Meidas Health, Episode 8: The Nation’s Top Doctors Rise Up (Ft. Drs. Annie Andrews and Sean O'Leary)
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Midas Mighty, welcome to episode eight of Midas Health. Again, what we're trying to do with Midas Health is do something that doesn't exist in the federal government today, and that's bring the nation's best healthcare leaders directly to you on the issues that matter, whether they're topical, newsy issues, or stuff that we should all be thinking about for our

overall wellness and longevity. You're not getting that from the highest levels of government, so we'll bring it to you. I hope you know by now, first seven episodes of Midas Health, the quality bar for the guests that we're bringing onto this show is extremely high, and episode eight is not gonna disappoint. First up, we have Dr. Annie Andrews, recently declared Senate candidate in the great state of South Carolina. I'm so excited she's with us. She's a pediatrician, a mom,

and a Senate candidate. She's a badass and speaks with conviction. And she is setting an example for healthcare leaders and healthcare providers across the country that we have to step up, get outside our comfort zone, and think big about the ways that we can have impact at scale well beyond the bedside. So proud to have Dr. Andrews with us. She's going to kick off

episode eight and then on the back end we're gonna have a separate conversation with dr sean o'leary professor of pediatrics at the university of colorado and he's the chair of the infectious diseases committee

at the American Academy of Pediatrics. You're seeing all this back and forth, confusing information on childhood vaccines, whether it's for measles or whether it's the COVID vaccine. And, you know, what do we do come the fall? Who should we be listening to when we're seeing the U.S. CDC directly contradict the Secretary of Health and Human Services? Well, I'm

We have experts here like Dr. O'Leary to help guide us, to help us think through what makes sense, what doesn't make sense.

So we're going to close there. But first up is Dr. Andrews and then Dr. O'Leary. Hope you'll join us for the full episode. Thank you. Hi, Midas Mighty. Welcome to episode eight. I'm thrilled to have Dr. Annie Andrews here. She just declared her candidacy for the U.S. Senate in South Carolina. We'll be talking to her about a range of topics, her platform, and

And what she sees as the biggest issues in healthcare and what she's going to do as the next US Senator from South Carolina. So she's going to be joining us in a second. Just as a reminder, what we're trying to build here, we're now into month three of Midas Health. We're bringing you the nation's best healthcare leaders across the board. And you've seen it based on our guests, Bob Califf, senior leaders from the WHO, Meena Seshamani from the state of Maryland,

others. Dr. Andrews is just continuing that trend of excellence. So that's what we're trying to do. We're trying to be efficient with your time. I'm going to keep these under 30 minutes and bring you the news that matters since you're not getting reliable, trusted information from previously trusted sources like the government. So with that, I'm going to bring in the great Dr. Andrews. Dr. Andrews, thanks so much for being here. Thank you so much for having me.

So we all saw the awesome ad that you and your team put out last week went viral. I think it said it. We'll make sure that we play it as part of this when this goes live. But just how are you feeling? And tell us about, I want to know the top three things that would be your immediate priorities as the next senator from South Carolina. But wondering, one, how are you feeling? And what are the three biggest priorities? Yeah.

I'm feeling incredibly overwhelmed by the support that our campaign launch received last week and continues through this week. I know that people are desperate for leaders like me, leaders with a background in healthcare, leaders who have not been corrupted by being career politicians. And one of the things about my candidacy is I am who I am, and I'm going to say what I want to say. I'm not...

an over-consulted, grown-up-in-DC kind of candidate. I think the reason our launch video broke through and went viral is because I am a regular person who talks like a regular person, who is running for reasons that are so deeply, deeply ingrained in who I am as a mom and a pediatrician. And in this day and age, people are desperate for a new kind of leader, and that's what I'm hoping to be once I'm elected to be the next U.S. Senator from South Carolina.

You know, Andy, I love that. People will look at, you know, the Cook Report or pick your sort of political forecast and say that, Andy, we love the video. We love everything you stand for. Love your bio, you know, as a fellow physician. And I think we need physician leaders in all levels of government, especially in the Senate.

How is his past prolonged here? And when you look at what Lindsey Graham, your opponent in the general, once we get to that point, you know, he's coasted to victory. And I'm wondering, how are you going to change that?

2026 is not 2020. It's not 2018. We are in unprecedented times. I don't have to tell you that. We have a conspiracy theorist, RFK Jr., running the Department of Health and Human Services. We have a convicted felon as president. Lindsey Graham has enabled all of this.

And the thing about it is what's coming out of the Trump administration, whether it's on health care, this coordinated attack on our health care system, gutting our nation's Medicaid program, cutting Medicare, slashing NIH funds, whether it's that or the chaotic on again, off again implementation of tariffs, people are feeling it. People are worried about losing access to health care.

South Carolina small business owners and farmers and workers in the auto industry and workers at the port just right down the street from my house are feeling the direct negative impacts of the chaotic administration in a way that they weren't in 2018, in a way that

we didn't think was possible in 2020. So yes, I'm in South Carolina. Lindsey Graham has won by double digits in previous elections. But Lindsey Graham is as unpopular as he's ever been because he is as corrupt as he has ever been. And people are ready for a change. And that's what I'm hoping to deliver. I'm hoping to inspire voters all across the state, give them something to believe in, give them a reason to get off their couch and go out and vote, and then convince some folks

who traditionally vote as Republicans that it's time to try something new. Lindsey Graham has been in the Senate for 22 years, which is half of my lifetime. And he's failed to deliver really in any way for South Carolinians. And so if people want to try something new, that's what I'm here to offer.

I'm curious, I know you're re-familiarizing yourself with the campaign trail. You ran a great race a few years ago. When you're talking to voters, especially those that might be independent or have voted for Lindsay in past cycles, I'm wondering what you lead with or what are the few things that you think that you're going to champion in this end of the chamber that you're finding is really resonating?

I mean, first, I've been thinking a lot about the idea of what corruption really means. You know, Lindsey Graham hasn't, you know, been convicted of felonies like our president, but he's still a deeply corrupt politician. And it's because he's willing to do anything or say anything to hold on to power. And so what I'm hoping to bring to the Senate is bringing us back to a sense of

basic moral decency and humanity and fighting for things because they're right, not because they will help me gain power or hold on to power. I'm primarily going to be running on issues that impact every South Carolinian, health care costs and corruption, because corruption is at the root of the problems we're seeing in our health care system and the problems we're seeing with rising costs.

You know, we've already touched a little bit on the direct coordinated attack on our nation's health care system. And, you know, when I was fighting so hard before the election of 2024 to elect the kind of leaders I know our countries have desperately needs and deserves, I never anticipated that if Trump won the election, we would see such a rapid and coordinated attack on our nation's health care system. I really didn't think it would happen this fast.

But we're talking about unprecedented cuts to the Medicaid program that will kick 1.1 million South Carolinians off of their health care. And we're talking about Medicare cuts and the NIH cuts that will, you know, you and I both know because we work in the health care sector that this will devastate the budgets of hospitals. I've been talking a lot about

you know, what Medicaid cuts mean to our communities. And it's not just the patients who are on Medicaid, because when 1.1 million South Carolinians lose their health care because of the Lindsey Graham-enabled Trump administration, those folks don't have access to primary care anymore. So...

I'm a pediatrician. If I'm a parent and my kid is sick and they don't have health insurance anymore, I don't have anywhere to take them. So I'm going to probably keep them home longer than I would otherwise while their symptoms get worse. But eventually they're going to get sick enough that I'm going to have to bring them somewhere. And the only place I'll be able to bring them is an emergency department. And so this is going to overcrowd our emergency departments, which means, you know, those...

Those of us who have private insurance, our kid falls and breaks their wrist. We go to that same emergency department that is all of a sudden overcrowded. And that hospital's budget is totally strange because they're not getting the Medicaid funds. They're not getting as much Medicare money and they're not getting as much NIH money. And it's going to completely change.

to devastate our nation's healthcare system in a way that I think people do not understand. So I'm going to be talking a lot about healthcare, but I'll focus on costs and corruption as well. I know. I'm thrilled that we're going to have a Democratic physician voice. I think the first in the Senate chamber, at least. I know there's 15. I'm looking at this right now. 15 Republican doctors, six Democratic doctors, all in the lower chamber. We don't have a doctor on the Democratic side.

in the Senate chamber. I don't know if we ever had, your history might be more up to date than mine, but you know, to your point on messaging, a lot of outside of clinical responsibilities, you know, I do a lot in the way of public health communication. And what I found was, and I want your take on this, Annie is,

since this is going to be really relevant on the campaign trail is it seems like the things that are happening right now, whether it's shared, as I was just talking to Dr. Sean O'Leary of the AAP, quite literally right before you and I started talking about this concept of shared decision-making when it comes to the COVID vaccines. And he was getting, going deep into it, you know, what's your decision making means and frankly, educating me on, on some aspects of it. And, and,

Whether it's sort of the nuance of that, whether it's cutting NIH budgets, whether it's, to your point, 1.1 million South Carolinians losing their health insurance because of the Medicaid cuts. Some of this seems so obvious that this is not in that your opponent and his peers are putting forth policies that are not in the interest of their people.

But there's something about the messaging element of that where it's not cutting through. And I'm wondering if you can talk about how you're going to navigate that. Because specifically, when I think about the NIH cuts, some of those things are not going to be wrought in the next few years. I want to see the impacts of that in 5, 10, 15 years potentially. So I'm wondering how you...

We're short-term thinkers. Elections tend to be about, what are you going to do for me yesterday? And what are you going to do for me tomorrow? I literally tomorrow. How do you combat that sort of, oh, these things are actually potentially going to impact you not just tomorrow, but over the next 5, 10, 15 years?

I think first we have to be relentless and persistent in our communication. We have to say the same thing over and over and over again in a way that will eventually help it to break through. We also have to say it in a way that people can understand. We need to talk like regular people to regular people.

But you're right, the Republican Party is so much better at getting messaging that breaks through. And we suffer from, you know, relying on data, lots of numbers. We like our graphs and our tables and our p-values, and we over-explain things. Or we think people will come along with us because we know what we're saying is right. But that's not how you explain.

communicate. So many folks who come from a background like we do as physicians, like we don't learn these skills. We learn how to talk individually to patients, to your point about shared decision making, but we don't translate those skills into this public messaging. And I think so many physicians shy away from sharing their opinions publicly, from putting themselves out there because they worry about consequences to their professional career. They worry about seeming biased.

You know, I don't I never advocate for bringing politics into the exam room or the hospital room, but that is a totally different thing than bringing your politics out for the world to see because voters need to understand why it is that physicians like you and I are so passionate about.

what is happening in this country in regards to our healthcare system and our public health infrastructure. And the only way to do that is to share what we know from our time at patients' bedsides. And so we have to find a way to effectively message that. I wish there was time in medical school or residency to teach us how to persuasively communicate publicly. But what we need to do is support those who step up to do it.

and then encourage others to come behind us and speak their truth as well.

Well, I have to say, I speak for many when I say thank you for stepping up in a state where it is enough, at least historically, you have to be brave to take something like what you're taking on on. And you're doing it in a way that is really resonating with all of us as your clinical peers. We really appreciate that. I don't think words can do that justice, Shani. There's a bravery that by putting yourself in the arena now for the second time,

taking on these challenges in a really meaningful, authentic way that is already resonating and will only continue to do so. And I think, again, I speak for not just myself, but many others in the medical community say that we have your back. Curious, switching gears here, sort of forecasting down the road, you're a U.S. Senator, 2026. There's a lot of problems in...

let's take the pediatric profession. My wife's a pediatrician, just talking to senior leaders at AAP. I am wondering if maybe we use that as an example of what's some of the challenges and the headwinds we're seeing in just pursuing a medical career. I hear from docs all the time, they're burned out, they want to do something different. They can never imagine telling their children that pursuing a healthcare career would be a smart decision.

As a senator, a leading voice in the country, curious what you think we can start talking about and or doing from a policy standpoint to really think about this primary care problem. And we don't have enough workers to care for the demand in healthcare services by 2030. What are the conversations that Lindsey Graham is not having that we need to be having leading on to improve the future of healthcare? Yeah.

You're right. We have a pediatric workforce crisis, and I and all of my pediatrician colleagues are really aware of this problem and the fact that it's going to take decades to build the pipeline of future pediatricians that we're going to need to treat pediatricians.

the children of America, and that includes pediatric subspecialists. It's a topic that most people don't really think a lot about until their child needs a pediatric subspecialist, like a pediatric gastroenterologist or endocrinologist. And all of a sudden they hear,

there's a six month wait list, but you just told me my kid has a gastrointestinal problem. I can't see a doctor. And it's because we don't support the pediatric workforce in the way that we should. Pediatricians are amongst the lowest paying physicians of all the specialties.

And that has a lot to do with the way we reimburse and value children's health care compared to adult health care. There's a lot of really incredible policy solutions that could address the pediatric workforce shortage, including, you know, achieving parity between Medicaid and Medicare. But thinking beyond that, you know, we have Medicare for adults.

Americans 65 and older, what if we had a federal Medicaid program where we insured all children in America under the age of 18? The problem, though, is leaders like Lindsey Graham never allow us to have these pie-in-the-sky conversations because they're busy attacking the parts of our healthcare system that are delivering healthcare to Americans right now. They're busy attacking Medicaid, Medicare. So we're on the defense. Right now, we are...

So on the defensive side of this, that we can't even really imagine what could be possible if we reimagined America's health care system in a way that would deliver quality, affordable health care to more of us. You know, I think back to my first campaign. I did one debate with a congresswoman who shall not be named. And I got asked this question about health care.

And the guy said, well, how are you going to pay for that? And I've gone over this so many times because I regret that I didn't take this opportunity to explain that providing primary care, preventative primary care, early screening and detection of disease saves the system money in the long term, that it is a cost effective approach to

provide access to quality, affordable primary care to as many Americans as possible. And that will save our health care system in the long run. There are so many ways we can improve our health care system. I hope we can have a follow up conversation about what could be possible if we elect the kind of leaders who are willing to, you know, to have these conversations and rather than attacking our current system. You know, I love I love that thread because

You know, I do a lot in health technology and it strikes me that we need a Dr. Annie Andrews

and your youth, I mean, I think you and I are almost basically the same age. And I feel like we're in the prime of our lives. You know, we've seen a lot and we've been exposed to a ton, but we fundamentally think about the practice of medicine in an evolved sort of futurist way that is important because everything that everybody wants to talk about in the private sector is artificial intelligence. And, you know, I don't think we're talking enough about

the ways in which it's going to impact clinical care, even though that is the conversation that's being had in a lot of circles, we're not having those conversations in the Senate. Because you have people like Lindsey Graham who have no clue what they're talking about when it comes to

you know, these new age technologies, how they'll impact the workforce, how we should be maybe training medical students differently. But that's a conversation, obviously, you're really well positioned to be leading on. And you're right. We're just, we keep every four to eight years circling on the same tug of war and we're not moving the needle forward on net new ideas like innovation. You know, how do we become a tech hub or how do we avoid slipping from sort of our position as a tech hub

given everything that's happening. That's really well said. I, you know, forecasts for us, all the listeners here, your sort of immediate next steps here and ways in which fans of yours, since you have a growing armada of fans here, how can we be helpful to you? Where can we go to learn more? What's helpful? I just,

I just first want to say again, thank you to everyone who supported us last week on launch day, who continues to engage with me on social media. I think, you know, when I ran in 2022, we tapped into that post-COVID physician frustration with the state of the world. But I think what we've tapped into here is so much bigger than that.

We have a Senate full of non-experts, a Senate full of career politicians, some of whom are deeply corrupted. And we need experts in the Senate, whether it's experts in health care or public policy, whatever. We just need expert voices. And I want to be one of those voices. I don't know everything, but I know that I am in this fight.

150%, I'm going to give it my all. And I hope, and I know that I am paving the way for future physicians to run for office at the highest levels because we are more than well equipped to do this. So if people want to support me and what I'm fighting for, and just the general idea that

physicians need to step into these arenas when we are given the opportunity or when we're ready to seize the opportunity. Please go to DrAnnieAndrews.com, sign up to get our emails. Please donate if you can. We can have a whole nother conversation about physicians and the way that they donate to political campaigns compared to other professions like lawyers. We have a

leaders who reflect our values in positions of power, we have to support them financially when they run for office because that is the system in which we are working right now. And if you elect more people like me, we can reform our campaign finance laws and we won't have to talk so much about donating to candidates. But right now,

That's money equals power in political campaigns. So I need folks to donate if they can. And I just, I want you to know that I see you all supporting me and it energizes me and it gives me the strength to keep going every day.

Here, here. Um, I, I, I, I was going to have you have last word there, but I am going to pick up on one last quick question. And then this is just part one. We're going to have Dr. Andrews back as her campaign trail schedule. And, you know, she wears multiple hats, doctor, campaigner for the next U.S. Senator for South Carolina, uh, mom, uh, uh, the most important role, of course, uh,

You're juggling a lot here, but this is just the first conversation. I do want to come to your point, though, about physicians and just healthcare providers more broadly. I felt the same. And I think part of it is, you know, speaking to all the listeners out there who might be in the healthcare profession, you know, we're taught to keep our head down, you know,

we're raised in an academic environment that prides itself on and values publications.

in journals. And I do feel actually that it de-emphasizes in some way, de-prioritizes public sector leadership. My case, having a voice in media platforms is not valued by academics and academia. It's misunderstood by a lot of my peers. And I would venture a guess, but I don't want to put words in your mouth, that you've been on a similar but different journey when it comes to

people understanding your intentions and getting them to support what you're trying to do, that this is not something that many people try to do in our profession. Barely no one does it. And as a result, there's a lot of misunderstanding. There's not enough support. But I'm curious your thoughts on that.

That's exactly right. I have so many thoughts about that, that this is not an inherently respected thing to do in a traditional academic setting. And I look back on my CV now over the first 15 years of my career, and I was such a rule-following academic pediatrician. You know, I wrote grants, I got grants, I wrote papers, I, you know, I published the papers, I mentored

I played by all the rules. I got promoted to professor. And then just a spark lit inside of me that I was so tired of dealing with

the problems our kids and families are facing in the individual hospital room to hospital room, because I knew upstream was where the problems were, and I knew I wanted to attack them upstream. So I got involved in advocacy, ultimately got involved in politics. But you're right. This is not something that is necessarily celebrated in academic centers. I felt that we can have this conversation another day, too.

The consequences of me running the first time were pretty devastating to my professional career at the time. It didn't stop me, though, because I know we have to disrupt these systems if we want our voices to be heard in rooms where decisions are made. Heck yeah. I cannot agree more with that. You're having impact. I'll close by saying this. I'm an ICU doc, an adult pulmonologist. I practice about 30% of my time. And when I do that, I...

I feel helpless because often there's not a lot you can do in an ICU, whether it's pediatric or adult. You have to just let things play out. And if you're really focused on, well, how do I prevent this hospitalization from happening in the first place? You really have to be thinking well beyond the bedside.

And that's exactly what you're doing. And that's exactly what these non-traditional careers in medicine are focused on, which is impact well beyond the bedside. But there isn't a mentorship structure in place. There isn't that support structure in place. You referenced our legal colleagues. You're right. They have that in place because people are taught to think big, take big swings, and have impact beyond their purview.

which is why I'm so thrilled for everything that you're doing, Dr. Annie Andrews. Go to drannieandrews.com to learn more, to donate. We have to have your back. You are leading and taking and you're courageous in what you're doing. And this is just episode one with Dr. Andrews. If you'll come back and join us again, it has been just an honor to have you.

Thank you so much. As we've done for the first seven episodes, really the emphasis here is to bring you the nation's best health experts, independent of politics, independent of noise, to talk about issues that matter to all of you that might be in the news cycle or that might not be in the news cycle, but are relevant to overall health, wellness, longevity. And so it's in that vein that I'm really delighted to bring you Dr. Sean O'Leary, who

Dr. Sean Lurie is a professor of pediatrics and infectious diseases at the University of Colorado. He also is the committee chair for infectious diseases at the American Academy of Pediatrics.

who are our close friends here at Midas Health. We rely on the AAP and their senior leadership, like Dr. O'Leary, to come on and really help us think through what's true, what's not, help us wade through what I think is, and I think we can all agree, has been confusing information coming from the very top of government, and really to do so in a way that, again, leans into evidence and science and nothing else. And so without further ado, I want to bring in Dr. O'Leary.

Dr. O'Leary, thank you so much for being here. Happy to be here. Dr. O'Leary, really getting to the crux of it, last week, and I've heard this from family members, from friends, everything in between, last week was very confusing when it came to some of the messages that we got, some mixed messages that we got from the Secretary of Health and Human Services, Robert F. Kennedy, and

And then what the CDC then seemed to do, which is contradict some of that messaging when it came to who should, from a pediatric standpoint, continue to think about getting the COVID vaccine. Wondering if you could give us your perspectives and actionable advice for parents out there. Who should under 17 continue to get the COVID booster? Sure. Good question. So,

The kids that are at highest risk for hospitalization from COVID are really those under age two and particularly those under six months of age.

What was curious about this maneuver that the administration made was that the ACIP, which is the body that makes these recommendations, was already considering moving to a recommendation, sort of making that point that the younger kids are most at risk. As children get older, they are at a bit lower risk.

Now, the others that are high risk are those with chronic medical conditions, particularly those who are immunocompromised. And there's a fairly long list of potential high risk conditions, some of them being more high risk than others. We know immunocompromised individuals being among the highest risk.

So for the one, six months to two years of age, they, they, well, really right now the recommendation, um,

Well, the recommendation up until this change the other day was kids six months to four years of age need a primary series. It's unclear exactly what this recent change, again, the confusion hasn't fully settled from this announcement last week on what the intention of the administration is, whether ACIP is going to have input or not, we're not really sure.

But those are the folks when people ask me who are the most at risk, it's those youngest kids and those with any kind of a risk condition. The other point I will make, though, is that it is a very safe and effective vaccine. And

Many families choose to get that vaccine even for their healthy children, and that's for a number of reasons. One, we do know that even in the lower risk age groups, 5 to 11, 12 to 17, some of those children do get hospitalized, even without risk factors. We also know that long COVID remains a thing. It doesn't affect as many children as it does adults, but it does affect children, and vaccination has been shown to protect children from long COVID.

And then the last thing I'll mention is there are many families in the U.S. who have people in the family who are high risk, whether that's an immunocompromising condition, an elderly grandparent, you name it. Lots. So lots of potential reasons to get even those healthy children vaccinated.

Is when you hear the term shared decision making and for our listeners out there, a lot of even in the revision from the CDC, it appeared to sort of tip a hat to this notion that parents should engage in shared decision making with their medical provider, in this case, pediatrician for their children.

to determine whether or not, say, a COVID booster in the fall is appropriate. It strikes me, again, on the adult side, I feel like everything that I do with my patients in my pulmonary clinic is shared decision-making, even if it's on something that the FDA or the CDC is very clear on. We still talk about it. We still have a conversation, generally speaking. So to me, it feels like it's a nuanced deflect in some ways to...

to make it harder to get access. And because we know insurance companies in some cases, when if there's not a clear cut guidance from the FDA or CDC on say a vaccine recommendation,

potentially that could cause complexity or a lot of people get their vaccines at a retail pharmacy, maybe not everybody of pediatric age, but we saw that play out in the pandemic. Roll up to a retail pharmacy, you can get a vaccine. It seems like it's hard to engage people

in shared decision-making or whatever they intend to mean by that. And some of the places that are familiar to us now to get vaccines very quickly. And I'm wondering your thoughts on that construct, because I feel like we're going to keep hearing about that. Sure. Yeah. So,

Let me back up a second. So shared decision making is a field in and of itself. And shared decision making is really designed for what we would call preference sensitive decisions, meaning there is no clear right or wrong answer according to medicine.

And so in that case, a physician or other clinician will go over with the family, okay, here are the pros of doing this action. Here are the cons. Let's talk about what your values are. And then we'll come to a conclusion on what the best thing to do in this particular situation is.

In general, vaccines are not an appropriate place for shared decision making as it's defined in general in the medical literature, because there is a clear cut answer that vaccines, the benefits of vaccines far outweigh the risks. Vaccines, routinely recommended vaccines are the standard of care.

Now, the reality is, of course, that, well, in many cases, a family goes in to see their pediatrician. The pediatrician recommends the vaccines. Family says sounds good and they get the vaccines. But the reality is, in many cases, there is a discussion there. General pediatricians have these conversations all day, every day, in a sense, shared decision making because they're having the conversation, answering the family's questions, etc.,

Now, from the framework of ACIP, there's a bit of a different meaning compared to what we're used to in other areas of medicine.

So the ACIP, when it's considering a policy recommendation, a policy change with a vaccine, whether it's a new vaccine or an older vaccine, can do one of three things. It can recommend the vaccine, and that can mean it's recommended for a specific age group or it's recommended for a specific group of individuals with a risk factor. It cannot recommend the vaccine, period. And then the third option is what has evolved into now, it's called shared clinical decision making.

10 plus years ago, it was called a permissive recommendation. Then they had category A and B recommendations. Now it's called shared clinical decision making. And in a sense, what happens, and that's happened a handful of times in about the last seven or eight years where they've made one of these recommendations. And in general, they make those recommendations for a variety of reasons, but it typically has to do with

The product may have benefit for some people, but it's often cost, frankly, that ends up leading to these. The cost-effectiveness analyses don't look very favorable for recommending it for the entire population. Serogroup B meningococcal vaccines are a perfect example.

I'm perhaps getting a little bit in the weeds here, but they look at cost for quality adjusted life year. And a typical, many vaccines are cost saving, meaning they save society money. Some vaccines are on the order of $50,000 per quality adjusted life year, 100,000. There's no clear cutoff in the US, but when they looked at meningococcal vaccines, those were in the tens of millions per quality adjusted life year for serogroup B.

But, they also recognized it can save lives, it's a safe vaccine, so they wanted to sort of leave it up to the individual clinicians. They wanted it available for people that wanted it. Now, what we've found though is that clinicians in general really don't like those types of recommendations. Because one, they're already going to have these conversations with families that have questions.

And two, I mean, one of the things I've heard from a number of pediatricians is essentially, you know, you all ACIP are the experts. If you can't tell us what the right thing to do is in this situation, how are we supposed to figure that out in a 10 minute office visit where we're talking about all kinds of other, you know, lots of other different things. So it's a really challenging recommendation to have. We can come back to COVID vaccines and what it means for these if you'd like.

No, I mean, I think that was beautifully said and exactly kind of my read on it, which was we're making the life of pediatricians across the country. And my wife's a pediatrician. She tells me about these 15 to 20 minute visits, newborn visits or anything, something similar. And there's only so much you can do. But to exact, as you pointed out,

you know, it's a form of shared decision-making on pretty much everything, but it's a lot easier to navigate those conversations if there's clarity from those that are looking deep, deep, deep at the data. And I, you know, I saw the FDA commissioner, Marty Macri, actually have an interview yesterday with Face the Nation on this concept, on the topic of COVID vaccines and pregnancy, where

He kept talking about, and to me, this is sort of letting perfect be the enemy, the good in some cases, saying that we didn't have randomized control trial data on safety and effectiveness of COVID vaccines in pregnancy. And he was getting a lot of pushback by the anchor, Margaret Brennan, I thought appropriately so. But he left us, I think the role of these leaders should be to leave the general public with clarity. And he left the conversation with,

Have a conversation with your medical provider. And I agree with you. I don't think any of those things are helpful, especially when the side effect profile for all these vaccines, you know, again, putting the noise aside is extremely safe. And yet I do want to sort of ask you a question here on vaccines.

The risk you think COVID now, year five into year six poses as we think now, I know we're coming into summer months, but as families in a few months think about back to school. Dr. O'Leary, sort of contextualize, you know, I think about hospitalizations from COVID, I think about 11,100 from an AAP analysis in just this last flu season were from COVID-19 cases. Flu, I think,

It's higher than that most recently. But I'm wondering just your thought on COVID burden in the pediatric population versus flu burden. Should we be thinking about the two in terms of similar magnitudes or are they different? And just generally the risk COVID poses.

Sure. Yeah. You know, I think it's a little early to, you know, quote unquote, declare victory on COVID. This last wave, encouragingly, the winter wave was smaller than the fall wave. So what we've seen now with COVID is that it's sort of settled into summer.

sort of two waves every year, one in the late summer, early fall, one in the winter. And our winter wave was relatively mild for COVID this year. But, you know, of course, we had a really bad flu year. So in this most recent winter, flu definitely hospitalized a lot more people, a lot more children than COVID did. But that doesn't mean it was nothing, number one. And number two, there were still thousands and thousands of deaths in adults.

The other piece I want to mention though is, so the reason that we think that these waves may be getting milder with time is that so many of us have been exposed to COVID so many times that it's becoming not quite as severe in the ones that have seen it several times, with the exceptions that I mentioned of immunocompromised and of course the elderly of immune senescence. But for the

The youngest kids, they have not seen COVID before. And so those kids that are six months, they remain at high risk. The kids six months to two years, those kids haven't really seen COVID so much. And that's why I was emphasizing that even though we are the majority of the population is

is definitely in a better place than we were, those kids are still at significant risk for hospitalization and death. And so that's why I think this announcement for shared decision-making across the board, that's one of the reasons I think that was a misguided announcement because it ignores the fact one, in pregnancy is really the only way, vaccination during pregnancy is really the only way to protect those youngest infants under six months.

and then vaccination with the primary seers for those kids six months to two years. And this new announcement essentially ignored that

So it sounds like, to summarize, a gradient of risk between six months and 17 years of age, obviously higher risk on the younger spectrum, primary series, meaning for those listening, if you haven't had a booster or any version of a COVID vaccine yet, and say you have a child between six months and four years of age, talk about that sort of first set of vaccines to get built up that initial immunity. Right.

And that we shouldn't be really talking about that age group as needing shared decision-making with your pediatrician. That's a firm recommendation that should remain in place. Curious, a few last follow-up questions here. For those, say, older than four, have had their primary series, parents have questions. We've seen booster uptake amongst the pediatric population and broader populations who really attenuate it.

What's what's just you speaking as Dr. O'Leary? What's your perspective on fall vaccines and how parents should be thinking about it? Sure.

I mean, I still think it's a good idea to get vaccinated. It's a very safe vaccine. It does offer protection even for people who are relatively low risk. And we really don't know what the future is going to bring. So I do still think it's a good idea to consider it even for those healthy older kids. Yeah.

The flu, of course, remains a big problem. We had a really severe flu year this year. No reason to think we will have a mild year next year. We've seen, unfortunately, flu vaccination coverage drop a bit coming out of the pandemic, which may have played a role in our more severe season that we saw this year. So I think that's one of the important things. I want to come back, though, to this shared decision-making thing. There's one important point that...

we didn't really talk about, which is insurance coverage. And so the good news on this announcement is that under any of the scenarios I mentioned, ACIP recommends the vaccine or they recommend it on a shared clinical decision-making, either one of those scenarios should be covered by insurance and included in the Vaccines for Children program. One of the issues, though, is that we know access is an issue for COVID vaccines.

And the if it's a routine recommendation and you and most pediatricians and family physicians participate in the vaccines for children program, you actually have to stock the vaccine if it's a routine recommendation, both BFC and the private version of the vaccine.

Under a shared clinical decision-making scenario, though, that's not true. And so I think what this means is that fewer pediatricians and family docs are probably going to be stocking these vaccines, making it even harder for families to get them. So that's one of my other big concerns about this move. I'm glad you brought that up because the way it's phrased, I think even amongst our clinical peers here, some will...

The level of depth in which you've described shared decision-making, I've learned a lot, frankly. But I think it's a confusing phrase, if you ask me, not just for our clinical peers, not frankly even for me, but for the general public, because it sounds good, it sounds reasonable, but there's some real impacts here on access, potentially on coverage,

that I think people need to recognize. And in some cases it's appropriate and in some cases it's not. And I think you've been very clear with us that there shouldn't have been a change. I mean, this is my interpretation of this. We shouldn't, you know, it's pretty clear that safety profile, it's quite safe. I think I often hear from those that like to be naysayers about this risk of myocarditis in adolescents, which we acknowledge that,

There has been some edge cases, very rare cases, self-limited. And those that have been impacted have recovered completely. Right. But I think the risk of that has been grossly overstated relative to the risks that the virus poses. Exactly. And so there hasn't really been a safety issue. There's been really no net new knowledge here other than these vaccines remain very safe.

very effective and that this revisionist approach right now, a few months before the fall season, seems somewhat arbitrary. And I appreciate just being able to have this conversation. Dr. Othuri, I want to give you the last word. Anything here that we didn't talk about that you want to make sure that listeners knew?

Yeah. I mean, I guess my biggest concern with all of this is that it went so far outside of the process. So, you know, maybe talked a little insider baseball here, I think, but just so people recognize this is a, the ACIP process has evolved decades and it,

It's a very public, transparent process, input from experts, input from all the professional societies, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, family physicians, et cetera. And this announcement, even though it ended up perhaps somewhat close to what ACIP may have ended up with on its own, is so far outside the process. To me, it sets a very concerning precedent that they're essentially saying,

ignoring science and going to kind of go their own way and ignore the scientists and the data. Yeah, I'm glad you brought that up. Advisory Committee on Humanization Practices, the ACIP committees. You know, I think everybody should be aware that whether it's been a Democrat or Republican in the White House for years and years and years,

These committee meetings have made appointed officials like the FDA commissioner just smarter. And these are, as you pointed out, leaders from entities like ACOG, American College of Obstetricians and Gynecologists, AAP, others, thought leaders, major scientists that have advised both Republican administrations and appointees and Democratic administrations and appointees to

And this is the first time that we're seeing these meetings either canceled or delayed or their input not really being injected into these types of decisions. And I'll say this from my perspective, what's the harm of having their recommendation or their input when thinking about a major pivot? And I think this is a major pivot and it was without expert opinion. And I'm glad you emphasized that. Yeah.

Well, Dr. O'Leary, again, we try to keep these sort of short and snackable, timely to the news. I'm hopeful that you'll come back. Midas Touch is just getting into the healthcare space, but millions of listeners, we really appreciate the Midas Mighty listening in. And Dr. O'Leary, thank you for being with us to start your morning.

Pleasure to be here. Thank you. Can't get enough Midas? Check out the Midas Plus sub stack for ad-free articles, reports, podcasts, daily recaps from Ron Filipkowski and more. Sign up for free now at MidasPlus.com.