When the surgeon general issued an advisory about the mental health of parents in the U.S. a couple of weeks ago, I knew I wanted First Opinion to cover it. I considered a few approaches: an assessment of how Vivek Murthy has approached the job, perhaps, or a deeper look at why parents are struggling. I'm still interested in the former, but the latter felt a bit too obvious.
Then I got a submission that really resonated with me. Ruby Mehta, head of behavioral health at Cityblock Health, wrote a smart piece arguing that the advisory's recommendations are "not nearly enough for the Medicaid population." As Mehta points out, people on Medicaid have an even harder time than the rest of the U.S. when it comes to finding a psychiatrist. Addressing that would help, but she also suggests "holistic approaches that begin with and last throughout pregnancy, such as further expansion of doula services under Medicaid to include doula services during both pregnancy and postpartum."
I was an easy target for this piece, because a postpartum doula saved me when I had a baby earlier this year. My baby is 6 months, but Kelly still comes by a few hours a week. She has cared not just for the baby but also for me, helping me heal physically and emotionally. My parents are both gone, so having a warm, kind person to tell me I'm doing OK, demonstrate how to use baffling baby gear, and promise the spit-up will end has been invaluable. At one point, I was working with a lactation consultant who texted me, "Everyone should have a Kelly," and I agree. My husband and I (probably?) could have done it without her, but we wouldn't have thrived. (If you're in the Philly area and want her info, email me.)
And I'm a white upper-middle-class woman the system is built for. Someone like Kelly could make an even bigger difference for someone less privileged, as Mehta writes: "Doula support can … provide a vital source of compassionate, consistent support in a system that struggles to gain the trust of those on Medicaid." I couldn't agree more.
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Also in First Opinion this week: Cardiologist Vishal Khetpal writes about steering his patients away from online compounded semaglutide. Were you alarmed by that recent New York Times article on doctors disregarding do-not-resuscitate orders? Lindsey Ulin, a palliative care physician fellow, explains that doctors receive very little education on how to talk to patients about DNRs. Giving birth in the U.S. is such a billing nightmare that even the CEO of a health care price transparency company struggled to estimate how much his baby's delivery would cost. Michelle C. Werner, a biotech CEO and mother of a teenager with Duchenne muscular dystrophy, writes about how a year of DMD breakthroughs has, in many ways, made things even more confusing for families. Jeffrey Flier, former dean of Harvard Medical School, shares the story of his work on GLP-1s in the early '90s—and how Pfizer shelved it. (The piece is based on a longer article he wrote for Perspectives in Biology and Medicine.) And in STAT+, Jack Hooper of Take Command writes about what the presidential election could mean for ICHRA, while Kendalle Burlin O'Connell of MassBio argues that the BIOSECURE Act, recently passed by the House, needs to come with more resources for the biotech industry.
Recommendation of the week: We're closing in on spooky season, and what's scarier than going to the dentist? I am still recovering from Angelina Chapin's fantastic feature in The Cut on how veneers mean "pain, debt, and regret" for many people who started out with perfectly good teeth.
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