In Tune

Nick Paumgarten’s behind-the-scenes report on the Met’s recent acquisition of a trove of special vintage guitars brought back memories of a summer day fifty years ago, when I stopped into Manny’s, a guitar shop on West Forty-eighth Street, to buy a Martin D-28 (“Guitar Heroes,” May 26th). I sampled a few, and none sounded right. Eventually, the salesman went upstairs to bring down another. It was magical, its tones like those of a vintage model. I said I’d take it, but then he told me that it wasn’t for sale—he just wanted to test my ear. The salesman informed me, sotto voce, that this guitar was a special order, crafted from aged wood, for Paul Simon.

I slipped the salesman some crisp Benjamins, and he phoned Martin, claiming that the guitar had been damaged. The company agreed to send a replacement, and I took the one from the store. Not long afterward, I was amused when a critic who reviewed a Paul Simon concert at Carnegie Hall marvelled at the timeworn timbre of Simon’s old D-28.

Dalton Delan
Belmont, Calif.

Taking Pains

Rivka Galchen, in “No-Pain Gains” (June 2nd), offers an insightful account of the development of a new painkiller, suzetrigine, and the search for other non-opioid analgesics. As a pharmacist, I appreciated the article’s attention to the science behind, and the promise of, this novel therapy. But the broader context of its clinical and economic value deserves greater scrutiny.

Suzetrigine, priced at roughly fifteen dollars per pill, enters a market already well served by effective, affordable options such as NSAIDs and low-dose opioids. The new drug’s non-opioid mechanism is laudable, but it has yet to be proved superior to existing treatments. Short courses of opioids aren’t likely to lead to opioid-use disorder, particularly in patients without known risk factors. In many cases, improving prescribing practices may do more to reduce opioid-related harms than adopting a costly new drug of uncertain comparative value. Indeed, the Institute for Clinical and Economic Review has rated suzetrigine’s long-term value, at its current price point, as “intermediate.”

Suzetrigine may mark the beginning of a new wave of analgesics, but, in a health system already grappling with affordability and access, novelty is no substitute for demonstrated value. That distinction must guide decisions regarding reimbursement, prescribing, and wider adoption.

Tom Dilworth
Wauwatosa, Wis.

I was diagnosed as having an aggressive form of breast cancer in April, 2024, and underwent a bilateral mastectomy that September. The word from the McGill Pain Questionnaire, which Galchen discusses, that best characterizes the pain I felt afterward is “agonizing.” I was treated with opioids. Last month, I had deep inferior epigastric perforator-flap surgery—a breast-reconstruction procedure that uses abdominal tissue—which is more invasive than a mastectomy. This time, my surgeon prescribed suzetrigine.

Not only has my pain been minimal; I also feel more alert and engaged than I did while taking opioids. Galchen writes that the cell biologist Paul Negulescu described the process of optimizing suzetrigine as “painful.” How marvellous that this work has already resulted in so much pain relief! My hopes soar for the further development of non-opiod medications.

Mary Keane
Longmeadow, Mass.

Letters should be sent with the writer’s name, address, and daytime phone number via e-mail to themail@newyorker.com. Letters may be edited for length and clarity, and may be published in any medium. We regret that owing to the volume of correspondence we cannot reply to every letter.