Readers respond to mothers in treatment for opioid use disorder, pandemic models, and more

First Opinion is STAT’s platform for interesting, illuminating, and maybe even 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.

“Mothers in treatment for opioid use disorder shouldn’t also have to fight child protective services,” by Arthur Robin Williams and Judith Cole

I completely agree with this article and feel strongly that pregnant women have been wrongly “labeled” as unfit or not worthy of being a mother if they are using medications to help them get off illegal drugs. No parent alive would like it if their right to be a parent was made on the basis of a mistake or mistakes they might have made in their lives. If a woman is on methadone it’s because she’s trying to change, be a better person or mother so who are we to judge that and deem her unfit to be a parent??!! There are millions of parents who don’t take methadone who have no business being parents, so why punish the ones who are actively doing their best to become better parents?? Taking away a woman’s right to be a parent doesn’t make our community or society better, it just makes us bigger hypocrites

— Jonathan Classen

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When I lived in greater New Haven I worked as a volunteer at Yale New Haven Hospital as a “baby cuddler” for three hours every Saturday. I was assigned to the Children’s Clinical Research Center which cared for newborns born with opioids in their systems; they had to stay for 4-6 weeks to be slowly weaned from the opioids. They were in withdrawal and reminded me of kids with colic. We swaddled them, rocked them, fed them and changed them. Some of us sang to them.

During those years, 2000 to 2004, mothers on methadone were not kept from being with their babies and were allowed to take them home. Mothers not on prescribed maintenance drugs were allowed no contact and the child left the hospital at age 4 to 6 weeks to go directly to foster care. I hope the regulations can be corrected before more families are traumatized by this craziness.

— Sue Fraser Frankewicz

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Hi I think more needs to be done where child protective services are concerned. My children are in state custody because of their father’s substance use disorders. I have been sober for five years. CPS has too much power and the state hands it to them. I agree completely that mothers in recovery should be protected against these people. I think that the people should be protected from them in general. There needs to be more legislation that protects parents and their rights. I am glad that I saw this article because someone should fight against the injustice conducted by the state and federal regulation. Thank you for your time and keep it up.

— Chelsey Burnham

“Outdated Medicare rules prevent some dementia patients from accessing the medications they need,” by Carolyn Clevenger

I understand the desire to help reduce very difficult behavior among dementia patients, but the scientific evidence clearly indicates that antipsychotic drugs significantly increase the chances of an adverse event called “sudden death” among older patients. This is true for all atypical antipsychotics, including the one the FDA recently approved for dementia patients. Even when the results are not fatal, many family members report that their loved ones become almost completely uncommunicative and unresponsive because of the use of these medications in nursing homes and similar facilities. That is the reason why these medications should very rarely be used for older patients, especially those who are not able to make the decision for themselves.

— Diana Zuckerman, National Center for Health Research

“100,000 models show that not much was learned about stopping the Covid-19 pandemic,” by Eran Bendavid and Chirag Patel

Unsurprising conclusion.

Non-pharmaceutical interventions are all based upon “the science of human behavior” (behavioral psychology.)

Whatever useful insights it can provide public health researchers and policymakers, who must plug survey data into models based upon a set of clear assumptions; the limitations of these models are of a much greater magnitude than anyone in public health seems prepared to accept.

(At the best of times, human behavior can be inscrutable. During the worst, it’s almost unpredictable.)

Yet, in my years of researching public health policy making, I see again and again references to the success of the anti-smoking ad campaign.

In essence, every public health policy decision has become a new anti-smoking ad campaign.

(“Leverage the fear response” is a phrase that I have seen used over and over.)

What this study appears to be showing is that this strategy is long past its use by date.

What the authors also points up is much less surprising to anyone who has studied statistics and probability theory: frequentist statistical models can be designed to output results that gratify a researcher’s expectations.

In sum, I think this paper is showing that public health policy makers need to re-examine their basic assumptions, and public health institutions need to dedicate much more effort to addressing over-reliance on the available statistical/analytical tools.

Thus, I find it disappointing to hear the call sounded for “more data, more surveillance” from the authors.

It seems that they have entirely misread the results of their research.

— Michael Doran, Springfield, MA