Readers respond to essays on young caregivers, digital health, and more

To encourage robust, good-faith discussion about issues raised in First Opinion, STAT publishes selected Letters to the Editor received in response to these essays. Submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.

“Digital health: A case of mistaken identity” by Omar Manejwala

This essay is based on a common but misguided assumption that all digital therapeutics are created equal and should be viewed the same way. Commenting on the category, Manejwala writes, “Most digital therapeutic solutions are not intended to be replacements for medications. Instead, they do what medications never could: influence the behaviors and habits of those who use them.”

Not all digital therapeutics act through behavioral mechanisms. One area Manejwala does not mention is ophthalmology, where clinical studies have proven the efficacy of digital therapeutics in improving vision for patients with amblyopia, the leading cause of vision loss in children. These treatments work by delivering therapeutic visual stimuli to the brain, have been proven in multiple clinical trials to improve vision, and are currently being prescribed through a pharmacy by ophthalmologists across the U.S.

Just as we wouldn’t compare an oncology drug to an eye drop, it is far-reaching to assume that all prescription digital therapeutics are the same. It would be more responsible to evaluate each new technology on its own merits.

— Scott Xiao, Luminopia

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I thoroughly enjoyed reading this article.

I work in a facility where we are trying to deploy digital innovations to help manage chronic conditions, particularly hypertension, diabetes, and mental health. In my experience, sustained behavioral change and habits that will drive good health outcomes should be on the part of both patients and health care providers .Health care workers are yet to fully appreciate and deploy these tools to help their patients.

Patients are also yet to fully understand and utilize and pay for these tools for their well-being. The identity crisis is on both sides.

I am yet to fully appreciate what companies of these tools position them in my setting.

We hope to get there soon in Sub-Saharan Africa.

— Emmanuel Amoah, University of Ghana Medical Center

“Caring for young caregivers, a hidden population” by Kimia Heydari and Romila Santra

This essay on caring for young caregivers, a hidden population, reminded me of my own family. My parents were deaf and very independent, but my mother was very sick when I was growing up. I had to do multiple things, including translating from hearing people calling on the phone to my parents talking on the phone with companies when I was young. My brother and sister and I had to grow up fast. My mother died when I was 14 years old and my sister died when I was 9 years old.

Darryl Blackwell, public sector professional

“Addressing health care workers’ trauma can help fight burnout” by Sadie Elisseou

Sadie: this is such a powerful story about health care workers, especially trauma care workers. Those amazing warriors see it all, around the clock, every day.

God love all of them!

— Sean McDowell, North Las Vegas

“Pandemic lessons must spur federal action to protect nursing home residents” by Julie K. Taitsman and Nancy Harrison

There are countless things CMS could do to protect vulnerable older adults in nursing homes beyond the fascination with staffing hours. The billing complexity for vaccination services for residents, based on whether or not they are in their skilled stay is one example. Depending on the vaccine, it may require pharmacy billing or nursing home billing, it may be covered or not covered, and who administers and reports the vaccination may differ. Staff members may not be able to be vaccinated when services are being provided by the nursing home. They may be required to go off site and elsewhere. We may lose them when they are ready to receive it.

CMS spends far too much time mandating and punishing and far too little time working alongside nursing homes to make the systems easier and more effective.

— Chad Worz, PharmD