First Opinion readers respond to essays on Long Covid and other topics

FFirst Opinion is STAT's platform for interesting, informative, and possibly provocative articles about the life sciences, written by biotech professionals, health care workers, researchers, and others.

To encourage robust, good-faith discussion about the issues raised in First Opinion essays, STAT publishes selected letters to the editor received in response to them. You can submit a letter to the editor here, or find the submission form at the end of any First Opinion essay.

“Long Covid feels like a gun to my head,” by Rachel Hall-Clifford

As someone with a chronic illness, I just want to a) show my appreciation for the author and everyone else who is surviving and struggling to find answers about Long Covid and other post-viral syndromes, and b) make a public service announcement:

At this point it is well known in the community of people with Postural Orthostatic Tachycardia Syndrome (POTS) that Long Covid is primarily a trauma/virus induced disorder of the autonomic nervous system (also known as dysautonomia), specifically POTS. Many of us have been living with “long Covid” symptoms long before Covid came along. Coronavirus was highly likely to cause it in people genetically prone to autoimmunity and other precursors to POTS. I am sad that this is still not common knowledge for sufferers. Please seek help from a POTS specialist and continue to explore your underlying condition while you still have the energy, so you can finally have a fulfilling life. It is not easy and requires a lot of time and willpower. But it will be worth it. Do the best you can!

— Sandra Ivanov

“FDA: Don't rush to publish your diversity guidance plan. Take your time and do it right,” By Tami Elliott and Maria Vassileva

“Equity” in clinical trial participation does not mean that trials “look like America,” but rather that they “look like the clinical population.” But it’s not just about clinical trial participants. It’s equally important that we also expand diversity among clinical trial designers, recruiters, principal investigators, FDA review teams, and advisory committee members — not just patient representatives. This is not the end, it’s just the beginning, and the goal should not be diversity for diversity’s sake, but to facilitate better trials for better data, better agency review, better and more accurate labeling, resulting in better patient choices and outcomes.

— Peter Pitts, Center for Medicine in the Public Interest

“AI and rural health care: A paradigm shift in America’s heartland,” by Bill Gassen

I found some of AI's potential remedies confusing. While the article states that AI does save physicians time by reducing cognitive burden, the burden of responding to patients cannot be alleviated by text prompts. And those perfectly written clinical encounters must be thoroughly reviewed. Without knowing the reasons for high rates of later-stage cancer, risk calculators and reminders cannot fulfill their purported promise. Much of what AI promises is to fix the unintended consequences of a previous great idea, the electronic health record.

Can AI address the disparities in care our rural citizens receive? Perhaps. But this, like many other articles, is more about vested interests eyeing the latest shiny object that promises to “move fast, break things and apologize later.”

— Charles Dinerstein, American Council on Science and Health

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