First Opinion is STAT’s platform for attention-grabbing, illuminating, and provocative articles concerning the life sciences writ giant, written by biotech insiders, well being care staff, researchers, and others.
To encourage sturdy, good-faith dialogue about points raised in First Opinion essays, STAT publishes chosen Letters to the Editor acquired in response to them. You may submit a Letter to the Editor right here, or discover the submission type on the finish of any First Opinion essay.
The story
“ER docs are too fast to imagine hashish customers are experiencing this uncommon facet impact,” by Jordan Tishler
The response
Affiliation of Cannabinoid Specialists’ president Jordan Tishler argues that cannabinoid hyperemesis syndrome, or CHS, is being “dangerously” over-diagnosed in Massachusetts emergency rooms. Sadly, his conclusion is predicated on anecdotal studies and his personal casual polling of his colleagues — not any exhausting information or statistics.
I’m a practising gastroenterologist and a CHS researcher, and our group’s epidemiological work reveals the other. Following our evaluation of Massachusetts emergency rooms between 2012 and 2021 (greater than 15 million visits), we discovered circumstances of CHS skyrocketed by greater than 1,350%. In our research, revealed within the American Journal of Gastroenterology on June 13, we had been cautious to solely rely CHS diagnoses after ruling out different causes of nausea and vomiting which may have in any other case confounded the prognosis.
Concerningly, the rise in CHS circumstances was largest in youthful adults between 18 and 34, a inhabitants typically the most weak to advertising and on the highest threat of growing substance habit. Moreover, the rising concentrations and efficiency of tetrahydrocannabinol — the lively ingredient THC in hashish — parallels the elevated threat of emergency room visits for CHS.
Our work helps Tishler’s assertion that CHS has led to rising prices which have overburdened an already straining well being care system, with my very own hospital spending 150% extra on CHS-related hospitalizations following hashish legalization.
Nevertheless, we discovered that these prices are as a result of our well being care staff performing X-rays, CT scans, and endoscopies, amongst different research, to rule out various situations, earlier than reaching a CHS prognosis. Different well being care techniques have cited related traits within the excessive prices attributed to diagnosing CHS.
Our state and well being care system have to do a greater job of diagnosing and supporting individuals with cannabis-related ailments. We’d like a nationwide billing code for CHS to higher perceive its prevalence. Medical techniques want to coach clinicians in methods to sensitively ask questions on hashish use, and discover ways to interact individuals in a nonjudgmental means. In Massachusetts, we want cash put aside from the record-breaking $1.64 billion in gross hashish gross sales final 12 months ($272 million in Massachusetts tax income in 2024) to fund analysis to higher perceive each good and dangerous results of vast public consumption of hashish.
As hashish use accelerates, we have to sensitively deal with methods to higher acknowledge and deal with CHS — a situation that we’ve proven to be rising in prevalence. Denying or ignoring that CHS circumstances are rising shouldn’t be the answer.
— Sushrut Jangi, M.D., gastroenterologist at Tufts Medical Heart and assistant professor at Tufts College College of Medication.
The response
A specialist in London, Ontario, strongly prompt that my morning nausea and throwing up was CHS. Despite the fact that I instructed him that my signs had been solely within the morning and as soon as I purged I felt higher, he stopped listening to me. I’d by no means needed to have a sizzling bathtub to alleviate my nausea. I nonetheless smoke marijuana to this present day, and no matter had been taking place within the mornings stopped. This physician made me really feel defensive as a result of I may inform he’d made up his thoughts. Very irritating expertise for me.
— Linda Hay
The response
As a lately retired emergency division doctor, I discover that this text does certainly elevate a sound level about anchoring. There are various sufferers whose look, frequent visits, historical past of drug or alcohol abuse, or one thing else set off an anchoring response amongst us. We as ED suppliers should be very cautious about recognizing and overcoming our biases.
Nevertheless, extensively working each affected person up who makes use of marijuana and presents with nausea and vomiting raises different crucial points. SMA syndrome could be very, very uncommon — hashish hyperemesis syndrome shouldn’t be. Ought to belly CTs be ordered on every affected person suspected of getting hyperemesis hashish? This may result in pointless radiation, extreme value, incidental findings which in flip may provoke nervousness and trigger pointless work up. The overwhelming majority of such circumstances don’t require CT scans.
Moreover, CT scans, particularly in youthful sufferers, improve lifetime threat of most cancers. If a small nodule, which is usually discovered on CT, is famous, then additional work-up with periodic CTs could also be indicated, despite the fact that the chance of that nodule growing the most cancers could be very small. I’ve witnessed colleagues who, sooner or later of their ED profession, missed a uncommon situation after which subsequently in each related case ordered in depth, pointless labs and CTs. In conclusion, neither anchoring nor in search of “zebras” (medical jargon for uncommon situations) in every case is an effective medical observe.
— Rick Tietz
The story
“PhRMA CEO: ‘Most-favored nation’ coverage isn’t the best way to decrease drug costs,” by Stephen J. Ubl
The response
Huge Pharma is doing what it does finest: defending its income by misrepresenting the information. PhRMA CEO Stephen J. Ubl’s arguments in his current op-ed towards President Trump’s most-favored nation (MFN) government order distorts the fact of america’ sky-high drug costs. Right here’s the reality: Trump’s MFN government order takes a crucial first step in tackling excessive drug costs by tying American drug costs to the bottom worth in different comparable nations. The Trump administration rightly factors out that america represents lower than 5% of the world’s inhabitants however funds round three-quarters of worldwide pharmaceutical income.
And that’s no accident. Huge Pharma expenses Individuals over 3 times greater than different rich nations for a similar medicine and isn’t doing something to adjust to the Trump administration’s EO — even if 78% of American voters assist its efforts to decrease American drug costs consistent with these overseas. As a substitute, drug producers have centered on exporting their affect overseas to boost costs in Europe — a tactic to keep away from dropping drug costs for Individuals.
The information are clear: Huge Pharma prioritizes its income forward of Individuals’ pursuits. The trade has deployed an arsenal of direct-to-consumer ads and anti-competitive techniques to cover the reality from its function in skyrocketing drug costs, whereas spreading fears that innovation will gradual if costs lower. We all know that is merely unfaithful, as a current evaluation of the ten largest pharmaceutical firms discovered that they spent $36 billion extra on promoting medicine than on R&D in a single 12 months.
What’s extra, Huge Pharma routinely exploits the U.S. patent system to dam cheaper, generic options from coming into the market. Fortunately, lawmakers have launched laws to encourage extra generic rivals to enter the market.
The American individuals acknowledge Huge Pharma’s playbook and are supportive of President Trump’s efforts to present Individuals a greater deal. A current nationwide survey discovered that 85% of American voters assist broader “America First” pharmaceutical reforms.
The Trump administration and lawmakers have taken essential first steps, however they should comply with by way of on these commonsense reforms to make sure that Huge Pharma stops its profiteering off American sufferers.
— J.D. Hayworth, spokesperson for the Pharmaceutical Reform Alliance and consultant for Arizona within the U.S. Home of Representatives from 1995-2007
The story
“The U.S. should spend money on mRNA vaccines towards pandemic influenza viruses now,” by Steve Osofsky
The response
Steve Osofsky notes that Operation Warp Pace saved lives not solely in america, however world wide. Residing in Canada, I benefitted from immediate entry to Covid vaccines made by Moderna and Pfizer. The willful ignorance of the present administration equally places in danger not simply the lives of residents and residents of america, however the peoples of the world. There isn’t any doubt that Canada and plenty of different nations have been freeloading on army preparedness. However the choice to cancel contracts with Moderna by the wealthiest nation on this planet reveals a set of values that lack an ethical basis.
— John G. Hollins, Ph.D.
