Vaccines 5 and Up
This months episode of “News you can Use” in the traditions of “Ask Me Anything” on HealthcareNOWRadio features news from the month of November
You can read more about the series here and the concept of keeping up with innovating 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 tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners.
The big news this week was the authorization of vaccines for children 5 and up opening the door for parens to get their children vaccinated. As Craig points out the way this group get vaccinated is very different to the roll out for adults. Pediatricians are experienced and have and will continue to deliver vaccines to their patients. COVID19 is just another vaccine to add to the list. But for this group they will have the opportunity to discuss and review the risk and benefits of this decision with their trusted expert, perhaps making for a smoother more complete roll out of the vaccines in this group.
While on the subject of coverage my ask is for the media to stop with the terrifying images and videos of needles bing thrust into arms and perhaps rather they could give a shout out to Dr Amy Baxter and her company Pain Care Labs who produce the innovative “Buzzy” pain prevention solution (Read about the company here)
CVS Store Closing
We review the news that CVS is planning on closing approximately 900 stores to refocus their attention to delivering health and health related services beyond traditional pharmacy or drug store and expanding their Digital Health footprint. In the vacuum left we expect to see more form Dollar stores who recently hired a Chief Medical Officer which will make for some interesting times ahead in the local delivery fo healthcare
Telemedicine Rule Roll Back
Finally we lament the pull back of telehealth regulations that are being returned to pre-COVID19 state despite their widespread acceptance and positive feedback. As Dr Jayne also laments
As a patient, it would be much better for my schedule to be able to see him virtually and have him compensated fully for his expertise, which is why I value his care
It barely made sense before the Pandemic and our view is it makes even less post pandemic. Consider reaching out to your legislator and ask them to keep the new readily available telehealth option in place.
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.
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Raw Transcript
Nick van Terheyden
Today as I am each month I’m joined by Dr. Craig Joseph, the Chief Medical Officer at Nordic consulting partners for our news you can use monthly episode, Craig, thanks for joining me today.
Craig Joseph
It’s a pleasure to be here as always, with me.
Nick van Terheyden
So we’ve had a little bit of news. On the COVID Front, we’ve now opened up the vaccinations for five and up, I believe with Pfizer. We’ve also seen boosters opening up for not just those that are at clinical risk, but in fact, to everybody. And I think of those two pieces. For me, the pediatric piece is probably the most significant because that’s the biggest audience of folks who are potentially, I am hoping champing at the bit to avail themselves of the wonderful technology and science and innovation that we have created called vaccines that can prevent, or at least mitigate much of the SARS cov. To disease. Big group. But obviously parents worrying a little bit, you know, something you’ve dealt with a lot. What are your thoughts?
Craig Joseph
Yeah, well, I agree with everything that you said. It’s very exciting and, you know, proof in pretty young kids now. Most of these vaccines are most of them are going to be given unlike for the adults in pediatricians offices. So I think most folks don’t go to their doctor to get their, their vaccines, although certainly at the beginning, that was the case, many of us now go to either, you know, drugstore or grocery store or other third party pharmacy. So pediatricians are the ones you know, I think doing most of the heavy lifting here. And you’re right, we’ve we know how to do this. I’m a pediatrician, and we’ve been a big part of our job is to explain to parents the benefits of vaccination for all kinds of different diseases. COVID is clearly a new disease and the vaccine for it is relatively new. They’re certainly reasonable folks who are concerned and have questions about side effects and, you know, long term long term problems. No, the good news is, they’re We’ve lots of data, and for millions, hundreds of millions of of that vaccines given. And so we know that the risks are very low. Always there, there’s always risk and everything that we do, but the risks are low. And so certainly I think we’re seeing what we saw when the vaccines first became available to the public, which is those folks who have been chomping at the bit and we want them are waiting in line. And once we get through those, then we’re going to start trying to, you know, deal with with the rest of the rest of the population. That’s that’s open. You know, there are people who have said that, Hey, kids don’t really get bad disease most of the time. That’s true, actually. However, they get, they end up, children end up with serious long term problems and potential death at rates higher than many of the vaccines that we we routinely give Polio is a great example of that. And so people who don’t question those vaccines are now questioning this vaccine. Again, I think, you know, reasonable people can ask reasonable questions and but it’s clearly exciting. And there’s it is a whole new population of fish. I’m looking for the word their kids, you know, of humans, who, who can be who, who can really significantly decrease the chance of them getting sick of them helping to get others sick. Remember, we have folks all around us who are immunocompromised to their can’t get the vaccine, or that the vaccine doesn’t function all that well for them because their body can’t create this immune response column can’t mount it. And so the only way to protect those folks is to make sure that we are protected so that we don’t pass on this, on this, this SARS cope to virus.
Nick van Terheyden
So I’m going to ask I mean, this is news to me. I didn’t realize that pediatricians were not in the game of giving vaccinations. When did that change? What was that about?
Craig Joseph
No, maybe you misunderstood. I’m saying that we’ve always been in the game of giving. Okay. I what I was saying and clearly not effectively was that we were not in the game of giving vaccines to adults for COVID. Right. So we’ve not been doing that. And I think that most people have gotten their vaccines, not from their internist or their family doctor, right. But from a third party or the vaccine side or the pharmacy. And so this is really the first time where most patients in a particular group, in this case, kids who are going to be getting these vaccines, they’re going to talk to their pediatrician, or their family doctor. And, and lots of research has shown that they’re your doctor, someone that you trust, as opposed to someone on TV or someone that’s got a podcast, who may or may not know what they’re talking about. And so,
Nick van Terheyden
oh, hold on a second. I don’t trust podcasts.
Craig Joseph
No, I’m, you know, like for this podcast, one of us clearly is informed and authoritative. And then there’s, there’s you and the other clearly, who knows, I don’t want to name names, but it’s not me. And so, so no, I’m pretty excited, though, that people are going to parents are going to get good information, because they’re going to get it mostly from their pediatricians. And then they can judge, you know, what they want to do based on based on that, I think that’s a much, much better outcome for everyone, when you get information from your doctor or another trusted advisor, as opposed to from TV,
Nick van Terheyden
you know, and it’s interesting, obviously, my ineptitude and understanding and as people listen to this podcast would be interesting if people listened to you and say, What the hell is Nick talking about here. But put that to one side, the reality that you point out here is actually really important. And maybe that would have changed a little bit of the trajectory of our COVID vaccination rates, if that vaccination had taken place. More so in the physician office where there is that relationship, or hopefully there’s that relationship, and an opportunity to question and you’re right, that’s been part of my experience, as a physician with three children who went through vaccination, and we would go and that would be part of the experience. But that wasn’t the case with the adult vaccination. And it isn’t with I think almost any that I can’t think of the last vaccine that I received at my physician office, he just tends to say, oh, have you had x while you ought to get it? And that’s about the beginning. And end of it seems like, there needs to be a little bit of a closing of the loop here, but okay.
Craig Joseph
Yeah, yeah. Well, you know, certainly, like I said, pediatricians, since there have been vaccines, it’s been one of the major things that we’ve done. And, and, and, you know, I think it’s hard for many people to understand how successful the vaccines are, that we get for routine childhood diseases, and we call them routine childhood diseases that we don’t see. And, you know, just to kind of make that even more clear, when I was a resident at a big Children’s Hospital. I would admit kids every night that I was on call to our infectious disease for with meningitis and other kinds of serious infections. And I was talking once with with one of my attendings, who was not significantly older, maybe 20 years older than me, he wasn’t archaic. And he had, he had said that, when he when he was a resident, every night, he would admit two or three kids with Haemophilus Influenza type B, or HIV, HIV, HIV, meningitis. It’s like that’s what we did every night, we just admitted kids with HIV, meningitis. And then he asked me how many kids with him in a genocide ever admitted to the hospital? And the answer was zero. And I said, I didn’t realize that was a thing. He said, Well, you know, it really was until we got a vaccine for that disease. And, and now look, you’re a resident in a big Children’s Hospital, you don’t even know that that’s a thing. Because it’s just it’s, it’s gone away. And so these vaccines are important. They and we know what happens when we stop using some of these vaccines. These diseases that were very common and now are a rare if not gone, they come back. And, and I think that’s part of what we’re seeing now with with with COVID. The, you know, people were vaccinated, they got either two of the mRNAs, at least in the United States or one of the j&j and now we’re finding that, hey, looks like almost everyone needs a booster. And so we’re seeing some of the diseases pop up. We’re seeing our I’m sorry that, you know, COVID start to start to come back in areas even in areas with excellent vaccine coverage, right? We’re we’re 70 or percent or more of the population has been vaccinated, starting to see patients starting to see the disease path back. Now folks who are at highest risk, the ones who are are in the ICU and dying are Generally still the unvaccinated but you know, how do they get the disease and they might have gotten from someone who’s immunity weaning. And so yeah, I think as we learn more, we become smarter is COVID going to be something like the flu where you have to get a flu shot every year? We don’t have to, but you should I do? I did. Yeah, I got mine, I got mine. Last year, I got mine this year, everyone should get a flu shot. And if you’re six months of age or older, you’re eligible for a flu shot in the United States. And that’s something that you should should absolutely pursue. And it might be like that for COVID. Who knows? We don’t know,
Nick van Terheyden
when we don’t. And, you know, to be clear, certainly on the stats that I’m seeing with some of the clients and people that I’m talking to, we’ve seen a big uptick in flu. And that would be an area of at least something that people could do. I think you’re right about that waning immunity and the contribution, we clearly did not get to herd immunity. And you know, that has consequences downstream. The one thing I do want to say, and you know, I’m going to call it out, I’ve done it a couple of times, will the media please stop with the needles in arms as part of the stock footage for every single item that talks about COVID, vaccination boosters, non boosters, I’m going to shout out to Amy Baxter. She has pain care labs, and they have buzzy, which is the little attachable unit that attaches very effective, huge amounts of needle phobia. And I gotta be honest, I looked at all these things I don’t, I’m just it’s never bothered me, fortunately. But it was my wife who pointed it out to me. And she says, Oh, you know, I really upsets me every time to watch the news. And of course, we’re not doing ourselves any favors. So I think we, we should really stop that at this point. But you know, as part of that, you bring up, you know, where the vaccines were occurring. And where we went, which was the pharmacies, and we saw that CVS is closing 20 20% of their pharmacies, because they’re not fulfilling the purpose. What what’s going on? I mean, I thought they were the humdrum of, you know, healthcare delivery in the local community.
Craig Joseph
They are, and it’s an evolution and you know, that we’re seeing where drugstores are becoming much more than drugstores are becoming healthcare providers, right. And so, Walmart has been kind of putting a toe in, they’re getting some clinics into their stores, including dental clinics. And so CVS has come out and said, over the next three years, they’re gonna close 900 stores, they haven’t decided which ones yet, but, and the purpose of they’re 900, or about 20% of all of their stores, is to focus on digital health, and focus on becoming much more than a drugstore and a pharmacy. But in fact, becoming a health care provider, whatever that means. And so likely, what that means is a significant chunk of their physical space is going to be given over to clinics of some sort, you’ll maybe see doctors and nurse practitioners and, and, you know, physician assistants, managing at those those places, I think you’ll mostly see primary care there. But they’re really, you know, moving into becoming whatever the future of healthcare delivery is in the United States. And, and CBS seems to be on the on the forefront of that, and acknowledging that they can’t do that everywhere. And so that some stores that are close to others, and are either underperforming economically, or they can’t imagine how they could make them perform in this new vision that they have. They’re going to close up. And and I was just reading this morning saying that the dollar stores are likely to benefit from this, as they you know, of CVS or Walgreens and others that are everywhere close. Though the dollar and other kind of discount stores are are potentially going to benefit by getting more traffic. And those stores I think we’ve mentioned before in a previous show, or I think Data General Data General Dollar General or one of the one of the stores that like that hired a Chief Medical Officer have not met too many months ago with the idea that they also think that they can provide care.
Nick van Terheyden
Or at least it’s interesting. I think there’s there’s tremendous opportunity because it’s in the local format and one of the interviews that I did on my show was with the barber shop that was trying to deliver. Not just, it was healthcare advice, but it was sort of a supportive environment in what essentially is a trusted environment for groups to be able to come in ask questions deliver basic health education, not just around COVID, but sex education, general sort of wellness, community based sourcing for food and so forth. And, you know, I think what bothered me about the 900 stores closing and I recognize the economics of it, you know, and no. Negative on CVS specifically, was it that closed all of those community locations that are, as you describe, other people are going to step in? So I think in that sense, is good, but hopefully they step in with some healthcare because that’s really the value proposition is that local element because we know we’ve got telehealth, but that’s not the sole deliverer. CVS has clearly gotten into this health delivery, they are much more than a drugstore and a pharmacy. They’re doing all of these I mean, I, even in at least one of the four that are equidistant from my property where I am currently has a clinic set up which I found kind of interesting, because I went and got one of my bags, I think it was the flu vaccine, I got there. And it was this sort of separated area that had some soundproofing. It was a little bit of space, it had a printer, you know, supplies, and you could step in and have a consultation without feeling like you were out in the open, which I certainly seen in some of the interactions before with other vaccinations. Not that there’s anything secret about it, but you know, as you get into more detailed healthcare delivery. For those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Dr. Craig Joseph, Chief Medical Officer at Nordic Consulting and our usual news, you can use ask me anything, we were just talking about the CVS closures and the loss of about 900 or so of these stores, in part for a pivot by that organization, the stepping in of others. But it brings up this area that sort of supportive of that that I think we’re seeing, I don’t want to say my my worst nightmare, but it feels like it’s part of it, where COVID-19 accelerated some great silver linings. I mean, there’s been no question. There’s been some positives out of it. And one of those has been telehealth, which people looked at and said, No, that’s not telehealth has been two years away for the last 10 years. And then suddenly it wasn’t. And everybody realized that it had value. It’s not a panacea doesn’t solve all problems, but it really helps. It’s fantastic. And now we’re seeing Oh, no, no, we can’t do that telehealth anymore, because we’re going to change the rules. And suddenly, if you’re in this state, you can’t have telehealth. And I did respond online to somebody who complained about that. And I said, Look, just say you’re in whatever state it is, other than how they can validate. And if they can validate, based on your IP address, hello, VPN, I can be anywhere in the world, which I am all the time. So but it seems like things are going to shut down again, and we’re going to lose a lot of telehealth.
Craig Joseph
Oh, you know, it’s the it’s what we’ve heard everyone has been worried about. And, you know, I it’s, it’s mostly not that anyone is saying you can’t do it. It’s just that oh, we’re just going to go back to the old rules, right? That that was the benefit is that all these rules that were there for, for different reasons to protect sometimes, the public or if you are more cynical, to protect private interest. Those rules are going back or coming back, right? They went away during the public health emergency in certain places, the public health emergency isn’t there anymore. So for some of the things you’re mentioning, hey, if I’m a physician, and I’m licensed in, in one state, that’s the only state I’m allowed to give medical advice in. And so that’s what you’re talking about. So if someone called and they were in a different state, I couldn’t talk to them. And so a lot of that has been relaxed, and is coming kind of back on those rules are coming back. Now. One, I think if the lay public were to think about this, they wait a second, why? Why can’t physician be licensed throughout the United States? Why? What is why would you be licensed in
Nick van Terheyden
Can I just stop you there? And this is a question I’ve asked for all the time that I have lived in this country because I gotta say, I have taken four driving tests and by the way I possible just to be clear, but it was
The first one is on the first try. Did you pass them on? to No,
Nick van Terheyden
I all on the first try. In fact, I’ve taken seven in total that’s in other countries. Now I recognize driving is a little bit different different side of the road, we drive on the correct side in England, you know, those four things? Yeah. On a medical front bodies do not vary. And they do based on other factors, but not based on geography. Yeah, I could never work this out.
Craig Joseph
It doesn’t. Yeah, I don’t know. It’s, there’s no national GAAP, and there’s no every state defines what a physician is, and defines what is required to, you know, get a license. And, and so yeah, every state is different. And, and whether that makes sense or not, is not completely relevant to the conversation, because that’s not going away.
Nick van Terheyden
So, but it’s not it’s not relevant. It’s, it’s, it’s just a news.
Craig Joseph
It is what it is. Yeah. But you know, so when this data, so I’ll just call out, you know, I’ll just make up a State Florida. If Florida says, Hey, we’re
Nick van Terheyden
real estate. Craig, did you not know, Florida is that you said you were making up a state that’s not making up a state?
Craig Joseph
Oh, that Florida is a state? Yes, I’m sorry, I was trying to make up a state and I came up with one of the state’s passion, I’m gonna have to work on my imagination
Nick van Terheyden
of Manchester.
Craig Joseph
City, Manchester City, no, we’re not doing that. So if if a state says, Hey, we are relaxing our roles, and now as long as you’re licensed in any state, in the United States, you can practice virtually in our state with our residents. That’s fine. But that those rules are all kind of going away and say, with insurance companies, insurance companies, relaxed their rules, whereby they, they used to have all kinds of requirements that, Hey, you can’t have a virtual visit with a physician that you’ve not already had an in person visit with. And they claimed that this was required for quality reasons. Boy, we only want you to see a doctor that really knows you already. Or to decrease fraud, hey, it’s much easier for us to make sure that this visit actually did happen. And we’re paying for services actually were provided. If we know that there’s a relationship there. And so those rules are from the payer side, or also comes back and slowly but surely, and and it’s disappointing. And so there are lots of I think there are lots of groups with horses in this race and trying to make sure that we don’t lose the for progress that we’ve made. Certainly telehealth is not perfect for every problem. Getting back to CBS though, it’s actually funny. Over the weekend, one of my adult daughters called and said she’s sick. And this is this is someone who has been fully vaccinated, and his RN, even after being fully vaccinated and had a breakthrough infection. Very, very mild, it was cold, but she went for a test and came back. And now she’s sick again. And she’s asking me what to do. And you know, what I would have liked to have said as well just have a virtual visit, you know, talk to a doctor, but really think everyone knows, as long as she’s not having trouble breathing and doesn’t have a high fever and all that. Most likely, we just need to know, is this COVID? Or is this not COVID? I’m not sure what we’re going to do with that information. But, but I think that’s part of the future of telehealth, as well as a doctor talking to you and saying, Okay, I really do need a rapid strep test and COVID Rapid COVID test. I’m sending those orders over to CVS, I’m sending it. So I need you to go two miles from your house, go there just walk in and they’ll know who we are, and they’ll swab you and then I’ll call you in an hour or two. And so kind of an extension of where those doctors are. I know I’ve gotten a little a little off kilter. But yeah, so that’s a concern. And I think everyone wants telehealth to continue. But again, like I tell my children sometimes when you misbehave, this is why we can’t have nice things. Yeah, if if, if, if we’re going to see increasing amounts of fraud with these tele visits, telehealth visits, then we’re not going to be able to have nice things. Yeah, it’s a
Nick van Terheyden
constant bug of mine, that it’s always down to the lowest common denominator. It just takes one person in one instance and then everybody suffers, which doesn’t seem like the right way to approach this. And, you know, it’s interesting, you bring up the telehealth and CVS but, you know, ultimately that shifted digital health would push out those capabilities for investigation. We’ve seen it with COVID tests and you can do at home. I’ve got a bunch of them. You know, I did them for international travel. So there’s some real capabilities that I think these companies can service As usual we’ve run out of time so this month it just remains for me to thank you for joining me on the show and look forward to next month great thanks for joining me you it was great
