Letters to the Editor   is a periodic feature. We  welcome all comments   and will publish a selection. We edit for length and clarity and require full names.

— Catherine Arnst, New York City

Seeing Vision Care for What It Is

Thank you for telling the story of EyeCare Partners and others ( Patients for Profit : “ Private Equity Sees the Billions in Attention Care as Firms Target High-Profit Procedures , ” Sept. 19). I went to EyeCare once. All I will say is I will never go back. I also went to a private-practice ophthalmologist. He should be ashamed of himself.

Unfortunately, doctors themselves are ruining their profession’s reputation. Please continue your stories to help us get at least halfway-decent care. I have no hope associated with it ever returning in order to good care.

Your story brings out one old-time fact: Patients need to know that an overly busy doctor does not necessarily mean a “good” doctor. Thank you again.

— Hazel M. White, St. Louis

— Julie Doll, Garden City, Kansas

American Herbal Products Association Weighs In on White Mulberry Leaf

The article written by Samantha Young on the untimely death of Lori McClintock, the wife of California congressman Tom McClintock, used this tragic event to challenge the robust regulation of dietary supplements by the federal government, despite there being zero information in the report showing that Lori McClintock consumed white mulberry leaf as a dietary supplement (“ Congressman’s Wife Died After Taking Herbal Remedy Marketed for Diabetes and Weight Loss , ” Aug. 24).

White mulberry leaf is normally administered with regard to therapeutic use in the form of a tea or powdered extract, plus the leaf is also used as a food ingredient. The two most comprehensive and authoritative English language compendia associated with traditional Chinese medicine — “Chinese Herbal Medicine” and “Chinese Medical Herbology and Pharmacology” — do not list any significant cautions or contraindications associated with mulberry leaf use.

Most clinical trials studying whitened mulberry leaf report no adverse events, although some placebo-controlled studies have reported minor gastrointestinal issues — such as a good upset stomach. A pooled analysis of these studies found no statistically significant difference in adverse events between participants receiving mulberry leaf and the placebo.

The scientific consensus around the safety of white mulberry leaf is also reflected in the “Botanical Safety Handbook, ” maintained from the American Herbal Items Association and subject to strict standards associated with expert review. The contributing experts placed white mulberry bags leaf in the reference’s safest classification based on an extensive review of the particular scientific literature. This category process included a systematic literature evaluation covering acute, short-term, plus sub-chronic toxicity studies as well as in vitro, human, and animal research. The reviewers also searched for, and did not identify, any kind of case reports in which white mulberry sale leaf produced a suspected drug or dietary supplement interaction.

Lori McClintock’s death certificate and the accompanying coroner’s statement identify the cause of death in order to be dehydration due to gastroenteritis due to adverse effects of white mulberry leaf ingestion. The particular coroner’s record states that will “a partial plant leaf” was present in the belly and that “portions associated with tablets plus capsules [were not] discerned inside the abdomen. ” A University of California-Davis botanist identified the particular material because white mulberry leaf and stated, “White mulberry is not toxic. ”

While the death certification declares “an autopsy along with toxicology testing confirmed the particular cause associated with death, ” there is no toxicology test regarding white mulberry bags, and none of the toxicology testing performed intended for other unrelated drugs or even common toxins revealed anything linking the particular death in order to white mulberry sale.

The coroner’s report failed to explain whether or not there was evidence of any specific product(s) the deceased might have been taking, and ultimately how a conclusion was drawn to implicate white mulberry. Without this information, it is not possible to corroborate the coroner’s findings plus conclusions.

Moreover, nearly half of the article is presented as a criticism of the robust federal rules of dietary supplements, claiming that “McClintock’s death underscores the risks from the vast, booming market of diet supplements and herbal remedies. ” The article reviews that two cases of people “sickened simply by mulberry supplements” have been reported to the FDA since 2004 and that will “[a]t least one of those cases led to hospitalization. ” AHPA has reviewed the publicly available records of these 2 cases plus notes the following significant details omitted from the particular article:

• A 77-year-old woman has been hospitalized in July 2008 with conditions described as including diabetes mellitus, gallbladder disorder, hypotension, myocardial infarction, renal disorder, and thrombosis; whether these conditions were preexisting is just not clear within the currently available public record. This record identifies 31 dietary supplements (including a mulberry leaf product) associated with this case.
• In the other case, a 63-year-old woman was reported since taking four products — goji berry; a combination of cinnamon extract, Gymnema sylvestre leaf, and mulberry bags leaf; the multivitamin; plus fish oil. She had been diagnosed with hypoesthesia (numbness) and was hospitalized in December 2009.

AHPA has obtained these two undesirable event reports through a Freedom of Information Act request. The particular conclusion attracted by the KHN article that either of those reviews represents an individual who was “sickened by mulberry sale supplements” will be simply not substantiated with the FDA’s database.

Given that consumption of white-colored mulberry leaf was unlikely to have already been a direct or indirect cause of Lori McClintock’s death, the Sacramento County Coroner’s Office should seriously consider conducting additional investigations and, as appropriate, revising the particular death certificate.

— Michael McGuffin, president, Us Herbal Products Association, Silver Spring, Maryland

— Keith Vance, Gaithersburg, Baltimore

Two Ways to Cut Medical Debt

Your own recent post “ Upended: How Medical Financial debt Changed Their Lives ” (Aug. 18) was very powerful and informative. Many thanks very much for your efforts.

There are two reforms that would greatly relieve the financial suffering of your subjects:

1. We need a law stating that if a health insurance claim is denied, and if the patient was not aware this could happen, then the patient is not really liable to get the charges. Medicare has had this rule for decades. With such a rule, the particular providers plus insurers can fight out their disputes and the patient will certainly not be harmed.

2. Patients with large medical debts ought to have access to a low-cost, federally funded bankruptcy attorney. Some associated with your topics seem not to have been aware of the bankruptcy option. Others made heartbreaking mistakes like cashing in retirement accounts, when that is unnecessary in personal bankruptcy. Most hospitals are ready to negotiate and reduce large bills, if a halfway-aggressive attorney or even consultant approaches them on a timely basis. Your subjects were, sadly, isolated and unadvised.

Thanks again for the work.

— Bob Hertz, St . Paul, Minnesota

— Lee Moss, Salt Lake City

Homelessness plus Social ‘In’-Security

I read your story within the Supplemental Security Income program and the particular woman inside the homeless shelter (“ The Disability Program Promised to Lift People From Poverty. Instead, It Left Many Homeless , ” Sept. 16). We lived within homeless shelters in St Louis and Mobile, Alabama, and there is something you left out of your content: If you live in a homeless shelter, the Social Security Administration may lower your SSI benefit even more because they figure you’re not really paying rent so you’re not entitled to full benefits. This did that will to me when I was in Mobile. It also happened to the friend associated with mine inside St . Louis. The agency reduced hers by $200. That’s exactly the time we need our entire benefits, so we can find a place.

— Lauralee Wiltsie, Bay Minette, Alabama

— Dennis Culhane, Philadelphia

Seniors in Need of a Lifeline

I’m a senior living in affordable housing and is thus sad. Not just because I can’t afford to take care of my personal needs the way I used to, but due to the fact I feel as if simply no one cares about seniors anymore. I actually read in one of your own stories it’s too expensive to stay alive ( Navigating Aging : “ ‘It’s Becoming Too Expensive to Live’: Anxious Older Adults Try to Cope With Limited Budgets , ” Sept. 7). During the height of the pandemic, people were so kind and I did have enough food in order to eat. Now that things are usually almost back to normal, people have started acting mean again. They just don’t care about us senior citizens. Help all of us.

— Barbara Little, Atlanta

— Ramsey Alwin, Washington, D. C.

Only One Side associated with the Story?

I listened to Dr . Elisabeth Rosenthal’s comments on CBS News this particular morning ( Bill of the Month : “ Watch: Crashing Into Surprise Ambulance Bills , ” Aug. 24).

First, her comments about coverage pertaining to ground ambulances being excluded from the federal government No Surprises Act, which usually purportedly guards against surprise medical bills. She said: “There’s some speculation that ground ambulances are revenue generators meant for many local fire departments. ” While that may be true in rare cases, most emergency medical services that are nonprofit barely get simply by. Why? Because insurance companies do not pay ambulances correctly.

Have a heart attack and EMS might bill you $1, 100. Insurance companies pay $400. Medicare pays around $300 for the particular same call. Medicaid pays $200 for the same call.

Let me put it another way: You own a restaurant. A person offer the dinner designed for two just for $100. You bill the person’s dinner insurance. It pays $40. This costs the particular restaurant $60 to put the meal together, which includes staff pay and utilities. You just lost $20 plus made nothing to put back into the business. How long are you going to stay in business?

Ambulance companies do not join insurance companies’ networks because they are offered a lower pay out rate in order to be in-network — so why should we join?

Allow me to put this yet another way: The fire department is run by municipality as well as the taxpayer pays for it. You pay approximately $600 per household in taxes for fire protection each year. So over 10 years, many taxpayers have paid $6, 000 for open fire protection they never utilized. But most municipalities usually do not fund EMS.

If you’re going to treat this story fairly, maybe have all the facts about EMS — not really just 1 side of it.

And as for shock billing, a person called 911 to get a ground ambulance to come. How is the expenses a surprise?

— Anthony Tucci, West Lawn, Pennsylvania

— Jon Wallner, Montgomery County, Pennsylvania

This article was really one-sided. Nonprofit ambulance services are being lumped into this mix unfairly. Inside addition, some states have enacted their own ground portion of the government No Impresses Act. I possess seen commercial insurance companies sticking the patient with a greater responsibility for the particular cost of emergency services than before the No Surprises Take action and yet the insurance companies themselves now reimburse at only around 67%, when these people used to spend nearly 100% of claimed charges.

In addition, a lot more ambulance businesses would join commercial insurance coverage companies’ systems if they will received fair, timely reimbursement. There are so many ground ambulance companies going out of company due to insurance policy company games, inappropriate denials, and lack of payment.

— Jennifer Costello, Columbus, Ohio

— Kathryn A. Phillips, San Francisco

If It is Broken, Fix It

I am a family practice physician. Spinning off of your Bill from the Month series, I think it would be extremely beneficial to publish more tales on what health care plus costs look like abroad. Hospitals and providers are simply functioning within a broken system. Of course , costs are astronomical whenever many of the mainstays on the particular Fortune 500 list are usually insurance providers. We think people (i. e., voters) need to hear more about what health care would seem like if Medicare and Medicaid were the only payers. The particular broken system exists, and people need to know how to work through that, but people furthermore need in order to hear that will there are other equally effective ways of delivering health treatment.

— Doctor Justin Riederer, Asheville, North Carolina

— Bill Kimler, Greenwood, South Carolina

An ‘Inherently Abusive and Ineffective’ Treatment for Autism

As a member of the autistic community (and the trained journalist myself), I am deeply disturbed by the particular recent write-up “‘So Rudderless’: A Couple’s Quest for Autism Treatment for Their Son Hits Repeated Obstacles” (July 21), simply by Michelle Andrews.

This article appears to be a follow-up to an article written by Andy Miller plus Jenny Gold and published on March 30. Both articles uncritically promote applied behavior analysis (ABA) and falsely portray families unable to access ABA as victims of the pandemic and/or healthcare bureaucracy.

You should be aware that both articles taint KHN’s reputation because a reliable source with regard to medical/health care news plus information and do not meet even basic journalistic standards.

ABA is a good inherently abusive and ineffective pseudoscience designed not to enhance the lives of autistic people, but rather to force us in order to suppress our autistic traits and perform neurotypical ones. Among the particular critics are usually survivors of ABA (Julia Bascom associated with the Autistic Self Advocacy Network and Amy Sequenzia of the Autistic Women & Nonbinary Network being two prominent examples). Further, for the past several years, the particular Department of Defense Office of Inspector General offers found that will ABA is largely ineffective, even by its own standards. None of this has been mentioned within either post.

Your content articles also do not mention the origins of ABA, including the fact that the particular practice has been pioneered by O. Ivar Lovaas, the same man who helped pioneer gay/trans conversion therapy and had been infamous regarding “treating” autistic children along with electric shocks and corporal punishment. They also did not mention critics’ specific concerns about presently practiced ABA, including that it teaches autistic individuals that they have no right to say no and that, if they do say no, they’ll be physically and verbally bulldozed in to compliance.

I actually also did not see any reference in your articles towards the 2018 survey conducted simply by autistic researcher Henny Kupferstein, which found that autistic individuals exposed to ABA were 86% more likely to exhibit symptoms consistent with post-traumatic stress disorder.

The few points I’ve mentioned above hardly scratch the surface regarding the particular controversy surrounding ABA. However, your reporters chose not really to reach out to any notable critics associated with ABA for a quote or to cite any of their specific concerns.

Additional, your reporters didn’t get in touch with a single autistic source, despite both articles becoming about the autistic community. Despite how the autistic community is definitely infantilized plus portrayed since incompetent by various prominent “charities, ” like Autism Speaks, our own community as a whole is fully capable of stating our opinions and engaging in self-determination.

I might appreciate the response to this letter. Hopefully, you realize the seriousness of this matter and intend to distribute a follow-up article examining ABA’s rampant abuses.

— Matthew Zeidman, New Hyde Park, New York

— The Children and Youth With Special Health Care Needs National Research Network, Denver