Buprenorphine, autism diagnoses, and long Covid: the most-read First Opinion essays of 2023

In a year of abortion restrictions, biotech industry upheaval, and revolutionary drug approvals, First Opinion strived to publish the most surprising, provocative, and conversation-starting essays from a wide variety of contributors. Below, you’ll find our top six most-read articles of the year by page views. Why six instead of five? Because why not?

And if your holiday plans mean you’re spending some time traveling, be sure to catch up with the “First Opinion Podcast,” where I speak with authors of recent First Opinion essays about their articles — and much more.

1. “The X-waiver for buprenorphine prescribing is gone. It’s time to spread the word,” by Beth S. Linas and Benjamin P. Linas.

This piece begged for people to spread the word about the bipartisan Mainstreaming Addiction Treatment (MAT) Act of 2023, which President Biden signed into law in the final days of 2022. The MAT Act removed the requirement for physicians to obtain an “X-waiver” before prescribing buprenorphine, a medication used to treat opioid use disorder. “Removing the X-waiver is a historic step forward in treating people with opioid use disorder. But it will do little good if clinicians and people who use opioids aren’t made aware of it,” the authors, who both study opioid use disorder, write. And spread the word the essay did, becoming the No. 1 most read First Opinion of the year.

2. “The haunting brain science of long Covid,” by E. Wesley Ely.

In this evocative essay that marries health policy, research, and personal experience, critical care physician and writer E. Wesley Ely shares the stories of two long Covid patients and asks: “What exactly is going on inside the brains of these people from a biological and pathological perspective?” Ely undertook a major challenge to find out: “Perhaps the most harrowing thing I have done in 30 years as a physician-scientist has been to ask family members I’d never met, often in the middle of the night via telephone during the height of the Covid surges, if I and my colleagues could study their loved one’s brain,” he writes. His findings shed light on a mysterious ailment.

3. “How Tennessee is creating new opportunities for doctors trained outside the U.S.,” by Jonathan Wolfson.

In this controversial First Opinion (Reddit’s medical sub went wild), Jonathan Wolfson of the Cicero Institute argues that new Tennessee legislation intended to address the physician shortage should be a model for the rest of the country. The bill “remove[s] redundant medical-residency requirements for top international doctors,” Wolfson writes. “The current system requires that doctors who complete residency abroad and have years of experience restart training after post-residency practice — and it doesn’t make sense.” It’s perfect fodder for debate.

4. “Why the aspartame in Diet Coke and Coke Zero probably isn’t worth worrying about,” by Gideon Meyerowitz-Katz.

I’m a Diet Pepsi gal myself, but I still found this piece comforting. After news hit that the World Health Organization’s International Agency for Research on Cancer was planning to label aspartame a class 2B carcinogen, many people panicked. But Meyerowitz-Katz, an epidemiologist, writes, “Class 2B does not mean that something definitely or even probably causes cancer — it means that there is some suggestion that the thing could plausibly cause cancer, and perhaps a small amount of evidence indicating that it does.” Moreover, he says, it truly is a small amount of evidence in the case of aspartame — “it’s still a bit of a meaningless risk for the average individual. It might be meaningful to population health workers but even then possibly not.” I’ll raise a glass of Diet Coke to that, even if I prefer Diet Pepsi.

5. “Long Covid is a new name for an old syndrome,” by Steven Phillips and Michelle A. Williams.

As long Covid patients remain frustrated by a lack of real progress into the causes of and treatment for their ailment, Steven Philips and Michelle A. Williams suggest a new framework for thinking about it. “Long Covid is really not new,” they write. “It is virtually indistinguishable from the condition long known in the medical lexicon as post-infectious syndrome or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).” By shifting the way we think about long Covid, they propose, we might be able to transcend some of the unproductive discussion and instead focus on delivery of care.

6. “There is no epidemic of autism. It’s an epidemic of need,” by John Elder Robison and Dena Gassner.

In March, the Centers for Disease Control and Prevention released a new estimate that 1 in every 36 children in the U.S. has autism — a huge jump from 1 in 110 in 2006 and 1 in 44 in 2021. That new number might seem frightening. But the authors — both autistic adults and parents of autistic children — offer some assurance: Experts are simply much better at diagnosing autism in girls and women, in people of color, and in those whose autism might be more subtle than previous screenings would have caught. Diagnosing these people who previously might have been overlooked is great for public health, the authors write: “[U]nsupported autism contributes to homelessness, abuse, self-harm, and other preventable damage. The more autism we recognize, the more people we can help.”

I hope that 2024 will bring even more First Opinions making challenging arguments, sharing eye-opening personal experiences, and bringing a critical lens to the life sciences. If you have an idea, submit it today (or maybe wait until the new year). And while you’re here, sign up for the weekly First Opinion newsletter.