Joe,
The good doctor is absolutely correct, and in many cases he may not even know the full extent of it. That to is by design. There is no question that the public/patient does not always get the best product, the best procedure, even the best potential outcome, largely all in the name of economics. The timeline is probably about right, when consolidation and economics began to really drive down margins in hospitals and force administrators to look deeper than they ever had before for financial solutions. In imaging, I would say it really began a bit earlier 2008 going into 2009, the market really slowed down, but large capital devices ($1M+) see those things first, they are easy targets. $100 stents take a little longer.
What I referenced in the first sentence though is that in the past 15-20 years, hospitals have been making it more and more difficult for technical sales people to reach the influential (or any) clinicians in their facilities at all. It started with the credentialing services where all reps had to prove that they met certain health criteria. After all, who could complain about making sure we all had our distemper shots right? But each system and in some cases each hospital developed more and more criteria, more requirements, at more expense for the companies, before reps were allowed into the facilities to meet with anyone. Any company representative caught without an official badge, an appointment and clearance would be banned, potentially permanently. The days of hanging out outside of the OR to catch the cardiologist or surgeon or an interventional radiologist between cases as Dr. Mulumudi described are virtually gone. The stated reason is of course for the safety of the patient population, but hang out in the lobby of any hospital and see the cross section of humanity that comes through, unchecked, under the guise of patient visitation. I have long maintained that nosocomial infections don't walk through the front door of the Hospital wearing a suit. No, the real reason, and some administrators and purchasing departments will actually admit it, is to restrict access to the physicians so they do not become aware of something new and then come asking for it to be purchased or added to a formulary.
This may sound like a case of sour grapes but in reality, other than the credentialing aspect, none of this really ever applied to me. These are just things that I have observed as they mostly relate to the disposable or consumable side of the business. I have always worked on the capital equipment side where larger singe purchases were made from a budget so cost pressures are very much present but not quite in the same contractual way. The one thing that does occur, is the bundling which was mentioned. It's funny that he says "It's never written anywhere that this is all connected together" because in many cases that would be illegal. It happens, however, all the time on both sides of the ledger. For example, while still with my former employer, I closed a large deal in Detroit last year, over $5.7 M in Imaging. There was a great deal of other equipment in play, as well, however, for a large project involving a two new buildings including a cancer center. The 'company' took $1 M of the money from one modality and subsidized another modality offering to make it much more financially attractive than the competitors which the primary clinician preferred. The 'company' got the business, but I lost $10K in commissions!

Unfortunately, being in the business we see a lot of examples where less than the best available option continues to be used. I would agree with your cardiologist that most physicians care and want to do the best for their patients. Unfortunately the crunch in healthcare financials over the past decade or so has not been without casualties. Docs get burned out when they can't practice medicine without interference or being bogged down in electronic record keeping. I give my own a hard time that he looks at the screen more than me when I see him! On the other hand I haven't seen another system yet that I would trade it for.
Somebody said it and I will steal it. We don't have a healthcare problem, we have the best healthcare available on the planet. We have a healthcare delivery problem!
Later,

Paul

So your religion “doesn’t allow vaccinations”? That’s really a disservice to your children, as well as mine. Actually, more than a disservice. A lot more.

Does your religion provide schooling to your kids, or do you home school them?

My school doesn’t allow unvaccinated children.

Thank God. Yes, the same God you are invoking. The same one who gives us the intelligence to develop vaccines and drugs, and yes, we make mistakes, but the bigger mistake is to allow epidemics.

I was decimated by measles when I was 16 - yes, many years ago. It attacked my joints and I was completely “frozen” for days. Couldn’t even hold a hairbrush. I’ve had joint pain ever since and have now had six joints replaced/fused (knees, feet, hands). You bet, I would have wished for a vaccine over my everpresent pain. These diseases are not insignificant.

Tough topic
Freedom of choice comes with a price, such as quarantine and loss of privilege to travel in public spaces. Rules should be in place to allow freedom of choice, as well as offer to protect people from each other’s anti-vax choices.

I had measles before I had my first day in school at the age of five. Result: I lost 50% of my hearing on one ear accompanied ever since by a nice tinnitus. I would love to have the possibility to lend that to anti-vacciners just for a week. Guess that would change minds.

In my opinion we should take decisions based on logic. And logic tells us that "the needs of the many outwheigh the needs of the few, or the one" (to quote Mr. Spock, which I think is appropriate in this context).

Freedom of choice? Yes, in principle I agree with that in most circumstances. However, we all have a social responsibility. That's how society works. Yes, there are conspiracy theorists who believe that there is some sinister NWO plot behind vaccination programmes and yes, there are trace toxic substances in formulations and again yes, there will be instances when patients suffer a severe adverse reaction to a vaccine or for that matter any medication but frankly, anyone who has seen the devastation caused by the illnesses which can be prevented by vaccination programmes would not hesitate to inoculate. Whilst Smallpox and Polio have been said to have been eradicated, Measles can be deadly and will spread like wildfire. Think in terms of TB which is on the increase due to migration from parts of the world where such preventative measure were not implemented or done so effectively. Then consider outbreaks of Ebola and other deadly diseases and consider whether or not you would venture onto a public transport system or even visit a hospital should there be an outbreak in your region.

Freedom of choice should trump everything. After all we the most suppressed living beings on this planet when it comes to laws and regulations. We are no more free than a bird in a cage so let's hang on to what's left of true freedom as much as we can.

That being said, the highly heated debate about vaccines can be simply put to rest by allowing the unvaccinated continue to go unvaccinated. If the vaccines are effective as the claims, then no one who is protected will fall to the unprotected. Just allow the infected to continue to infect the infected right? If you want to ride around with the top down while its raining, then you're going to get wet. No worries if you have the shots (We're told). Personally, I am up to date with my shots.

One last thing. Most people resist getting the shots mainly because of the harsh ingredients found in the vaccines. We know these ingredients are needed for the "reaction" to occur or the vaccines would be a non factor.

Merck should go through court before promoting it's MMR vaccine. Two whistle blowers from Merck claim that MMR is not 95% effective and should not even be on the market. They said 10 years ago that measles outbreaks begun the year after MMR hit the market.

First day on duty at a clinical ICU; 19 year old patient with measles and influenza. They didn't see the end of the week. A tragic waste because of not vaccinating.

from Davide Patti
In a world where 50-80% of the population develops at least one chronic disease with a serious impact on the quality of life I say whatever we are doing is definitely not working and so at this point we almost must be for personal freedom.

from Saeed Marzvaan
The decision should be based on facts and not opinion. Not vaccinating brought back the measles epidemic. Opinion out, results in. We live in a society. Ones freedom ends where other's start.

Thank you for this rigorous, yet amateur, debate. I say "amateur" based on the "real answer" from the Medical Director of Epidemiology from a well-known major health system. With emphasis mine, I highlight two sentences and his closing hypothetical.

𝗖𝗼𝗺𝗺𝘂𝗻𝗶𝗰𝗮𝗯𝗹𝗲 𝗱𝗶𝘀𝗲𝗮𝘀𝗲𝘀 𝗵𝗮𝘃𝗲 𝗽𝘂𝗯𝗹𝗶𝗰 𝗵𝗲𝗮𝗹𝘁𝗵 𝗰𝗼𝗻𝘀𝗲𝗾𝘂𝗲𝗻𝗰𝗲𝘀 𝘁𝗵𝗮𝘁 𝗽𝗲𝗿𝘀𝗼𝗻𝗮𝗹 𝗰𝗵𝗼𝗶𝗰𝗲 𝗱𝗼𝗲𝘀𝗻’𝘁 𝘁𝗮𝗸𝗲 𝗶𝗻𝘁𝗼 𝗮𝗰𝗰𝗼𝘂𝗻𝘁. -and- 𝗧𝗵𝗲 𝗻𝗲𝘁 𝗯𝗲𝗻𝗲𝗳𝗶𝘁 𝗼𝗳 𝘃𝗮𝗰𝗰𝗶𝗻𝗲𝘀 (𝘀𝘂𝗰𝗵 𝗮𝘀 𝗺𝗲𝗮𝘀𝗹𝗲𝘀) 𝗶𝘀𝗻’𝘁 𝗰𝗼𝗻𝘁𝗿𝗼𝘃𝗲𝗿𝘀𝗶𝗮𝗹 𝗮𝘁 𝗮𝗹𝗹 𝗶𝗻 𝘁𝗵𝗲 𝗺𝗲𝗱𝗶𝗰𝗮𝗹 𝗰𝗼𝗺𝗺𝘂𝗻𝗶𝘁𝘆.

Let’s do the thought experiment of a highly contagious disease that was 50% fatal to others, like Ebola. If an effective vaccine were created, when would it be OK not to get the vaccine in an outbreak?

🎤 To me, this is a "mic dropping" answer. I know, we're talking laws and government mandates and many bristle at being "forced" to do anything.

But if Ebola hit your city and government quarantined the un-vaccinated, where would they put you? If you said "in quarantine," I join the vaccinated majority thanking you for going into seclusion for the public health.

P.S. Go get vaccinated 💉, I now say with conviction!

from Ryan Latterell
You tried man. You even took it up here to show every one. Pretty cool brochure

from maria assuncao oliveira
If we can prevent some diseases and contagious because of vaccination my opinion is yes.

from Joseph Prunesti
To vaccinate or not to vaccinate that is the question. When you ask yourself that question, Vaccinating does two things
It protects you against numerous diseases and protects those whom you come in contact with. Those with compromised
Immune systems, IE Children people on chemotherapy. If you work in healthcare, you should be required to obtain employment.
My question to Anti VAX people, Could you look yourself in the mirror if your child or someone else's child or family member died.
Just because you failed to get vaccinated. How do you explain to a child they are paralyzed from polio. Or aren't able to have children
because you failed to get them vaccinated. Just as there are possible side effects to vaccination, there are possible long term complications
from getting some of these childhood illness as an adult.

from Julie Omohundro
Just to clarify, vaccines are disease specific. Vaccination per se will not protect you from numerous diseases. Vaccination will protect you only from the disease(s) against which you have been vaccinated. There are some combination vaccines available (eg, MMR and MMRV), but those are multiple vaccines combined in one dose, each vaccine protecting against one specific disease. Vaccination with MMR or MMRV will not protect you from, for example, polio. Only polio vaccine will protect you from polio.

from Thierry Desira
Funny, we have the same in France! Should we be vaccinated or not ....

from Serdar Yanikoglu
Smoking in public can not be considered a personal decision.

from Andrew Kyle
All possible diseases we can use vaccines to control requires the highest level of medical support. Vaccines work to prevent diseases that killed and disabled our ancestors. How dearly would parents have valued a polio vaccine years before it was available. Lowest cost to highest benefit I can envision.

from Russ MacDermott
A "personal decision" that's convenient for one, but which puts others at heightened risk isn't merely a personal decision.
This is more complicated than that since we have various "rights" bumping up against each other, and in the worst cases, it's a right to life of "someone else" that's infringed by a decision of "personal freedom".
Whatever the solution, there must be a responsibility side that goes along with freedom, so that people are held responsible for consequences of their actions in light of state of the art knowledge of the pertinent facts (alternative options, credibility of risks, actuarial data, etc.), and not just gut feel.

from Sherman Couch
Once you're over 18, you can do what ever you want. Until then, the grandparants could be given standing in a court case. Lacking that, let it go --- there's not a universal truth here, there is only the appearance of a universal truth.

Sherman Couch,once you're over 18, you can do 𝑤ℎ𝑎𝑡𝑒𝑣𝑒𝑟 𝑦𝑜𝑢 𝑤𝑎𝑛𝑡? They do have laws in Cincinnati, yes? And science? You believe contagious and potentially fatal diseases, which can largely be prevented through vaccination, have issue with "truth?"

from Sherman Couch
Well Joe, the article was about forced vaccinations, and I was making points about law and what seems to be your view of "truth". For what its worth I council folks to keep up their vaccinations. But let me tell you one thing (because you seem so darn sure that you're right), I FOR ONE SAID NO TO THE JIMMY CARTER SWINE FLU "VACCINATION" because I didn't want my body turned into a chemistry set. Yes Joe, that lovely shot exposed you paralysis, respiratory arrest, and death. But, since you know the "truth", and if you had the power, you would have just forced people to take that one, wouldn't you have?

Sherman Couch,Jimmy’s vaccination story predates me. Is my position infallible? If it were, there would be no interest in our spirited debate. I’m going with statistics and recommendations from the medical community. Thank you for contributing to the discussion.

from Francesco Salvioli
very good Sherman, i agree !

from Richard Johannes
I think we need to put away our own experiences with childhood diseases, particularly if they were relatively benign. We need to remember the statistics of these diseases, which include crippling Polio or fetus altering german measles (neither of which just mean a few days at home and a little discomfort).

from Ryan Latterell
You do realize that if we immunize several successive generations we could face another black plague right? Is that more or less important to you than virtue signaling. For someone so much older than me, well.. you either don't get it or you don't want to talk about it

from Kristen Bower
We all recall the Oral Polio vaccine which when introduced to the public inflicted some with Polio rather than eradicated it. This is why when vaccines or any drug for that matter are first introduced on a large scale we must wait to see the true effectiveness or ineffectiveness and weigh the benefits against the harm that can be done. This is why I stated on my original post that for those parents who for religious or whatever personal reasons chose against a vaccine that those children should have restrictions on the back end such as mandated home schooling etc to separate those unvaccinated to protect the rest of the community who are vaccinated. This solution is one in which we are not infringing on human rights yet still implementing methods to protect the mass society....

from Francesco Salvioli
why to protect vaccinated by non vaccinated? vaccinated are already protected by the vax, arent they?

from Joseph Prunesti
The only problem with that is the unvaccinated coming into contact with people that have compromised immune systems
Or a infant before they receive vaccinations. In a perfect world that would be ok

from George Arnau
My thoughts are if you choose not to be vaccinated then you must agree to be isolated from those who potentially carry the germ. With over 1,000 reported cases this could turn into a pandemic and children could die needlessly.

from Ryan Latterell
Spoken like a man who who has no ambition beyond his tiny village. Most men are like that, though

from Travis N. Smith
Hot topic right now for certain. What I've never understood is this...if person A is vaccinated and person B isn't, why does person A care what person B did or didnt do? Person A - you're vaccinated, if it works so well shouldn't you be protected from those who aren't vaccinated? Isn't that why you got vaccinated in the first place? Drugs aren't meant to be a one size fits all remedy. Side effects are guaranteed, just listen to the list of side effects on TV commercials marketing drugs. We need to focus more on ourselves and not be worried about what everyone else is or isn't doing when it comes to personal decisions, especially health related. I'm for individual choice, regardless of the topic. The second a govt of any kind starts dictating what we need to do with our bodies the snowball effect afterwards is both inevitable and scary. Good topic Joe Hage

You know,Travis N. Smith that's a really interesting perspective I never considered. Now you've inspired me to reach my epidemiologist friend. Stay tuned.

from Russ MacDermott
some problems with that A and B example are: 1-5% of "A" people don't actually develop a full immunity response with all vaccines, so they remain vulnerable to full exposure as hosts, and then as vectors, we also have population segment C (children too young to immunize, including the unborn), and segment D (people with compromised immune systems due to old age, disease, or medication).

These vulnerable segments (as well as the voluntarily un-vaccinated) depend on/enjoy protection from most other people being vaccinated (i.e. Community Immunity) for their protection (a value they enjoy for free if enough others invest..). as a result, if/when too many make that "personal choice" to rely upon other people's investments and immunity falls below the Community Protection Threshold significantly more in such populations suffer from the disease.

from Travis N. Smith
Russ MacDermott worthy observations. Thoughts on the one size fits all approach to drug administration? How do we account for the rise in side effects and the associated fiscal fallout.

from Amy Baxter MD FAAP FACEP
7% of those who fear needles say they won’t vaccinate. Coincidence? I think not.
https://www.npr.org/sections/health-shots/2017/12/28/571928692/fear-of-needles-may-chip-away-at-vaccination-rates

from Ryan Latterell
Stop pretending to contribute to the discussion and just be honest if you think this is a joke. This comment is worthless

from Francesco Salvioli
i am more scared by the vax than by the needle

from Vincent D Duwyn
It's an important debate. Thanks for the post

from Frank DeFazio
Requires nuance and intelligent conversation. It's not all or nothing. Public health policy should be driven by the risk associated with the particular disease...severity of the illness, how easily it is spread, how easily spread is prevented by other means, the maturity of the science on the topic, etc. There should be a high bar for mandating vaccination (space for maximum tolerable individual liberty) but it probably makes sense with some diseases to do so or to at least apply considerable societal pressure/incentive for individuals to do so.

from Nooruddin Tejani
First they scare you and thereafter, you yourself get yourself vaccinated 😀

from Mercè Vilamú
Nowadays it is easy to debate about vaccines, forgetting the eradicated diseases and the lives saved thanks to this practice.
In my opinion, it is a practise that has been proven effective, we only have to see how health or life expectancy was like before vaccinates existed.
however, we must work with safe vaccines and related to diseases with high mortality or serious sequelae.

from Ryan Latterell
see

Good discussion, but the point seems to be whether decisions should be driven by reason or instead by emotions. I would suggest that emotional decision making can be misleading, since it's a process that evolved to take immediate decisions and therefore it does not consider the whole picture...

from Bonnie Burch Ward
Ryan Latterell this is proving the point you are fighting. Not everyone was vaccinated year 1 and people died from polio, years after they contracted it as well. Look at the sharp decline. You have a lot of comments but no discussion.

from Ryan Latterell
Bonnie - you haven't explained what you think the graph actually means. What do you think it means?

Ryan Latterell to me it suggests, polio rates were dropping before the vaccine. (This predates me so, without researching, I don't know what behavior or societal changes brought this about.) It seems to also suggest shortly after the vaccine was widely adopted, the rate of polio dropped to almost zero.

Please, tell us your interpretation. 😷

from Ryan Latterell
I think you hit it right on the head, Joe. Polio rates were dropping before the introduction of the vaccine, despite the baby boom's huge population push toward the very young demographic. The rates were dropping a lot.

So why were they dropping before the vaccine was introduced. Would they have kept dropping? Maybe those are leading question to ask, but the chart begs to be examined. Most people have just acknowledged the chart and stopped the analysis there, but you seem to want to dive in and see what it's about. Whatever angle of bias someone has to interpret with, interpretation is still good. Maybe you see this in a different way.. maybe the data itself isn't even good! Did I source it?

from Ryan Latterell
A side note - a lot of diseases were causing fewer deaths during the 20th century because of access to more hospital beds. Maybe when the war was over that caused a spike in the critical care industry and as a bonus, we were able to contain polio with that new infrastructure. It may also just be the vaccine, too. I would consider all of it and still conclude that it wasn't necessary to commercialize a technology so ripe at that time.

I will remind you that there are no medical treatments that exist with 0% risk. There never have been. I can't do the "vaccines do this, they do that, be afraid" thing here - because I have a lot of respect for the complexity of biology. I wish I saw more people that could reciprocate that with their own argumentative restraints. If I've said anything unreasonable let me know

from Maricela Lucatero
No

from Ryan Latterell
You don’t get it

@Fair warning, Ryan Latterell. You've posted three rude comments in this post. Debate is welcome, rudeness is not.

from Ryan Latterell
I appreciate your contribution to the debate

from Richard Young
Definitely vaccinate and segregate the unvaccinated from schools, hospitals etc etc....controversial? This becomes a debate between rights and societal respinsibility

from Dino Batanović
I don’t think this is an issue of vaccination but rather trust. Someone who refuses to vaccinate does this with a reason. This reason appears to be lack of trust in the pharmaceutical companies and the FDA.

from Michael Kotowski
We can eradicate diseases - not nuisances - DISEASES that cause death and destruction. Vaccinate.

from Julie Omohundro
And anyone who would like to read the full discussion on LinkedIn can find it in my posts and activities:
https://www.linkedin.com/in/julieomohundro/detail/recent-activity/

from Kristen Bower
If a parent wishes to decline vaccination of their child, they should be required to home school the child. Herd effect immunity is only possible with compliance and widespread vaccinations. Therefore, if there is a religous or other reason / strong belief in which vaccination is declined by a parent than home schooling is the logical mandate by the state. You do not need mandates of the state to vaccinate if you instead have mandates in place for those who decline vaccination...
This offers a choice with a mandate which protects others as well.

from Kevin Morwood
I agree with everything except the implication that home schooling is sufficient separation. If the child is unvaccinated they can't be allowed to interact with other children...period. For their safety and the safety of 'the herd'.
As we talk about herd immunity it is impossible to avoid the simple comparison to herds of wild beasts. In the wild, sick animals are left behind...for the betterment of the herd. At the end of the conversation we, the supposedly civilized world, are not nearly as far from the wild beasts as we would like to think. If a member of the 'herd' refuses to partake of one of the key requirements to inclusion in the herd...then they must be excluded from the herd.
As we get more and more severe outbreaks of previously controlled (controllable) diseases there will be only one path. We seem hesitant to take it but I believe that soon we will have no choice.

from Bob Radcliff
If the "herd" has been vaccinated, where's the threat?

from Amy Baxter MD FAAP FACEP
Bob Radcliff the measles vaccine is only 95% effective. It’s SO contagious that one sick person in a room will get 18 people sick, (R0=18) which equates to needing a 92%+ effective vaccination rate to reach effective community immunity. Adding anti-vaxx percent numbers to those who don’t mount an immune response drops is below whAt will protect babies less than 1 year of age and the imminocompromized (kids with cancer, for example).

from Joseph Mackey
Measles is an infection. It is not a "disease". There is no 'measles' epidemic, and most children who contract the infection recover fully in a very short time with no lasting side effects. That's a fact that everyone is aware of. I have spent the past 45 years researching this subject, and I have interviewed MANY "anti-vaxxers", most of them are very health conscious people who understand the science much better than the average person. I also fully understand the approach to vaccination in Europe, particularly Germany. What is ABSENT in nearly every media story, blog, social media page, TV coverage, etc. is a discussion of the simple yet profound science of immunity, alkaline diet, the role of nutrition, etc. What's so absurd and amazing to me is the fact that we have no 'typhoid' vaccine, And the ingredients in these vaccines is FRIGHTENING, and often includes a disclaimer regarding carcinogenic effects of vaccines. That's what I'm reading and seeing. Yes, and no 'common cold' vaccine, and no 'ebola' vaccine, etc. Why were there just a handful of vaccines back in the 60's, and NOW? 27 shots by age 2? What the hell is going on here? This is NOT about public health.

Joseph Mackey, if I understand you, you reject this statement from a well-known epidemiologist? http://ow.ly/LmS930p0s1v

from Julie Omohundro
Joseph, an interesting distinction you make, between infections and diseases. Does this make "infectious diseases" an oxymoron?

from Joseph Mackey
To Joe Hage & Julie O ... What I am saying here is this. I have read, listened and contributed to so many discussions on this subject. And yes, I am largely an 'anti-vaxxer', and I respect the rights of parents to not subject their children (or themselves) to a dizzying array of vaccines. And I have listened to medical professionals on both sides of the issue. When organs, tissues and most importantly, the lymph system (our body's sewer system), is bathed in an alkaline environment (naturally anti-viral), our immune system can really do its job. That means very little organic meats (or none) from healthy raised animals, NO white flour, NO dairy, NO sugar, NO chemical additives, NO pesticides. This isn't an extreme position, it's simply fostering a 'natural state' devoid of toxins that never get flushed out of the body creating a breeding ground for bacteria and viruses. Those who understand this, understand the flaws in America's 'just vaccinate everyone' campaign. One of the best commentators on this subject is Dr. Suzanne Humphries, MD. Her book "Dissolving Illusions" is an EXHAUSTIVE study that brings the actual HISTORICAL FACTS into clear light. If we don't address these things, we are all just talking in circles,

from Joseph Mackey
Actually 'infectious disease' is not an oxymoron. A disease (a chronic state) "potential" can be transmitted by a disease agent/parasite (virus, bacteria). The condition of the host (human body) plays a major role in its ability to support or reject a parasite. The parasite obviously found something to EAT when it arrived. It then also defecates and reproduces in the host. Think about it. It can then multiply (if conditions are right) and eventually compromise body tissues. The role of red and WHITE corpuscles and their relationship to foreign matter floating around in the body should be taught in kindergarten. Leukocytes are a big deal. If we overload the body white cells have to work overtime, and they can't fight off everything coming in. Everything is related. The SKIN is an organ of ELIMINATION. We stink (more or less) when we sweat. Think about it. We freak out over blotches on our skin. We find a 'bug' residing there. We call it 'measles'. For some it becomes overwhelming, and a few people can die from it. But the vast majority recover in less than a week with no lasting side effects. Think about it. I'll choose to do all I can to strengthen the immune system of my loved ones, and anyone else who is so inclined.