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Medscape
23-06-2025
- Health
- Medscape
Avoiding the COVID Shot Talk? Here's What to Do
Do you hesitate to bring up COVID vaccines with your patients? You're not alone — and experts said these conversations are becoming less common in routine care. The reasons are complex, ranging from short visit times and shifting clinical priorities to the health attitudes of both physicians and patients — and something Arthur Caplan, PhD, head of the Ethics Division at NYU Grossman School of Medicine, New York City, called 'COVID exhaustion.' Arthur Caplan, PhD 'There is a feeling that everybody who's going to get COVID either got it or got vaccinated or doesn't want [the shot],' said Caplan. But your silence can leave patients feeling unsure about what to do. New CDC guidance for COVID boosters — and even baseline vaccination — for healthy people (including children) has shifted toward shared clinical decision-making. What does that mean? According to the now-fired CDC vaccine advisory panel, shared clinical decision-making means 'informed by the best available evidence of who may benefit from vaccination; the individual's characteristics, values, and preferences; the healthcare provider's clinical discretion; and the characteristics of the vaccine being considered.' The panel added, 'There is not a prescribed set of considerations or decision points in the decision-making process.' In other words, you're on your own. All the major US physician organizations still recommend the shots for everyone 6 months and older. Amid widespread misinformation about the vaccines' risks and lack of benefit, there's another reason providers should bring them up — protecting those most at risk for severe COVID, Caplan said. 'We're so individualistic, so focused on personal choice, so focused on the individual, that we're undercutting a moral basis or the ethical basis for vaccination, which is the community,' he said. Surveys consistently showed that more people say they plan to get COVID vaccines than actually do, and the barriers throttling that conversion rate are unclear. If you find yourself hesitating to bring up the COVID vaccine, ask yourself why — so you can thoughtfully address that hesitation in practice. Why You Don't Bring Up COVID Shots With Healthy Patients Timothy Callaghan, PhD First, the elephant in the room: Many people are hesitant to talk about COVID vaccines because of how politically charged the topic has become, and clinicians are no exception. 'Physicians may be hesitant to bring up any topics that might induce partisan beliefs and lead people to be less trusting of seeking out medical care,' said Timothy Callaghan, PhD, associate professor at the Boston University School of Public Health, Boston, and an expert in vaccine hesitancy and health behavior. 'They might forego discussing those to make sure they're doing everything they can to keep patients engaged with the healthcare system so that they can keep them safe and healthy.' Jen Brull, MD Another key challenge is the topic's complexity. 'Sometimes those conversations need to be lengthy to let people feel comfortable that their questions were answered, their fears were addressed, the confusion was resolved,' said Jen Brull, MD, president of the American Academy of Family Physicians. 'In a 10- or 15-minute office visit, you might say, 'Do I want to open this Pandora's box today? Do I have time to do this? How late am I?'' In the pediatric setting, parents' perception is often that COVID is generally well-tolerated by healthy children, and they view COVID vaccines differently than they do vaccines that are required for school, said Jesse Hackell, MD, chair of the American Academy of Pediatrics Committee on Pediatric Workforce. 'If I've got a kid who needs the measles vaccine and the COVID vaccine, I don't want to poison the atmosphere for the measles vaccine by pushing the COVID vaccine,' Hackell said. Your move? Don't wait for the Pandora's box moment. Start preparing now. Your Vaccine Recommendation Plan You may not be thinking about your fall vaccine campaign yet, but now is the time to plan — before an unexpected surge leaves you unprepared. Jesse Hackell, MD One exception to fall timing is baseline vaccination of 6-month-olds, Hackell said. Data show the risk for severe illness during the first year is high, so these babies should get vaccinated 'as soon as possible.' Otherwise, here are some ways to incorporate COVID vaccine recommendations both in and outside the clinic:
Economic Times
16-06-2025
- Health
- Economic Times
New VA policy sparks outrage as doctors may refuse treatment to Democrats and unmarried veterans alike
What exactly changed in the VA policy? Live Events Has the VA responded to the backlash? What did the experts say about the policy? Who could lose access to care under these rules? FAQs (You can now subscribe to our (You can now subscribe to our Economic Times WhatsApp channel A new VA policy has sent shockwaves through both veteran communities and the medical community. The change, which follows a Trump-era executive order, has already raised serious ethical and legal concerns.A contentious policy change at the Department of Veterans Affairs allows VA doctors to refuse treatment to veterans based on their political beliefs or marital status. Critics describe it as discriminatory and dentists, and a variety of other professions are also subject to the new regulations. The new regulations have already taken effect in certain VA medical facilities, as per a report by The order "Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government" issued by the president on January 30 is cited by VA officials as the reason for the of race, colour, religion, or sex, medical personnel are still expected to treat veterans, and all veterans still have the right to since federal law does not specifically forbid it, individual employees are now free to refuse to provide patient care due to personal hospitals have the authority to exclude physicians and other medical personnel on the basis of union activity, marital status, or political party affiliation. Impacted are certified clinical social workers, podiatrists, speech therapists, chiropractors, CNPs, and optometrists, as per a document, reported The executive order sought to deny the majority of government protections to transgender individuals. The VA no longer offers the majority of gender-affirming care and has prohibited the use of terms like "gender affirming" and "transgender" in clinical VA press secretary, Peter Kasperowicz, responded to inquiries via email, saying that all eligible veterans will always be welcome at the VA and will always receive the benefits and services they have earned under the he did not dispute that the new rules allowed doctors to refuse to treat veteran patients based on their beliefs or that doctors could be fired based on their political affiliation or marital new regulations were described as "extremely disturbing and unethical" by Dr. Arthur Caplan, the original head of the medical ethics division at New York University's Grossman School of the surface, it appears to be an attempt to exercise political influence over the VA medical staff, he are worried about how new policies will affect their healthcare, especially those who are female, LGBTQ+, or reside in rural see a doctor, some people might have to travel more than a hundred miles, which could have a cascading effect. Because these changes were implemented without consulting the doctors in the system, medical experts are also worried about the under the new rules, VA doctors can refuse care based on factors such as political affiliation or being veterans, LGBTQ+ veterans, and those living in rural areas are expected to be disproportionately affected.
Time of India
16-06-2025
- Health
- Time of India
New VA policy sparks outrage as doctors may refuse treatment to Democrats and unmarried veterans alike
A new VA policy has sent shockwaves through both veteran communities and the medical community. The change, which follows a Trump-era executive order, has already raised serious ethical and legal concerns. A contentious policy change at the Department of Veterans Affairs allows VA doctors to refuse treatment to veterans based on their political beliefs or marital status. Critics describe it as discriminatory and dangerous. What exactly changed in the VA policy? Psychologists, dentists, and a variety of other professions are also subject to the new regulations. The new regulations have already taken effect in certain VA medical facilities, as per a report by The Guardian. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like Join new Free to Play WWII MMO War Thunder War Thunder Play Now Undo Executive order "Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government" issued by the president on January 30 is cited by VA officials as the reason for the modifications. Regardless of race, colour, religion, or sex, medical personnel are still expected to treat veterans, and all veterans still have the right to care. Live Events However, since federal law does not specifically forbid it, individual employees are now free to refuse to provide patient care due to personal characteristics. VA hospitals have the authority to exclude physicians and other medical personnel on the basis of union activity, marital status, or political party affiliation. Impacted are certified clinical social workers, podiatrists, speech therapists, chiropractors, CNPs, and optometrists, as per a document, reported The Guardian. The executive order sought to deny the majority of government protections to transgender individuals. The VA no longer offers the majority of gender-affirming care and has prohibited the use of terms like "gender affirming" and "transgender" in clinical settings. ALSO READ: Juneteenth 2025 events near me: Is Juneteenth a Federal holiday in the U.S? What day is Juneteenth? Has the VA responded to the backlash? The VA press secretary, Peter Kasperowicz, responded to inquiries via email, saying that all eligible veterans will always be welcome at the VA and will always receive the benefits and services they have earned under the law. However, he did not dispute that the new rules allowed doctors to refuse to treat veteran patients based on their beliefs or that doctors could be fired based on their political affiliation or marital status. What did the experts say about the policy? The new regulations were described as "extremely disturbing and unethical" by Dr. Arthur Caplan, the original head of the medical ethics division at New York University's Grossman School of Medicine. On the surface, it appears to be an attempt to exercise political influence over the VA medical staff, he stated. Who could lose access to care under these rules? Veterans are worried about how new policies will affect their healthcare, especially those who are female, LGBTQ+, or reside in rural areas. To see a doctor, some people might have to travel more than a hundred miles, which could have a cascading effect. Because these changes were implemented without consulting the doctors in the system, medical experts are also worried about the process. FAQs Can VA doctors now refuse to treat some veterans? Yes, under the new rules, VA doctors can refuse care based on factors such as political affiliation or being unmarried. Who is most affected by the changes? Female veterans, LGBTQ+ veterans, and those living in rural areas are expected to be disproportionately affected.
New York Times
16-05-2025
- Health
- New York Times
When a Vaccine Safety Trial Becomes Unethical
The Department of Health and Human Services last week announced a new standard for testing the safety of vaccines, a 'radical departure from past practices.' All new vaccines will be evaluated against a placebo, an inert look-alike that serves as a point of comparison, the department said. Health Secretary Robert F. Kennedy Jr., as well as many anti-vaccine groups, has long argued that placebo-controlled trials were the only way to fully understand vaccine side effects. To scientists who have spent their careers evaluating vaccines, the plan did not seem so radical. New vaccines are often tested against a placebo in clinical trials. One researcher has created a crowdsourced spreadsheet of more than a hundred examples. But it also concerned vaccine experts that Mr. Kennedy seemed not to recognize the circumstances when placebo groups are neither ethical nor practical. The idea is widely accepted by scientists and enshrined in ethics frameworks for medical research. 'He's asking for something that's not ethical,' said Arthur Caplan, a leading bioethicist at the New York University Grossman School of Medicine. Why Are Placebos Used in Vaccine Trials? Randomized placebo-controlled trials are often described as the 'gold standard' of research: they allow scientists to tease out whether the effects they observe result from the drug itself or some other factor, such as the expectation of treatment. Patients in trials of drugs for depression or pain, for example, often report feeling better even if they haven't received the treatment — the so-called placebo effect. In vaccine trials, researchers also use placebos, often shots of a saline mixture, to help quantify behavioral and psychological changes that might arise from participants knowing whether or not they received the real vaccine. Had some participants during the Covid-19 vaccine trials known they didn't get the actual vaccine, for example, they might have avoided the virus by staying home, potentially skewing data about infection rates. Similarly, simply believing that they have gotten the real shot can make trial subjects more attuned to possible side effects and more likely to report them. One study found that nearly a third of participants who received a harmless placebo during Covid vaccine trials reported side effects, most commonly headaches and fatigue. Why Don't Some Trials Include Placebos? Placebo-controlled trials, which may last years and cost tens of millions of dollars, are not always feasible or necessary, especially for vaccines that are updated every year, like the flu shot. 'By the time you're done with that trial, it would be two years later and your vaccine is already outdated,' said Dr. Daniel Salmon, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health. 'Pragmatically, it's just not possible.' Instead, updated flu shots — which are only slightly tweaked each year — are tested in animals to see whether they produce an immune response similar to earlier versions of the vaccine, which have extensive safety and efficacy data. There are also ethical reasons why using a placebo may not be appropriate. Perhaps the clearest example comes from the polio vaccine trial in 1954. Hundreds of thousands of children had volunteered, eager for a chance at protecting themselves against a devastating disease that was sweeping through classrooms and communities, causing irreversible paralysis and death. More than 200,000 of those children were randomly assigned to the placebo group, receiving doses of saline water instead of the vaccine. By the end of the trial, 16 of those children had died of polio. All of the children who received the vaccine survived. Bioethicists and scientists believe that the saline shots were ultimately necessary to prove the vaccine's effectiveness. And since there was no alternative vaccine or treatment at the time, the children assigned to the placebo were not at higher risk than the average American primary schooler. But institutional review boards, which are charged with evaluating the ethics of medical studies before they start, carefully weigh the experimental benefits of using a placebo against their responsibility to protect the participants in the trial. 'It is better to do a randomized, placebo-controlled trial,' said Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia. 'But there is a certain cruelty to that.' How Are Vaccines Tested Without a Placebo? In general, review boards abide by the principle that placebos are not appropriate if there is a 'proven intervention' that already exists that has an established record of safety. In those cases, researchers will compare the new vaccine with the standard of care. For example, during the development of the first vaccine for HPV, a sexually transmitted virus that causes nearly all cases of cervical cancer, researchers compared its efficacy and safety with that of a placebo. The vaccine was a huge success. The shot reduced the risk of cervical cancer by 70 percent. Years later, when researchers developed a vaccine that they believed would protect against five additional types of the virus, they could not ethically test it against a placebo. Doing so would have meant withholding a safe and very effective vaccine from half the participants. Instead, scientists measured how much more effective the new HPV shot was than the original vaccine. Michael Osterholm, an epidemiologist at the University of Minnesota, said offering a saline shot in such a scenario would be akin to running an experiment in which 'half the parachutes opened and half did not.' The same logic often applies to clinical trials for new cancer medications, which commonly enroll patients undergoing chemotherapy and radiation as a control group, rather than a placebo. 'It's going to be a little harder to see the effect because you're getting some benefit from the control group,' said Dr. Caplan, the bioethicist. 'But it's wrong to say, 'Well, sorry, you have to die faster if you're assigned to the placebo.''
Yahoo
18-04-2025
- Health
- Yahoo
Supreme Court to hear challenge to Obamacare rule on free preventive care
The Supreme Court on Monday is set to hear arguments in a case challenging a provision of the Affordable Care Act that requires private insurers to cover health care screenings, tests and checkups for free. Experts say the court's ruling in the case, called Kennedy v. Braidwood Management, could have sweeping consequences for patient access to preventive health care across the United States. Since the ACA was passed in 2010, most insurers have had to cover a wide range of prevention services at no cost to patients — including cancer screenings, mammograms, statins for heart disease and HIV prevention medications. About 150 million people are currently enrolled in private health insurance plans that cover free prevention services, according to KFF, a nonpartisan group that researches health policy issues. A KFF analysis found that 1 in 20 people — about 10 million people — received at least one prevention service in 2019. 'This is a really crucial case,' said Arthur Caplan, the head of the division of medical ethics at NYU Langone Medical Center in New York City, noting that many Americans say they can't afford the high out-of-pocket cost of medical care. 'The price will be paid in dead bodies if the court rules against.' The lawsuit was filed in 2022 by a group of conservative Christian employers in Texas. They argued that the ACA rule requiring them to cover the HIV prevention pill PrEP in their employee health plans violated their religious rights. They also challenged the U.S. Preventive Services Task Force — an independent panel that recommends which preventive services insurers must cover — calling it unconstitutional because its members aren't appointed by the president or confirmed by Congress. Last year, the 5th U.S. Circuit Court of Appeals sided with the employers, but limited the decision to just the eight Texas companies involved in the case. The court declined to make the ruling apply nationwide. The federal government, under the Biden administration, appealed the case to the Supreme Court. The Trump administration then told the court in February that it intended to defend the requirement. The Supreme Court is expected to make a decision sometime in June. If the court strikes down the ACA rule, it would mean insurers could deny coverage for preventive services recommended by the task force, said Laurie Sobel, an associate director for women's health policy at KFF. 'The recommendations would go back to March 2010,' Sobel said, referring to the year the ACA was enacted. Notable changes, she added, could include the starting age that most insurers cover colorectal cancer screens as well as coverage of PrEP. The current recommended age for colon cancer screening is 45, which the task force lowered from age 50 in 2021 and is credited with saving thousands of lives. If the free preventive services requirement goes away, Richard Hughes, a health care attorney for Epstein Becker Green and lead counsel for the HIV+Hepatitis Policy Institute, said coverage could vary by insurance company. 'I think you'll see some gradual erosion across the board,' Hughes said, referring to the services that insurers cover. 'I think you're going to see some restriction of access, you're going to see cost sharing applied to certain services, and that's been shown to be a barrier, because people are more inclined to walk away from a service when they're presented with an out-of-pocket cost.' It'll also be harder to get people into the doctor's office to seek preventive care, Sobel said. 'Right now we can say, if you're on a private health insurance plan … then you're entitled to no cost sharing,' she said. Even if the Supreme Court sides with the Trump administration, Sobel said, there are concerns about what Health Secretary Robert F. Kennedy Jr. could do to the task force. In a court filing, the Trump administration said task force members 'are inferior officers, because the Secretary of HHS — a quintessential principal officer — remains responsible for final decisions about whether Task Force recommendations will be legally binding on insurance issuers and group health plans.' 'Even a ruling in favor of the federal government doesn't necessarily assure that the preventative services will remain how they are right now,' Sobel said. Chronic conditions such as heart disease, cancer and diabetes are the leading causes of death and illness in the United States, according to the Centers for Disease Control and Prevention. A 2024 report from the Center for American Progress found the ACA rule has been linked to more Americans with better blood pressure, blood sugar levels and overall heart health. Other studies suggest it increased early-stage cancer diagnosis. Caplan said he hopes Kennedy himself weighs in on the case. 'It doesn't make any sense to keep talking about Make America Healthy Again while taking away preventive services,' he said. A spokesperson for the Department of Health and Human Services did not immediately respond to a request for comment. This article was originally published on
