Vaccine critic Robert F. Kennedy Jr. has accepted Donald Trump’s invitation to chair a panel on vaccine safety and scientific integrity, according to an article posted on the STAT website. “President-elect Trump has some doubts about the current vaccine policies, and he has questions about it,” Kennedy told reporters.

During the presidential campaign, Trump said he wanted “smaller doses over a longer period of time.” He previously tweeted: “Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes—AUTISM. Many such cases!”

While Trump’s remarks on vaccines have alarmed public health advocates, they have energized the antivaccination movement, according to the article. Last summer, Trump met with Andrew Wakefield, a former medical doctor who wrote a well-publicized study that kicked off the movement. Wakefield’s study was later discredited, and his medical license was revoked.

Kennedy, too, is no stranger to the vaccine controversy. In 2005 he wrote a purported exposé, copublished by Salon and Rolling Stone, contending that scientists were hiding the link between thimerosal and autism. Thimerosal is a mercury-based preservative used in vaccines. Years later, Salon retracted the story, noting that its basic thesis was inaccurate. Rolling Stone deleted it.

Then, in 2014, Kennedy edited a book titled Thimerosal: Let the Science Speak: The Evidence Supporting the Immediate Removal of Mercury—a Known Neurotoxin—from Vaccines.

In related news, the Cleveland Clinic has vowed to discipline Daniel Neides, MD, the medical director and COO of the health system’s Wellness Institute, for a controversial blog on vaccines and toxins that he posted on January 6. In his column, Neides condemned flu shots and other vaccines because of the “toxins” they contain and questioned their link to autism—a link that has long been debunked among physicians.

“Does the vaccine burden—as has been debated for years—cause autism? I don't know and will not debate that here,” Neides wrote. “What I will stand up and scream is that newborns without intact immune systems and detoxification systems are being overburdened with PRESERVATIVES AND ADJUVANTS IN THE VACCINES.”

He also challenged the timing of vaccines, particularly for infants. “Some of the vaccines have helped reduce the incidence of childhood communicable diseases, like meningitis and pneumonia. That is great news. But not at the expense of neurologic diseases like autism and ADHD increasing at alarming rates,” he wrote.

After receiving a wave of criticism—including calls for his resignation—Neides issued the following statement through a hospital spokeswoman: “I apologize and regret publishing a blog that has caused so much concern and confusion for the public and medical community. I fully support vaccinations, and my concern was meant to be positive around the safety of them.”

His employers were quick to issue their own statement, saying: “Cleveland Clinic is fully committed to evidence-based medicine. Harmful myths and untruths about vaccinations have been scientifically debunked in rigorous ways. We completely support vaccinations to protect people, especially children who are particularly vulnerable. Our physician published his statement without authorization from Cleveland Clinic. His views do not reflect the position of Cleveland Clinic and appropriate disciplinary action will be taken.”

Sources: STAT; January 10, 2017; and Becker’s Hospital Review; January 9, 2017.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.