Critics say ‘talk to your doc’ requirement for some vaccines causes confusion : NPR
A recent change places some long-recommended childhood vaccines in a new category called “shared clinical decision-making.” The consequences of this seemingly lopsided change could be far-reaching.
JUANA SUMMERS, HOST:
The Trump administration has turned childhood vaccinations on its head. A recent change abandons the recommendation that all children receive six vaccines, long considered routine. Instead, they now belong to a category called shared clinical decision making. NPR health correspondent Rob Stein explains what that means.
ROB STEIN, BYLINE: Shared clinical decision making. It sounds pretty wonky, but also pretty good.
WENDY PARMET: In theory, shared clinical decision-making sounds great.
STEIN: Wendy Parmet studies health care policy at Northeastern University.
PARMET: It’s the idea that a patient or, in the case of a child, the patient’s parents and the clinician talk together and decide what is appropriate. It’s kind of an idea that we’re all familiar with, that of informed consent and talking to your doctor. You know, should I have surgery or should I not have surgery?
STEIN: But shared clinical decision-making is usually reserved for complex medical calls where the answer is unclear, like which men need a regular PSA test for prostate cancer? Should you have surgery or physical therapy for back pain? Vaccine critics argue that is the case with these six vaccinations, and administration officials say the change is aimed at restoring confidence in vaccines. But doctors like Stanford’s Jake Scott say there’s no ambiguity about these vaccinations, which protect against hepatitis, flu, meningitis, RSV and a dangerous stomach infection called rotavirus.
JAKE SCOTT: These vaccines, as you know, have clearly demonstrated their benefits for all children. So moving them to shared decision making does not reflect the scientific uncertainty for which the category exists, so it creates this type of uncertainty where no uncertainty actually exists.
STEIN: And, Scott says, leaving these vaccines lower in the CDC’s new vaccine hierarchy is causing confusion. And there are practical implications like removing automatic alerts from the electronic medical record when injections need to be given.
SCOTT: Moving from routinely recommended clinical decision-making to shared clinical decision-making has a dramatic effect on the practical delivery of immunization.
STEIN: And while the administration says the ruling shouldn’t affect whether vaccinations will be covered by government programs or private insurance, some legal experts say they might not be guaranteed. Dorit Reiss studies vaccine policy at UC Law San Francisco.
DORIT REISS: There are a number of problems there. First, they can change their interpretation later. Second, if a private insurer wanted to challenge this and say this vaccine is no longer recommended, I don’t have to cover it, they probably have a good case.
STEIN: Even with insurance, parents now risk having to pay co-pays for these additional conversations with busy pediatricians. Another big question is: Does this make vaccine makers and doctors vulnerable to lawsuits? Many lawyers don’t think so, but some argue that it is, and Northeastern’s Wendy Parmet says the uncertainty is alarming.
PARMET: We don’t really know if shared clinical decision making will be considered a sufficient recommendation to provide liability protection. And if it doesn’t, then there will be real concerns about whether manufacturers will continue to make vaccines.
STEIN: Which means vaccines could become unavailable, and even the possibility of lawsuits could be enough to intimidate doctors.
PARMET: A child gets sick the next day. Even if it has nothing to do with a vaccine, will they, you know, be the ones held responsible and someone say, you asked the nurse to do this without telling the doctor?
STEIN: Making doctors hesitant to recommend vaccinations, which means imposing shared clinical decision-making, could make more children more vulnerable to dangerous infections. Rob Stein, NPR News.
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