Emily Jashinsky’s Dec. 11 op-ed, “A marriage gap is growing — and it could spell disaster,” presented the most likely reason for women’s declining interest in wanting to get married (at least to a man) over the past eight years: About 40 percent of women surveyed identify as liberal, compared with just 19 percent who said they’re conservative. Young men were more likely to identify as conservative than liberal. Why would anyone be inclined to want to marry someone who does not share their basic values?
The op-ed went on to discuss men’s declining value as marriage partners in terms of their declining economic opportunity. By all means, we should make changes to curriculums, pay scales and job requirements to promote opportunities for boys as well as girls, but that’s only part of the marriage story. Gender roles and expectations have also changed. Expectations of entitlement won’t get our boys where they need to go as men.
Barbara Meierhoefer, Arlington
Understanding Title VI
The Dec. 11 editorial “Pam Bondi’s welcome woke rollback” applauded the reversal of Title VI disparate-impact rules by suggesting they encouraged “racial preferences.” As former career leaders of the Justice Department’s Civil Rights Division, we can say plainly: That is not how Title VI works.
Disparate-impact liability does not rest on disparities alone. It requires proof that a policy both creates significant racial disparities and does not serve a legitimate, nondiscriminatory justification. Far from authorizing preferences, disparate-impact standards promote fairness by helping uncover discrimination that is otherwise difficult to detect and by removing unjustified barriers that perpetuate the lingering effects of past discrimination — effects the Supreme Court has long recognized as real and measurable.
Disparate impact has been used, for example, to identify unjustified racial disparities in law enforcement stops after controlling for the reason for the stop, time of day and other legitimate factors; to remedy unequal sanitation services; and to ensure meaningful access to life-saving information for people with limited English proficiency.
Eliminating Title VI’s disparate-impact rules does not restore equal protection. It removes a vital tool for ensuring that federal funds do not entrench discrimination in schools, health care, the justice system and other public services.
To top it off, the Trump administration demonstrated its lack of interest in transparency by making this change without notice or opportunity for public comment.
Disparate-impact standards do not mandate racial preferences. They require evidence, rigor and accountability. Discarding them weakens, not strengthens, the promise of equal protection.
Christine Stoneman, Alexandria
Bonnie Robin-Vergeer, Washington
Regan Rush, Bethesda
Shaheena Simons, Silver Spring
Man vs. machine
Jim Geraghty’s Dec. 17 op-ed, “Where’s the surveillance state when you need it?,” about the shooting at Brown University, highlighted a sobering truth: Even in an age saturated with surveillance, technology isn’t foolproof. Despite the hundreds of cameras around campus, investigators were left with only a vague image of the suspect.
We’ve placed so much faith in technology that we sometimes forget it’s just a tool. Cameras can be avoided, networks can glitch, and algorithms can misfire.
When the digital trail goes cold, we’re reminded that justice still depends on old-fashioned police work: interviewing witnesses, canvassing neighborhoods, following hunches, checking alibis and connecting the human dots that no machine can see.
The best investigators combine what’s new with what’s timeless. Data may guide the search, but instinct, persistence and experience still close the case. In the end, no amount of surveillance can substitute for skill, judgment and the human touch.
Stephen M. Flatow, Long Branch, New Jersey
GLP-1s need utilization management
Roger W. Ferguson Jr. and Grant Verstandig’s Dec. 16 op-ed, “How to cut the velvet rope to GLP-1s,” rightly observed that flexible, employer-driven solutions promoting value and empowering patients can help expand access to medication. But attacking those who are carefully stewarding health care resources won’t fix the situation.
Specifically, Ferguson and Verstandig made an oversimplification in stating that “utilization management isn’t about safety or clinical appropriateness. It’s about cost.” Many low-cost drugs are subject to utilization management. Employers decide which treatments are covered and how much utilization management is in place. Yes, cost is a consideration. GLP-1s are expensive drugs with low persistence rates among obesity patients. Health resources are finite, and we must carefully consider how to maximize the benefit received from every dollar spent.
But the bigger issue is shortages for at-risk patients. GLP-1 utilization management has a significant clinical component. GLP-1 utilization management has a significant clinical component; it can reduce broad “off-label” use for weight loss when not supported by clinical evidence.
FDA-approved labels are more than just a formality. Although the active ingredient may be the same, important factors for clinical appropriateness such as dosage are not. With GLP-1s, the dose for weight loss is higher than for diabetes. That’s why payers review prescriptions for clinical appropriateness. Without this crucial step, shortages can result, threatening access for patients with diabetes.
GLP-1s are incredible, innovative drugs. Responsibly stewarding our finite resources through tools such as utilization management is essential to ensure that all Americans have affordable access to the prescriptions they need.
Susan Cantrell, Alexandria
The writer is a pharmacist and CEO of the Academy of Managed Care Pharmacy.
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