Vaccination for
This month’s episode of “News you can Use” on HealthcareNOWRadio features news from the month of June
This month’s episode of News You Can Use for Jun 2022 with Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners features discussions on the recent approval for COVID19 vaccination for infants and younger children, the Facebook pixel privacy issue and a discussion on Pharmacy Benefit Managers and Cost Plus Drugs
First up Craig reviews the recent news on COVID19 vaccination availability expanded now to children 6 months and up that was recently approved for children 6 months and up by the FDA. While this group has a lower than average incidence of severe disease they still do get COVID and we do see long-term effects and we both agree this is welcome news for any parent with children under the age of 5
In privacy-related news tracking capabilities on healthcare websites that a recent investigative piece exposed is offering up far more information about individual patients and people visiting the website than anyone might expect. Many of the sites did respond by pulling the tracking code and promising investigation but many still remain and as we discuss this extends well beyond tracking on websites to extend to the information you type using forms that store everything you type, even if you delete it
We close with a discussion on Mark Cuban’s CostPlus online pharmacy offering that is break-in through current systems to offer drugs at greatly reduced rates and deliver great customer service as well. They are attacking the Pharmacy Benefit Managers (PBM), a concept that was originally designed to bring buying power to reduce the cost of drugs but has gotten wrapped up in a house of smoke and mirrors and rebates that are opaque and remain protected under regulations that have a moratorium on implementation of any rules relating to eliminating the anti-kickback statute safe harbor protection for prescription drug rebates till January 2026
You can read more about the series here and the concept of keeping up with innovation in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter by tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
XX
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
And today as I am each and every month, I’m delighted to be joined by Craig Joseph. He’s the chief medical officer for Nordic consulting. And we are talking news you can use for the month of June. Great. Thanks for joining
Craig Joseph
me. Well, thank you for having me. It’s always a pleasure.
Nick van Terheyden
So I think it’s important given were this month, this was the month of the approval for vaccinations for a lower age group. That’s a pretty big deal on a whole range of spectrum of measurement. Tell us what the reality is and what the details are,
Craig Joseph
oh, as you’re, you’re referencing COVID, specifically, and we have not had a vaccine in the United States that’s been approved for children between six months and five years of age, until now. So that just came a few a few days ago was approved by first the FDA and then the CDC. And it’s the two mRNA vaccines that are chiefly used in us. moderna, from moderna, from Pfizer, very small dose, I think it’s a third or a quarter of the dose of an adult. And depending on the vaccine, think it’s two or three doses over over the course of several months. This is huge news. This has been well received. I was just talking to a friend of mine, I’m a pediatrician, as you may recall, and I was just talking to a friend who’s got children under five. And, you know, he said they were going to wait, they’re going to wait four to six weeks before going and giving it to their child. And what did I think about that? And I said, Well, certainly it’s your choice, I will tell you that I haven’t met a pediatrician yet who will not run out and get this vaccine for their children as soon as possible. And so that would be my recommendation. That’s what I would do with my kids. If I had, my kids are much older than that now. But they were under five, I would certainly put them as close to the front of the line as possible. So I think it’s great news,
Nick van Terheyden
let’s cover off a couple of things that I know people, you know, ask or relative to this. So one of the reasons that people are hesitant is obviously, you know, potential side effects and so forth. And, you know, that exists. But there’s a reason for wanting to be expeditious in this, despite the fact that that younger age group ostensibly has less in the way of symptoms or even disease, I think, and you know, I’m with you. To be clear, there’s no disagreement here, but I’m just trying to sort of voice, you know, people’s resistance here. Or we’re not sure that it’s safe. But from a risk reward standpoint, as best as we can tell, and they’ve done some, you know, decent work, they’ve published the data. And you know, as you rightly say it depending on Maderna, or Pfizer, one is a third, the other I think, is one 1/5 of the dose, and then it’s a different sequencing. So numbers of doses split up by time. But the important reason here is that those individuals, those young individuals are actually big transmission points. And that’s the major challenge for these families who are interacting with elderly relatives, you know, so it’s essentially trying to produce this herd immunity. That’s a term I haven’t heard a long time in this. But that’s part of the plan, as well as obviously, protecting some of those children who we do see some long term securely I so you know, COVID extended, albeit rarer, but you know, certainly is occurring.
Craig Joseph
No, absolutely true. And so, you know, vaccination does two things. One is it helps to protect you, the person being vaccinated, but it also protects those around you. And, you know, there are people that’s not my job to protect everyone, no, but to surround you most right? Oh, that would be your friends and family. And so those are folks that you’ll want to protect and certainly elderly and people with, with compromised immune systems are are at high risk, and even if despite being vaccinated, and so, yeah, anything that we can do to kind of decrease the number of vectors and the children are vectors in this case, is a good thing. Also, it’s not common, thank God, but there are children absolutely United States that have died from COVID. And they there’s a multi organ failure syndrome that If that can can affect kids that a very young age and isn’t rare? Yes. But is it something that we should protect against if we can safely do so? Absolutely. And so, you know, I kind of look at it as car seats. Are most kids going to get into a dangerous auto accident on the way to the grocery store? No. Does that mean that you shouldn’t put them in a car seat every single time you go to the grocery store? No, you should try and do everything you can to to decrease, although we’ll never eliminate but to decrease problems. And so yeah, I put I put this vaccine, certainly into that into that group. And in terms of research, has it been expedited and done more quickly than before? Yes. Has the research been done? And the answer is, yes. That’s why it’s taken so long. That, in fact, you may recall that they were they tried doing, I think, two doses with, you know, two shots with varying doses. And so we kind of are doing these experiments to see, hey, does it work? Is it effective? Is it effective against the latest strain, even though it wasn’t developed against that strain? So it’s taken some time to get to a point where everyone is comfortable that it it, the benefits outweigh the risks, and the benefits are real. And we’re at that point now. So go get vaccinated and get your children vaccinated. That’s what the pediatrician say. And if you have questions, certainly talk with your with your doctor.
Nick van Terheyden
Right. And, you know, in the spirit of Rogers, Rogers, Rogers and Ebert, it’s two thumbs up from these parents of children who, albeit their children are grown up. But if they were of that age, we would certainly be advocating
Craig Joseph
way which ones which, which is Rogers, and which is cheaper,
Nick van Terheyden
I couldn’t even begin to answer that question.
Craig Joseph
All right, because that’s important, but we’ll have to figure that out before the next show.
Nick van Terheyden
Okay, well, we’ll do that. Or maybe we’ll get some show listeners suggestions as to who’s
Craig Joseph
that would be awesome.
Nick van Terheyden
Maybe some memes even. All right. So that’s good news, I think. And, you know, continuing on that sort of spirit of where we are in terms of scientific discovery and progress, but there was also some other trending news, this this month, which, for me, it was not a surprise, I’ve got to be honest, as this DEF CON attendee, I’m, no, this wasn’t news. But I saw a lot of people weighing in on this topic of Facebook and others, who are essentially taking forms data. And in fact, this is, you know, there was a couple of things here, there was the forms that people fill in digitally, that were being provided by third parties that essentially those third parties were mining some of that data. And also, in this case, the social media company, Facebook was also taking data that was being entered in a healthcare setting, and essentially misusing or taking that data that would have been deemed, I think, under the protections that we have in place. But because it wasn’t in that domain, as such, they were not I don’t think transgressing the law, but I’m no lawyer to say, fair sort of summary. What’s your take?
Craig Joseph
Well, you know, I like to talk. I’ve been accused of talking too much from time to time, but when I read this, I tweeted it out. And what I tweeted was three words, wow, period, just wow. Period. I had so not being a DEF CON, you know, convention goer. i It’s I’m almost speechless now. That the idea that there’s a I think it’s called the Facebook pixel, or it’s, it’s something that’s put behind the scenes so that you don’t know it’s on a web page. And it’s collecting all kinds of information. And from what seems this is early on in this, what I think it’s fair call controversy, it seems that most hospitals, they knew, at some level, someone knew that this thing was there, because they put it on their websites. And again, I’ve read maybe this will turn out not to be true that some of it is actually behind the on the patient portal after you’ve logged in. And so that’s, that’s really confidential information, because that’s not public. That’s that’s stuff that only you’re supposed to be able to see. And so they, as I understand it, they put this code there so that they can collect information about who’s doing what and what they’re seeing and how they can effectively communicate with their target audience and they get all kinds of nice metrics from Facebook, and analytics. Add, you know, they kind of serve all that up for you. Yet, as you point out, lots more stuff is happening and all of this information, seemingly, which seems to me that again, not being a lawyer is all stuff that we would all agree is private health info personal health information. It’s yeah, I’m, again continuing to be to be speechless. And I think some of the hospitals that had this are also going to be, have difficult, have a difficult time responding. I, it’s hard for me to believe that any hospital that put this on their on their website knew what was going on. They truly understood what was going on. I think they were just trying to use this as a as a, you know, a another tool to collect information about how they do what they do, which is completely respectable and allowable. But yeah, I maybe I’m wrong, right. You’re, are you thinking I’m naive?
Nick van Terheyden
Well, no, I think you’re in the Gaussian distribution of people’s understanding of this, let’s be clear. And I’m almost certain that that distribution is not as typical as it might be. Or maybe it is, I don’t know that there’s even NS people that are even less aware of this. It continues to surprise me and, you know, much like I advocate travel should be a mandatory thing for everybody. I think it really opens your mind to other people’s other cultures. You know, I’ve been very privileged, I’ve lived all over the world. You know, I also feel the same way about DEF CON, I actually think people ought to go to DEF CON, because it would open your mind. I took my kids to DEF CON. And it did open their minds. And I’m terribly excited about the way that they behave. Because they come to me and say, This is a scam dad. Right? And I go, yep. Job done is how I feel about this. And sure, DEF CON is, you know, at times extreme, certainly has been I think it’s not quite in the the heyday of when it was really out there. But you know, it’s filled with people that think about things differently. And that’s what’s important. And I think, you know, to be clear, your point about the intent of the individuals who do this, I would agree with you, I start out with that premise. I think the vast majority of people have good intentions. This wasn’t about pervasive invasion of privacy, trying to tie things together, and, you know, go do misdeeds with it. But the reality is that, you know, if you’re using tools, I think there’s an onus to actually understand what they do and the consequences of this. The good news is that people are looking over your shoulder, you know, there’s more of that. So this has come to light, but didn’t surprise me, because I’ve seen it. And let’s explain this a little bit, because it’s worth, maybe we can shift the Gaussian distribution a little bit in this point. So I went to a presentation back in 2017, it was called the Dark data or dark web data. And it was by two reporters who had essentially gone and accessed or purchased this kind of information. And it was meta data. It was individually, it had been anonymized. And it was browsing history. That’s all it was, but it was multiple elements. And they did a very elegant piece of study and analysis of this that allowed them to uniquely identify some extraordinarily embarrassing pieces of data in there about famous politicians, and individuals and some of their browsing history and the things that they had done. And they showed that with, at that time, 10 pieces of data about you. And it was things about like your browser. And by the way, if you ever want to know what your browser is showing, you can see it demonstrates inordinate amounts of data, including the resolution, and all of these other things. And all of those are very unique. And just based on that I can hone in on who you are. And if I can tie it back to your medical data, which is what this is about. Now, I’ve got all of the insights that are linked to you, the individual and everything that you shared publicly on Facebook, which now becomes essentially sellable data. That’s what that was what they were looking at. So this to me is it’s it’s a very challenging problem, I think. It’s just going to get worse because we’ve got less and less privacy as such. And, you know, I think my learning point or the thing that I would advocate here is that if you’re using something using a piece of technology, you really ought to understand the full depths of what it’s capable of before you start to roll that out, especially in private portal. Areas of clinical knowledge. For those of you just joining, I’m Dr. Nick the incrementalist Today I’m talking with Craig Joseph, the Chief Medical Officer of Nordic consulting, we were just talking about the Facebook reveal of connecting and the pixel that people talk about this tracking pixel that allows you to associate and what do you think’s going to happen? Great, where are they going to go with all of this?
Craig Joseph
Well, just to be clear, when you’re saying you should know what that technology does, I’m assuming you’re not talking about me, the user of the page? Oh,
Nick van Terheyden
no, I’m talking about the people that put that pixel in, you didn’t put the pixel in, you just use the website.
Craig Joseph
I didn’t know that the pixel was there. Obviously, that’s why it’s called a pixel. Right, which is tiny, tiny, tiny, the tiniest part of the screen. Yeah, well, I think what’s happening is we’ve already seen so this particular journalist or team of journalists, I think they look at 100, the top 100 hospitals by some survey, and found that 33 of them had this pixel on there somewhere on their website that they could see. And some, some chunk of those 33 When they because all of them were contacted by the journalist took it off. And either they said, Oh, we didn’t realize we took it off. Or they’re like, Well, we, we think it’s okay, what’s happening, but we’re gonna, we’re gonna turn it off until we can do a more thorough study, which if I were a betting man, I would say there, it’s not coming back on. So I, I think that what’s going to happen is that this will go away, but this particular this particular Facebook pixel will will go away, or Facebook will reconfigure it so that it absolutely does not collect everything could possibly harvest and only, you know, gives the information to the hospital. But then again, if that’s the case, why would Facebook make it available to anyone? So? I don’t know. It does. It does remind me of that, that that standard saying that? If I’m going to mess it up now? If, if, if you’re not, oh, gosh, how does it go? Nick?
Nick van Terheyden
I think what you’re thinking of is if you’re not paying for the product, you are the buyer.
Craig Joseph
Thank you, Nick, that is another example for our audience of you reading my mind. Yes, if you’re not paying for the product, you are the product and none of us pay for Facebook.
Nick van Terheyden
That’s, that’s your renaissance man. For you. That’s the one point in time where recall actually worked for me, it doesn’t always to be clear. So alright, so I think important, you know, space to watch will certainly continue to watch it certainly an area for me, I think, you know, from a healthcare security, very challenging, even more challenging with genomics, if you think about, you know, anonymization of data, but, you know, we’ll have to watch that space. And we’ve seen some, I think, continued progress with Mark Cuban and his cost plus solution. I had additional personal experiences through a friend of mine who ordered thanks to my recommendation, and was a little bit hesitant who is caused by you know, but actually proved to be very easy. And then got a phone call or a voicemail message and actually had this sinking feeling what on, you know, an expectation of the usual quagmire of No, it’s not covered, it’s this expense, whatever. And in fact, it was then calling to say, We’re terribly sorry, we don’t have the drug in stock, is it okay if you wait a day, because we will get it to you in a day which, you know, just completely excelled in terms of customer service. So, you know, doing a fantastic job, but filling this gap of pharmacy, where we have this, I want to say a hole of mirrors of costs that I have written about that I struggle with. And I recently discovered that there is content that sits in the I’m get I’m Forgive me if I get this wrong, but the Federal Register wherever the sort of rules and regulations are, that is in the infrastructure investment and jobs act that essentially says there is a moratorium on implementing any rules to eliminate the anti Kickback Statute Safe Harbor protection for prescription drug rebates, which is essentially where all this come From, because we have all of these pharmacy benefit managers that are supposedly delivering benefit, but they’re not. And he’s gone after that space very successfully. I’m a little bit despondent because that resolution currently sits January 2026, that there’s no action involved. And I’m concerned that, you know, Mark Cuban is trying to disrupt and really replace a broken system with a system that actually is working very well. But it’s going to be stymied, because there’s going to be no pushback on the existing system, and everybody’s just going to continue to buy drugs the way they did.
Craig Joseph
You’re there your points well taken. And I think, you know, maybe we need to kind of come back a little bit and, and talk about how does the system work so, so today, for those of us who have insurance, those of us who are lucky enough to have insurance, when we go to the pharmacy to get a prescription drug, they run our insurance, and the insurance generally tells them, hey, we’re going to you, hey, Walgreens or CVS, you want to charge $300. But since you’ve got a contract with us, we’re only going to let you charge $100. And Dr. Nick, because of where he is in the part of the year, those $30. And so that means is you’ll pay $30, the insurance company will pay $70.02 $100, we’ll just go into the air because that That’s just funny money. And so you think you’re getting a pretty good deal because it says, Hey, this actually costs $3,300, but you’re only paying $30. And I think these numbers are realistic for for your standard prescription now. So every month, you’re supposed to pay $30. And that’s pretty good deal. And now what you’re saying is that cost plus that that system that Mark Cuban’s is created, that company that’s created, comes through and says, Hey, we don’t actually care about your insurance at all. We’re willing to sell you the same one month’s supply for how much would you say, based on your 320 $9 $28?
Nick van Terheyden
No, I would say $5. Yeah.
Craig Joseph
So significantly, significantly, significantly less than the $300 that that CVS or Walgreens or any, any of the large commercial chains might charge you if you said I don’t have insurance, I’m here to pay cash,
Nick van Terheyden
and do so making money with this.
Craig Joseph
So how is this possible? It’s impossible seems impossible that I could, I could call up or go to this website. And they don’t have every drug to be clear, they’re concentrating right now on the common drugs, which is great. They apparently can buy them in large quantities, and then pass that savings on to you, which is what I thought, Dr. Nick, the PBMs, the pharmacy benefit managers were doing. And now are you saying that that’s not necessarily the case. So I and
Nick van Terheyden
I think that’s part of the problem they’re buying. So they do get the discounts. But instead of passing on the discounts, they’re essentially passing back rebates that are hidden with smoke and mirrors to various parties that have a vested interest in this transaction. The one exception being the patient who who gets no benefit, especially in the high deductible plans, but you know, it also transgressors into other areas, and Mark Cuban and his group, and they’re not even I mean, sure there’s some purchasing power there that’s allowing them to buy it, but they’re just buying the drugs at the cost of whatever the drugs are, and essentially loading a 15% cost on top. And then they also have a $3 handling charge. And that’s their, their cost of doing business. So it’s it’s the smoke and mirrors. And that’s what surprised me to discover that there is actually regulations preventing, exposing that or creating regulations to preclude that, which is harming patients. And I think stat News wrote a report just recently saying, huge impact if if Medicare went and use the cost plus system, they would save millions, if not billions of dollars in their drug bill, which, you know, ultimately who’s paying that bill? Well, it’s as the taxpayer, so we ought to be doing more. So it very complex area, I think we’re going to have to dive into this and get some more data and share that perhaps next month. So unfortunately, we’ve run out of time as we do always, so we didn’t get everything but we’ll, we’ll certainly be watching this space again. And talking about it next month. And obviously if any of our listeners have some input, we’re always excited and looking forward to getting feedback but As for this month just remains for me to thank you as always for joining me today Craig
Craig Joseph
what’s my pleasure and I hope that we can solve the world’s ills next time
Nick van Terheyden
as we do each and every month of course absolutely
