Vaccine-autism how long will this crap be taken seriously

LawBeefaroni · Post by **LawBeefaroni** » Thu Apr 30, 2009 11:06 am

HPV (Gardacil) vaccine and Rotavirus (RotaTeq) reimbursement are issues I deal with on a daily basis. In fact, I can give you code for RotaTeq without out looking it up: 90680. A sad statement about how much rotateq reimbursement is a part of my life

.

Anyway, yes there are issues with payors (I'm ignoring Medicare and Medicaid becuase they are special case clusterfucks). When Gardasil was coded, no one knew what the price from Merck was going to be. So there were estimates all over the place built into fee schedules. Some were low. The first year, reimbursement could have been far below purchase price. Payors fixed this. We took care of it quickly so our peds were ok. Most immunizations and injectibles are usually updated quarterly on fee schedules and payors, while they might love to, don't expect to reimburse less than the purchase price of the drug/vaccine. In cases where they do, it's usually because of price changes or poor price estimates.

Which brings up the issue of price and cost. The article you quote has RotaTeq at $190 for 3 doses. Redbook has average wholesale price at around $83/dose ($833 per 10 dose vial). So something doesn't add up. [EDIT: And Gardasil is about $150 and the article has $360. AAP is using some funny numbers] I will say that our providers pay roughly around AWP and don't lose money on RotaTeq, MMRV, or Gardasil, taxes included.

Inventory control is part of the cost of doing business. If offices are writing off large amounts of vaccines to spoilage, they need to monitor their stock better. Note that for each set of injections there is usually also an office visit, injection fee, and equipment (needle/syringe) billed as well which can help cover overhead such as inventory control.

I guess it all comes down to this:

One practice reported that the vaccine purchase price exceeded the most common payer reimbursement for 15 of the 21 vaccines, the researchers said.

That practice needs to renegotiate their reimbursement or terminate participation with that most common payor.

It's hard out there for a ped, no doubt. But it's like any other business. You don't end up with a successful restaurant by simply being a good chef. You don't end up with a great GC business simply by being a great builder. You don't have a profitable pediatric practice by simply being a good doctor and giving shots. Does every pediatric office that opens have an automatic right to profit?

silverjon · Post by **silverjon** » Thu Apr 30, 2009 11:12 am

Eightball wrote:
Gardasil, the new cervical cancer vaccine

Arrrrrrrrrrrgggghhhhhhhh WTF medical community!?

Seriously, it is not a vaccine against cancer. It is a vaccine against HPV which can be linked to some kinds of cervical cancer (many but not all).

I have seen this "cervical cancer vaccine" over and over and OVER again in the media. Heaven forbid anyone should actually talk openly about what it is and whether or not girls should have a choice in the matter.

LawBeefaroni · Post by **LawBeefaroni** » Thu Apr 30, 2009 11:18 am

Eightball wrote:
With declining immunization profit margins over the course of the prior three years for 53% of respondents, more than one in five strongly felt that reimbursement for vaccine purchase was inadequate.

Overall, 21% of family practices and 5% of pediatric practices had seriously considered whether to stop all vaccination of privately insured children

Berman's paper, in part is located here. It's frightening to think that such a large % of practices were considering stopping vaccinating children because of cost...when all docs know how important it is.

Such a large %age? 5% and 21%? These are practices that apparently cannot manage cost or income (reimbursement). What's the failure rate in other industries for similar shortcomings?

I'm sympathetic to these practices, despite how I may seem. I know payors squeeze the hell out of them (again, dealing with it is my 9-5) but there's more to running a business than just showing up and doing what you do. You'd be amazed how many of these practices don't even review their books, if they keep them at all. They may keep meticulous medical records but their accounts look like a bar dart scoreboard at 4am.

EDIT: Oh, and they're probably in violation of their provider agreements if they stop vaccines only for insured or select insured patients. Big no-no. They agree to accept the reimbursement when they enter into the agreement in return for patient direction.

LawBeefaroni · Post by **LawBeefaroni** » Thu Apr 30, 2009 11:25 am

silverjon wrote:
Eightball wrote:
Gardasil, the new cervical cancer vaccine
Arrrrrrrrrrrgggghhhhhhhh WTF medical community!?

Seriously, it is not a vaccine against cancer. It is a vaccine against HPV which can be linked to some kinds of cervical cancer (many but not all).

I have seen this "cervical cancer vaccine" over and over and OVER again in the media. Heaven forbid anyone should actually talk openly about what it is and whether or not girls should have a choice in the matter.

Agreed.

FWIW, it's Merck that has probably spent millions (billions?) establishing the perception that Gardasil is a "cancer vaccine."

Oh, and "girls?" Do not discriminate on basis of gender. Merck isn't.

silverjon · Post by **silverjon** » Thu Apr 30, 2009 11:28 am

LawBeefaroni wrote:Oh, and "girls?" Do not discriminate on basis of gender. Merck isn't.

Sales are slowing, eh?

At least they won't be able to peddle it as a cervical cancer vaccine for men. Or will they?

Eightball · Post by **Eightball** » Thu Apr 30, 2009 12:30 pm

silverjon wrote:
Eightball wrote:
Gardasil, the new cervical cancer vaccine
Arrrrrrrrrrrgggghhhhhhhh WTF medical community!?

Seriously, it is not a vaccine against cancer. It is a vaccine against HPV which can be linked to some kinds of cervical cancer (many but not all).

I have seen this "cervical cancer vaccine" over and over and OVER again in the media. Heaven forbid anyone should actually talk openly about what it is and whether or not girls should have a choice in the matter.

Yeah...it's too hard to distinguish the vaccine is against the etiological agent, I guess.

Interestingly, Gardasil was originally an NCI invention. One of my friends wrote the licensing agreement between NCI and Gardasil.

I'm sympathetic to these practices, despite how I may seem. I know payors squeeze the hell out of them (again, dealing with it is my 9-5) but there's more to running a business than just showing up and doing what you do. You'd be amazed how many of these practices don't even review their books, if they keep them at all. They may keep meticulous medical records but their accounts look like a bar dart scoreboard at 4am.

Good lord I didn't know you dealt with reimbursement. My sincerest apologies (that's one area of health law I stay far, far away from. It's so...technical and...boring). Anyways, I understand your point; however, I was just presenting information stating that vaccines aren't exactly big money makers for these peds.

It's hard out there for a ped, no doubt. But it's like any other business. You don't end up with a successful restaurant by simply being a good chef. You don't end up with a great GC business simply by being a great builder. You don't have a profitable pediatric practice by simply being a good doctor and giving shots. Does every pediatric office that opens have an automatic right to profit?

No, but if they're identifying vaccines as a zero sum game, don't they have a right at the same time to spend their time in more lucrative endeavors?

Edit: This article provides a good overview of this argument. Also I'm fairly sure that your physicians probably get a reasonable rate from the insurance companies you deal with, as you work in a large hospital in an urban setting. Lots of leverage to negotiate good rates.

LawBeefaroni · Post by **LawBeefaroni** » Thu Apr 30, 2009 12:42 pm

Eightball wrote:
It's hard out there for a ped, no doubt. But it's like any other business. You don't end up with a successful restaurant by simply being a good chef. You don't end up with a great GC business simply by being a great builder. You don't have a profitable pediatric practice by simply being a good doctor and giving shots. Does every pediatric office that opens have an automatic right to profit?
No, but if they're identifying vaccines as a zero sum game, don't they have a right at the same time to spend their time in more lucrative endeavors?

Sure, but what parent is going to want to go to one doc for an office visit and another for required immunizations? I wouldn't exactly call vaccines as "loss leaders" but they are something you need to offer for complete pediatric care, even if they are just break-even.

Kind of off-topic, but some of our peds are petrified of walk-in health clinics (Take Care Clinics in Walgreen's for example). They're afraid the pediatric practices will only see the sickest of patients, which are also the costliest, while the clinics cherry pick the cases they can handle, like coughs/colds, routine immunizations, etc. We haven't officially analyzed it yet but on the face there appears to be some reason for concern.

Eightball wrote:Good lord I didn't know you dealt with reimbursement. My sincerest apologies (that's one area of health law I stay far, far away from. It's so...technical and...boring). Anyways, I understand your point; however, I was just presenting information stating that vaccines aren't exactly big money makers for these peds.

Fortunately IANAFL and we have a good OGC. But 1,300 private physicians and ~18 plans is enough. I put my bartenders' kids through college.

tjg_marantz · Post by **tjg_marantz** » Tue May 05, 2009 11:58 am

http://www.cnn.com/2009/HEALTH/05/04/au ... index.html" target="_blank

Link says it all.

Toe · Post by **Toe** » Tue May 05, 2009 1:14 pm

tjg_marantz wrote:http://www.cnn.com/2009/HEALTH/05/04/au ... index.html

Link says it all.

It does not "say it all" since there is nothing presented as to why the amygdala grows larger in some children. We are right back to square one.

Isgrimnur · Post by **Isgrimnur** » Tue May 05, 2009 1:44 pm

Square one would be talk of "refrigerator mothers." Nor is this the end of the journey. We have found what appears to be a specific symptom that is not replicated by other diseases/disorders. We have yet to determine if this is the root cause or an after effect. But it gives us another place to start looking.

tjg_marantz · Post by **tjg_marantz** » Tue May 05, 2009 3:53 pm

I was more saying the link says it all in response to the OP and the Jenny McCarthy stuff. These kids are showing signs BEFORE vaccines. This is important. I believe this is a step towards proving the vaccines do not cause autism. They MAY be a trigger for full-blown autism but not the cause. And even at that, if they already have signs of autism, don't get the shots and then develop full blown autism, you prove even more that the shots are not the cause. If this can be proven, then you can work towards identifying babies who should not receive shots instead of saying nonsense like NO babies should receive these shots. Sorry for not being clearer.

tjg_marantz · Post by **tjg_marantz** » Tue May 05, 2009 3:59 pm

I was more saying the link says it all in response to the OP and the Jenny McCarthy stuff. These kids are showing signs BEFORE vaccines. This is important. I believe this is a step towards proving the vaccines do not cause autism. They MAY be a trigger for full-blown autism but not the cause. And even at that, if they already have signs of autism, don't get the shots and then develop full blown autism, you prove even more that the shots are not the cause. If this can be proven, then you can work towards identifying babies who should not receive shots instead of saying nonsense like NO babies should receive these shots. Sorry for not being clearer.

deucalion · Post by **deucalion** » Tue May 05, 2009 10:29 pm

Looks like Jenny is getting a new soap box to spew her nonsense:

http://www.people.com/people/article/0, ... 58,00.html

"McCarthy has already been a frequent guest on The Oprah Winfrey Show, discussing, among other topics, how she took on the medical establishment to deal with her son Evan's autism." - <sarcasm> Sounds like a true crusader to me... </sarcasm>

Turtle · Post by **Turtle** » Tue May 05, 2009 10:46 pm

Actually, there's already plenty of evidence, hard evidence at that, that vaccines do not cause autism. However, it's because of the dumbass media who knows nothing about science or the reality of the situation that are killing kids. Yes, they are killing kids by promoting this stuff.

Smoove_B · Post by **Smoove_B** » Fri Feb 26, 2010 7:22 pm

New article in Time suggests that some are questioning Jenny McCarthy's diagnosis of Autism for her son:

There are dark murmurings from scientists and doctors asking, Was her son ever really autistic? Evan's symptoms — heavy seizures, followed by marked improvement once the seizures were brought under control — are similar to those of Landau-Kleffner syndrome, a rare childhood neurological disorder that can also result in speech impairment and possible long-term neurological damage. Or, as other pediatricians have suggested, perhaps the miracle I have beheld is the quotidian miracle of childhood development: a delayed 2-year-old catching up by the time he is 7, a commonplace, routine occurrence, nothing more surprising than a short boy growing tall.

Figured I'd bump since it's the first time I've seen her son's diagnosis (and "recovery") questioned.

Odin · Post by **Odin** » Fri Feb 26, 2010 7:26 pm

Smoove_B wrote:Figured I'd bump since it's the first time I've seen her son's diagnosis (and "recovery") questioned.

Wow, that's nuts. I certainly have experienced the concern and frustration any time one of my kids exhibits behaviour that deviates from the norm (one of my kids had speech issues that were mostly resolved with speech therapy, for instance), but this chick went completely round the bend over her son's condition. To the point of spearheading an anti-vaccine movement that may actually (almost certainly did) harm other children. Way to go, Dr. McCarthy. It's a shame she's not an actual doctor. Then at least her credentials could be stripped. What do you do when a former nude model who never should have had a bully pulpit in the first place is found to be a quack?

Turtle · Post by **Turtle** » Fri Feb 26, 2010 8:07 pm

Also, you guys know that she also tried to pass her child off as an indigo child first?

You remember the Mayan mythology that was part of the Farenheit/Indigo Prophecy game? Yeah, it's that exact thing.

It's sad that I have to attack her character, in fact I should be avoiding it since it's basically an ad hominem attack, not good for the skeptic movement, but it must be said. Do you really want to trust such a woman with the health of your child?

Blackhawk · Post by **Blackhawk** » Fri Feb 26, 2010 11:56 pm

Turtle wrote:
It's sad that I have to attack her character, in fact I should be avoiding it since it's basically an ad hominem attack

Perhaps, but not a fallacious one. You didn't attack her scientific and medical views on the basis of her being a bad actress. You attacked her scientific views on the basis of her being a bad scientist. That's valid.

Odin · Post by **Odin** » Sat Feb 27, 2010 8:55 am

Turtle wrote:Also, you guys know that she also tried to pass her child off as an indigo child first?

Pretty sure that came after - I remember having to go to wikipedia after she was interviewed on the news to find out what the hell she was talking about with this indigo child/crystal mom nonsense. I read the article twice and I still don't understand. I'm OK with that.

Smoove_B · Post by **Smoove_B** » Tue Mar 09, 2010 7:37 pm

I should have known better...here's Jenny's response.

With so many kids with autism, the environment has to be to blame, and vaccines are an obvious culprit. Almost all kids get vaccines -- injected toxins -- very early in life, and our own government clearly acknowledges vaccines cause brain damage in certain vulnerable kids

I...I just can't.

Who's afraid of the truth? Usually the people it would hurt the most.

Well, at least we can agree on something.

EDIT: Jenny McCarthy cares not for Floyd. Thanks Lawbeef

LawBeefaroni · Post by **LawBeefaroni** » Tue Mar 09, 2010 7:41 pm

Smoove_B wrote:I should have known better...here's Jenny's response.

Pink Floyd - Pink Floyd Take Emi To Court

Um...

Exodor · Post by **Exodor** » Tue Mar 09, 2010 7:43 pm

Psst, Smoove - I think you cut and pasted the wrong link

Pink Floyd have started legal action against their record label, EMI.

The legendary 'Wish You Were Here' rockers began proceedings over their entitlement to royalties from the record company, and how they are calculated today

Unless you're claiming that Pink Floyd causes autism

EDIT:

Smoove_B · Post by **Smoove_B** » Tue Mar 09, 2010 7:44 pm

Pink Floyd does not cause autism - but you can't deny there's a relationship to global warming and the number of Pink Floyd albums that have been released.

Isgrimnur · Post by **Isgrimnur** » Fri Mar 12, 2010 6:31 pm

'Vaccines court' rejects mercury-autism link in 3 test cases

The government's " vaccines court" ruled Friday in three separate test cases that the mercury-containing preservative thimerosal does not cause autism, a finding that supports the broad scientific consensus on the matter but that is likely to disappoint parents who are convinced that their child's illness has been caused by vaccines.

The court had ruled 13 months ago that the measles-mumps-rubella vaccine, commonly known as MMR, does not cause the disorder, and the new ruling may finally close the bulk of litigation on the matter. More than 5,000 parents had filed claims with the court, formally known as the U.S. Court of Federal Claims, seeking damages because they believed their children had developed autism as a result of vaccinations.

The cases that three special masters for the court chose to include in the omnibus proceeding were considered among the strongest, so the outlook appears grim for others making the same claim.

Kraken · Post by **Kraken** » Fri Mar 12, 2010 6:44 pm

When the government denies something, that means it's true! Case closed.

Mr. Fed · Post by **Mr. Fed** » Fri Mar 12, 2010 7:54 pm

Ironrod wrote:When the government denies something, that means it's true! Case closed.

If the court ruled that I do not have the most impressive schlong in the universe, would you take that as any sort of support for the proposition that I do?

Eightball · Post by **Eightball** » Fri Mar 12, 2010 8:45 pm

Not a surprising verdict, as we ALL know that the scientists and the court are all paid off by Big Thimerosal(TM).

Kraken · Post by **Kraken** » Fri Mar 12, 2010 10:04 pm

Mr. Fed wrote:
Ironrod wrote:When the government denies something, that means it's true! Case closed.
If the court ruled that I do not have the most impressive schlong in the universe, would you take that as any sort of support for the proposition that I do?

What does Jenny McCarthy think?

Clanwolfer · Post by **Clanwolfer** » Sat Mar 13, 2010 9:40 am

I can't wait to see the "test case" where the parents of kids that die of Mumps sue McCarthy for wrongful death.

El Guapo · Post by **El Guapo** » Sat Mar 13, 2010 10:33 am

Looks like the anti-vaccine people are taking this rationally:

“The deck is stacked against families in vaccine court,” said Rebecca Estepp, of the coalition’s steering committee. “Government attorneys defend a government program using government-funded science before government judges. Where’s the justice in that?” The coalition claims to represent 75,000 families.

I assume that they would have the same objections to a government attorney arguing against a government public defender before a government judge in criminal court. I mean geez, it's like the government is all involved in government and law.

http://www.nytimes.com/2010/03/13/scien ... ne.html?hp" target="_blank

Kraken · Post by **Kraken** » Sat Mar 13, 2010 10:38 am

Clanwolfer wrote:I can't wait to see the "test case" where the parents of kids that die of Mumps sue McCarthy for wrongful death.

Do kids die of mumps? It was a routine childhood disease when I was little. Measles, mumps, and chicken pox were all a normal part of growing up before your fancy vaccines came along.

AWS260 · Post by **AWS260** » Sat Mar 13, 2010 11:13 am

Ironrod wrote:
Clanwolfer wrote:I can't wait to see the "test case" where the parents of kids that die of Mumps sue McCarthy for wrongful death.
Do kids die of mumps? It was a routine childhood disease when I was little. Measles, mumps, and chicken pox were all a normal part of growing up before your fancy vaccines came along.

Mumps isn't bad. Measles can kill, though rarely.

Measles immunization, incidentally, is one of the greatest public health success stories of recent years. Measles deaths worldwide have declined from 733,000 in 2000 to 164,000 in 2008.

silverjon · Post by **silverjon** » Sat Mar 13, 2010 2:34 pm

How long before a veritable rash of rubella (the ignored part of the MMR vaccine) starts actually causing pregnancy issues and the whole thing backlashes the other way? I guess it can't really until the crop of un-vaccinated kids start breeding.

When we got these vaccines in elementary school (the second MMR dose, I guess), we were taught what diseases the letters stood for and how they could make us sick. The explanation of rubella really got to me because the vaccine is really to protect someone else, from something a lot worse than a rash and fever. Horrifying.

Diphtheria was personalized because my grandmother almost died from it as a child. Her father actually did die in that outbreak. I think it is deeply significant that people who have grown up with vaccines typically have no understanding of the diseases themselves, and that is why they fail to see the positive effects of vaccines... no context for anything else.

Interesting blurb about a US measles outbreak in 2005 here:
http://en.wikipedia.org/wiki/MMR_vaccine" target="_blank

Kraken · Post by **Kraken** » Sat Mar 13, 2010 6:22 pm

silverjon wrote: I think it is deeply significant that people who have grown up with vaccines typically have no understanding of the diseases themselves, and that is why they fail to see the positive effects of vaccines... no context for anything else.

They didn't have MMR when I was in grade school, as I've said, but I do remember getting polio vaccine in sugar cubes. The oral Sabin vaccine was just a couple of years old by the time I got it in 1964, and herd immunity had already nearly stopped natural transmission of the disease. But there were still upwards of half a million Americans paralyzed by polio, so its shadow remained scary enough.

Polio was eradicated in the US by 1988 because we dutifully required all children to get the cheap, effective vaccine. MMR will persist for as long as there are parents who think that vaccines are optional.

LawBeefaroni · Post by **LawBeefaroni** » Mon May 10, 2010 9:58 am

Oh great, more ammo. Thanks Merck. Glaxo's Rotarix had the same thing but it wasn't nearly as widely used as Rotateq.

Pig virus DNA found in Merck's Rotateq vaccine

The U.S. Food and Drug Administration reported May 6 that fragments of two types of pig viruses were found in Merck & Co.'s Rotateq vaccine.

One virus is the same one found in GlaxoSmithKline PLC's Rotarix vaccine in March. The FDA, at the time, recommended doctors stop using that vaccine and use Rotateq instead, even though the agency said it didn't think the virus posed any safety risks to humans.

Both vaccines are designed to protect infants from a gastrointestinal illness caused by rotavirus and have been given to millions of babies since Merck's Rotateq vaccine was approved for use in the U.S. in 2006.

Officials said tests identified fragments of DNA from PCV1 and from a related porcine circovirus, PCV2, in its Rotateq vaccine. PCV1 and PCV2 are common in pigs. Neither PCV1 nor PCV2 are known to cause illness in humans. However, FDA officials said PCV2 may cause illness in pigs.

“We don't exactly know the source of the PCV finding in Rotateq,” Mark Feinberg, vice president, medical affairs and policy at Merck Vaccines Mark Feinberg, told Dow Jones Newswires.

Smoove_B · Post by **Smoove_B** » Fri Aug 20, 2010 3:56 pm

On next weeks' episode of 19 Kids and Counting, it's revealed that 12 of the 19 kids came down with Chicken Pox earlier this summer. I'd like to think this will spark healthy debate over vaccines...but I know it won't. From my quick searches, I can't tell if they're an anti-vaccine family, anti-Chicken Pox vaccine or just really, really unlucky.

Arcanis · Post by **Arcanis** » Fri Aug 20, 2010 4:07 pm

I'm sad to say we are among those parents who don't have their child vaccinated, but at least we have a logical reason (2 surgeries and in hospital care for almost all of her life) for it and are rectifying that quickly (she starts them next week under her pediatrician and cardiologist's supervision they will get her immunized out the wazoo before flu season hits). Though I must say it has been useful in getting seen when Karleigh needs to go to the doctor's office, about 2-3 times a week right now, since as soon as we tell them the situation, if they don't already know, we are brought to the back immediately.

LawBeefaroni · Post by **LawBeefaroni** » Fri Aug 20, 2010 4:31 pm

Arcanis wrote:I'm sad to say we are among those parents who don't have their child vaccinated, but at least we have a logical reason (2 surgeries and in hospital care for almost all of her life) for it and are rectifying that quickly (she starts them next week under her pediatrician and cardiologist's supervision they will get her immunized out the wazoo before flu season hits). Though I must say it has been useful in getting seen when Karleigh needs to go to the doctor's office, about 2-3 times a week right now, since as soon as we tell them the situation, if they don't already know, we are brought to the back immediately.

That's exactly why kids who can should always get vaccinated. It's not just to protect themselves but also to protect those who, for health reasons, cannot yet or ever be vaccinated.

FWIW, the 0-6 vaccine schedule.

fancydirt · Post by **fancydirt** » Fri Aug 20, 2010 5:24 pm

LawBeefaroni · Post by **LawBeefaroni** » Fri Aug 20, 2010 5:26 pm

fancydirt wrote:
I didn't know that there was a Chicken Pox vaccine. Is this something that is regularly given to kids even though the disease itself is considered mild as long as you get it at a young age? I can definitely see the merits of vaccinating someone who has gotten through childhood without contacting Chicken Pox since it can become much more severe in older patients but for kids all I ever hear about are Chicken Pox Parties that parents set up to get it out of the way at a young age.

I think you're right that this show won't spark any debate over other vaccines.

It's the varicella vaccine. Recently it's been combined with the MMR vaccine to make the MMRV vaccine (measles, mumps, rubella, vericella). I guess the thinking is that since you're getting the MMR anyway, throw in the V. Four for the quick stinging pain of one.