Tag: ethics

Do Anti-Vaccine Pediatricians Lose Millions Not Vaccinating Kids?

Paul Thomas is upset…

He thinks that Willamette Week, an alternative weekly newspaper in Portland, is trying to discredit him.

How are they using their platform “to try to discredit an ethical top Pediatrician in the community?”

An “ethical top pediatrician” who made up his own immunization schedule???

Paul Thomas was barred from the Vaccines for Children Program.
Paul Thomas was barred from the Vaccines for Children Program.

Willamette Week published a story about how Paul Thomas was kicked out of the Vaccines for Children Program.

“VFC (Vaccines for Children) does not provide any funding (no real dollars) just free vaccines for the underprivileged. What I lost was the ability to provide this free federal program to my patients who qualify for this program. This is simply a major inconvenience to those affected. Financially it is neutral to me.

My clinic had actually stocked the vaccines Rachel mentions – we just didn’t comply in a timely manner, so you got this part right “I didn’t jump through their hoops fast enough.”

Paul Thomas

To make a long story short, he got kicked out of the Vaccines for Children Program because he didn’t follow the rules of the program.

What about the idea that he “just didn’t comply in a timely manner?”

This all started over two and a half years ago???

Although Paul Thomas says in his post that his “clinic had actually stocked the vaccines Rachel mentions,” the order kicking him out of the VFC program says otherwise.

“Dr. Thomas submitted a Declaration signed under penalty of perjury stating his office does not keep stock of HPV vaccines and instead sends patients to pharmacies.”

Default Order Terminating Integrative Pediatrics from VFC

He also did not have any rotavirus vaccine in his office.

Not exercising medical judgement in accordance with accepted medical practice? Where is the Oregon Medical Board???

To get to the point of being terminated and which Paul Thomas characterizes as “I didn’t jump through their hoops fast enough,” actually involved:

  • ignoring an offer for a probationary agreement (August 2018)
  • asking for a contested case hearing (October 2018) which was scheduled for July 12, 2019
  • withdrawing his request for a contested case hearing on July 10, 2019

I’m surprised they gave him that much time!

Did he lose Medicaid funding?

I’m not sure he even takes Medicaid, but he did lose the ability to give his patients vaccines that he didn’t have to pay for.

“One huge misconception, and I see the comments on this, is that pediatricians don’t make money on vaccines or that they are not financially incentivized to vaccinate. There are profits from vaccine mark-ups and huge profits from vaccine administration fees. The average admin fee is about $35 per vaccine. For the 715 patients born into my practice who have refused to give any vaccines (each child would have had 28 vaccines by age 2 and over 60 vaccines in their childhood) amounting to income of $700,000 for the 2 years and $1.5 million over their childhood. Those are real dollars lost for Integrative Pediatrics. The money lost when considering that we serve over 15,000 patients, with most being selective about how they vaccinate would have driven most practices out of business.

There are also built in incentives in many contracts with health plans. Vaccines are a quality measure (if your practice does not reach a bench mark in numbers vaccinated) you loose a % on all services provided to patients under that insurance contract.

Is it any wonder most of my peers discharge patients from their practices who won’t follow the CDC schedule? Often these patients are told to call Dr. Thomas (Integrative Pediatrics).

Let us be clear. It is not a good business decision to allow families not to vaccinate or to permit selective vaccination.”

Paul Thomas

Let us be clear. He certainly doesn’t understand vaccine administration fees…

Some things he gets wrong?

  • pediatricians might charge $35 as an admin fee, but they are lucky if insurance companies pay them 1/3 or 1/2 that or even less. Your average vaccine administration fee is only going to be $35 if you don’t take insurance and can set your own fees!
  • you get a lower vaccine administration fee for the second vaccine component given (you use a different CPT code – 90461) vs the first (90460), and it pays less, so doctors make less when they give multiple vaccines at the same visit. Is that why many vaccine friendly doctors recommend giving one vaccine at a time?

And he misses the whole point behind vaccine administration fees.

It costs pediatricians money to order, stock, monitor, and give vaccines!

“This study shows that the variable costs of vaccine administration exceeded reimbursement from some insurers and healthplans.”

Glazner et al on Cost of Vaccine Administration Among Pediatric Practices

Do they make any money?

Hopefully they do, as health care is a business in the United States, but they certainly aren’t making millions in net profit as Paul Thomas suggests. And if they aren’t very careful, after considering all of the factors that go into giving a vaccine, it is very easy to lose money.

How Do Anti-Vaccine Pediatricians Make Money?

Which brings us back to the business decision of being a pediatrician who scares parents away from vaccinating and protecting their kids.

Is there any money in that?

Paul Thomas doesn't mention that he gets a big cut of the sales for a "free" summit that costs $197 as he promotes his anti-vaccine lecture.
Paul Thomas doesn’t mention that he gets a big cut of the sales for a “free” summit that costs $197 as he promotes his anti-vaccine lecture.

Books, seminars, supplements, essential oils – there are lots of things to sell parents who don’t vaccinate their kids.

Compared to these pediatricians in California, Paul Thomas is a bargain at just $295/year.

Don’t forget the annual membership fees that many of these pediatricians charge for the privilege of skipping or delaying vaccines and at extra risk to get a vaccine-preventable disease.

And the vaccine exemptions that some of them sell…

More on Do Anti-Vaccine Pediatricians Lose Millions Not Vaccinating Kids?

Is Vaccine Discrimination a Thing?

Hopefully everyone understands that discrimination is still very common these days. From race and religion to age and sex based discrimination, even with protective laws and regulations, many people face discrimination each and every day.

Is Vaccine Discrimination a Thing?

We should start by saying that vaccine discrimination is not really a thing. After all, no one is discriminating against children and adults with true medical exemptions to getting vaccinated.

Is a physician or nurse being nosy or bossy if they ask about vaccines when you go to a clinic or ER with your sick child?
Is a physician or nurse being nosy or bossy if they ask about vaccines when you go to a clinic or ER with your sick child?

It is only folks who intentionally skip or delay vaccines who think they are being discriminated against.

How does that work?

If their intentionally unvaccinated kid without a medical exemption can’t go to camp, play in a baseball tournament, or has to find a new pediatrician, they are now crying discrimination.

Which type of person is Bob Sears?
Which type of person is Bob Sears?

Bob Sears goes as far as saying that the discrimination against parents whose children are intentionally unvaccinated is worse than the treatment of blacks in the Jim Crow era!

“In my opinion, this is a new type of discrimination at its worst. It’s taking a new class of vulnerable children — the vaccine-compromised — and saying that because they refuse to finish their damn shots, they don’t get school. Forget separate but equal. This is separate … and NOTHING! No school at all. Soon it’s going to be no playgrounds and no drinking fountains either. Hey, the last time our government did this to a group of people, at least they GOT drinking fountains. They even got to ride buses, as long as they sat in the back. Because our government said “those people” were not safe for the rest of us to be around, and our society stood by and let it happen. And the discrimination we perpetrated on our equals so many years ago is one of the great evils our country is still guilty of. Is that what this article, and the California SB 276 bill it’s supporting, is asking us to go back to?”

Bob Sears

I would say that this is the worse thing that he has ever written, but I remember his post about how we were going to start making unvaccinated kids wear yellow stars

This isn’t even the first time that Bob Sears has written about vaccines and discrimination.

Life was good in 1988... if you weren't affected by discrimination, segregation, or any of these now vaccine-preventable diseases.
Life was good in 1988… if you weren’t affected by discrimination, segregation, or any of these now vaccine-preventable diseases.

Bob was right about one thing… There is a carefully crafted PR campaign going on. It’s full of propaganda to scare parents away from vaccinating and protecting their kids.

This isn’t discrimination though.

These are the consequences of their vaccine choice. Unfortunately, it is typically the kids who get stuck with the consequences of the choices their parents make.

Equating real problems of discrimination and segregation to the issue of parents choosing to keep their kids unvaccinated and unprotected is not only silly, but it is also offensive.

“We shouldn’t accept the idea that there is an ounce of discrimination when we are confronted with these bogus accounts of abuse. By conceding some degree of unfair treatment, when unwarranted, we undermine the real meaning of discrimination. Providing a soundboard to advantaged phonies who are unable to discern between a privilege and right only emboldens those at the top.”

Time to Fight Fake Discrimination

It subverts the work of all of those who are trying to end true discrimination.

More On Vaccine Discrimination

More Vaccinated vs Unvaccinated Studies

Anti-vaccine folks continue to call for vaccinated vs unvaccinated studies.

A vaccinated vs unvaccinated study that anti-vaccine folks don't talk about...
A vaccinated vs unvaccinated study that anti-vaccine folks don’t talk about…

Not surprisingly, they ignore all of the studies that have already been done.

More Vaccinated vs Unvaccinated Studies

Listening to these anti-vaccine folks, you would actually think that the only vaccinated vs unvaccinated “study” that has ever been done is the survey about homeschoolers that they always talk about

That leaves out a lot of other vaccinated vs unvaccinated studies, including:

Do we need even more studies on vaccinated vs unvaccinated children?

We already know that unvaccinated kids get sick more and they have more severe disease. Who is going to approve of or want to do a study that only puts kids at risk to get a vaccine-preventable disease?

Vaccines are safe, with few risks, and they are obviously necessary.

More on Vaccinated vs Unvaccinated Studies

Update on Vaccine Exemption Rates in California

Vaccination rates in California are dropping.

Wait, what?

Didn’t they recently pass a vaccine law that removed non-medical exemptions? How could vaccination rates be dropping?

Update on Vaccine Exemption Rates in California

While SB 277 did indeed remove all non-medical exemptions to getting vaccinated, some folks found a way around it. Since 2015, when it passed, some doctors are giving kids fake or unnecessary medical exemptions. These extra medical exemptions are likely making up for their previous personal belief vaccine exemptions.

The result?

It isn’t fewer exemptions since 2015.

Explain to me how it is ethical to misrepresent the rates of medical exemptions during a measles outbreak?
Explain to me how it is ethical to misrepresent the rates of medical exemptions during a measles outbreak?

While personal belief exemptions are certainly down, medical exemptions keep going up.

In addition to the 0.9% of medical exemptions, another 1.5% of kids, also up as a percentage, are unvaccinated “for other reasons specified under SB 277.”

There are also about 1.7% of kids in kindergarten who enroll as conditional entrants.

Why is that important? Among those conditional entrants are kids with temporary medical exemptions.

And how many kids aren’t vaccinated simply because they are “receiving IEP services?”

So it is not only wrong, it is unethical to try and say that only 0.9% of kids have vaccine exemptions in California this year.

Update on Vaccine Exemption Rates in California’s Clusters

Still, the big story continues to be what’s going on in the clusters of intentionally unvaccinated kids in California and other parts of the United States.

Are they getting vaccinated and protected under SB 277?

Wait, I thought Dr. Bob said that the vaccine exemption rate was just 0.9%. What happened at this Waldorf school? 30% of the kids have medical exemptions!
Wait, I thought Dr. Bob said that the vaccine exemption rate was just 0.9%. What happened at this Waldorf school? 30% of the kids have medical exemptions!

Some actually are!

The MMR rate at the Waldorf school in San Diego was just 44% back in 2014, as a whopping 56% of kids had a personal belief exemption. As sad as it sounds, even though it is still below herd immunity levels of protection, their current MMR vaccination rate of 68% is a big improvement!

Unfortunately, there are many schools with even lower immunization rates. And of course, that means even more students with “medical exemptions” at those schools.

SchoolPMEs
Marin Waldorf School31%
Yuba River Charter64%
Westside Waldorf School37%
Sebastopol Independent Charter45%
Muse Charter50%
Live Oak Charter41%
Nevada City School of Arts31%
Sunridge Charter47%
Santa Cruz Waldorf School34%
Cedar Springs Waldorf School30%
Journey33%
Waldorf School of Orange County33%
Coastal Grove Charter36%
Mariposa School of Global Ed31%
Waldorf School of the Peninsula36%
Maple Village Waldorf School30%

In addition to these permanent medical exemptions (PMEs), some schools also have high rates of temporary medical exemptions.

Medical Exemptions for Vaccines in California are Unusually High

What’s the usual rate of medical exemptions?

As there are few reasons to skip or delay a child’s vaccines, it is lower than those rates.

A lot lower.

In one recent report, Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year, the median rate of medical exemptions in the U.S. was just 0.2%, with a range of <0.1 to 1.5%.

Also unusual is that in some cases, many of those exemptions are written by just a few doctors. In fact, families often go to these doctors just to get their kids their medical exemptions!

“…the removal of nonmedical exemptions in California was initially effective in increasing vaccination rates, but the substitution between exemption types may render the repeal partially ineffective in improving immunization coverage and preventing VPDs over time.”

Richwine et al on Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-medical Exemptions for School Mandated Vaccines

How do we fix this and get more kids vaccinated and protected?

“Beyond fostering compliance, tightening the requirements around medical waivers will also aid in promoting public policies that protect public health.”

Richwine et al on Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-medical Exemptions for School Mandated Vaccines

In addition to closing the loopholes that allow some doctors to abuse medical exemptions, it will be important to help parents be more skeptical and see through the anti-vaccine propaganda that other doctors use to scare parents away from vaccinating and protecting their kids.

Vaccines are safe, with few risks, and are obviously necessary.

More on Vaccine Exemption Rates in California