Health News Digest

June 14, 2010

Should Doctors Be Immunized Against Vaccine Contracts?

Take your best shot

By  Michael D. Shaw

While the gravy train has long since passed for most medical specialties, those who go into pediatrics are keenly aware that it ranks near the bottom in remuneration. But, for those who love kids, and enjoy being able to practice internal medicine in perhaps its purest form (working on a relatively clean slate), it ranks near the top in job satisfaction.

It is noted that a prime activity of any pediatric office is the dispensing of vaccinations.

Too many people take for granted the tremendous health benefits afforded by large-scale vaccination programs. Indeed, far too much ink and pixels seem to be devoted to lunatic conspiracy theories and continually debunked tales of the alleged harm of vaccines. Make no mistake, the alternative—returning to widespread deaths of young children from a variety of scourges that are all but unknown today in the first world—is not even worthy of discussion.

The technology of vaccines is constantly improving. Few parents are aware that although the number of recommended childhood vaccines has increased during the past 30 years, with advances in protein chemistry and recombinant DNA technology, the immunologic load has actually decreased.

The 14 vaccines given today contain fewer than 200 bacterial and viral proteins or polysaccharides. Compare this to the more than 3000 of these immunological components in the seven vaccines administered in 1980. Moreover, vaccines represent a minute fraction of what a child’s immune system routinely contends with.

No doubt, a share of the credit for enhanced technology should go to the government’s generous support of the vaccine industry. Given the vast public health benefits, though, who’s complaining?

Dealing with the economic realities of a pediatrics practice is not for the fainthearted. This specialty has few chargeable procedures, time-consuming non-remunerative activities are commonplace, and contending with insurance reimbursement issues is a fact of life. It is an understatement to say that expenses and cash flow must be carefully monitored.

Pediatricians are advised to determine if vaccines are providing an operating margin or a loss to their practices. The American Academy of Pediatrics provides a variety of tools to help its members figure this out.

One seemingly attractive proposition is the vaccine purchasing contract, also known as a compliance contract. Vaccines currently covered by compliance contracts include those to protect against polio, tetanus, whooping cough, diphtheria, influenza, and meningitis. The most aggressive proponents of such arrangements are the pharmaceutical giants Sanofi Pasteur and Merck.

Such arrangements offer negotiated low prices to members, but carry the stipulation that no vaccines for diseases covered can be purchased off the contract. Enforcement techniques range from warning letters to dismissal without prior notice. Stories are told of competitive (non-contract) vaccines, which are treated less than factually in some of the warning letters.

At first glance, the compliance contracts seem to be nothing more than a sharp business practice, and a consequence of the free enterprise system. But, consider the circumstances…

The two companies dominating the contract universe have enjoyed significant financial support from the federal government. And, these contracts are played out against a backdrop of reimbursements to pediatricians, artificially limited because of the third party payer system. Thus, the market dynamics are skewed at both ends by external forces.

More than that, innovation is stifled since new products from non-contract companies are locked out.

The net result is predatory, monopolistic practices in an over-regulated market, where the needs of the consumer (the patient) are completely ignored. It’s hard to imagine a scenario that is less free enterprise than this one!

Vaccine economics may get sorted out someday, but in the meantime, parents of small children can only hope that the best vaccines are on contract.