First Opinion is STAT’s platform for interesting, illuminating, and provocative articles about the life sciences writ large, written by biotech insiders, health care workers, researchers, and others.
To encourage robust, good-faith discussion about 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.
The story
“Beware elected leaders who would weaken patents,” by Daniel M. Skovronsky
The response
Daniel Skovronsky’s defense of the current patent system overlooks its fundamental flaws — chiefly, how it disproportionately rewards drugs with limited clinical impact, like Lilly’s donanemab for Alzheimer’s, while sidelining low-cost alternatives. Repurposed generics, nutraceuticals, biosimilars, and nonpharmaceutical options, like dietary and lifestyle interventions, offer far greater potential for improving health at a fraction of the cost. Yet our current “blockbuster drug” model under the patent system fails to incentivize these innovations. Patents can yield enormous multi-billion-dollar financial rewards relative to limited health benefits (e.g., in quality-adjusted life years gained).
However, instead of merely weakening patent protections, we should explore innovative payer reimbursement models that fund R&D for affordable therapies using the cost savings they generate. This approach enables payers to de-risk development for cost-effective therapies without financial risk, creating a sustainable model for medical innovation. For example, self-funding interventional pharmacoeconomic (IVPE) trials can identify affordable alternatives to high-cost therapies, where the cost savings of payers during the trial exceed its cost, effectively eliminating the financial risk.
Additionally, mechanisms like advance market commitments (AMCs) and outcomes-based contracts can reward data-driven approaches and algorithms for personalized, low-cost therapies — shifting focus from maximizing drug profits to maximizing health. Such a shift would promote value-driven, affordable innovations, tackling the unsustainable costs threatening health care systems — especially in the face of an aging population. Leveraging technologies like AI, which can identify low-cost therapies through analysis of medical records and scientific literature, would further boost the health impact of this novel approach.
— Savva Kerdemelidis, Public Good Pharma
The story
“It’s time for a new medical specialty in asynchronous care,” by Muthu Alagappan, Rishi Khakhkhar, and Ben Kornitzer
The response
I feel this is a great option in primary care medicine — but with guardrails. Primary care providers are overwhelmed, and patient portal questions only add to the burden. Just like urgent care centers, asynchronous medicine for patient queries could be great, or a disaster.
One option would be for the patient’s primary care practice to have the option to answer a query within 24 hours, with separate reimbursement going directly to the responding doc. That way, if possible, the PCP could be looped in and patient care would be optimized. If no one from the PCP group is available, the work could be farmed out to another vetted doc or group in the same specialty, again, with separate and guaranteed reimbursement, with a copy of said advice going to the PCP. Outsourced advice could be evaluated for accuracy and helpfulness to assure quality. It’s time for insurers to pay for separate physician points of contact without relying on primary care docs to work for free.
— Marc Grella, Massachusetts General Hospital
The story
“Beware hospital consolidation,” by Laura and John Arnold
The response
The authors get it right — hospital consolidation of independent community practices is bad news for physicians and patients. The current unlevel playing field is driving physicians out of private practice and into hospitals, where they’re often forced to make decisions that are best for the bottom line, not the patient. While physicians report a loss of autonomy when their practices are acquired, the consequences of consolidation also have a major impact on physicians who choose to remain independent.
For example, I was shocked when a local hospital revoked my inpatient oncology privileges after my practice refused a merger with their health system. Simply because I preferred to remain in the community setting, I suddenly found myself unable to care for my patients who had been hospitalized. As a result, I am now forced to hand them off to unfamiliar hospital-affiliated providers at a time when patients need an oncologist who has gotten to know them and their condition.
To make sure independent practices can stay not only operational but competitive, we need site-neutral payment reform — like that proposed in the Lower Costs, More Transparency Act — that closes the yawning gap between physician and hospital payments. Doing so would reduce the incentive for hospitals to gobble up physician practices and give patients more power to choose independent care.
— Moshe Chasky, M.D., Alliance Cancer Specialists
