Readers respond to H5N1 and livestock movements, insulin discontinuation, and more

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

“An AI-based second opinion service could improve clinical decision-making today,” by Adam Rodman and Arjun K. Manrai

Drs. Rodman and Manrai rightly argue that AI-based clinical decision-making tools can help clinicians overcome anchoring bias, but they do not discuss an additional cognitive bias that arises when humans use AI tools: automation bias. Automation bias arises when users of an assistive technology come to overly rely on the output of a tool, a phenomenon that worsens in resource- or time-constrained settings. While the authors pitch an AI-based second opinion service as akin to the second opinion of another human physician, the former carries the extra risk of automation bias. Empirical studies have shown that incorrect results from automated decision-making tools may color, or even change, a physician’s decision-making process, despite there being evidence to the contrary.

Though the authors suggest enacting an additional layer of human oversight before delivering the “second-opinion” to the ordering physician, they do not discuss a mitigation strategy for a scenario in which, over time, both reviewing and ordering physicians come to favor automated decision making systems over their own judgements. LLMs and AI tools will inevitably become invaluable tools in clinical-decision making, but the design, development, and deployment of these technologies require thorough consideration of all the possible effects, including behavioral changes of physician users.

— Anish Kumar, Icahn School of Medicine at Mount Sinai

“As livestock move around the country, so does H5N1. The U.S. needs real-time tracking of livestock movements,” by Shweta Bansal and Colleen Webb

Effective livestock disease management requires real-time tracking of animal movements. The recent spread of H5N1 avian influenza among U.S. dairy cows highlights the urgency of this need. With Caravan Tech’s innovative tracking system utilizing bolus and ear tag technology, livestock movements can be monitored in real-time, enabling rapid response to disease outbreaks. The key features of Caravan Tech’s tags and boluses include GPS tracking, temperature monitoring, and health status indicators, providing comprehensive data for disease surveillance and control. By incorporating this system, the U.S. can enhance its ability to detect and contain livestock diseases, safeguarding the nation’s agricultural economy and food security.

— Alex Joost Newbery, Caravan Tech

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For the past 40+ years, the Argos satellite system has been used to track wildlife movements across the globe. Ever watch Shark Week or hear about an entangled North Atlantic right whale being tracked to help disentangle it? That’s the Argos system at work. Developed by the French space agency in cooperation with the U.S.’ NOAA/NASA, the Argos system is the oldest system in place to track wildlife movement.

Only in the last few years have we begun to shift focus towards domestic livestock (commercial species) and have pilot projects in Australia, Siberia, and South Africa, to name just a few. The U.S. has been a bit more resistant partially because of cost implications, but this article does an excellent job at pointing out the pitfalls to a lack of tracking data.

We hope that in the future, all commercial species are tracking by some system to have a better understanding of movement patterns and how infectious diseases are traveling between individuals, species, and regions.

— Thomas Gray

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During my time working as the bovine tuberculosis epidemiologist in Michigan (from 2001 to 2008) we used electronic ear tags (EID) extensively in tracing movements of cattle in and out of bTB infected herds. The USDA has been attempting to implement an EID tagging system since this time; however, some producers (mostly Western cow/calf operations) have resisted this system, mainly because they feel these tags can be easily removed (cut out). Their main concern is theft and while EID cannot help reduce cattle rustling (not as well as branding does), branding does little to assist tracing of cattle if a disease situation arises. I feel the time has come where national disease traceability concerns should override any objections to the use of a country-wide EID system. Incentives for EID use a could be offered to resistant producers and/or movement restrictions for cattle not bearing EID (such as only one lifetime movement allowed) could be implemented. I feel the time is long passed where a national cattle disease traceability system should be given high priority and established as soon as possible.

— Larry Judge

“Cutting-edge insulin is good. But it’s the ‘trailing edge’ of older versions that can keep it affordable,” by Robin Feldman

Walmart sells R insulin, which is comparable to Humalog, for $25 a vial, and the syringes are only about $15 for a hundred. Yet under Part D and my doctor’s orders, I am not supposed to use this insulin. This makes no sense.

— Elaine King

“Measles is coming back. My sister Marcie isn’t,” by Emmi S. Herman

You gave your readers the best advice!! I remember Marcie. I remember the love and patience you always had for this very lovable woman! As terrible as this story is, Marcie was lucky enough to have the support and love from a very remarkable family. Not everyone is so fortunate, especially under these circumstances. It’s the, if only we had that vaccine for Marcie, people should hear and understand!!! Well, today people are lucky enough to avoid the devastating effects your family endured. This story and information should be published everywhere! What could have been and extraordinary and fulfilling life for this remarkable person, turned out to be a life of bullying, heartache, and robbed of all the happiness and promise she could have had. In this day and age, to not take advantage of the vaccines and other medical breakthroughs is quite unfortunate and shortsighted. Thank you for this beautiful paper and always being the kindest and most sensitive person I’m lucky enough to call my friend .

— Elizabeth Cohen

“What nurses really want: sufficient staffing for patient care,” by Karen B. Lasater and K. Jane Muir

Chronic short-staffing is the result of deliberate minimal hiring and reflects the fact that nurses are considered an expense to the bottom line, not an asset.

At yet another “meet your new CEO” meeting I was required to attend before I left nursing, we were told in pep-talk fashion that we were going to “do more with less.”

We must remove the burden of profit from health care. It attracts all the wrong intentions.

We must decouple health insurance from employment to allow nurses more control over their work-life balance.

Ideally we should dismantle the insurance industry, have the government subsidize the providers directly who can then deliver care to all. Perhaps some of those millions of insurance industry middlemen and women can be re-employed in professions closer to the direct care of patients.

And I DO mean PATIENTS, not “clients or “consumers.”

— Denise Jones