T standing indicator, which reveals a nationwide copay of $52.25. After I do a lookup on the unique Medicare web site, it reveals a mean out-of-pocket cost of $61. So, if the affected person was paying for a Medicare Half B plan underneath Medicare fee-for-service, the out-of-pocket would have been $61, not $354.68. Folks typically assume that Medicare Benefit plans are “free,” however the plan’s protection could be very completely different from unique Medicare. The usual month-to-month premium for enrollees is $148.50, so there’s a trade-off, but it surely must be famous that if the affected person had Medicare FFS, the hospital would have acquired solely $61 from the affected person.
— Agatha Nolen, Ph.D., FASHP, CRCR (a Healthcare Monetary Administration Affiliation licensed income cycle consultant), Nashville, Tennessee
This can be a fully solvable drawback: “However Riley famous it’s tough to battle highly effective hospital lobbyists in a pandemic political local weather…”Her Physician’s Workplace Moved One Ground Up. Her Invoice Was 10 Occasions Greater. https://t.co/15jVzA5sc5 by way of @khnews
— Mark Miller (@MarkMiller_DC) March 26, 2021
— Mark Miller, Washington, D.C.
I’m a senior. Even with a Medicare Benefit or supplemental plan with zero premiums, copays are unaffordable. Medical clinics typically lie about fees. I ask beforehand each time, and I get all the pieces in writing. Insurance coverage corporations give incorrect recommendation or flat-out lie about coverages, and the shock will be bankrupting. I’ve some severe well being points however is not going to search medical remedy for any of them. My household and pals are all instructed to by no means ever take me to a hospital as a result of, if I dwell by no matter (covid, coronary heart assault, stroke), I might by no means be capable of pay the invoice. The medical system within the USA is insanely predatory on the aged. I now not want to be the sufferer of predators and really feel that I’m in a greater place, even when sick, by merely avoiding it. There isn’t a such factor on this nation as trustworthy, inexpensive well being care. Folks assume “Medicare-for-All” is the reply however individuals are improper, based mostly on my expertise with Medicare, together with a shortage of docs prepared to simply accept Medicare even with so-called “good” supplemental insurance coverage. I’m selecting zero-premium Benefit and, if by some distant likelihood I find yourself sick or injured and in opposition to my will am taken for remedy to some predatory medical facility, I’ll select chapter to remove the invoice. A buddy was lately identified with most cancers — she had “good” insurance coverage. She selected to forgo remedy, ended up in hospice, and died — by alternative — there was no approach she may pay for all the pieces.
— Rox Sitterley, Corvallis, Oregon
One other absurd cause HC prices are so excessive. I am not shopping for the hospital’s causes for facility charges. Her Physician’s Workplace Moved One Ground Up. Her Invoice Was 10 Occasions Greater. https://t.co/MIF9UiH4pa by way of @khnews
— Victor Vaughan (@vicgvaughan) March 27, 2021
— Vic Vaughan, Fairfield, Connecticut
Would not MATTER. WHICH Administration is in workplace…FIX THIS!!New Value-Reducing Medicare Rule, Identical Surgical procedure, Identical Place, Totally different Invoice https://t.co/FD3fr38fBg
— Deborah Daly-Case (@DeborahDalyCase) March 24, 2021
— Deborah Daly-Case, Fullerton, California
Reduce By means of the Surgical procedure Confusion
Moreover getting a blood oath of admission, why not present some steerage as to what one ought to do to keep away from chapter (“Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill,” March 23)?! Going to the native abattoir isn’t precisely a time for one to have presence of thoughts.
— Jack Shaw, Littleton, Colorado
https://t.co/HFvzwXnvfjA pleasant goodbye current to all Orthopedic supporters of the final administration
— James Gerald Floyd (@Flobhm) March 28, 2021
— James Gerald Floyd, Orlando, Florida
Vaccine Hesitant? Seek the advice of Historical past
That is an open letter to anybody who hesitates or chooses to not immunize themselves or their kids. Educate the historical past of immunization. Historical past — have you ever ever seen footage of somebody with smallpox? Look on the web. Thousands and thousands took the chance to be immunized, now smallpox has been eradicated on the earth inhabitants. My nice aunt and cousin had the chance to be immunized in opposition to diphtheria and weren’t — regardless of the cause — they usually each died of diphtheria, leaving a husband and babies.
Amongst my experiences as a pupil nurse was working on the pediatric hospital in Indianapolis in 1960 watching a 10-year-old with tetanus mendacity on his facet together with his physique and head severely arched, a tube in his throat for respiration. Additionally on the hospital have been massive, metallic, tube-like machines. Inside every machine was a baby with Bulbar polio who couldn’t breathe on their very own. Their head caught out one finish of the machine, the remainder of their physique lay limp contained in the tube, and nurses cared for them by “portholes.” They have been in “iron lungs.” I additionally cared for kids recovering from polio. I labored nights and would apply heat flannel “Kenny packs” to ease the ache of their legs and arms so they may sleep. These kids have been amazingly brave.
After I had kids of my very own, how extremely grateful I used to be that almost all mother and father had accepted the chance of an immunization for polio. Due to this, polio is nearly eradicated in america. It causes me nice emotional ache to listen to of individuals refusing to take their half in stopping these and different sicknesses.
— Donna Fellinger, Burlington, Vermont
Buddies – This angers me! America must learn about this! DC we’re coming and see you in a few weeks! This is the reason @jonstewart & are a teaming up but once more! This is the reason failure won’t ever be an choice! https://t.co/XZULFC7dki
— @JohnFeal2 (@johnfeal2) March 21, 2021
— John Feal, Smithtown, New York
The Struggle Behind Tax {Dollars} and Politics
Dr. Elisabeth Rosenthal’s article “How the US Invested in the War on Terrorism at the Cost of Public Health” (March 29) is balderdash. Criticizing the struggle on terror for the failure of the general public well being forms to guard the nation in opposition to covid is shameful and outrageous. And denouncing Donald Trump for it’s like blaming Franklin Delano Roosevelt for Pearl Harbor. The progressive politics that inform the worldview of institutional well being care have broken (maybe destroyed) the independence and popularity of drugs, and that’s one thing that may’t be quantified nor simply recovered.
— Stephen Energy, Vacaville, California
That is the simplest learn for what can be a complete take a look at our grim public well being scenario. https://t.co/gvB1YI6Vjp by way of @khnews @RosenthalHealth
— Jordan Reese (@mediajordan) March 31, 2021
— Jordan Reese, Philadelphia
Retaining the Truth Checkers Trustworthy
Your “reality checking” is approach too form to the Trump administration (“Biden’s Criticism of Trump Team’s Vaccine Contracts Is a Stretch,” March 8). Sure, Operation Warp Pace did set off the big expenditure of analysis {dollars} that produced three U.S.-backed vaccines in file time. Nonetheless, the Trump administration devoted no sources to creating them obtainable to the American inhabitants in an organized vogue, and one may speculate that the whole venture was designed primarily to inflate the worth of the American Large Pharma corporations tasked with growing the vaccines (I’m not disparaging the businesses, simply the Trump administration’s motives for stoking their monetary fires). And, simply to indicate that left-leaning politics will also be gilded with conspiracy theories, I’ll supply one other. Early within the fall, many people watched a “60 Minutes” episode throughout which we discovered that our “wonderful army” can be tasked with managing vaccine supply. That actually was not obvious as soon as the vaccines grew to become obtainable and most “linked” Individuals started obsessing over acquiring their very own doses by way of their computer systems and cellular units. When the historical past of the pandemic is written, I might not be shocked to study that the Trump administration was mounting a shadow plan to ship a wholly completely different sort of useful resource all through the nation — troopers to impose and implement martial legislation as soon as he misplaced the election he knew he would lose except he may hijack it.
Anybody with no flat-line cerebral cortex may have seen that vaccinating 300 million-plus Individuals in only a few months can be an info know-how nightmare, truly made worse by the HIPAA limitations on well being info data-sharing, however Trump’s administration “wasted” no time on that venture, whereas changing top-level administration staffers on the Pentagon with secretive sycophants. One wonders what they have been hiding from the Joe Biden transition workforce in a very unprecedented rejection of the protection of our democracy between Election Day and Inauguration Day.
— Dr. James Robertson, Hamilton, Montana
The a Trump Admin additionally ought to get credit score for the pre-purchase of 800 million doses of vaccine earlier than it was even FDA authorized. Truth checked. https://t.co/UsieYciYdn
— Matt Deitchle (@MattDeitchle) March 14, 2021
— Matt Deitchle, Indianapolis
