Vaccines and California Senate Bill-276: The epitome of the physician outlaws with political controversy riddled with heedless public health policies
Vaccines! - The biological ingredient that delivers actively developed immunity to a particular infection! - We are doomed with them and doomed without them. Up until not too long ago back in the century citizens were suffering devastating infections such as smallpox and polio when today’s preventable infectious disease were then slayers of the human existence. Throughout the 20th century amid 20 and 60% of all those infected and over 80% of infected children died from the infectious diseases, from which that smallpox was responsible for 300–500 million deaths. In the 1950s, approximately 50 million cases of smallpox befell in the world annually. In the United States, the 1952 polio epidemic was painstaking to be the worst epidemic in the nation's history. Of the virtually 58,000, cases described that year, 3,145 died and 21,269 were with mild to incapacitating paralysis.
The infectious outbreaks of my childhood age for those which there were no available vaccinations, I recall; if one sibling contracted measles virus, parents not only did not isolate the child, but they stressed out boosting the close contact between the siblings to encourage iatrogenic procurement as active vaccination. Just to elucidate, at the phase of the era, it was not a surprising insight that contracting infections such as measles late in life would carry more risk of complications. Under such an assumption, they would have been instinctively weighing the risk against the benefits of contracting measles earlier in life vs later in adulthood as a preventative measure. Under circumstances such as limited technology, this attitude would carry significant weight. Even so, bearing in mind the risks, measles would have accounted for one of the hands full of infections one could reasonably apply such exercise to, as in the case of smallpox and polio would be more treacherous.
The point of the argument, although such outdated practice does not necessarily apply to today’s standard of medical care, the notion of risk and benefit ratio somewhat still stands in clinics of modern healthcare. Indeed, that is how quality medicine must work today. Logically, one would fittingly postulate that the practice of authentic conception such as weighing the untoward effects of treatment against its beneficial outcome is in full-fledged effect in today’s medical practice. But then again, I must say— that is the intent of any physician and the indistinct meaning of the legislators, but in realism, such messages are confusedly mixed- the trend an absolute discontent.
Historically, since its introduction, vaccination has helped the humankind and societies alike. Nevertheless, has had its own set of backlashes and controversies. Not long ago, I published an article under the title “Vaccination—Century of Personal Choice and Obligation to Public Health”. In my piece, I briefly touched on the importance of individual choice, physician’s clinical judgment and the significance of ensuring the sovereignty of the doctor-patient relationship. Within the framework, I tried to shed light on the historical as well as the political perspectives surrounding the idea of immunization.
Today, I would like to focus more on the current turmoil, as to reinforce some of the points I made in my past publications.
Anti-Vaccination movement, ethics, and legal dilemma
It all began during the 1800s in the United States and England when people rebelled against smallpox vaccination, forming an anti-vaccination league.
With the discernment of individual liberty, everyone would be naturally being entitled to the right to choose what his or her famines to put in a body or not. Yet, it doesn’t dismiss placing the lives of the others at risk by exercising that right. We as the individuals and social beings are mutually dependent on one another for survival, as we collectively contribute to the social harmony of the community we live in, hence the laws we conform. In fact, keeping the truth from the public about not having been vaccinated is against our ethical obligations. Today’s scandalous media coverage is not merely about vaccination safety, its benefits or if vaccination benefit outweighs the risks. Indeed, the significance of the matter goes beyond the confines of health and wellness, way into a delicate space by invading the moral boundaries, and disrespecting personal values. One cannot find a patient with the sound cognizance to voluntarily risk her baby to be proven wrong that immunization is very much essential or come across a physician who would go against his professional and ethical commitment eloquently that such action may result in the disciplinary exploit. Instead, equally physicians and the patients have become the culprits of the evolving current bureaucratic turmoil.
Partial administrative moves of today are utterly against Independent physician's practices. It not only affects them at local and state jurisdictions but also at the expanding federal political climate.
According to a recent press release California Senate, legislators recommended an amendment to the bill SB-276 that is aimed to preclude or at least edge the physician's clinical judgment to make immunization exceptions. This bill represents a noteworthy alteration to the original contentious vaccine bill to which after California Governor. Gavin Newsom, and other state officials raised concerns that the ration if taken on into law would hamper physicians and would further empower administrators in deciding which children could be exempted from routine immunization.
The disparity in the political scenery in itself is not unsubstantiated given the argument, but where does it leave the healthcare community and autonomy of the physicians in general, is a case in point of what the general trend is within the contemporary healthcare system.
So, are we taking the right approach by letting bureaucracy rule our medical decisions?!
According to a report by the San Francisco Examiner — “An Orange County mom Michelle Sabino says her daughter experienced 16 seizures in two months after she was vaccinated for diphtheria, tetanus, and whooping cough when she was a baby. She’d never considered that vaccines could be dangerous. Even so, after consulting with two physicians whom both recommended brain scan, and a medical review of her family’s history and records, Sabino said she was shocked when a doctor said future vaccines could be fatal.”
According to a survey recorded by the physicians' foundation, Less Than a Third of Physicians Owned Independent Practices in 2018 and currently continues to fall, while the percentage of doctors employed by hospitals or medical groups decreased by 50% in 20018.
Even though, this trend has been nationally universal, but more so noticeable in the state of California, making it the most independent physician hostile state in the country.
For decades, the state of California has progressively favored the Health Maintenance Organizations (HMO) and has served as the native land for entities such as Kaiser Permanente health plan and its sister branches, Permanente medical group and Kaiser Foundation hospitals, and clinics. Founded as an American integrated managed care consortium, based in Oakland, California, United States and instituted in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield, as of December 31, 2018, Kaiser Permanente had 12.2 million health plan members, 217,415 employees, 22,914 physicians, 59,127 nurses, 39 medical centers, and 690 medical facilities. According to a recent census as of early 2019, the Total Lobbying Expenditures by Kaiser Foundation Health Plan has reached $610,900.
California Hospitals Association (CHA) on the other hand is one of the most influential healthcare players, with a longed-for seat at the negotiating table that has merely monopolized the financial mixture of for-profit and nonprofit breadwinners who have given California and the nation a bottom-ranked healthcare system. Thus, the hospital trade group ranked #1 with $593,369 recorded by March 31, according to new numbers posted by the California Secretary of State. Kaiser spent $586,157. The California Medical Association was #3 with $466,075 spent in the first quarter for health care lobbying during the first quarter of the 2015-16 legislative sessions. Kaiser Permanente, which is also a CHA member, was a close second.
Between the line
“The extreme planning of population-based healthcare models leads to autocracy because authoritarianism is the most effective instrument of enforcement that is essential, if central micromanagement on a large scale is to be possible” Adam Tabriz, MD
For the past decades' California has served the role of the alpha dog as the country's extreme left-wing pro-micromanagement pack policies. Furthermore, the federal government has not been shying away from adopting policies originally commenced by the state of California. Over the years, California has led the mission of corporatizing the Healthcare and the practice of medicine by hosting and upholding the interests of the biggest managed care system in the country.
In the world of bureaucracy, maintaining efficient and most effective micromanagement system is essential, thus implementing it on a large scale requires significant transparency, accountability, and standardization.
But—Transparency is a must; accountability is the virtue
In many ways, our system has been unable to show and support effective transparency. That by itself is a subject of distinct debate. By definition so, Standardization is created by a selected person or persons which tend to serve as the collective measure of narrowing down the scope of services or deliverables into a single cookie-cutter solution that is to be followed by the entire community. Standardization through standard operating procedures (SOP) and protocols are valuable tools in every industrialized nation, as it promotes quality, efficiency, and public safety. If utilized wisely, it too serves as a useful tool in healthcare and medical practice. Even so, one must never forget medicine is the science of indefinite variability, as no two cases are the same. Thus, across the board application of protocols governed by the extreme population health is premature with overwhelming risk for conflict of interest.
The authoritative application of protocols by the California legislatures has promoted the confinement of Health Maintenance Organizations, which in turn reflect strict protocols and profiling as the core stock of their system. The physicians who have had the prospect to work for managed care systems would unmistakably appreciate the capability of top-down influence which commonly dictates physician's day in and day out clinical judgment, Hence the product of protocols and guidelines written within the bureaucratic system.
The administrative leadership of the State of California, is it the medical board or department of consumer affairs, in general, are all in support of extreme reliance on protocols and Inflexible guidelines compelling physicians to exercise at the edge of their profession as opposed to the core.
Vaccination bill ( SB-276) is one of many pointers of the statewide managed care system expansion, which directly or indirectly, inevitably or coincidentally brands the health maintenance organizations the preferred choice above independent physician practice, making the state administration the subsidiary of State of California managed care systems monopoly. In many ways, the standard of medical care in California has grown into medical care based on one-size-fits-all quantifiable protocols, and standard operating procedures created by policies driven by the lobbyist's funds. The physician’s Clinical judgment in the state of California as well as in many other states is revolving into a more or less the matter of sentiment, as it merely serves the bureaucratically premeditated process to treat an assemblage of metadata reaped from the patients using mathematical algorithms. In conformity with the bill SB-276 California medical board has invariably been in support of such policies, as the licensing agency habitually has retained all the power of glazing the slippery slope for the independent physicians through the influence of lobbyist efforts.
Not surprisingly, the Physicians society's role too has been no less bureaucratic than the opposing administrations, as on June 8, 2015, American Medical Association publishes a memo in support of tighter limitations on immunization opt-outs and against physician sovereignty. This comes from an organization that is “supposedly” a pro-physician establishment!
Non-Physician healthcare professional's role
Every healthcare professional's mission is to offer the best of their skills to the patient, but what positions the physician apart from the rest of their aristocracies in the medical domain is their source of pride to navigate the variable scope of the clinical diagnostics. On the same scale, their ethical, professional obligation is to avoid tunnel vision and one-size-fits-all approach in their professional verdicts. By circumventing independent physicians; the system has opportunely taken the shortcut of exploring alternate avenues such as expanding the role of physician assistants and nurse practitioners under the vindication of “physician shortage”, who are more disposed to follow pre-written guidelines and protocols—-A win for managed care systems and the government organization the same.
Political, legal, the scope of medical practice, vaccination and the media
Unions
In Support of expanding the role of the non-physician healthcare provider, National Union of healthcare workers spent $117,588 in Lobbying Contributions to federal candidates (list recipients; 100% to Democrats, 0% to Republicans). In a 2009 NURSES UNION APPLAUDS PASSING OF SB-294 NURSE PRACTITIONERS BILL. And in March 2018 Alliance of Health Care Unions (AHCU) announced Executive Director Peter di’Cicco, founder and longtime Executive Director of the original Coalition of Kaiser Permanente Unions, from which the alliance unions withdrew the week prior to his assignment to that position. Before, di’Cicco founded the original Coalition of Kaiser Permanente Unions (CKPU) in 1997 and served as its first Executive Director from its start through February 2006.
Media
The mainstream media is widely propagating that California medical Doctor Bob Sears is facing discipline by the California State Medical Board after he wrote a medical exemption for vaccines on behalf of a 2-year-old patient who experienced adverse reactions from earlier vaccines. State public health officials said they expect students and their families to make 11,500 requests (4 in 10 students) each year seeking an exemption from immunizations due to a medical reason, with 5,000 of those to be rejected under the New Authority Senate Bill-276 would grant to the agency. The San Francisco city attorney investigates doctor for excusing kids from mandatory vaccines, which will be more consolidated if Senate Bill 276 is passed.
Political party
Individual liberty and choice are the hallmarks of libertarianism and vaccination have occupied some highlights of their political discussions as well, however, for past decades they have to stumble upon their own inner controversies. For instance, in 2016, then-Libertarian presidential candidate Gary Johnson announced that he had reversed his position on vaccine mandates under the heading “Herd Immunity”.
By definition, the Herd immunity is the resistance to the spread of contagious disease within a population that results if a sufficiently high proportion of individuals is immune to the disease, through vaccination, thus the level of vaccination needed to achieve herd immunity varies by disease but ranges from 83 to 94%
Is it about school districts?
According to a recent publication by the foundation for economic equality (FEE) Senator Pan of the state of California presents the SB-276 as the means to enforce a standard that is being abused even though such standard does not exist, and whether a child should have a medical exemption or not is made at a doctor’s discretion. What SB-276, in fact, implies is to impose a standard, and a restriction that practically applies to 6,700,000 children enrolled in public and private schools in California; hence positioning the bill to have far-reaching implications that would concomitantly carry potential to hurt many families.
Take home message
It is obvious that the purpose of SB-276 is suggestive of virtuously organizational concept. Nevertheless, the bill exemplifies the strict and forceful bureaucratizing the otherwise set of recommendations on vaccination practice by the Centers for Disease Control (CDC). And twofold enforcing the vaccine administrations already licensed by the Food and Drug Administration (FDA) through further restricting the physician’s license. Thus, brings me to my story “Vaccination—Century of Personal Choice and Obligation to Public Health” —The focus of which was, the individual choice and liberty and our responsibility to the community around us. However, on the recent political deportment by the California legislator's initiatives, as anticipated we can rest to assure the path which the healthcare system is navigating by simply connecting the dots of lobbyism, corporate medicine, unions, interest groups, and medical board's position.
Current vaccination issues are nothing short of commotion, and swindle to further weaken the position of medical doctors, hence giving corporations the opportunity to control the healthcare market.
Let’s find out how!
The Current argument is about ensuring quality and value of care delivered and reimbursement through a set of well-defined metrics. But recent public health vaccination policies, like many other handfuls of policies, have failed by the virtue that quality must be defined in specific terms or metrics-as it cannot be something abstract. Quality metrics enables physicians to translate patient needs into measurable goals. But in its realistic context Quality means public acceptance and greatest contribution in care delivery that concomitantly matches the patient and the physician’s expectations and abilities given the available options. The value of healthcare is in fact the measure of such quality of medical service provided to the patient by his or her physician solely based on their unique mutual relationship, by essentially taking into account every aspect of the person’s life circumstances, including the social, emotional, physical, financial, environmental, familial, genetic, mental, ideological and personal.
“The majority of policymakers support either monopolization and /or nationalization by trying to convince the citizens through populist oratory”- By establishing Cookie-cutter protocols, creating Licensure to hold the power of veto and sways over the intellectual constituents.
To contrivance, a closed system corporation and managed care system would be the perfect environment. Employing healthcare professionals such as nurse practitioners and physician assistants who proactively serve as the dedicated cohorts and facilitators of the pre-write protocols and guidelines would be the practical approach in pursuing corporate medicine.
Closing Argument
Independent physicians have a problem at their hands! - Patients are facing the risk of losing the liberty of maintaining quality relationships with their physicians. They both are on the verge of losing individuality to Collective Corporate bureaucracy.
One of the most controversial traits of the SB-276 is, in fact, the following:
The majority of people still believe vaccination is guarded and works, among which 79% of believe that vaccines are safe to use, with 84% believing they work, but, despite considerable evidence to the contrary, only 7% of people strongly or somewhat disagreed that vaccines are safe, with 5% disagreeing that they work. People in higher-income countries tended to trust vaccines less and less to believe they worked than in lower-income countries.
Therefore, mind-boggling is to imagine that restricting physician license solely by rationalizing legitimacy of vaccination or in the least based on the significance of “Herd immunity” is the way to go!
In criticism!!- the bill-276 is a gateway for the corporate entities to shackle down the flexibility and variability of Hippocratic medicine by the heavy-handed bureaucracy of government funded through the lobbyist efforts of those corporations.