Tag Archives: prevention

Vaccine opposers lack any evidence

This is important: Dorit Reiss on vaccine misinformation in the Point Reyes Light.  The anti-vaccine crowd is vicious, rabid and unfortunately very poorly informed. Yet they have been able to get the attention of enough media to cast doubt on the effectiveness and safety of the most important medical intervention ever devised.

When the only argument against requiring vaccines for school relies on mistaken beliefs about vaccine safety, it cannot stand. Vaccines are safe, effective and save lives. Immunization mandates make our schools safe. By shoring up California’s mandate, S.B.277 is helping to safely protect our kids and our communities.

Cost effectiveness of well child visits

We published this back in 2008 on the old blog. It remains germane to the economics of primary care and I updated it with a link to The Incidental Economist.


Immunizations are simply the best and most cost-effective intervention ever conceived by the science of medicine. They are so important that health care providers have toyed with various techniques to improve immunization rates. For example, my current facility has a full-time immunization nurse who can give missing vaccines to children following a sick visit (as long as they don’t have a fever.)

The principle of vaccinating when you got ’em in the clinic is common in many developing countries and under-served areas, since you never know when you will see these children again.

Now the practice is being questioned. According to an article in Pediatrics, some parents don’t bring their children back for well visits. The well-child visit includes a brief developmental assessment, physical examination and anticipatory guidance. These aspects of the visit have great value, especially for the young, low-income mothers who are the most likely to conflate a well visit with a shot.

As a clinician, I understand the value of well child visits, but my public health degree must question the data. There is insufficient evidence to support annual adult examinations. Studies with children are naturally more likely to yield a benefit, but I just haven’t seen them. After all the well-child visit schedule is tied to… you guessed it, immunizations.

It’s good to know that there is documentation of the downside of opportunistic immunization (which has been our experience). I am not sure it matters in the big picture. After all, one of the few things on which health economists agree is that prevention usually doesn’t pay off.