Tag: medical exemptions

Bob Sears Ignores Death Threats Against Dr. Pan

Interesting.

Bob Sears ignores death threats against Dr. Pan, but thinks lobbyists who support SB276 are like a mafia.
Bob Sears ignores death threats against Dr. Pan, but thinks lobbyists who support SB276 are like a mafia???

Actually, it’s kind of amazing.

“Lawmakers sponsoring the bill say they’ve been receiving death threats for months. Someone in June mailed Assembly members dozens of bricks etched with appeals to kill the measure.”

Bricks, death threats and fury: A last-ditch fight against California’s vaccine crackdown

Instead of calling out the folks who are making death threats against Dr. Pan, a fellow California pediatrician who is working to get more kids vaccinated and protected with his new bill, SB 276, Bob Sears goes after medical lobbyists who are supporting the bill!

Why are these folks ‘like a mafia,’ as he suggests?

Did they put a horse’s head in someone’s bed?

Vaccines are safe, with few risks, are obviously necessary and something you shouldn't refuse.
Vaccines are safe, with few risks, are obviously necessary and something you shouldn’t refuse.

Or are some Legislators just “feeling intimidated and bullied” because they are getting called out for echoing the anti-vaccine talking points that are being used to oppose SB276?

“Any lawmaker who votes yes on SB 276 will have blood on their hands. It’s up to each of them to decide if they will be accessories to the real human cost of this lethal legislation. How much is a life worth? Will lawmakers sacrifice children for political purposes or will they acknowledge and act according to the truth?”

Jonathan Lockwood

Lethal legislation? Yes, that’s how the anti-vaccine movement describes a bill that the AAP, California Medical Association, California State PTA, Children’s Defense Fund of California, County of Los Angeles, Infectious Disease Association of California, the March of Dimes, and many other organizations supports.

Bob Sears, as he fights for kids to be allowed to get fake medical exemptions, is also routinely promoting the efforts of consultant, Jonathan Lockwood of Oregon, who has been described as an “out-of-state political operative known for provocative campaigns.”

No one should have to deal with getting death threats.
No one should have to deal with getting death threats.

And despite the fact that legislators have been getting death threats for years, Bob Sears hasn’t called on folks to stop making them. He even promoted the failed effort to recall Dr. Pan.

And while this is all kind of interesting, no one should be surprised.

More on Bob Sears Ignores Death Threats Against Dr. Pan

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?

Are There 6 Reasons to Oppose SB276?

Not surprisingly, folks are pushing misinformation in trying to get support in their efforts to oppose SB276, the California bill that will help stop doctors from writing fraudulent medical exemptions.

Are There 6 Reasons to Oppose SB276?

It also shouldn’t be a surprise that none of their “reasons” hold water.

There are no good reasons to oppose SB276.
There are no good reasons to oppose SB276.

Are the guidelines for writing medical exemptions too limited under SB276?

If you consider that true medical exemptions to getting vaccinated are not common, then no, they are not.

Remember, medical exemptions for vaccines should be for kids who can’t be vaccinated, not just because you’re scared or don’t want your child to be vaccinated.

What about the high rates of vaccination and low rates of exemptions in California?

Uh, what about the schools in California where 30 to 50% of students have medical exemptions? These clusters of unvaccinated kids with medical exemptions are the concern, not the overall rates of vaccination and exemptions in the state.

And it is only the doctors writing excessive medical exemptions that will trigger an investigation.

What about the Medical Board of California?

While the system that they have in place has allowed them to investigate some doctors, it has mostly failed. While they do have the authority to investigate physicians, for some reason, they can’t get medical records unless a parent cooperates.

“Ms. Simoes provided background on Senate Bill (SB) 277, which passed in 2015, eliminating the personal belief exemption from the requirement that children receive specific vaccinations for certain infectious diseases prior to being admitted to any school or daycare center. She explained that after the passage of SB 277, the Board has had a difficult time investigating complaints related to medical exemptions since an authorization of medical records needs to be signed and many parents or guardians do not want to sign the authorization since it would identify the doctor that provided the medical exemption. She explained that this causes a barrier to investigation since most medical exemption cases cannot be subpoenaed and medical records are needed to conduct an investigation.”

Discussion and Possible Action on SB 276 (Pan) Immunizations: Medical Exemptions

And the Medical Board of California supports SB276.

Who else supports SB276?

In addition to the Governor of California, supporters include the AAP, California Medical Association, California State PTA, Children’s Defense Fund of California, County of Los Angeles, Infectious Disease Association of California, and the March of Dimes.

What to Know About Reasons to Oppose SB276

It should be clear that there is no reason to oppose SB276, unless you don’t want your kids immunized and you want to find a doctor to write them a fake medical exemption.

More on SB276

What Is Standard of Care?

Anti-vaccine folks who are talking about “standard of care” when deciding who gets a medical exemption for vaccines obviously don’t really understand what it means.

Why are these advocating against keeping kids protected against life-threatening vaccine-preventable diseases?
Why are these advocating against keeping kids protected against life-threatening vaccine-preventable diseases?

Maybe that’s why they put standard of care in quotes in the above infographic against SB276, a new vaccine bill in California that will eliminate fake vaccine exemptions.

What Is Standard of Care?

When we talk about standard of care in medicine, it is important to understand that it is a legal term, with a legal definition:

“That which a minimally competent physician in the same field would do under similar circumstances”

Moffett et al on The Standard of Care: Legal History and Definitions: the Bad and Good News

Does this mean that the minimally competent physicians can choose whatever criteria they want to write fake medical exemptions for vaccines?

Of course not!

“Treatment that is accepted by medical experts as a proper treatment for a certain type of disease and that is widely used by healthcare professionals. Also called best practice, standard medical care, and standard therapy.”

NCI Dictionary of Cancer Terms

Just because a few doctors do something a certain way, that doesn’t make it the proper way for it to be done.

These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.
These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.

And that’s why a doctor making up their own rules for what counts as a vaccine medical exemption, especially when it goes against published guidelines and advice, isn’t standard of care.

More on Standard of Care