{"id":138594,"date":"2019-08-05T12:00:02","date_gmt":"2019-08-05T11:00:02","guid":{"rendered":"https:\/\/www.transcend.org\/tms\/?p=138594"},"modified":"2019-08-12T11:06:45","modified_gmt":"2019-08-12T10:06:45","slug":"the-pharmaceutical-industrys-front-men","status":"publish","type":"post","link":"https:\/\/www.transcend.org\/tms\/2019\/08\/the-pharmaceutical-industrys-front-men\/","title":{"rendered":"The Pharmaceutical Industry\u2019s Front Men"},"content":{"rendered":"

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23 Jul 2019 – <\/em>The pharmaceutical has a \u201ccomplex and mutually-dependent<\/a>\u201d relationship with physician trade groups and physicians. Although the details are not always fully or accurately documented<\/a>, the funding trail can often provide revealing clues. Thus, the American Academy of Pediatrics (AAP), one of the most notorious vaccine industry front groups<\/a>, receives funding from all four manufacturers of childhood vaccines in the U.S. (Merck, Pfizer, Sanofi, GlaxoSmithKline). The AAP also gets substantial funding<\/a> from the Centers for Disease Control and Prevention (CDC)\u2014more than $20 million since 2009\u2014over a third of which is explicitly vaccine-related.<\/p>\n

Currently, Pediatrics [AAP\u2019s journal] is also leading the way in browbeating vaccine questioners by drumming up faked concerns about \u201cvaccine hesitancy\u201d and parental noncompliance.<\/em><\/strong><\/p><\/blockquote>\n

Two other front groups that routinely propagate misleading information about vaccine safety are the Immunization Action Coalition (IAC) and Every Child by Two (ECBT). A 2017 analysis<\/a> in The BMJ<\/em> showed that\u2014far from being credible and independent sources of information\u2014these outfits, like AAP, receive significant funding from vaccine manufacturers and the CDC, with a third of ECBT\u2019s annual funding coming from the CDC. With industry and CDC funding in hand, these front groups can guarantee vaccine makers\u2019 ability \u201cto influence policy<\/a> without having to stand on the front lines.\u201d<\/p>\n

Enlisting medical journals<\/strong><\/p>\n

The pharmaceutical industry advertises in the medical journals that are affiliated with the AAP and other physician organizations. This advertising generates anywhere from a tenth to a third<\/a> of total revenues. In fact, advertising income not infrequently outpaces revenues earned from subscriptions.<\/p>\n

Various financial incentive programs also encourage pediatricians and family doctors to follow the CDC vaccine schedule, including insurers who give bonus payments to practice groups who achieve specified vaccination targets.<\/em><\/strong><\/p><\/blockquote>\n

In return for their advertising lucre, the journals published by medical trade groups\u2014such as the AAP\u2019s journal Pediatrics<\/em>, the American College of Physicians\u2019 Annals of Internal Medicine<\/em> and the Journal of the American Medical Association<\/em> (JAMA)\u2014willingly disseminate uncritical and substandard vaccine research. Thus, Pediatrics<\/em> has published studies since the early 2000s\u2014by authors with blatant conflicts of interest<\/a>\u2014designed to hide any relationship between thimerosal-containing vaccines and autism. Currently, Pediatrics<\/em> is also leading the way in browbeating vaccine questioners by drumming up faked concerns about \u201cvaccine hesitancy<\/a>\u201d and parental noncompliance<\/a>.<\/p>\n

Co-opting physicians<\/strong><\/p>\n

Americans can be critical of physicians who own drug company stock or receive lavish meals or other freebies from the pharmaceutical industry, but the public generally accepts that financial ties of one sort or another are pervasive<\/a>. On its end, the pharmaceutical industry has considerable expertise in turning physicians into \u201ca cog in their marketing machine<\/a>.\u201d Thus, encouraged by the AAP and other trade groups, physicians have by and large been willing participants in the U.S. vaccine program. With few exceptions, few doctors are willing to rock the boat, no matter how many vaccines are added to the schedule.<\/p>\n

Pediatricians who achieve the 63% threshold therefore stand to make an additional $40,000 in bonus payments for every 100 fully vaccinated two-year-olds, creating a formidable incentive not to let any patients slip through the cracks, and a disincentive to continue serving families who decline one or more vaccines.<\/em><\/strong><\/p><\/blockquote>\n

Physicians\u2019 complacency about vaccines begins in medical school<\/a>, where doctors are taught that vaccines are \u201cwonderful\u201d but learn nothing about vaccine ingredients, risks, effects on brain and immune system function or any other aspects critical to understanding vaccine safety and effectiveness. Once in practice, pediatric well-child visits ensure a steady stream of repeat customers and revenue. The CDC advises practices to administer vaccines at about half of the visits<\/a> through the adolescent years, with 11 visits recommended by the AAP over a child\u2019s first 30 months (and annually thereafter). Various financial incentive programs also encourage pediatricians and family doctors to follow the CDC vaccine schedule, including insurers who give bonus payments<\/a> to practice groups who achieve specified vaccination targets. Practices publish and share these medical and clinical data to show \u201chow the care\u2026each [physician] give[s] to kids compares with the care given by their peers,\u201d thereby exerting pressure on doctors to toe the line<\/a> rather than deviate from or object to the targets.<\/p>\n

Incentives and disincentives<\/strong><\/p>\n

An example of a pay-for-performance model is the Michigan Blue Cross Blue Shield \u201cPerformance Recognition Program,\u201d which uses \u201cmeaningful\u201d payments<\/a> to reward Blue Care Network health maintenance organization providers \u201cwho encourage their patients to get preventive screenings and procedures.\u201d For vaccination, providers receive $400 for each eligible two-year-old who has received all 24-25 vaccines by that age (including flu shots)\u2014but only if the provider manages to administer each and every shot to at least 63% of his or her patients. Pediatricians who achieve the 63% threshold therefore stand to make an additional $40,000<\/a> in bonus payments for every 100 fully vaccinated two-year-olds, creating a formidable incentive not to let any patients slip through the cracks, and a disincentive to continue serving families who decline one or more vaccines. In fact, a survey of pediatricians found that twice as many pediatricians<\/a> (12%) reported \u201calways\u201d booting uncooperative families out of their practices in 2013 as in 2006, and the AAP has pronounced it \u201cethical and legal<\/a>\u201d to do so.<\/p>\n

A 2010 study<\/a> of publicly funded community health centers (CHCs) serving low-income patients in Houston furnished another evocative example of how pay-for-performance models work. Even in the less-than-posh CHC setting, physicians could receive up to $12,000 annually in incentive payments for meeting vaccination and other targets. As the researchers explained:<\/p>\n