Physician incentives - Page 3

[SunshineJ]

The whole vaccine incentive/reimbursement is very insidious. I know in at least one state there is additional funding available to those areas or regions that reach a certain level of immunization compliance. For example if they can show a certain % of children in the area are immunized, then there is a pretty healthy distribution of funds to that region. It is not uncommon then for those regions to offer incentives to the physicians in their area to encourage them to boost the numbers. Of course these are not usually called "incentives" but rather reimbursements (irregardless of how much the dr may already be being reimbursed by the insurance companies). Not surprising a lot of this information simply isn't on the internet - a lot of fiscal policies and programs aren't. However, it's amazing how much you can learn when you spend 5 yrs working in the IT dept of local governments!

[carriebft]

When we are talking about 'incentives' and these bonus and all that, it might be tempting to want to jump to the conclusion that the incentives and bonuses balance out the loss from vaccines, but that doesn't seem to be the actual case. They might get "a thousand here and there" (which is what the Sears article seems to be saying) but how can that possibly balance out the losses spoken of in the NYT article? and why would there be so much concern over the cost of vaccines and that factor contributing to the loss of peds/difficulties in maintaining practices?

[BoringTales]

You are exposed to more 'toxins' walking down a busy street than you are when you get a vaccination. I hope all of you that are not vaccinating because of the evil 'toxins' aren't drinking tap water, or living in large cities with poor air quality, or spending any time in heavy traffic. I also hope that you've had your soil tested for heavy metals if you grow any of your own food.

[MoonWillow]

Please keep the thread on topic (physician incentives) so it can stay on the board.
Thanks.

[Scattershoot]

1. Doctors "push" vaccines because the vast majority of them believe that they are beneficial to people's health. It is as simple as that. Most doctors went into this profession to help people, not to make money. Why do most people on MDC promote breastfeeding and cloth diapering? Because they believe in it. Same thing.

How many medical students would make it through medical school if they said they did not believe in vaccination and that they refused to be a part of that system? How well would that go over? The problem is that vaccination is so accepted as a medical procedure that it is the status quo. Questioning it is heresy. It’s only after medical school that doctors see the damage vaccines cause leading to a small number of them having the courage to act on what they witness. They become pariahs for doing so. Look what happened to Dr. Mendelsohn. Look at Dr. Wakefield.

I wouldn’t compare injecting known toxins that can maim and kill a child to cloth diapering.

2. No, there are no $1000 junkets for doctors for vaccinations.

Maybe there are no “educational” junkets specifically saying they are for vaccination, but that is misleading since the same drug makers that pay for these junkets also sell vaccines. It’s the overall influence, and it cannot be separated.

A friend of mine waited tables at arguably the nicest restaurant in Austin. Every Friday, the pharmaceutical reps would rent out the banquet area and spend on average $5000 per luncheon. There would be about 20 doctors and the reps. My friend loved his Fridays because he made big time tips.

I don't know what else to say to make you believe this. The AMA has no "power" over doctors.

Policies, such as vaccination mandates, are heavily influenced by the role of medical journals such as JAMA. What doctors are told to believe about vaccination comes from journals like this. These journals are so influential that thousands of parents can say the exact same thing in regards to vaccine reaction and it is ignored because it did not appear in a journal. The AMA spends millions every year to get certain political candidates favorable to their agenda elected. Once elected, the agenda is created and doctors follow this. The AMA quickly disseminates any evidence it can to prove vaccines are safe. It is of the highest priority to promote vaccination. The “power” is therefore substantial.

I was a member of the American Psychological Association for a long time so I understand what these associations do. Even though I later chose not to be a member, the influence of APA was still vast as far as insurance reimbursement, policies and recommendations were concerned. It’s the influence over the entire field of practice.

It is a political lobby group. Less than 30% of doctors even belong to it. They do not set policy.

They have substantial influence on policy. That’s AMPAC’s goal.

[waiflywaif]

Policies, such as vaccination mandates, are heavily influenced by the role of medical journals such as JAMA.

Studies in medical journals are peer-reviewed science. Not mouthpieces for the publishing organization. If policy is "heavily influenced" then it's because the science is sound and evidence-based.

[carriebft]

How many medical students would make it through medical school if they said they did not believe in vaccination and that they refused to be a part of that system?

Do you have evidence for this? I know quite a few that have gotten through medical school in the midwest with a stance against circumcision and now practice but do not do these. It was tough sometimes with the red tape and all, but they managed. Is there evidence that doctors who are personally against vaccines cannot get through medical school?

[k9sarchik]

Originally Posted by CorasMama

So, that's a "no" to her question, then?

I did answer. I am sending them directly to the source. But I will contact the source myself.
I don't want to site the book yet again that I already posted in the thread.

[Scattershoot]

Originally Posted by carriebft

How much money do they make of pertussis patients? mental retardation from hib? That argument can be made on both sides.

But we cannot compare vaccination to non-vaccination. One side wants to force something onto the other while the other side just wants to be left alone. If it is a washout, then no advantage can be claimed for the former. Incentives are given to promote a program of vaccination. The incentives are given to doctors, policy makers, schools and health facilities. These incentives are very real.

Pediatricians are not making any money at all off of parents like me. There is a growing number on non-vaccinators who are choosing the same route. The current media backlash against non-vaccination is an attempt to sway this.

As far as acquired mental retardation goes there are a LOT of questions regarding that theory. Since vaccines can cause encephalitis it makes one wonder how many children developed severe enough brain damage from vaccination to lead to mental retardation. Then blame that on a microbe. As mentioned, these can always be argued more than one way.

[Baby_Vol]

Originally Posted by carriebft

Do you have evidence for this? I know quite a few that have gotten through medical school in the midwest with a stance against circumcision and now practice but do not do these. It was tough sometimes with the red tape and all, but they managed. Is there evidence that doctors who are personally against vaccines cannot get through medical school?

Even the AAP is against routine circ now. The AAP is not against routine vaccinations. I'm not seeing the connection of how the two are related?

So, you all are trying to say that Merk gives zero incentives to vaccinate? They spent all this money promoting Guardasil, even lobbying the government, but they don't give any kind of perks to doctors? At all? AND they loose money on it? Interesting. Honestly, I don't believe it.

The problem is cognitive dissonance. It's the inability to look at a situation with an open mind and open heart to try to understand what may be happening. This is evidenced by the constant response from the medical profession to an injured child who has recently received a vaccination that goes like this, "We have no idea what caused this, but we are sure it is not the vaccination."

Exactly. Well said.

You are exposed to more 'toxins' walking down a busy street than you are when you get a vaccination. I hope all of you that are not vaccinating because of the evil 'toxins' aren't drinking tap water, or living in large cities with poor air quality, or spending any time in heavy traffic. I also hope that you've had your soil tested for heavy metals if you grow any of your own food.

This argument has been said time and time and time again on here. It's very different than injecting it into your arm. However, this is not in any way on topic at all ...so I'll drop it. This has nothing to do with the topic at all. It's up to individual parents, and I find your remarks insulting.

[k9sarchik]

Originally Posted by carriebft

Do you have evidence for this? I know quite a few that have gotten through medical school in the midwest with a stance against circumcision and now practice but do not do these. It was tough sometimes with the red tape and all, but they managed. Is there evidence that doctors who are personally against vaccines cannot get through medical school?

They don't vocalize this when they are in school. My Dr. is one of them. They ignore what they feel is false information.

How is one suppose to find "evidence" that a doctor can't get through school due to personal beliefs?

Except there is this NY Times story about Pfizer photographing protesting Harvard Medical Students. I bet they could make life hard for them.
http://www.nytimes.com/2009/03/03/bu.../03pfizer.html

[k9sarchik]

Originally Posted by waiflywaif

Studies in medical journals are peer-reviewed science. Not mouthpieces for the publishing organization. If policy is "heavily influenced" then it's because the science is sound and evidence-based.

Unless the peer-reviewed journal doesn't have any Big Pharma advertisements in it, you can't rely that all of the information is being published. For example,
When the CDC was working on the Varicella Active Surveillance Project they only published the positive findings from the study. They ignored the findings of the increase of shingles and didn't publish it.
It took one of the members of the project to leave and publish the findings. In doing so the members of the CDC who sit and review on the peer-reviewed journals in the US ignored and turned down the submission. So he went to the European journal VACCINE. The members of the CDC tried to prevent the publisher from printing the journal if it had that submission in it. Well that didn't work and it got published.
Thanks to his submissions in the peer-reviewed journal Vaccine and in the International Journal of Toxicology countries like Israel will not vaccinate for chickenpox.
(anyone in need of sources I already posted it earlier in the thread)

[Mirzam]

Originally Posted by waiflywaif

Studies in medical journals are peer-reviewed science. Not mouthpieces for the publishing organization. If policy is "heavily influenced" then it's because the science is sound and evidence-based.

Really?

Review of scientific journals shows steadily increasing conflict of interest in funding of drug trials

The issue at hand is bias, and sadly, it's not a new phenomenon. It is also not limited to psychiatric drug studies. According to a June 2006 Agence France-Presse (AFP) article, private drug companies finance 75 percent of the studies published in the New England Journal of Medicine, the Journal of the American Medical Association and The Lancet in Britain. Do the math. That's a lot of potential bias.

[waiflywaif]

"Finance" usually means that they provide the drug to be studied, however. Drug companies do not see the manuscript or influence the results in any way.

I don't know how to make you believe that, but any study that even let a drug company make changes to the manuscript before it was published would be thrown out immediately. No journal would touch it.

[Mirzam]

Originally Posted by waiflywaif

"Finance" usually means that they provide the drug to be studied, however. Drug companies do not see the manuscript or influence the results in any way.

I don't know how to make you believe that, but any study that even let a drug company make changes to the manuscript before it was published would be thrown out immediately. No journal would touch it.

I used to work for Merck, they do a lot more than just provide the drug for studying.

[claddaghmom]

Hmm, I knew this wasn't legally happening right now, but I thought it was in the process?

I remember taking a class on bioethics and patient rights at WashU STL. The chairman of the board of ethics was a heavy proponent of "rewarding" doctors for 100% vaccine compliance (his words, not mine).

At the end of the class, during the Q&A section I asked him if the monetary rewards would be prorated for partial compliance. He said 100% compliance gets a reward, everyone else gets a "punishment" from the "government." I said, "really?" and he said, "Rewards don't work without punishments."

Even the rest of the class looked a little stunned.

And we're not talking about some pharma quack.


So although I can't claim this is legally happening right now, I won't be surprised when certain programs become active.

Personally, I feel sorry for doctors and the current situation in the medical field has me ambivalent over med school. Poor doctors. They get screwed while everyone else makes money.

[Marnica]

Originally Posted by savithny

Any evidence to back that claim up? I've been doing a lot of historical and anthropological reading lately, and that is the exact reverse of everything I've been reading about the history of child mortality.

Well I am not as big on "proof" as some people here, but IMO all one has to do is look at the children today with chronic health issues and compare it to the days of yester year. I'm not talking about child mortality. Im talking about chronic health problems.

[waiflywaif]

I used to work for Merk, they do a lot more than just provide the drug for studying.

Then that particular research is not being published in a reputable peer-reviewed journal like NEJM, etc.

I work in the industry too. On the watchdog side of things. Believe me, if Merck or anyone had any say-so in the outcome of the study, the study is trash.

[Mirzam]

Originally Posted by waiflywaif

Then that particular research is not being published in a reputable peer-reviewed journal like NEJM, etc.

I work in the industry too. On the watchdog side of things. Believe me, if Merck or anyone had any say-so in the outcome of the study, the study is trash.

Then you have no idea of all the subtle ways that pharmaceutical companies influence outcomes of studies.

[Karry]

Originally Posted by k9sarchik

You will have to contact www.medicalveritas.com to get your answer. I'm sure that the Editor-in-Chief will be more than happy to get you that info.

That site is not very search friendly. Do you have the link to the article?