Do doctors get paid to vaccinate?

Source

Lately, people opposed to vaccines have been very upset about a recent finding that Blue Cross Blue Shield of Michigan has a Performance Recognition program for provider incentives, including paying $400 to providers for every fully vaccinated two year old in their practice.  This screen shot comes from page 16 of the document:

 

 

As you can see, the target is 63% of patients, so people opposed to vaccines think this means that if a provider can vaccinate at least 63% of two year olds in his or her practice, they will receive $400 per patient. As many pediatricians have between a few hundred to 1000 patients, people opposed to vaccines postulate that providers could be earning as much as $80,000 extra a year for vaccinating.

There are many problems with this claim.  First of all, most people opposed to vaccines  (POTVs) are not recognizing or posting that this program is only for BCBS of Michigan providers and only if they join the incentive program, called the Physician Group Incentive Program.  Secondly, POTVs are not clarifying this only works for patients insured by BCBS, with providers enrolled in the program. Thirdly, they are also not clarifying that the program is comprehensive and involves many different healthcare outcomes, not just vaccines. There are incentives for helping patients achieve healthy weight, healthy diabetes control, hypertension control, and more. Finally, POTVs are not sharing that these programs SAVE the insurance company money.

 

Blue Cross Blue Shield of Michigan is a non-profit company.  Saving $155 million a year is considerable and enables them to make healthcare more affordable for all enrollees.  They have done a seemingly tremendous job creating partnership programs with providers that save money and keep people healthy. Pediatricians earn a good living, but compared to most specialties, they earn considerably less. The average pediatrician earns $175,400 a year while cardiologists earn $525,00 a year and orthopedic surgeons earn almost that much. Clearly, pediatricians could earn far more money with other medical specialties. Furthermore, BCBS of Michigan doesn’t come anywhere near paying out the $80,000 per provider POTVs estimate because this benefit only applies to a few children.

Think about this:  How many fully vaccinated, two year old children are there in a pediatrician practice?  Pediatricians see patients from age newborn to 21. Even if they are getting $400 per fully vaccinated two year old, pediatricians usually have a case load of 1000 patients each so that would be about 45 two year olds per practice. They are not going to all be fully vaccinated. The threshold is 63% and not all providers will meet it. Assuming they do meet it, 63% is 28 two year olds so that could mean $11,000 a year, but only if they  meet the threshold. After taxes, that would be an extra $7000 a year, perhaps? And, remember, the insurance company IS SAVING MONEY by offering this and other incentives. In fact, if you browse the brochure, they pay out more for vaccines than anything else. That tells me that vaccination saves them MORE money than the other health indicators.

So what if insurers pay out providers a benefit when they vaccinate? This is about saving money, in the long run. Insurance companies save money when children are healthy. They lose money when children are chronically ill or hospitalized. This incentive is PROOF that vaccines work and save insurance companies money.

Always think for yourself.

 

Kathy

 

 

 

 

 

Hepatitis B vaccine is safe & necessary

There is a reason one should not take healthcare or medical advice from daytime talk show producers with no college education: they don’t do science. And this is a real problem when they have some influence among people who do not vaccinate.

Yes, that is this week’s message from Del B.  He crashed the Assembly Select Committee on Infectious Diseases in High Risk Disadvantaged Communities meeting, this week, in Sacramento, California, hosted by Assemblyman Mike A Gipson. State Senator Dr. Richard Pan was a speaker, as were numerous other experts on Hepatitis infections. Towards one hour, 40 minutes, the public were allowed to make 2 minute comments and that is when Del Bigtree speaks first. He questions the statistic that 10,000 kids under age 10 were infected, not by their mother,  with Hepatitis B before the vaccine was introduced. Del goes so far to imply Dr Pan made this up this data about Hepatitis B risk and that as long as women are tested for the disease, and are not carriers themselves, then newborns do not need this vaccine at all. Further, he makes some pretty outrageous claims that might lead someone to not choose this vaccine for their child:

1. He infers the vaccine is the cause of USA having “highest infant infant death rate than all other western nations combined” and asks why we are not investigating that risk;
2. Education alone could reduce Hepatitis B risk;
3. The vaccine was only tested for 4 days during pre-licensing phase;
4. The vaccine has 5X the recommended amount of aluminum;
5. The vaccine wears off after 6 years;
6. Saving 10,000 children a year (pre-vaccine numbers) from Hep B is not worth risking millions of other children’s lives by giving them this “dangerous” vaccine.

I am not sure why Del thinks this statistic is Dr Pan’s making ( he seems to think the science behind the California vaccine mandate law, SB277, all originates from Dr Pan) but I have taken some time to help Del understand the Hepatitis B risk and the vaccine safety.

What is Hep B?

Hepatitis B is a bloodborne pathogen transmitted through contact with blood or other bodily fluids. It can also be sexually transmitted but to say it is only transmitted via drugs or sex is incorrect.  It is a potentially life-threatening liver infection and a major global health problem.  An estimated 850,000–2.2 million persons in the United States have chronic hepatitis B virus infection. The rate of new HBV infections has declined by approximately 82% since 1991, when a national strategy to eliminate HBV infection was implemented in the United States. The decline has been greatest among children born since 1991, when routine vaccination of children was first recommended.

(source)

Del’s concern 1: first day death

Del is concerned the vaccine is the cause of USA having “highest infant infant death rate than all other western nations combined” and asks why we are not investigating that risk.  Currently, the USA ranks 168 out of 224 countries in the infant mortality statistics (224 being the best infant mortality rate).  Monaco has the best IMR, at 1.82 deaths per 1000 live births, Afghanistan is the worst at 115.08 deaths per 1000 live births, and USA is in the top 1/3rd at 5.77 deaths per 1000 live births. Looking at the list, there are many countries in the 3-5 deaths per 1000 live births range, so USA is absolutely not faring the worst of all western countries nor has the highest IMR of all western nations combined. The CIA defines IMR as infants dying before age one.

For first day of life deaths, I looked at a report by published by Save the Children in 2013 that was funded by Johnson and Johnson, Gates Foundation, and Mattel. Having googled, this is the source cited by many news reports and likely what Del is quoting from. According to the report, the USA does have a high first day death rate with 11,300 newborn deaths a year. “This is 50% more first day deaths than all other industrialized countries combined.” Poverty and racial/ethnic makeup are linked to prematurity, low birth rate, and high first-day death rate. Prematurity is the single largest cause of first day death.  By far the most first day deaths occur in India, with several African countries, China, and Afghanistan also in the top ten worst countries. Somalia has the worst first day mortality statistic, at 18 deaths per 1000 live births. Being a larger country, India has more deaths but a lower statistic, at 11 deaths per 1000 live births. Iceland, Sweden, Singapore, Estonia, Cyprus, and Luxembourg have the best statistics, at less than 0.5 deaths per 1000 live births.

And where is the USA?  Three first day deaths per 1000 live births. We share that ranking with 19 other countries.  Yes, we could do better but it is not THAT bad. I would be more than willing to pay higher taxes to offset poverty and racial issues, insuring that all Americans have access to good food, decent living conditions, and universal healthcare. That would improve our IMR and first day death statistics tremendously.

The single greatest reason cited for our first day death statistic is poverty and race, both of which are also risk factors for prematurity. This has absolutely nothing to do with vaccines. 

Del’s concern 2: education

This is inexplicable to me. Does he really think education will prevent toddlers from biting each other and sharing their teething toys? Will education alone lead to people telling their partners about their disease status instead of hiding it and inadvertently spreading it? Education will do nothing for women who test negative for Hep B but really are positive. False tests results is a real issue.

Del’s concern 3: safety testing

Del is concerned that the Hep B vaccine was only tested for 4 days during pre-licensing phase. This comes from the insert, of course, and it is actually stated that children in the clinical trial were monitored for 5 days after the vaccine. Of course, we know the limitations of vaccine inserts.  Del, however, seems to be unaware of the safety and efficacy testing that is done after the insert was written. Let me give you a little research hint. If you want to find studies related to a vaccine, go do the CDC’s page for that vaccine and click on the information for providers and healthcare professionals. This is where they list the safety and efficacy studies.  The parent information section is written much more simply.  In the provider section, you can find a lot of research information, including the link to the recommendations of the Advisory Committee on Immunization (ACIP)’s document on Hepatitis B virus and vaccination. This document has a long list of safety and efficacy data, including data analysis from the vaccine safety datalink (VSD) and the Vaccine Adverse Events Reporting System (VAERS). A great deal of safety study has been done AFTER the clinical trial.

Del’s concern 4: The vaccine has 5X the recommended amount of aluminum

The Hep B vaccine has between 0.225 to 0.5 mg/dose of aluminum. An FDA study found that the maximum amount of aluminum an infant could be exposed to over the first year of life would be 4.225 milligrams (mg), based on the recommended schedule of vaccines.  According to the Vaccine Eduction Center,  “infants receive about 4.4 milligrams of aluminum in the first six months of life from vaccines, they receive more than that in their diet. Breast-fed infants ingest about 7 milligrams, formula-fed infants ingest about 38 milligrams, and infants who are fed soy formula ingest almost 117 milligrams of aluminum during the first six months of life.” Thus, the vaccine does not have 5X the recommended amount of aluminum. It is likely Del is thinking of the recommended amount of aluminum for intravenous solutions. This is comparing apples to oranges. Vaccines are not IVs.  Here is information about IV feeding solutions and aluminum and here is the information about aluminum in vaccines. As you can see, antivaxers often get these confused.

Del’s concern 5: The vaccine wears off after 6 years

Del need not worry. “Studies indicate that immunologic memory remains intact for at least 20 years among healthy vaccinated individuals who initiated hepatitis B vaccination >6 months of age. The vaccine confers long-term protection against clinical illness and chronic hepatitis B virus infection. Cellular immunity appears to persist even though antibody levels might become low or decline below detectable levels.” (source)  The populations at risk for Hep B as adults are being studied to determine actual immunity rate. The first infants vaccinated with this vaccine are now in their early 20s and 30s, a great age to begin studying them for risk of Hepatitis B and duration of immunity with vaccination. To test immunity, scientists have to study those with Hep B infection to see if they were vaccinated. Del does not understand how this is done because he is, after all, a former producer of a day time talk show. One would not expect him to have any actual knowledge in science.

Del’s concern 6: This is a dangerous vaccine

The ACIP study included analysis of reports of adverse events and found no association between the vaccine and reports of chronic illness, alopecia, diabetes, Guillain-Barré syndrome, arthritis, multiple sclerosis, or SIDS.  In other words, the Hepatitis B vaccine does not cause any of those health issues. The study also mentions the possibility of a yeast allergy connection. “Hepatitis B vaccination is contraindicated for persons with a history of hypersensitivity to yeast or to any vaccine component (92,189–191). Despite a theoretic risk for allergic reaction to vaccination in persons with allergy to Saccharomyces cerevisiae (baker’s yeast), no evidence exists that documents adverse reactions after vaccination of persons with a history of yeast allergy.”  So, there is no reason to worry about a yeast allergy with the Hep B vaccine.

Del also wondered at the veracity of the number, 10,000, of children who were found to have Hepatitis B yearly, not from their mothers, pre-vaccine. This data comes from a study called Childhood Hepatitis B virus infections in the United States before Hepatitis B immunization.  If you have access to the full document, as I do through my university, you will see that vaccination for at-risk infants began in 1982 and was broadened to include all children in 1994.   Before the vaccine was recommended for all children in 1994,  30% of infected adults had no risk factors. Vaccinating only those infants from at-risk groups was not halting the spread of the infection to children. This was because of incomplete maternal screening and a “substantial proportion of infections occurred in children of Hepatitis B surface antigen (HBsAG)-negative mothers.” Let that sink in a bit. A substantial number of infections in children came from mothers who had tested negative. You got it. Testing all mothers doesn’t help. The study estimates that 16,000 children under the age of ten were infected with Hep B a year and that does not include the additional 15,000 children a year who acquired Hep B from their mothers, perinatally. Most of these 16,000 children had clinically silent infections that will lead to chronic liver infections later in life, with 25% leading to death.  The study concludes that routine vaccination of infants will save 2700 deaths a year.

Conclusion

It is clear to me, in reading all of the above, that the Hepatitis B vaccine has a strong safety record, does not contribute to US first day death rate nor SIDS rate nor infant mortality rate and does very much lead to healthier lives for American children.  What are the actual risks associated with the vaccine? Minor soreness for a few days or a mild fever are most common. Anaphylaxis (severe allergic reaction) is possible with anything but they are very rare with this vaccine and would occur within a few hours.

As always, remember to think for yourself!

 

Kathy

 

 

 

 

 

 

 

 

 

Yes I have read vaccine inserts

Quite often, in vaccine debates, a comment will be made by someone opposed to vaccines, “you obviously have not read a vaccine insert!”

 

Actually, I have read pretty much all the vaccine inserts and, no, I am not freaking out. Here is why:

Please feel free to use and share the above meme all you like.

Yep, that is it, in a nutshell. Vaccine inserts are legal documents, they list a whole bunch of things reported during the clinical trials, but they are saying nothing about what vaccines actually cause. They list adverse events reported, not side effects. Basically, they are like rumors not verified by any facts. Yet. When the further research is done and the facts are verified, then we know what vaccines can possibly cause and these are listed as side effects on the vaccine information sheets (VIS).

Stop using them as arguments to not vaccinate.

If you want to learn more, two other bloggers have in-depth posts fully explaining the nitty gritty details.

Harpocrates Speaks

Skeptical Raptor

 

Remember to think for yourself!!

 

Kathy

 

 

 

 

 

 

How much do doctors and nurses know about vaccines?

I recently discovered that an out of work tech guy has started a YouTube channel devoted to spreading antivax rhetoric.  His name is Forrest Maready and he has been doing this for about two months. He has a Facebook page that seems to get a good amount of traffic. His most recent video, How much does medical school teach about vaccines, has had 174,00 views and 6551 shares on Facebook alone in less than a week. According to his Linkedin profile, he is a “creative technologist and opinionator.” He is also an out of work technology officer with a degree in religion and music. Exactly the last person I would expect anyone to take seriously when it comes to advice about health and medicine.

And, yet, his videos are being noticed and questions are arising. Since this is not the first time an antivaxer has questioned how much doctors and nurses learn about vaccines in college, nor will it be the last, I think this is a great topic to debunk.

Here is the nitty gritty of the antivax argument (google it, you will see many AV sites discuss this topic):

 

Truly, this is the crux of this position. The issue of how much doctors and nurses learn about vaccines in college is a minor, cherry-picked detail the way it is presented by antivaxers. Why? Because they are merely counting hours spent on topics or pages in textbooks and this is not how nurses and doctors are trained.

In his video, Forrest takes a pile of medical textbooks (we are not told from which medical school or year they originate) and examines the number of pages devoted to vaccines. Out of 6700 pages total, he found four and a half pages that discuss vaccines. He further looked at a pediatrics reference textbook and found 11 pages of vaccine schedules and three paragraphs of contraindications, out of 5000 pages total.

And from there he surmised that doctors in training spend two hours learning about vaccines. Let that sink in. Two hours.

Um, no. Just no.

If the art and science of being a medical doctor or nurse could be learned solely from textbooks, doctors and nurses would never have to spend any time at all in clinics, doing residencies and fellowships, and pursuing further education into specialties beyond the basic degree. What doctors and nurses learn is far more than what is in their textbooks. And it is more than just one textbook in isolation. Looking the number of pages on vaccines takes the education of nurses and doctors out of context. And this is cherry picking, trying to make an argument based on incomplete information selectively chosen merely to fit one’s agenda.

This survey, from the University of Central Florida College of Medicine, indicates doctors-in-training spend between 1 and 10 hours learning about vaccines. But, I believe that refers specifically to learning about just vaccines.  As this Facebook video from the Insufferably Intolerant Science Nerd explains, “The anti-vaccination movement would have you believe there are no books regarding vaccinations anywhere and that doctors are never taught about vaccinations. This is incorrect. Doctors are taught the knowledge needed to understand vaccinations and the role they play in eradicating disease from Day 1. There is an entire subdiscipline of scientific research “vaccinology” that specifically deals with vaccinations. Our medical knowledge of vaccinations has been built upon the information accumulated from many different disciplines of science – microbiology, virology, bacteriology, bioinformatics, epidemiology, biochemistry and organic chemistry.”  From the Violent Metaphors blog, “without even counting the related fields of physiology, the respiratory system, gastroenterology, histology, neurology, etc, I came up with 920 hours of graduate education in immunology, microbiology, and infectious disease – and that’s before ever hitting the wards in 3rd and 4th years.”

A nurse on Facebook puts it well: I have seen that video, and I find it to be completely bogus. Vaccines are a small topic amongst a wide array of information. It’s kind of like getting mad at a baker for not knowing the composition of an egg when he makes a recipe. It’s kind of a weird abstract. The entire education process about vaccines starts with anatomy and physiology. Learning and mastering the understanding of the immune system is step number one. Next, microbiology comes in when you start to understand and are taught the different types of bacteria as well as DNA and RNA transcription and reproduction. This is very important with understanding viruses as well as different kinds of bacteria. Next, you need to know about pathophysiology. Using pathophysiology, you learn about how the disease process happens, as well as how the different viruses and bacteria are spread. This can also be tied into Epidemiology or Immunology. After that, you have to delve into pharmacology. Pharmacology is a very interesting topic, and with knowledge gained from pharmacology we can understand how different parts of the vaccine as well as any drug are handled by the body and further information about their methods of action, adverse effects, and side effects. Also, we learn about the way drugs are eliminated and disposed of by the body like the liver, kidneys, and intestines. Finally, scientific literacy as well as an understanding of current evidence based practice, helps us understand the current stance as well as scientific standing on vaccines as well as all of their effects and efficacy. Of course we also talk about the schedule and when to give these immunizations, however by taking information from all of the classes mentioned, we can understand vaccines very thoroughly. Vaccines and the knowledge needed to understand them, is not one class. Instead it is an amalgamation of information that we have learned throughout our schooling. Not understanding microbiology or the immune system, greatly hinders and almost eliminates and full understanding of vaccines their uses and why they are given. For me personally, I opened up my textbook really quick for Pediatrics, and there is about 10 pages dedicated to each vaccine preventable illness, 5 pages on administration and contraindications, and another three pages as an overview of scientific research as it stands currently. I’m sure that I can look in my other text books and find other information within them that furthers the understanding of vaccines individually, but as I said it is a compound understanding. My textbook also talks about the Vaccine injury Compensation Program as well as the Vaccine Adverse event Reporting System. We are taught about it, very thoroughly in fact. In summation, we do not focus one class on vaccines. Instead, we take our understanding from previous courses like chemistry, microbiology, pharmacology, anatomy, physiology, pharmacology, and public health to complete one comprehensive picture of what vaccines do, what they are, and how they work.

A doctor on Facebook says In the first place, we don’t get lectures on every drug, but we do get lectures on pharmacology, physiology, and pathophysiology, which helps us understand why and how a drug might be useful for a particular person.  Similarly, we learn about the immune system and microbiology so we can understand how vaccines work. You can’t just study vaccines out of context. That superficial knowledge, which some of our AV friends have, lacks the depth and perspective. As a trivial example, you can read about how live polio vaccine can cause poliomyelitis in rare cases. But you might not know how many people died from polio before the vaccine, or how terrified people became every summer.

On top of this education in classes, doctors and nurses learn a great deal in the field, in their clinics and residencies and fellowships. More to the point, they learn how to prevent and treat disease more outside of classroom than inside. But, more to the point, they are not learning to be experts in drug and vaccine composition. If you want to talk to someone who is an expert in drug ingredients, reactions, side effects, etc, then that person is called a pharmacist. Doctors and nurses do learn about diseases and treatments but it is unreasonable to expect them to be walking pharmacology reference guides. Furthermore, the “expertise” most antivaxers expect doctors and nurses to know off the tops of their heads is usually something they can easily look up in their handheld or laptop or desktop device.

And it is not just in medical school that professionals learn about vaccines. Osteopathic medical school also teaches doctors-in-training a great deal about vaccines. “Today’s students need to know how vaccines work from a microbiological perspective and how vaccination is viewed and implemented from a public and prevention perspective for overall population health. Additionally, they must now be able to use information technology, health care implementation science, and evidence-based data analysis to assess their own skills and ability in educating their patients to make wise health decisions regarding vaccination.”

The bottom line is that doctors and nurses learn a lot about the human body, diseases, treatments, drugs, and vaccines. But, it is mostly learned in context, not all from textbooks. Context. That is the key word here. Context.

And, doctors and nurses who want to learn more can take courses, such as one that might use this textbook:

As always, remember to use your thinking skills when it comes to making healthcare decisions.

 

Kathy