There has been a dispute regarding the public benefits of universal flu vaccine requirements. It is below:
I had a difficult time interpreting the study.
The way they presented the information didn't seem to make it clear that this was a self-selected group of ill patients -- and it was confusing in regards to how they sorted out the risks of hospitalization for those vaccinated vs. not.
Looking at the article some more, they do mention their limitations...
However, several limitations should be acknowledged.
First, hospitalization due to influenza is rare in healthy adult populations.
Despite eight seasons, there were few hospitalizations in our study, all of which were from a single hospital in central Wisconsin.
Second, antigenic characterization was not performed for many positive samples, and minor antigenic drift can be difficult to detect and interpret. As a result, we were not able to assess the potential impact of antigenic variability. The 2007–08 season accounted for the majority of A (H3N2) infections, and during that year there was circulation of A/Brisbane/10/2007-like viruses that were minor antigenic variants from the vaccine strain .
Third, our classification of high risk medical conditions was based on ICD-9 diagnosis codes without medical record validation. However, all diagnoses were entered by physicians and automatically mapped to ICD-9 codes in the electronic medical record, which reduced the potential for coding error.
Finally, our study population included only outpatient influenza cases and there may have been differential health care seeking behavior between vaccinated and unvaccinated individuals. We cannot exclude the possibility that vaccinated individuals had milder influenza illness and did not seek medical attention. In that scenario, vaccination would have reduced illness severity, leading to fewer outpatient visits and hospitalizations,
but this would not be evident when comparing the risk of hospitalization in vaccinated and unvaccinated outpatients.
However, we note that estimates of vaccine effectiveness in the outpatient setting are generally similar to estimates of efficacy based on randomized clinical trials, and the primary endpoint for clinical trials is influenza illness rather than severity.
Because of these limitations, results should be interpreted with caution.
A note on the limitations mentioned: “all diagnoses were entered by physicians and automatically mapped to ICD-9 codes in the electronic medical record, which reduced the potential for coding error”. SERIOUSLY???? As my medical staff continues to “adapt” to Cerner, I have found the details and diagnoses documented to be markedly less accurate due to doctor computer fatigue. We are being encouraged to compile “lists of our favorite diagnosis” (this may work for specialists but I found it to be fairly useless for primary care), but it far easier to just list the major admitting diagnosis, not the “chronic” dx that contribute to severity of illness. Can't imagine this is so different in other systems.
D. Sutcliffe, MD
Once again government and our universities have confused quantity with quality. They have arrogantly persisted in the heuristic fallacy best described in "The emperor's invisible clothes".
Massive amounts of information dredged from flawed EMR systems will not improve quality. We were early adopters in 1999, and did OK until there was a massive growth of new rules in 2009. Our Practice Partners record just would not connect efficiently with the new clearing house regulations, and they had no service network. We regularly inspected our data from this system, and some of it was wrong.
At our expense[100k] we "upgraded" to eMD in 2012. We have recouped our investment though the meaningful use program, but this required the acquisition of A $10 k consultant, and an onsite IT person[$36 k per year]
With annual office visit volumes of 36-40k, ClinicaMedicos has always required that physicians assume responsibility for charges and ICD reasons at the point of care. We are a privately funded teaching program supporting a fellowship in surgical family medicine obstetrics. Physicians must be involved in a curriculum which includes ownership training(stewardship). Physicians are required to learn the system and must participate in feedback. WE hoped to maintain the quality of the information and the integrity of our physicians.
Physician integrity was and still is the priority. Medicos been forced to create a complicated feedback process($80 k per year) which checks physician data on each encounter. It provides weekly feedback for continuing quality improvement. Physicians are required to attend a weekly academic conference which includes ownership training/practice management. This is paid time.
Without lying Medicos has restricted ICD9 choices(There is one headache code used for all headaches) For example, we discourage tedious searching for the exact code needed for cluster headache. It makes no difference in the reimbursement, and the billing reason does not improve quality.
When flawed data are dredged by researchers whose pay depends on telling the paymaster what he wants to hear, the results are spectacular. Vioxx, PSA, and whole variety of BigPharma fines for misrepresentation are quickly forgotten.
As George Orwell said, "When deception is universally endorsed by the state, telling truth will be viewed as a threat to the law". In 2013 physicians are being told to accept flawed data or face removal of their hospital privileges and/or their corporate employment.
From the academic witness protection program
Index-Flu vaccine data, BigPHarma