STAT’s First Opinion editor collected selected Letters to the Editor responding to recent essays on medical education, artificial intelligence, grief, postpartum psychiatry, and surrogacy. Contributors include organizational representatives, practicing clinicians, and academic researchers who expand on and critique the arguments raised in the original pieces.
Respondents pushed back on proposals to eliminate distinctions between M.D. and D.O. education. Robert Cain, writing for the American Association of Colleges of Osteopathic Medicine, argued that osteopathic medical education encompasses more than administrative or accreditation differences and that it embodies an intentionally organized cognitive architecture. That architecture, he wrote, integrates biomedical, clinical, health-systems, and biomechanical sciences, together with concepts aligned with complexity science, into a coherent framework that shapes clinical reasoning and physician formation.
Cain emphasized that osteopathic philosophy acts as an integrative lens: it cultivates physicians who aim to promote and maintain health as well as treat disease, value relationships alongside diagnoses, recognize links between structure and function, and apply medical, surgical, manual, behavioral, and social interventions as complementary tools. He noted that osteopathic medical education is growing — about 30% of U.S. medical students train at colleges of osteopathic medicine — and argued for preserving osteopathic principles rather than subsuming them into a single allopathic pathway. He also expressed support for policy efforts to expand fair residency access, citing the FAIR Act as one approach to address inequities in residency placement without eliminating the osteopathic pathway.
Other readers described workplace realities and practical differences in training. Sharon McKelvey praised the original article and said patients and colleagues judged her by her care and openness to feedback rather than her D.O. credential. She raised concerns about the economic incentives surrounding credentialing boards and suggested that credentialing and maintenance-of-certification processes may persist because they generate revenue. She questioned whether current board processes and continuing education requirements — along with legal accountability — might already suffice to ensure physicians keep current.
Alfred Sassler of the University of Cincinnati Medical Center highlighted differences beyond osteopathic manipulative treatment, characterizing D.O. training as beginning with a broad emphasis on history taking and physical diagnosis that fosters a holistic clinical approach and a higher proportion of graduates entering primary care. He noted that osteopathic curricula teach evidence-based medicine and surgery alongside osteopathic manipulative medicine, and that many osteopathic physicians embrace these unique aspects throughout their careers.
Responding to an essay arguing that medical AI will further diminish physician autonomy, Jody Whitehouse, M.D., agreed that autonomy has eroded over time. Whitehouse framed physicians as workers in a system where control resides with owners of the means of production — insurers, corporate entities, and investors — and suggested that new technologies, including AI, will be deployed chiefly for cost savings rather than to improve patient care. She cautioned that AI tools used by clinicians for documentation could be outcompeted by insurer-facing AI systems designed to identify overcoding.
Whitehouse urged physicians not to passively accept these developments and called for organization and collective action, while expressing skepticism about current professional organizations’ independence given ties to corporate interests.
A reader responding to an essay about “whale songs” and experiences of grief connected the author’s descriptions to their own experience working at ground zero after Sept. 11. Naomi Boak of the National Park Service recounted accompanying grieving families with a therapy dog and described hearing a distinctive wail among bereaved mothers. She compared human grief manifestations to observations of grieving behavior in wildlife and argued for more study and social acceptance of grief’s processes.
In reply to a piece on the Lindsay Clancy case and the limits of postpartum psychiatry, Golan Shahar of Ben-Gurion University argued that the authors rightly highlighted gaps in scientific precision about postpartum psychopathology. Shahar advocated for integrating clinical psychological science with psychiatry to achieve greater precision in risk assessment and intervention. He listed methodological tools developed over recent decades — psychometrically validated self-report measures, semi-structured interviews, computerized cognitive-affective tasks, and validation against neural and behavioral markers — that can refine identification of risk and protective factors.
Shahar emphasized malignant self-criticism as a documented risk factor across psychopathology, including postpartum depression and anxiety, and suggested it may worsen mother–child communication and treatment response. He recommended collaboration between psychiatry and psychology to build a biopsychosocial precision approach to prevention and treatment. Shahar acknowledged that one cannot know whether self-criticism contributed to any individual tragic case, but he argued for broadening scientific markers and interdisciplinary practice.
A reader responding to an essay on ethical reforms for surrogacy critiqued the underlying concept of surrogacy itself, calling attention to patriarchal assumptions that privilege gametes over the pregnant person. The letter began to argue that cultural framings treat the pregnant person as a vessel rather than a substantive participant in parenthood, but the published extract ends before the full argument was presented.
These letters reflect a range of perspectives from organizational spokespeople, clinicians, and scholars. They underscore persistent debates about professional identity and training pathways in medicine, the influence of technology and corporate incentives on clinical autonomy, the need for interdisciplinary scientific approaches in mental health, and ethical tensions in reproductive practices. STAT invites continued submissions of Letters to the Editor in response to First Opinion essays.