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The physicians in my life - including my spouse - have essentially all abandoned the CDC and FDA as a source of decision-making on vaccines and pharmaceuticals,

The physicians in my life - including my spouse - have essentially all abandoned the CDC and FDA as a source of decision-making on vaccines and pharmaceuticals, except for what is required by law. Other sources of guidance, such as the American Academy of Pediatrics' immunization schedule[0] and the WHO recommendations[1] are gaining prominence instead. If you are an opponent of vaccines or a supporter of "MAHA", who is happy with what the CDC/FDA is doing, you might want to consider that the way they're doing it has utterly failed to convince the vast majority of people who are responsible for actually executing their guidance, and therefore will have limited impact. As I am neither of those things, I am just glad these other options exist. [0] https://publications.aap.org/redbook/resources/15585/AAP-Immunization-Schedule https://publications.aap.org/redbook/resources/15585/AAP-Imm... [1] https://www.who.int/teams/immunization-vaccines-and-biologicals/policies/who-recommendations-for-routine-immunization---summary-tables https://www.who.int/teams/immunization-vaccines-and-biologic... (And no, I am not looking to debate vaccines or whatever else with you. I'm making a point about how fringe movements who get into power then have to solve the same problems the powerful movements did originally.)

analog31 1y ago
A concern of mine is where the insurance companies will get their guidelines, i.e., who pays. Also, being willing to pay out of pocket is not a panacea, as you can still be turned down.
- clumsysmurf 1y ago
  Indeed, "Nineteen states have laws or regulations that only let pharmacists administer vaccines recommended by ACIP, according to the American Pharmacists Association. In those states, pharmacies may not be able to dole out shots even for people who fit the FDA’s narrowed range until the committee makes its recommendation." https://apnews.com/article/covid-19-vaccine-insurance-coverage-pharmacists-16b166a86548b37849eff2debc6e6100 https://apnews.com/article/covid-19-vaccine-insurance-covera...
- SoftTalker 1y ago
  I'd expect insurance companies realize that paying for vaccines is a lot cheaper than paying for measles, mumps, covid, and the flu. They are in business to make a profit, not to pinch pennies at the cost of pounds. Not to mention that common vaccines are not very expensive, even if you're paying out of pocket.
  - wredcoll 1y ago
    Not if you get to stop paying for treatments if they get sick!
    - SoftTalker 1y ago
      Why would they? Why would anyone buy insurance that didn't pay for treatments of illness? I get frequent emails from both my employer and my insurance plan reminding me to get flu shots, annual physicals, etc. because it's cheaper for them if I stay healthy vs. having to pay (potentially a lot) for treatment of preventable illness or health problems.
      - jmclnx 1y ago
        Because you have no choice. In the US, I noticed a trend that companies are starting to offer one choice for Insurance, the cheapest for them.
        mathiaspoint 1y ago
        There's always self insurance. These days that's likely cheaper.
      - wredcoll 1y ago
        Same reason people buy baby formula that's poisonous: they don't know or are desperate.
      - const_cast 1y ago
        Because you don't buy insurance, you're essentially assigned it. There is no insurance marketplace. And no, healthcare.gov does not count. These companies act in lockstep and the service is socialized - you pay for everyone else. Its the most shitty approach imaginable to healthcare. You get all the greed and ass fucking of private healthcare, with all the choice (or lack thereof) of huge socialized medicine. And, cherry on top, the private sector has WAY less rules than the public sector.
- peterbecich 1y ago
  Divergence from the CDC guidelines could also enable (scientifically meritless) lawsuits from patients against their doctors, no? What a sorry state of affairs.
- franktankbank 1y ago
  Why are insurance companies involved here at all?
  - IAmBroom 1y ago
    That requires a lengthy US history lesson, which you can read elsewhere.
    - franktankbank 1y ago
      Rhetorical question I suppose... I don't think Health Insurance should cover typical things. When I've gone to the hospital with kids or as someone nearing 40 its more expensive with insurance than without, not including the 30k in payments through employment we already endure. I don't care to subsidize the boomers.
      - _DeadFred_ 1y ago
        I'm glad people are finally saying their true position is 'I don't care, let old people/disabled people die'. We're really starting to see the real American values system.
        mingus88 1y ago
        The boomer generation is also well known as the “me” generation, so it’s something they should expect, to be quite honest. They are the ones who raised us.
        _DeadFred_ 1y ago
        'It's someone else's fault I'm cool with letting people die, I have no agency in the matter'. Keep telling yourself that.
        deleted 1y ago
        [deleted]
        1y ago
ggm 1y ago
> The physicians in my life - including my spouse - have essentially all abandoned the CDC and FDA as a source of decision-making on vaccines and pharmaceuticals, except for what is required by law. The risk in this implicitly will be that some vaccines may be declared illegal, or not permitted in some other licencing model, which means physicians will be at risk of their professional registration to make them available. I could imagine a similar risk in the prescribing of Mifepristone/Misoprostol. Not to actually declare 'day after' pill illegal, but withdraw licence to use the drugs, and put doctors at risk if they go ahead.
- epistasis 1y ago
  This is already happening with covid vaccinations, in that only some age groups are getting approval. The decision is not being made according to safety, but justified with economics. I don't recall the FDA doing that before.
  - timr 1y ago
    > This is already happening with covid vaccinations, in that only some age groups are getting approval. The decision is not being made according to safety, but justified with economics. I don't recall the FDA doing that before. Incorrect. A lot of scientists believe the Covid vaccinations should never have been approved in healthy young children. Omitting the Covid vaccine from the childhood schedule, in fact, is the position of the WHO, and many European countries, including the UK [1], Germany [2] and France [3]. The USA was an outlier [4]. [1] https://www.nhs.uk/vaccinations/covid-19-vaccine/ https://www.nhs.uk/vaccinations/covid-19-vaccine/ [2] https://www.bundesgesundheitsministerium.de/en/coronavirus/faq-covid-19-vaccination.html https://www.bundesgesundheitsministerium.de/en/coronavirus/f... [3] https://www.lemonde.fr/en/health/article/2023/02/25/covid-19-primary-vaccination-for-general-population-no-longer-recommended-by-the-french-health-authority_6017208_14.html https://www.lemonde.fr/en/health/article/2023/02/25/covid-19... [4] https://archive.ph/aD00n https://archive.ph/aD00n (NYT link)
    - epistasis 1y ago
      Wrong. Regardless of your links there, that's not the justification that FDA used.
mcswell 1y ago
I worry that the pharmaceutical companies won't have the funding to develop vaccines for new variants of existing diseases (like the yearly Covid-19 and flu variants), or even for "new" diseases (e.g. there's a dog vaccine for Lyme disease, but not one for humans). IIUC (please correct me if I'm wrong), vaccine development is expensive, and relies on government subsidies--which certainly won't be coming from the US in the near future. And even provision of existing vaccines depends on there being a market, where the US has been the most reliable such market--again, correct me if I'm wrong (I'm hoping I am!).
knowitnone2 1y ago
I, for one, will be happy to see Covid make a vigorous comeback in the US. Theories need to be tested.
- userbinator 1y ago
  We're probably past herd immunity at this point.
  - wredcoll 1y ago
    Yeah, just like how no one gets other forms of the flu these days... herd immunity...
  - thrill 1y ago
    Because everyone knows viruses don't mutate.
    - userbinator 1y ago
      They tend to get weaker.
- bitlax 1y ago
  COVID is endemic.
timr 1y ago
[flagged]
- magicalist 1y ago
  > In fact, the AAP recommendations include some extremely questionable vaccines for children in the USA, such as Mpox and Dengue Let's see: > The AAP recommends dengue vaccination for children between ages 9-16 who have had a previous dengue infection confirmed by a laboratory test and live in dengue endemic areas (eg. Puerto Rico, American Samoa, US Virgin Islands) > There is a vaccine available to individuals < 18 years who have been exposed to mpox (ie, JYNNEOS vaccine for post-exposure prophylaxis,) under expanded use authorization issued by the Food and Drug Administration. > Point being: there's obviously a reasonable amount of disagreement here. Only if you misrepresent their recommendations!
  - timr 1y ago
    > Only if you're dishonest about their recommendations! I literally just went to the PDF guide the OP linked to, which presents it as a recommended vaccination (for a non-endemic disease in the USA): https://downloads.aap.org/AAP/PDF/AAP-Immunization-Schedule.pdf https://downloads.aap.org/AAP/PDF/AAP-Immunization-Schedule.... But fine, you've touched on 1 out of the 9 differences. You still won't find it in the WHO guide, which is odd, considering that the WHO is recommending vaccines for a number of countries around the world where the disease actually is endemic.
    - magicalist 1y ago
      > I literally just went to the PDF guide the OP linked to, which presents it as a recommended vaccination (for a non-endemic disease in the USA): https://downloads.aap.org/AAP/PDF/AAP-Immunization-Schedule.pdf https://downloads.aap.org/AAP/PDF/AAP-Immunization-Schedule.... They have a 1-6 steps right on the first page. Step 1: "Determine recommended vaccine by age (Table 1)" OK, turn to Table 1. Dengue: > Seropositive in areas with endemic dengue (See Notes) Mpox: 18+ "for certain high-risk groups or populations" You can also turn to page 7 for the same notes for Dengue, and page 11 for what constitutes risk factors that would lead you to consider administering the mpox vaccine.
JohnFen 1y ago
> The physicians in my life - including my spouse - have essentially all abandoned the CDC and FDA as a source of decision-making Same here. And personally, as someone who isn't in the medical field in any way, what's been done to these agencies has removed pretty much all trust I have in their recommendations. They look like they are being run by political hacks for political purposes now, and actively disregard things like evidence and truth.
deleted 1y ago
[deleted]

analog31 1y ago

A concern of mine is where the insurance companies will get their guidelines, i.e., who pays. Also, being willing to pay out of pocket is not a panacea, as you can still be turned down.

clumsysmurf 1y ago
Indeed, "Nineteen states have laws or regulations that only let pharmacists administer vaccines recommended by ACIP, according to the American Pharmacists Association. In those states, pharmacies may not be able to dole out shots even for people who fit the FDA’s narrowed range until the committee makes its recommendation." https://apnews.com/article/covid-19-vaccine-insurance-coverage-pharmacists-16b166a86548b37849eff2debc6e6100 https://apnews.com/article/covid-19-vaccine-insurance-covera...
SoftTalker 1y ago
I'd expect insurance companies realize that paying for vaccines is a lot cheaper than paying for measles, mumps, covid, and the flu. They are in business to make a profit, not to pinch pennies at the cost of pounds. Not to mention that common vaccines are not very expensive, even if you're paying out of pocket.
- wredcoll 1y ago
  Not if you get to stop paying for treatments if they get sick!
  - SoftTalker 1y ago
    Why would they? Why would anyone buy insurance that didn't pay for treatments of illness? I get frequent emails from both my employer and my insurance plan reminding me to get flu shots, annual physicals, etc. because it's cheaper for them if I stay healthy vs. having to pay (potentially a lot) for treatment of preventable illness or health problems.
    - jmclnx 1y ago
      Because you have no choice. In the US, I noticed a trend that companies are starting to offer one choice for Insurance, the cheapest for them.
      - mathiaspoint 1y ago
        There's always self insurance. These days that's likely cheaper.
    - wredcoll 1y ago
      Same reason people buy baby formula that's poisonous: they don't know or are desperate.
    - const_cast 1y ago
      Because you don't buy insurance, you're essentially assigned it. There is no insurance marketplace. And no, healthcare.gov does not count. These companies act in lockstep and the service is socialized - you pay for everyone else. Its the most shitty approach imaginable to healthcare. You get all the greed and ass fucking of private healthcare, with all the choice (or lack thereof) of huge socialized medicine. And, cherry on top, the private sector has WAY less rules than the public sector.
peterbecich 1y ago
Divergence from the CDC guidelines could also enable (scientifically meritless) lawsuits from patients against their doctors, no? What a sorry state of affairs.
franktankbank 1y ago
Why are insurance companies involved here at all?
- IAmBroom 1y ago
  That requires a lengthy US history lesson, which you can read elsewhere.
  - franktankbank 1y ago
    Rhetorical question I suppose... I don't think Health Insurance should cover typical things. When I've gone to the hospital with kids or as someone nearing 40 its more expensive with insurance than without, not including the 30k in payments through employment we already endure. I don't care to subsidize the boomers.
    - _DeadFred_ 1y ago
      I'm glad people are finally saying their true position is 'I don't care, let old people/disabled people die'. We're really starting to see the real American values system.
      - mingus88 1y ago
        The boomer generation is also well known as the “me” generation, so it’s something they should expect, to be quite honest. They are the ones who raised us.
        _DeadFred_ 1y ago
        'It's someone else's fault I'm cool with letting people die, I have no agency in the matter'. Keep telling yourself that.
      - deleted 1y ago
        [deleted]
      - 1y ago

ggm 1y ago

> The physicians in my life - including my spouse - have essentially all abandoned the CDC and FDA as a source of decision-making on vaccines and pharmaceuticals, except for what is required by law. The risk in this implicitly will be that some vaccines may be declared illegal, or not permitted in some other licencing model, which means physicians will be at risk of their professional registration to make them available. I could imagine a similar risk in the prescribing of Mifepristone/Misoprostol. Not to actually declare 'day after' pill illegal, but withdraw licence to use the drugs, and put doctors at risk if they go ahead.

epistasis 1y ago
This is already happening with covid vaccinations, in that only some age groups are getting approval. The decision is not being made according to safety, but justified with economics. I don't recall the FDA doing that before.
- timr 1y ago
  > This is already happening with covid vaccinations, in that only some age groups are getting approval. The decision is not being made according to safety, but justified with economics. I don't recall the FDA doing that before. Incorrect. A lot of scientists believe the Covid vaccinations should never have been approved in healthy young children. Omitting the Covid vaccine from the childhood schedule, in fact, is the position of the WHO, and many European countries, including the UK [1], Germany [2] and France [3]. The USA was an outlier [4]. [1] https://www.nhs.uk/vaccinations/covid-19-vaccine/ https://www.nhs.uk/vaccinations/covid-19-vaccine/ [2] https://www.bundesgesundheitsministerium.de/en/coronavirus/faq-covid-19-vaccination.html https://www.bundesgesundheitsministerium.de/en/coronavirus/f... [3] https://www.lemonde.fr/en/health/article/2023/02/25/covid-19-primary-vaccination-for-general-population-no-longer-recommended-by-the-french-health-authority_6017208_14.html https://www.lemonde.fr/en/health/article/2023/02/25/covid-19... [4] https://archive.ph/aD00n https://archive.ph/aD00n (NYT link)
  - epistasis 1y ago
    Wrong. Regardless of your links there, that's not the justification that FDA used.

mcswell 1y ago

I worry that the pharmaceutical companies won't have the funding to develop vaccines for new variants of existing diseases (like the yearly Covid-19 and flu variants), or even for "new" diseases (e.g. there's a dog vaccine for Lyme disease, but not one for humans). IIUC (please correct me if I'm wrong), vaccine development is expensive, and relies on government subsidies--which certainly won't be coming from the US in the near future. And even provision of existing vaccines depends on there being a market, where the US has been the most reliable such market--again, correct me if I'm wrong (I'm hoping I am!).

knowitnone2 1y ago

I, for one, will be happy to see Covid make a vigorous comeback in the US. Theories need to be tested.

userbinator 1y ago
We're probably past herd immunity at this point.
- wredcoll 1y ago
  Yeah, just like how no one gets other forms of the flu these days... herd immunity...
- thrill 1y ago
  Because everyone knows viruses don't mutate.
  - userbinator 1y ago
    They tend to get weaker.
bitlax 1y ago
COVID is endemic.

timr 1y ago

[flagged]

magicalist 1y ago
> In fact, the AAP recommendations include some extremely questionable vaccines for children in the USA, such as Mpox and Dengue Let's see: > The AAP recommends dengue vaccination for children between ages 9-16 who have had a previous dengue infection confirmed by a laboratory test and live in dengue endemic areas (eg. Puerto Rico, American Samoa, US Virgin Islands) > There is a vaccine available to individuals < 18 years who have been exposed to mpox (ie, JYNNEOS vaccine for post-exposure prophylaxis,) under expanded use authorization issued by the Food and Drug Administration. > Point being: there's obviously a reasonable amount of disagreement here. Only if you misrepresent their recommendations!
- timr 1y ago
  > Only if you're dishonest about their recommendations! I literally just went to the PDF guide the OP linked to, which presents it as a recommended vaccination (for a non-endemic disease in the USA): https://downloads.aap.org/AAP/PDF/AAP-Immunization-Schedule.pdf https://downloads.aap.org/AAP/PDF/AAP-Immunization-Schedule.... But fine, you've touched on 1 out of the 9 differences. You still won't find it in the WHO guide, which is odd, considering that the WHO is recommending vaccines for a number of countries around the world where the disease actually is endemic.
  - magicalist 1y ago
    > I literally just went to the PDF guide the OP linked to, which presents it as a recommended vaccination (for a non-endemic disease in the USA): https://downloads.aap.org/AAP/PDF/AAP-Immunization-Schedule.pdf https://downloads.aap.org/AAP/PDF/AAP-Immunization-Schedule.... They have a 1-6 steps right on the first page. Step 1: "Determine recommended vaccine by age (Table 1)" OK, turn to Table 1. Dengue: > Seropositive in areas with endemic dengue (See Notes) Mpox: 18+ "for certain high-risk groups or populations" You can also turn to page 7 for the same notes for Dengue, and page 11 for what constitutes risk factors that would lead you to consider administering the mpox vaccine.

JohnFen 1y ago

> The physicians in my life - including my spouse - have essentially all abandoned the CDC and FDA as a source of decision-making Same here. And personally, as someone who isn't in the medical field in any way, what's been done to these agencies has removed pretty much all trust I have in their recommendations. They look like they are being run by political hacks for political purposes now, and actively disregard things like evidence and truth.

deleted 1y ago

[deleted]