Many digital health products fail to offer sufficient ROI, and other letters

Regarding “Digital health firms, say goodbye to easy venture capital," great article. I attended the J.P. Morgan Healthcare Conference, and as a physician, I am inundated by sales pitches and e-mails that offer another app to use or portal for me to check, adding work with no return on investment for me as a physician. The products that really understand our workflow will rise to the top.

Dr. Randall Porter

Barrow Neurological Institute; founder and chairmanThe Medical MemoryPhoenix

Regarding “California hospital doesn't have to do tubal ligation, judge rules," the judge made the correct decision. Liberal organizations and their lawyers have intensified their attacks recently on organizations that practice the beliefs of their founders, and this practice should be strongly resisted. Other than when needing true emergent care, people can go to doctors and hospitals that share their personal beliefs—as this woman could. And the idea that this is sex discrimination is preposterous: Catholic organizations will not normally perform voluntary sterilization procedures on men either. This woman can either deliver elsewhere if she chooses (although inconvenient to her, it should be possible), or deliver at the Catholic facility, then have the sterilization elsewhere.

The “medical treatment” argument is faulty. Fertility is the natural state; thus, how can sterilization (suppressing permanently the natural state) truly be considered medical treatment, unless another pregnancy would clearly endanger the woman's life?

And the “government money” argument is also faulty: Hospitals are not being paid flat amounts by the government to perform all “medical services”; they are being paid, by one method or another, to perform specific, individual services, or bundles of services, on government-covered patients. They normally have no obligation to perform specific non-emergent, non-active-labor services.

Ross Case

Edwardsville, Ill.

Regarding the recent article “CRNA profession at a crossroads," even dating to before Dr. Charles Mayo taught one of his nurses to do anesthesia, the history of safe practices by nurse anesthetists cannot be denied. I am a proud member of the certified registered nurse anesthetist profession, and for the past 35 years of practice, I was a sole provider of anesthesia services with a perfect safety record. There were no anesthesiologists present, unless they were on the OR table and being anesthetized by me. The federal government recognized our right to independent practice when CRNAs became the first nursing specialty to be reimbursed by Medicare. Economically responsible and measured quality care—the perfect solution for anesthesia care.

Jan Mannino

Laguna Niguel, Calif.