Letters to the Editor<\/a>\u00a0is a periodic feature. We\u00a0 welcome all comments<\/a>\u00a0and will publish a selection. We edit for length and clarity and require full names.<\/em><\/p>\n

On a \u2018Woke\u2019 Journalist\u2019s Journey<\/strong><\/p>\n

I found Jay Hancock\u2019s piece rather intriguing (\u201cSevere Sleep Apnea Diagnosis Panics Reporter Until He Finds a Simple, No-Cost Solution<\/a>,\u201d Oct. 3). While I agree that positional therapy is often overlooked as a first-line treatment for obstructive sleep apnea, one has to look at this serious, life-threatening health issue in a bit more detail. First, Mr. Hancock\u2019s diagnosis was central sleep apnea, which suggests either a neurologic and\/or breathing control etiology. Sleeping on the side may prevent airway obstruction, but the underlying cause has likely not been addressed. Second, the danger here is that \u2014 a bit like hypertension, with which there are little or no perceived symptoms \u2014 a catastrophic event might occur with little or no warning. Third, it sounds as if the positional therapy in this case alleviated the condition \u2014 but as one gets older, the condition will likely worsen. <\/p>\n

Bottom line: Why does this particular patient have this condition and what can be done to address the root cause instead of taking a symptomatic approach? My fear is that, left untreated, the patients fall asleep with a false sense of security to never wake up the next morning. <\/p>\n

\u2014 Dr. Dave Singh, an adjunct professor in sleep medicine at Stanford University, Oakland, California<\/em><\/p>\n

\n
Not loving the tone here. For every Jay Hancock, there are how many lives changed\/saved by CPAP therapy? https:\/\/t.co\/28XDe3JZib<\/a><\/p>\n
\u2014 Liz Beaulieu (@hmeliz) October 4, 2022<\/a><\/p><\/blockquote>\n
\u2014 Liz Beaulieu, Yarmouth, Maine<\/em><\/p>\n
Finally! Jay Hancock exposed the sleep apnea medical racket. I have another treatment option: During covid, many inpatients were intubated in the prone position. I was curious about that and did some Googling. Not only does sleeping on your stomach increase lung capacity, the gravity on the throat is a natural treatment for sleep apnea. While difficult to adapt to, it\u2019s better than a CPAP. Again, doctors don\u2019t mention it. No money in a simple gravity solution.<\/p>\n
\u2014 Peg Keohane, Syracuse, New York<\/em><\/p>\n
\n
A reminder of how medical providers work to drive up costs for treatment resulting in reduced pay for working Americans!”Unnecessary care is a big reason Americans\u2019 insurance costs \u2014 premiums, copays, and deductibles \u2014 tend to rise year after year.)”https:\/\/t.co\/F0zqPfGApS<\/a><\/p>\n
\u2014 Stanley Morrical (@StanMorrical) October 3, 2022<\/a><\/p><\/blockquote>\n
\u2014 Stanley Morrical, San Francisco<\/em><\/p>\n
I want to thank you for this very timely article. I have suspected there was more to the question of apnea than was being reported. As stated, it is a big industry that perpetuates the idea that everyone is affected.<\/p>\n
The reporter\u2019s discovery that side-sleeping is the answer is absolutely valid, as I determined long ago. The article should be widely disseminated as it is of extreme importance to millions who are falling for the hype!<\/p>\n
\u2014 Lawrence Dee, <\/em>Chino Valley, Arizona<\/em><\/p>\n
\n
Sleep apnea is over-diagnosed, based on guidelines set by an organization funded partly by makers of CPAP machines used to\u2026 treat sleep apnea, @JayHancock1<\/a> reports. An alternative \u201ctreatment\u201d is often overlooked: Sleep on your side! https:\/\/t.co\/29lohfjI6i<\/a> via @khnews<\/a><\/p>\n
\u2014 Robert Roy Britt (@RobertRoyBritt) October 4, 2022<\/a><\/p><\/blockquote>\n
\u2014 Robert Roy Britt, Phoenix<\/em><\/p>\n
My mouth dropped open when I read Jay Hancock\u2019s piece about sleep apnea. You are the harbinger of a tidal wave, my friend. The party is just getting started.<\/p>\n
Empowered Sleep Apnea is a project we created to protect individual patients from the \u201cconveyer belt\u201d of the American health care system, as it\u2019s poised to deal with tens of millions of new diagnoses of sleep apnea, which will soon be made in primary care and dental offices all over our great land, using automated, wearable technology. That time is coming within 18 months.<\/p>\n
You suffered because there was inadequate coaching for a terribly complicated disease. Simple as that. All those who will be subjected to a cloudburst of automated diagnostics will have the same journey to make. Out of necessity, your solution was to slog through your own research to get yourself some sane direction. You empowered yourself. Good on you.<\/p>\n
My solution was to take my life\u2019s work as a patient-centered sleep medicine physician and turn it into something beautiful to behold, so that everyone can benefit from sane coaching. Our project hinges on patient empowerment. Our website<\/a> is a nice introduction. Our podcast<\/a> is also a blast that I think your readers would find very interesting.<\/p>\n
\u2014 Dr. David E. McCarty, owner and CEO of Empowered Sleep Apnea, Boulder, Colorado<\/em><\/p>\n
\n
I\u2019m sure it works \u2013 excellent summary of messy #sleep<\/a> #apnea<\/a> \u2018treatments\u2019 and 0 costs solution for many people https:\/\/t.co\/6Jt09rbtf1<\/a><\/p>\n
\u2014 Art Sedrakyan (@ArtsyTwits) October 6, 2022<\/a><\/p><\/blockquote>\n
\u2014 Dr. Art Sedrakyan, New York City<\/em><\/p>\n
As president of the American Academy of Sleep Medicine (AASM), I write to address several concerns about the recent article \u201cSevere Sleep Apnea Diagnosis Panics Reporter Until He Finds a Simple, No-Cost Solution<\/a>\u201d (Oct. 3). While I commend the author for seeking medical help for his daytime drowsiness and snoring, I fear his article may mislead readers in a way that could jeopardize not only their own health and safety but that of others as well.<\/p>\n
The author is clearly dissatisfied with the care he received; however, using this to suggest that nearly everyone diagnosed with sleep apnea should simply treat it on their own \u201cfor free\u201d is dangerous. Sleep apnea is a common and chronic medical condition that increases the risks for numerous physical and mental health consequences, diminished quality of life, motor vehicle crashes, and premature death.<\/p>\n
Positional therapy (which typically requires the use of a device to maintain a side-sleeping position), though useful for some patients with sleep apnea, is not the best treatment for most patients, especially those with moderate to severe sleep apnea. Positive airway pressure (PAP) therapy is the best-supported, evidence-based treatment for sleep apnea. The most recent systematic review and meta-analysis included 80 randomized controlled trials investigating the use of PAP therapy to improve outcomes. Millions of patients with sleep apnea can attest to the life-changing \u2014 and even lifesaving \u2014 impact of PAP therapy. Treatment selection is an important decision that should be made together by a patient and their treating provider.<\/p>\n
Furthermore, it is inappropriate for the author to use his experience as justification to malign our entire organization and our 12,000 members. AASM strongly refutes the implication that support from industry biases our clinical practice guidelines and policies. Our guidelines are based on a review of the latest research by a task force of experts who determine the strength of evidence for a given treatment. The AASM also ensures conflicts of interest are mitigated through a stringent clinical practice guideline development process. While the author claims our organization \u201cfinances its operations\u201d with industry support, this is simply untrue. Industry support represents roughly 1% of our annual revenue and is guided by a clear policy that helps ensure transparent interactions to prevent undue influence and support public health. Likewise, the implication that our members are prescribing PAP therapy as part of a revenue-generating scheme is fallacious. The vast majority of PAP devices are sold by durable medical equipment suppliers, not by sleep centers or sleep doctors.<\/p>\n
I hope that readers struggling to get a good night\u2019s sleep will seek information from credible sources and talk with a trusted health care professional to determine which treatment best addresses their specific situations.<\/p>\n
\u2014 Jennifer L. Martin, president of the American Academy of Sleep Medicine, Darien, Illinois<\/em><\/p>\n
\n
Psst. Sleep apnea is kind of a racket. https:\/\/t.co\/PHepAmgLaz<\/a><\/p>\n
\u2014 Timothy Noah (@TimothyNoah1) October 4, 2022<\/a><\/p><\/blockquote>\n
\u2014 Timothy Noah, Washington, D.C.<\/em><\/p>\n
I just saw Jay Hancock\u2019s article on my Google feed and read it, as I suffer from serious sleep apnea as well. I\u2019ve received tailor-made mouthguards, so to speak, which appear to work rather well.<\/p>\n
But I\u2019ve also been reading books on breathing, starting with \u201cBreath, the New Science of a Lost Art\u201d by James Nestor, and then on to \u201cThe Oxygen Advantage\u201d by Patrick McKeown. I realized I was a mouth breather and that that contributes to the apnea problem as well and have since been trying to learn to breathe through my nose at all times \u2014 thus far with mixed results, but the subject is very interesting as it pertains to a lot more than just how to get a good night\u2019s sleep.<\/p>\n
\u2014 Dimitri F. Frank, M\u00e1laga, Spain<\/em><\/p>\n
\n
More and more hospital systems own urgent care centers which have limits on who they treat \u2014 for both financial reasons. Urgent care centers are a new high revenue stream for a health system to generate fast money creating a pipeline of new patients.https:\/\/t.co\/GQU1HDQC3T<\/a><\/p>\n
\u2014 James Hughes (@JamesHu29812484) September 30, 2022<\/a><\/p><\/blockquote>\n
\u2014 James Hughes, Savannah, Georgia<\/em><\/p>\n
Treating Trauma \u2014<\/strong> Followed by Billing Trauma<\/strong><\/p>\n
I\u2019m an emergency physician who also works at urgent care. While I appreciate patients trying to be fiscally responsible with their choices, the urgent care did precisely the right thing in this case (Bill of the Month<\/a>: \u201c Turned Away From Urgent Care \u2014 And Toward a Big ER Bill<\/a>,\u201d Sept. 29). Urgent care can typically manage fender benders or other minor accidents, but someone whose airbags deployed and whose car rolled three times and wound up \u201ccrushed\u201d up into a tree should always go to the emergency room. The mechanism of such accidents is very concerning and typically justifies a trauma activation and CT scans to evaluate for internal injuries. Urgent care is not equipped to handle patients if they develop life-threatening complications from a severe injury.<\/p>\n
\u2014 Dr. William Weber, Harvard Medical School \/ Beth Israel Deaconess, Boston<\/em><\/p>\n
\n
More evidence that we need an everyone covered for everything, zero copay, federal single payer health care system financed by fair taxes. https:\/\/t.co\/NNhMceezD0<\/a><\/p>\n
\u2014 James Conner (@jrcflatheadmemo) September 29, 2022<\/a><\/p><\/blockquote>\n
\u2014 James Conner, Kalispell, Montana<\/em><\/p>\n
This article is missing the perspective of a medical provider. I am a retired board-certified emergency physician with 33 years in the emergency department and more than five years in urgent care and feel the need to address the medical care differences between the ED and urgent care.<\/p>\n
I agree with the facts of your article and don\u2019t dispute the financial issues, problems, inequities of the broken system. But there is more to the story.<\/p>\n
The knowledge, ability, skill, and experience of the provider are key. The location of care predisposes to the abilities of the provider but doesn\u2019t guarantee them. You may receive excellent to below-average care depending on the provider. I have seen people die from auto accidents that were sent home from urgent care after receiving an evaluation by a general practitioner not trained in trauma. Some ED physicians miss things, but the odds are better that the ED doctor will not miss critical cases.<\/p>\n
Conversely, you might get care from an experienced ED physician at an urgent care.<\/p>\n
Then there are the personnel and resources provided. If it is a simple \u201curgent\u201d problem, no significant difference in outcome is likely to result.<\/p>\n
There is the dilemma. What is an emergency? This has been argued in Congress: to err on the side of not missing serious problems for which a \u201cprudent layperson\u201d could observe symptoms. So an emergency is what a \u201cprudent layperson\u201d believes it is.<\/p>\n
Some of the urgent care centers I worked in turned away \u201cthird-party\u201d cases but most didn\u2019t \u2014 even within the same hospital-owned urgent care chain. An option would be to offer to pay cash, asking for the cash-upfront price. Difficult to be accurate in predicting the cost ahead of time, but an estimate is not unreasonable. Instead of a low four-figure bill, the family might have turned out to have a low three-figure bill if not referred to the hospital after the urgent care evaluation.<\/p>\n
In my experience, I\u2019ve never seen a patient sent from urgent care (owned by or affiliated with a hospital) to the hospital for the sole reason of the hospital billing a second charge. Many patients are sent because they need a higher level of care that isn\u2019t available, such as hospitalization, injectable medications, specialty care, imaging, and \u201cstat\u201d lab work not available.<\/p>\n
Sure, the hospital uses the urgent care as a feeder site, but the patient (or the paramedic) gets to choose which hospital to go to, if they have a preference.<\/p>\n
Please remember that not all hospitals or urgent cares are the same. Many smaller hospitals do not<\/em> have some\/many specialists required to back up the emergency department. Some urgent cares use primarily general practitioners, while others use only board-certified emergency physicians, nurse practitioners, or physician assistants.<\/p>\n
Yes, the system is broken. Per a recent webinar by the California Medical Association: In the past 50 years, the increase in the number of physicians was 2%. Administrative health care personnel increased more than 3,000%. (That includes both the provider and the payer side.)<\/p>\n
\u2014 Dr. Mickey Kolodny, Palos Verdes Peninsula<\/em>, California<\/em><\/p>\n
\n
The US healthcare system is so dysfunctional, it still staggers me at times.https:\/\/t.co\/nU3nZG94rE<\/a><\/p>\n
\u2014 Donald Farmer (@DonaldTreeHive) October 3, 2022<\/a><\/p><\/blockquote>\n
\u2014 Donald Farmer, Woodinville, Washington<\/em><\/p>\n
After 40 years as a board-certified emergency medicine physician, I believe the article by Sam Whitehead is very misleading. First of all, the patient should never have gone to an urgent care. Had she called 911 as she should have, just because of the mechanism of the crash, she would have been brought to an emergency room. The ER obviously believed two CT scans were needed, which the urgent care would not have been able to provide. The reporter did not dig into the details of the acute trauma care this patient needed \u2014 other than understating her post-accident situation, which was self-defined. The author writes as if it is strictly an insurance issue or a way for the urgent care\/hospital system to gain patients.<\/p>\n
There is no indication of this happening given that the patient needed, by protocol, Advanced Trauma and Life Support (ATLS). By EMS protocol and by malpractice case law, this patient needed a visit to a trauma center emergency room. And the bill is a totally different issue. In other words, the author totally missed the medical issues to overstate and sensationalize billing issues.<\/p>\n
\u2014 Dr. Anthony F. Graziano, Oconomowoc, Wisconsin<\/em><\/p>\n
\n
think twice before heading to an urgent care https:\/\/t.co\/ixllGV7a1d<\/a> via @khnews<\/a><\/p>\n
\u2014 kendra lee (@kendraedits) October 3, 2022<\/a><\/p><\/blockquote>\n
\u2014 Kendra Lee, Woodbridge, Virginia<\/em><\/p>\n
I listened to your story as retold on NPR about a young woman who had a high bill for an ER visit after a car accident. I felt that the story was editorially biased, as it mentioned nothing about the requirements for care for traumatically injured patients. It seemed to recommend visiting urgent care centers instead of emergency rooms. Although less expensive, such facilities generally should not care for patients with serious injuries. Most hospitals require board-certified emergency medicine physicians and have extensive resources whereas an urgent care doctor may not have completed a residency. The \u201cphysician expert\u201d in the story clearly had no experience in the care of traumatically injured patients. Having such insight would lend depth to what I saw as a superficial look at a nuanced issue. Clearly the public should be better informed about cost-effective care, but an evaluation after a serious car crash is inappropriate to be sent to an urgent care.<\/p>\n
\u2014 Dr. Christopher Goltz, Flint, Michigan<\/em><\/p>\n
A Wealth of WISDOM<\/strong><\/p>\n
Nice article (\u201cGenetic Tests Create Treatment Opportunities and Confusion for Breast Cancer Patients<\/a>,\u201d Sept. 21). With breast cancer awareness month upon us, I would also point out the existence of the WISDOM study funded by the National Institutes of Health, which is looking at different approaches to using genetic testing to screen women for breast cancer. Check it out at www.thewisdomstudy.org<\/a>.<\/p>\n
\u2014 Dr. Daniel Halevy, New York City<\/em><\/p>\n
\n
Let the buyer beware. The fact that a marker can be detected does not mean that it will help you optimize therapy. #snakeoil<\/a> #breastcancer<\/a>@acog<\/a> @apha_mch<\/a> @aafp<\/a>https:\/\/t.co\/oyixlxBwRH<\/a><\/p>\n
\u2014 Cee A. Davis,MD,MPH (@cdBRComHealth) September 22, 2022<\/a><\/p><\/blockquote>\n
\u2014 Dr. Cee A. Davis, Winchester, Virginia<\/em><\/p>\n
On the Birth of Obstetrics Emergency Departments<\/strong><\/p>\n
I was disappointed by your article \u201cBaby, That Bill Is High: Private Equity \u2018Gambit\u2019 Squeezes Excessive ER Charges From Routine Births<\/a>\u201d (Oct. 13). While I recognize that medical billing is often confusing and at times even alarming to patients, I would like to share a few points that I feel were downplayed or omitted:<\/p>\n
\n
The article gives the impression that the obstetrics emergency department, or OBED, is created simply by rebranding an existing process within hospitals. The author neglects to mention that before the OBED, most hospitals did not have OB-GYN hospitalists stationed in-house 24\/7 to address emergencies. Prior to the implementation of the OBED, many expectant mothers, concerned that something might be wrong, were not able to see a physician when they visited a hospital emergency room. Instead, they were transferred to the labor and delivery department to be evaluated by a nurse taking instructions over the phone from a physician. If the patient and her baby were in serious distress, it became a waiting game, with the risk escalating every minute she waited for medical attention from her doctor \u2014 or any doctor. Hundreds of thousands of life-threatening emergencies are managed each year by OB-GYN hospitalists who staff obstetrics emergency departments.<\/li>\n
Reporter Rae Ellen Bichell seems to have a beef with the practice of hospitals charging for an emergency evaluation when unscheduled pregnant patients arrive at the hospital with medical complaints. Whether we like it or not, that is simply the way that health care works in America. If you show up unexpectedly at a hospital for evaluation of a health concern, you will be treated as an emergency \u2014 and you will likely receive a large bill corresponding to the unscheduled care you received.<\/li>\n
The author works hard to establish or imply a causal relationship between the private equity backing of medical staffing companies and the fact that hospitals are billing patients for emergency medical services. However, hospital service providers and vendors have absolutely no control over a hospital\u2019s billing practices. This bit about private equity seems to serve no logical purpose in this article except to make the story appear as a \u201cwhodunit,\u201d casting private equity firms in the role of immoral shadow bosses turning a profit at the expense of unwitting expectant mothers, when in fact they play no role in establishing the billing policies that Ms. Bichell incorrectly and perhaps unfairly characterizes as \u201cmoneymaking \u2018emergency\u2019 events.\u201d<\/li>\n<\/ul>\n
I have dedicated my career to the development and implementation of obstetrics emergency departments in hundreds of hospitals across the U.S., but I am unaware of any hospital turning routine births into moneymaking emergency events as claimed in the title and misleading argument of this article. I stand by my statement \u2014 and my sincere belief \u2014 that having trained doctors available 24\/7 on the labor-and-delivery floor has significantly enhanced the quality of care available to expectant mothers at some of the most challenging and medically consequential hours of their lives.<\/p>\n
Thank you for considering my point of view.<\/p>\n
\u2014 Dr. Christopher C. Swain, Charleston, South Carolina<\/em><\/p>\n
\n
Healthcare hyper-capitalism is going just great https:\/\/t.co\/oZWmp5EFVL<\/a><\/p>\n
\u2014 Adam W Gaffney (@awgaffney) October 13, 2022<\/a><\/p><\/blockquote>\n
\u2014 Adam W. Gaffney, Boston<\/em><\/p>\n
Shooting Craps?<\/strong><\/p>\n
Online stock brokerage houses have made all cellphones into \u201cgambling devices\u201d years ago (\u201cAddiction Experts Fear the Fallout if California Legalizes Sports Betting<\/a>,\u201d Oct. 5). What a load of crap that California gaming would suddenly create new cases of addiction. Stop the crap reports.<\/p>\n
\u2014 Matt McLaughlin, Carpinteria, California<\/em><\/p>\n
\n
I’m already battling screen addiction with my 13 yr old boy. last thing i need is to worry about online sports betting as he gets older. No way on #Prop27<\/a>. Addiction experts fear the fallout if California voters legalize sports betting https:\/\/t.co\/v9ECIhNn6w<\/a><\/p>\n
\u2014 Kristina Bas Hamilton (@kbashamilton) October 6, 2022<\/a><\/p><\/blockquote>\n
\u2014 Kristina Bas Hamilton, Sacramento, California<\/em><\/p>\n
Measuring Fat: A Gut Check<\/strong><\/p>\n
Julie Appleby provided useful information on how modern medicine misclassifies patients\u2019 health status through the use of the body mass index (\u201cBMI: The Mismeasure of Weight and the Mistreatment of Obesity<\/a>,\u201d Oct. 12). She included comments advocating the use of waist circumference (WC, by tape measure in the standing position) rather than body weight to indicate more specifically where the metabolic problems can be found. She\u2019s on the right track, but her article might have gone further to explore alternative, more focused indicators of excess adiposity.<\/p>\n
Anatomically, more than 90% of human body fat can be classified into three main depots: gluteo-femoral (hips, buttocks, and thighs) subcutaneous adipose tissue, abdominal subcutaneous adipose tissue, and visceral (inside the abdomen) adipose tissue. Of these three, only the visceral fat is clearly associated with cardiac and metabolic disorders. Increased gluteo-femoral subcutaneous fat has been shown repeatedly to be associated with improved health outcomes. Abdominal subcutaneous fat tends to have neutral, benign effects for most individuals.<\/p>\n
What we need is a simple adiposity indicator that can estimate the burden of visceral fat. Three decades of research suggests that a simple measure of the supine sagittal abdominal diameter (SAD, sometimes called the \u201cabdominal height\u201d) predicts poor health better than the standing WC. When persons are in the supine position, their benign, abdominal subcutaneous fat falls to the sides of the midline. For this reason, variation in the SAD, rather than in the WC, is more strongly associated with the variation in visceral fat volume. The SAD\/height ratio (SADHtR) is arguably even better than SAD alone. The SADHtR has been shown in the federal National Health and Nutrition Examination Survey (NHANES) to be significantly better than BMI for identifying major cardio-metabolic risk factors, i.e., insulin resistance or serum triglycerides.<\/p>\n
There is a simple tool<\/a> that researchers or clinicians can use to measure the SAD: a low-cost, portable, sliding-beam caliper. Various calipers are available, all of which are less expensive than a high-quality scale. And the calipers are easier to calibrate, too.<\/p>\n
Choosing between the adiposity indicators SAD or WC could depend on the method\u2019s simplicity and replicability. Especially among persons with large bellies, the reliability of the standing WC is challenged by conflicts between minimizing tension on the measuring tape and the tape\u2019s tendency to droop unpredictably below the horizontal plane. For the SAD, both the examinee and the examiner can relax as the upper arm of the sliding-beam caliper descends just to the point where it touches the abdomen. No further judgment is required.<\/p>\n
\u2014 Dr. Henry S. Kahn, Atlanta<\/em><\/p>\n
\n
Now can we stop talking about #BMI<\/a> and start using metabolic scores as measures of health? And if you’re not someone’s personal physician, your opinion is neither wanted nor warranted.https:\/\/t.co\/ep8eYbN4SK<\/a><\/p>\n
\u2014 Morgan Harlan (@baiacou) October 13, 2022<\/a><\/p><\/blockquote>\n
\u2014 Morgan Harlan, Washington, D.C.<\/em><\/p>\n
Revisiting the Homelessness Conundrum<\/strong><\/p>\n
To me, there is only one solution to helping our homeless get off the streets and into an environment that is safe, that will provide them with food, medical attention, and security, as well as provide them a means to regain the loss of self-esteem of so many of the homeless (\u201cSobering Lessons in Untying the Knot of a Homeless Crisis<\/a>,\u201d June 21). Our military bases could provide all the above, of course, with the permission of the Department of Defense and base commanders. I see so many efforts at trying to utilize hotels, apartment buildings, and the like, that are costing our cities, states, and federal government so much money that really is just a waste of time. We need to show our homeless that our government and all of us really care about them. We need to offer them the opportunity to settle in on a military base. They have the human resources and financial resources to really do something, and in a short period of time. These homeless could even be offered up some tasks to do on the bases. Please support this effort. Thank you for your efforts, too. I think every heart cries when we see this tragic situation on our street, and leaves us feeling helpless and hopeless for them.<\/p>\n
\u2014 Mike Stalsby, La Jolla, California<\/em><\/p>\n
\n
Fantastic article exploring the intersection of high living costs, drug use, and policy to explain the homelessness crisis in Portland. https:\/\/t.co\/RVg0BwSABs<\/a>But how does so much funding yield such limited results? $36 million translates to 1500 mini homes\/RVs?<\/p>\n
\u2014 Arielle Kane (@ariellesophia) June 21, 2022<\/a><\/p><\/blockquote>\n
\u2014 Arielle Kane, Washington, D.C.<\/em><\/p>\n<\/div>\n