Readers Write (Aug. 15): Doctor burnout, failed health care merger, middle-class patient access, GMOs, the U.S. and Afghanistan, media bias

As a recently retired physician, I found the Aug. 7 article "Doctors battling crisis of burnout" provocative. Kudos to the institutions and physicians who are struggling with this problem (especially Dr. Mark Linzer, who has been at the forefront of this issue for some time). However, as I read about efforts to "help doctors cope" with this problem, I was reminded of the well-worn but valuable public health analogy: Better to climb to the top of the cliff to prevent people from falling off than to hurry more ambulances to the foot of it to treat the injured.

One interpretation of this experience is that our health care "system" is fundamentally flawed by conflicts between expectations and resources. For example, in clinics, providers are being "measured" for their patients' satisfaction, including timeliness; nevertheless, they are also expected to "squeeze in" additional patients who have turned up without appointments. The electronic medical record and "home access" permits providers to spend a bit of time with their family, then sit down to the computer to finish "documentation" of their clinical activities of the day. Cost-conscious managers continue to reduce the number of support staff for providers but increase the number of tasks expected of them.

Treating the injured at the bottom of the cliff (the burned-out) is an unsustainable approach; rather, hospitals and clinics should be trying to fix the system that causes these problems in the first place. Solving the problem might be expected both to reduce costs (including those of provider replacement) and to improve care.

In the Aug. 9 article on the collapse of the Fairview-University of Minnesota merger, a former chief of cardiology linked the decline in the ranking of the university's research programs to the sale of the University of Minnesota Hospital to Fairview. This is an opinion that shouldn't have been accepted at face value. Data show that research funding and National Institutes of Health ranking at the U began declining in 1982, well before Fairview purchased the hospital in 1997. Rather than undermining research at the U, Fairview's purchase of the hospital saved it from financial disaster.

The reporter could have consulted publicly available information detailing factual causes for the U's research declines rather than reporting only one person's opinion. For example, the Governor's Blue Ribbon Commission on the University of Minnesota Medical School issued a report in January 2015 showing a sharp drop in NIH ranking in the early 1990s when the U was put on NIH "exceptional status" designation after the U.S. Food and Drug Administration shut down the U's production of ALG, an anti-rejection drug not approved by FDA. As noted in an MPR News article in 2006 (http://tinyurl.com/znhmcfw), "Before the scandal, the medical school enjoyed an NIH funding rank in the top 15 in the country. Afterward, the ranking slipped out of the top 20, even as NIH total funding nationally nearly doubled." This, combined with the departure of almost 90 tenured and tenure-track faculty members (many of whom took their research grants to their new institutions), are more accurate reasons for declining research ranking at the university.

I was encouraged by the Aug. 9 headline "More poor patients getting to doctor under health care law" — if by the statement you mean that the poor are using doctors in clinics more than using emergency rooms, that's a good thing. If a service (Medicaid) is free or low-cost, it will be used more, though complaints of health care delivery remain. The poor have never, in my 30 years of providing health care, had a lack of opportunity to access health care. Increased health insurance premiums, copays and outrageous deductibles contribute to providing health care to the poor but are pricing the middle class out of visiting doctors. Many middle-class families have simply foregone health insurance altogether.

I am curious to know if middle-class insured and uninsured are reducing their access to health care due to the increased costs, or if it is just me. Recently, I stepped on a rusty nail while mowing my daughter's lawn. I shut off the mower, removed the nail, removed my sock and shoe, poured some vodka on it, applied a bandage, then continued mowing.

One of the greatest ailments to American society today is the toxic stew of scientific illiteracy combined with confirmation bias for partisan conspiracy theories. An Aug. 10 letter ("OK, suppose they're safe. They still have a detrimental impact") illustrates the regressive left's version of scientific denial through the form of GMO conspiracies. While the writer admits that GMO foods are safe, he postulates that their environmental impact still makes them a hazard to society.

This view is erroneous on several fronts. First, there is nothing inherently problematic about GMOs with regard to their environmental impact. In fact, some GMOs are being developed with insect resistance encoded in their genes, rendering pesticides unnecessary. Second, the writer falsely claims that glyphosate (Roundup) is harmful to humans. A joint effort by the United Nations and the World Health Organization in 2016 concluded that "glyphosate is unlikely to pose a carcinogenic risk to humans from exposure through diet." A 2002 review by the European Union reached a similar conclusion. In addition, the claim that Roundup-resistant crops are doused in chemicals is completely false: For corn and soybeans, 16 ounces of glyphosate are sprayed over an acre. I would hardly consider that "dousing." Among other mammals, glyphosate has a "low to very low level of toxicity." If that isn't enough to convince anti-GMO advocates, a letter signed by 107 Nobel laureates states that GMOs "have been shown repeatedly to be less damaging to the environment, and a boon to global biodiversity."

Fellow Americans, who are we and what will become of us? The Aug. 10 article "Afghan translators wait for U.S. to fulfill promise" highlights the dangerous shortsightedness of our stalemate politics. The world recognizes it is morally corrupt for our lawmakers to renege on our pledge to protect thousands of translators and their families who aided us in the wars in Iraq and Afghanistan. Given this track record, who do you think will provide intelligence and material support when the battle against terrorism threatens more Americans at home and abroad?

I am always amazed at what passes for reporting in the Star Tribune, and the Aug. 10 article "Lewis tops 3 others in heated GOP District 2 Primary" was no exception. The article included the following comment on candidate Darlene Miller's take on Lewis: "She had publicized and criticized some of Lewis' outrageous radio comments and writings." Note that the sentence states as fact that his comments and writings were outrageous, not that Miller says they were.

Compare that with the following statement a few paragraphs later: "Meanwhile, the Minnesota Republican Party accused Craig" — Lewis' DFL opponent in the upcoming general election — "of having a radical left-wing agenda." Note the difference: Here the authors are careful to point out that it was the Republican Party that made the accusation, not that it is a fact. Anyone looking for proof of blatant liberal bias by the Star Tribune and its writers need look no further.