After all this time, Dr. Bob Sears finally tips his hand on vaccines

Yesterday, I wrote a post about what fellow ScienceBlogger Isis would term “hot, hot science.” As much as I love science like that, writing such posts is a lot of work and takes considerably longer than my run-of-the-mill bit of insolent brilliance. Often, after writing an analysis of a peer-reviewed paper like that, I need a bit of a break. No, not a break in writing, but a break in difficulty. To that end, I had seen David Kirby’s latest bit of disingenuous goalpost shifting over on The Huffington Post, but damn if Steve Novella didn’t beat me to it. I had thought of taking sloppy seconds, because it’s impossible to pile on David Kirby too much, given his unctuously self-righteous blather, but leave it to the merry band of anti-vaccinationists over at Age of Autism to give me blog fodder with a post that perfectly limns the thinking of the antivaccine movement these days.

What do I mean by “these days”? Well, despite all the P.R. success that the anti-vaccine movement has had, with the bubble-brained and arrogantly ignorant spokesmodel Jenny McCarthy as its public face, side by side with her equally dim soulmate Jim Carrey, I sense a disturbance in the anti-vaccine movement force, if you know what I mean. After all, even though the movement has had enormous success in frightening parents into not vaccinating, very likely bringing us to the dawning of a new age of infectious disease, from a strictly scientific standpoint, it hasn’t had a single victory, or even a whiff of one, in years. Of course, that’s because science does not support their fervent belief that, all science, all evidence notwithstanding, it’s absolutely, positively got to be the vaccines causing an “autism” epidemic. And you know what? I think that, deep down, antivaccinationists know it. They simply don’t accept it. When science doesn’t support their viewpoint, like so many other cranks and unlike scientists, they reject science..

All of this is probably why Age of Autism trotted out Dr. Bob Sears the other day.

Dr. Bob Sears, as you may recall, is the crunchy pediatrician who is best known as the author of The Vaccine Book: Making the Right Decision for Your Child, a book that I have heard pediatricians describe as the “bane of their existence.” Why? It’s because Sears’ book recommends an “alternate” vaccine schedule, in which some vaccines are delayed and spread out, that does nothing other than to cater to the fear of vaccines stoked by the anti-vaccine movement and cash in on said fear. I’m not going to address Dr. Sears’ schedule itself, given that Paul Offit has done a fine job of deconstructing it, and Steve Novella has pointed out some of the misinformation in it and describes Dr. Sears thusly:

What Dr. Sears accomplishes ultimately is to fuel the fire of that fear by spreading misinformation, or withholding from his readers the scientific information that has lead the scientific and medical communities to the recommendations they currently make. He also sets himself up as a guru – first by facilitating the spread of fear about vaccines, then offering himself as a solution – you don’t trust the Centers for Disease Control, the American Academy of Pediatrics, and the American Academy of Family Physicians (who all endorse the current vaccine schedule)? Don’t worry, good ‘ol Dr. Bob has the answer.

What interests me more than his science-free “alternative” vaccine schedule is why Dr. Sears agreed to write an essay for AoA. The reason I’m so curious, of course, is that Dr. Sears clearly craves respect and legitimacy. He says over and over again that he is “not anti-vaccine” and neither is his book. He was clearly very offended when Dr. Offit lumped him in with the anti-vaccine movement, just as Dr. Jay Gordon acts oh-so-wounded when I describe him as an apologist for the anti-vaccine movement if not an anti-vaccine advocate himself. Clearly, Dr. Sears is not happy being on the outside and craves the respect of his peers.

I have bad news for Dr. Sears: Being associated in any way whatsoever (other than as a staunch opponent) with the anti-vaccine cranks at Generation Rescue and AoA (and, make no mistake, AoA is nothing than a propaganda arm of Generation Rescue) is about as good a way of destroying whatever medical or scientific credibility you might have had left as I can think of. Really. You might as well start publishing your work in JPANDS and presenting at Autism One. No, it’s worse than that. You might as well start writing posts for The Huffington Post. No, wait. Skip the Huffington Post. That’s not anti-science enough. Instead go straight for WorldNet Daily. Heck, skip WND and go straight for the Weekly World News or start hanging out with the Geiers in their basement lab in Silver Spring. After agreeing to write a post for AoA, you might as well, because you’ve just put a bullet in the head of whatever remnants of medical credibility you had left (metaphorically speaking, of course).

Really, writing for AoA is just that bad; it’s just that full of cranks. There’s an old saying: “If you lie down with a dog, you risk waking up with fleas.” Right now, Dr. Sears should be feeling a bit of an itch coming on.

In any case, Dr. Sears has a burning question on his mind (note the use of the “burning” metaphor; what other “burning” metaphor do I like to use?), and AoA is the perfect venue for him to ask it. His question is this: If A Vaccine/Autism Link is Proven, Will Vaccine Policy Change? His post is full of weaselly waffling, in which he acknowledges that, yes, some diseases that vaccines can prevent are pretty horrible, but then plays the argumentum ad ignorantiam logical fallacy again and again and again to sow doubt and fear about the current vaccination schedule. But first he has to suck up to the anti-vaccine contingent at AoA:

Before I dive into my opinion on this, allow me to introduce myself (for those of you who don’t know me). I’m a pediatrician, a DAN doctor, and a writer. I’ve been researching vaccines for about 15 years now. While I’m not anti-vaccine, I do acknowledge there are problems with our current vaccine system, there are potential very serious side effects, and I view the decision that some parents make to not vaccinate their babies as an understandable choice. I have always openly accepted such patients into my practice and have never come down on such parents.

Wow. I never knew that Dr. Sears was a DAN! doctor. Here’s another hint to Dr. Sears. If you really want medical and scientific respectability, you shouldn’t admit you’re a DAN! doctor. Really. I mean it. DAN! doctors are known for all sorts of dubious biomedical woo, up to and including chelation therapy for autism. One of them even killed an autistic boy in 2005 with chelation therapy! If you want real scientists to take you seriously, then associating yourself with such pseudoscience is not a good idea. Also, if you really want people to believe that you are not “anti-vaccine,” admitting to being a DAN! doctor doesn’t help. DAN! doctors as a group are about as anti-vaccine as it gets. But enough of that. Let’s see what’s eating at Dr. Sears:

As the autism epidemic continues to rage on, everyone is searching for a cause or causes. Many parents and some medical professionals believe there is already enough evidence to show a link between vaccines and autism, and they are calling for a change, even a halt, in vaccine protocol. They hope and pray that someday mainstream research will give them vindication and make a clear declaration that “vaccines cause autism.” Not that this would help any children who have already been affected (except for easing the financial burden these families have to endure), but it would bring peace and closure to families who have been trying to find why their child regressed into autism. And it would help protect future children. For many parents, such a ruling would also create renewed anger and a demand for accountability. Is such a day ever going to come? It may or may not.

Clearly, Dr. Sears buys into the anti-vaccine rhetoric that there even is an “autism epidemic.” Apparently he doesn’t realize that widening of the diagnostic criteria for autism in the 1990s, along with diagnostic substitution can explain much and probably all of the apparent increase in autism diagnoses, recent efforts to show otherwise notwithstanding. He also appears to share the fervent belief of anti-vaccine parents that someday, some way, it’s absolutely, positively got to be the vaccines because…well, because it does. Oh, sure, he denies it with his words, but his attitude and sucking up to the anti-vaccine fringe say, “Yes!” Dr. Sears appears to that belief enough that he fantasizes what might happen if such a link is found first asking the question:

The question that I want to address is this: If a link is proven, will the routine use of vaccinations change dramatically? I actually don’t think it will. Now, should it change? Yes. But will it? I’m not so sure.

I can play thought games and do hypothetical exercises with the best of them, and that’s all this is, because the evidence is so overwhelmingly against there being a link that the chances that a link will ever be found are pretty darned slim. But that doesn’t stop Dr. Sears from letting down his guard and letting his anti-vaccine freak flag fly high, all the while couching it in hypothetical terms buried in anti-vaccine talking points and denials that he is anti-vaccine. First Dr. Sears lists a number of diseases against which we vaccinate, downplaying the severity of many of them and grudgingly admitting that pertussis, among others, can kill:

But let’s explore what most doctors believe could happen if we stopped vaccinating all babies. Right now there are five childhood diseases that kill infants: Pertussis (whooping cough) kills about 20 babies each year, Rotavirus (vomiting, diarrhea, and dehydration) about 50, HIB meningitis kills around 10, Pneumococcal disease approximately several hundred (precise numbers aren’t known), and the flu kills around 100 infants and young kids each year. Those are just the most serious diseases. And these numbers are probably this low because most parents vaccinate. What would these numbers look like if we didn’t?

This is what would happen, Dr. Sears. This is what would happen. As a pediatrician, Dr. Sears should know that. He should also know better than to dismiss mumps and rubella as “very rare” and only causing the “occasional complication.” Tell that to all the boys rendered sterile by mumps orchitis or children who’ve suffered from encephalitis, pancreatitis, and deafness. True, some of these are uncommon, but if the caseload of mumps skyrockets, thanks to the efforts of the owners of AoA, then expect to see a lot more of these “occasional complications.” In any case, in the article, Dr. Sears argues that we should only vaccinate against diseases that can kill children. Apparently preventing suffering means little or nothing to him. Of course, his “logic” makes a certain sense if one believes that vaccines are so incredibly risky, in which case it would be reasonable only to vaccinate against the deadliest infectious diseases. But his position is based on a massive overhyping of the actual risk of vaccination plus a heapin’ helpin’ of argumentum ad ignorantium.

Dr. Sears is also so enamored of being a “brave maverick doctor,” iconoclast fighting for your–yes, your–children, not to mention hero to mothers frightened by the anti-vaccine movement, that he tries to suck up to it, and that’s why he starts pulling the big bad pharma gambit against vaccines:

Vaccines and disease prevention is so ingrained into our nation’s healthcare policy that I really don’t think the government’s answer is going to be to stop vaccinating, or even alter the schedule to any significant degree, if a definite link to autism is found. The very thought of stopping routine vaccines in all children would give most doctors a heart attack. Infectious disease specialists and public health officials would probably have a stroke right before their coronary. And the stockholders of the pharmaceutical companies? Well, they can probably afford to have their bodies cryo-preserved right before their own attacks, so they’ll be alright. Although I poke fun, this is a fairly accurate assessment of how the medical community would react if anyone tried to put a halt to vaccinations.

Of course, this is all hypothetical again, because the scientific evidence is so overwhelmingly against a link between vaccines and autism. The reason the medical community reacts so strongly to nonsense like Dr. Sears is laying down right now is because vaccination is the single medical intervention conceived by the mind of humans that has saved more lives than any other. The reason the diseases that Dr. Sears discusses are so uncommon is because of vaccination. He even admits that but feels obligated to butter up his audience by saying that he knows some of them don’t believe that the reason the incidence of vaccine-preventable diseases is so low is because of vaccination because they don’t believe that vaccines work. He also points out that he knows “many of you” believe that it is not rare for vaccines to “cause” autism. Who cares what they believe if what they believe is scientifically unsupported nonsense? Dr. Sears is either sympathetic to anti-vaccine pseudoscience or too much of a wimp to confront the anti-vaccine movement, which represents his best customers. Most disgustingly, he goes to great lengths to assure them that he is only presenting the “mainstream viewpoint” scientifically viewpoint and apologizes to his readers for doing so! A responsible physician should never apologize for presenting the scientific consensus! There’s no reason to.

In any case, in Dr. Sear’s mind, if there ever were found to be a link between vaccines and autism, the medical profession would be so hidebound by ideology that it would not change anything, and the vaccination schedule would remain as it is. Yes, Dr. Sears really thinks so little of scientists and physicians that he believes them incapable of change in response to the evidence. Yet again (this cannot be emphasized enough), despite his disclaimers that he is not “anti-vaccine,” entire tone and premise of Dr. Sear’s post tell me loud and clear exactly where his sympathies lie: He is suspicious of vaccines and thinks that they do cause autism. Oh, he denies it with his words, but his tone and obsequious sucking up to the anti-vaccine movement and parroting its misinformation is all I needed to see to know where his heart is. Indeed, he even brings up the Bailey Banks case as evidence that the government has “conceded” that vaccines can cause autism. (It ain’t.) He invokes the case of Hannah Poling, which is similarly not evidence that vaccines cause autism. Then he launches into a paranoid conspiracy theory that could easily have come right from the keyboard of J.B. Handley or David Kirby:

But many parents, and some researchers, believe that vaccine susceptibility isn’t a rare condition. However, those who are trying to prove a link between vaccines and autism are fighting an uphill battle. Here is why: Most medical research is supposed to begin on neutral ground, then study a subject to determine a yes, no, or we-don’t-know answer to a hypothesis. Well, when the autism/vaccine debate first came to light in the 90s, virtually every doctor and health care official said, “No way! Impossible. There is no way vaccines could possibly cause autism.” I’ve actually been to medical meetings where doctors sit around and laugh, literally laugh, at the very idea. Seeing that made me embarrassed to be a doctor. I always took the position, “Well, how do we really know until we study it?” But the medical community doesn’t think that way. Standard operating procedure is to assume vaccines are safe, unless someone finds and proves a problem with one. And vaccine safety research is designed to look for noticeable immediate side effects that cause significant harm. Long-term safety research isn’t nearly as thorough. As long as initial safety studies don’t yield any immediate problems, the vaccine is released to the public. And it stays there unless a major problem is then proven. In essence, vaccines are assumed safe unless proven otherwise. I don’t mean to bash the vaccine safety research system, because they do try to be as thorough as possible. But it isn’t a perfect system, and it could be better.

So, the burden of proof is put on trying to find that vaccines do cause autism. Researchers and the vaccine manufacturers don’t have to try to prove that they don’t, because it is already assumed that they don’t. Plus, virtually all doctors already passed judgment on this idea back in the 90s before any research began. So, in order to convince the medical community, research would have to shift the thinking of an entire nation of doctors from a “No way” mindset to at least a neutral mindset of “We don’t know – we better research it,” and then eventually to a “Yes, vaccines can cause autism” belief. This task is much more difficult than if everyone had started off neutral on the whole idea in the first place.

No, Dr. Sears. The medical and scientific community took the idea seriously for a while. In the late 1990s, they were even alarmed that the mercury dose from vaccines may have exceeded recommended safe limits. They even preemptively recommended that the mercury-containing preservative thimerosal be removed from vaccines, thus ensuring David Kirby several years worth of employment and Generation Rescue a raison d’être. In any case, they looked into it. They spent millions of dollars doing studies, both in the U.S. and in multiple other countries. And guess what? They didn’t find a link between either thimerosal and autism or vaccines and autism, despite multiple studies and hundreds of thousands of subjects. Nothing. Nada. Not a whiff. There’s no “there” there, scientifically speaking. These were studies with enough subjects and enough statistical power to find even a weak correlation between vaccines and autism.

Apparently Dr. Sears has been reading too much Generation Rescue propaganda like Fourteen Studies, which is the only reason I can think of why Dr. Sears either believes or suspects that there is just such a link. Either that, or, like Dr. Gordon, he values his own personal clinical experience above science, clinical trials, and epidemiology. In any case, he paints the anti-vaccine movement as victims abandoned by a dogmatic and uncaring medical profession, which leads him to this rhetorical flourish:

Meanwhile, as this battle rages on, 5 million babies are born each year in the U.S., and 33,000 of them are destined for autism (1 in 150). Since we don’t yet have valid screening tests, should parents just accept that risk without at least thinking about it? If there is a connection to vaccines, is that simply an unavoidable risk that every parent has to take? Or is there a way to lower the theoretical vaccine-autism risk? What can parents do today in light of all the uncertainty and debate?

Again, Dr. Sears puts the cart before the horse. There is no credible evidence that vaccines are correlated with autism or that they cause autism. There just isn’t. Dr. Sears assumes that the risk is real without evidence. He hopes that future studies will vindicate the beliefs of the anti-vaccine movement and, I suspect, his own belief or suspicion that vaccines cause autism.

Dr. Sears then boasts about how he thinks his schedule is safer than the currently recommended schedule, but, as is the case for the rest of his assertions, he presents no scientific evidence that the current schedule is not safe or somehow causes autism. More importantly, he not present any evidence that his proposed schedule is any safer. It’s argument by assertion; if you repeat it enough times people will believe it. After all, Dr. Sears is a doctor!

Finally, Dr. Sears finishes with a series of evidence-free “recommendations”:

1. If you have a family history of autism or severe autoimmune disease, you need to approach vaccines very carefully.

There is no evidence to support such a recommendation with regard to autism, nor is there evidence that children with a family history of autism should be vaccinated any differently than anyone else. Notice how he conflates autism with “severe autoimmune disease.” It’s questionable at best that the two have much, if anything, to do with each other.

2. Realize that severe reactions CAN happen. They may not be common, and there hasn’t been enough research to determine just how common they are, but they can occur.

Sheer nonsense. The rates of serious adverse reactions to vaccines are studied and tracked by the CDC and other organizations. The Vaccine Safety Datalink project, for example, is a massive undertaking designed to do just that, and the VAERS database is designed for easy reporting of suspected adverse reactions to vaccines.. Just because Dr. Sears is ignorant of this data or chooses to ignore it doesn’t mean that it doesn’t exist.

3. Understand that there is disease risk as well. Several hundred infants die each year of what should be vaccine-preventable diseases.

This is perhaps the only statement that Dr. Sears makes in this article that is correct.

Of course, if the anti-vaccine movement leads to a resurgence of infectious disease or to an unvaccinated child suffering from such diseases, Dr. Sears, just like Jenny McCarthy, washes his hands of any responsibility:

6. Do I think that all parents should stop vaccinating, or delay all shots for a couple years, until more research is done? Parents certainly have the right to do so. I don’t take a position on what parents should or shouldn’t do, except that I insist they educate themselves first.

This is an abdication of professional responsibility so egregious that it fills me with disgust. What does a doctor exist to do if not to provide the best science-based recommendations to their patients and try very hard to persuade them to follow them? Yet Dr. Sears ignores that responibility by not even answering his own question: Whether he himself thinks that all parents should stop vaccinating while waiting for new research. Too cowardly to take a stand, he doesn’t even offer a professional opinion in response to his own question and just leaves it up to the parents–after having filled their heads with misinformation and exaggerated risks of vaccines. He lamely ducks his responsibility by foisting it off on parents’ “rights” not to vaccinate, all the while seemingly thinking that “a couple years, until more research is done” will produce results significantly different than what the last decade of research into this question has produced. While it is possible that further research might produce the result Dr. Sears clearly craves, it’s incredibly unlikely given what has been found thus far.

When I first learned about Dr. Sears, he struck me as being a lot like our old “friend,” Dr. Jay Gordon, in that he seemed to be trying to have it both ways. He struck me as wanting to portray himself as being for vaccination but still express “skepticism” about the current vaccine schedule, make a name for himself, and bask in the adulation of “vaccine skeptic” moms. (Unlike Dr. Jay, Dr. Sears appears to have made a tidy sum selling his book catering to just those fears.) However, as time went on, Dr. Gordon became more and more allied with the anti-vaccine movement, even going so far as to give speeches at Jenny McCarthy’s “Green Our Vaccines” rally last year. Dr. Sears hasn’t reached that point on the road to full anti-vaccine apologist yet, but his agreeing to be so tightly associated with AoA as to write a guest post for it is a major step away from science and towards anti-vaccine pseudoscience. I like to think Dr. Sears doesn’t know what he’s getting into, but I fear that he does and doesn’t care because, deep down, he believes as the loons at Generation Rescue do. Perhaps he should look at this example of the scientific knowledge of the people he’s associating himself and ask himself if he really wants to go through with it.

Be that as it may, I’m actually rather glad that Dr. Sears has written a guest post for AoA. To me, it signifies that he’s finally tipped his hand. If he’s not an anti-vaccine activist himself, he, as Dr. Jay already has, is clearly drifting closer to being allied with the anti-vaccine movement. It wouldn’t surprise me to see him speaking at Autism One next year or to show up on the podium at the next anti-vaccine rally that Jenny McCarthy holds. Maybe next April he’ll appear on Larry King Live with Jenny McCarthy and J.B. Handley. Maybe, if he’s really, really lucky and sucks up enough to the pseudoscience-loving fringe at AoA, he can supplant Dr. Jerry Kartzinel as the co-author to the inevitable followup to Jenny McCarthy’s Healing and Preventing Autism: A Complete Guide. If that happens, he can then go on a media tour and bask in the fame and palling around with celebrities that comes along with it!

Come on, Dr. Sears! Stop fighting it! Give in! Release your inner antivaccinationist! You know you want to! You’ll feel so much better not having to play both sides of the fence anymore!

ADDENDUM: This comment by Dr. Bob in response to questions and comments on AoA is most illuminating. For example:

As a DAN doctor, I tell every single one of my patients with autism NOT to vaccinate their next kids. A few still choose to anyway, and if they do I go very slowly and carefully. So in that respect I think I fit the profile of most DAN doctors.

Geez, if you have to beg a pediatrician to vaccinate your child, you really should find another pediatrician. I can’t help but see echoes of Dr. Gordon in this statement, specifically when he said he gave vaccines one day because the parents insisted. In any case, there is zero good scientific evidence to support not vaccinating an autistic child. Quite frankly, in my opinion, not vaccinating autistic children as a matter of general policy borders on malpractice.

In other words, Dr. Sears goes around telling the parents of his patients how dangerous vaccines are. Because he’s a doctor, most parents will believe him, become alarmed, and not vaccinate. However, for those smart, science-based parents who don’t fall for Dr. Sears’ fearmongering, he doesn’t even offer the standard schedule, just his cobbled-together, science-free schedule that has no evidence to show it to be safer than the standard schedule! Unbelievable!

But this quote tells me everything I need to know about Dr. Sears:

As for the purpose of this post, you raise a very interesting point. I like my posts to be useful – give parents something to do or act on or be educated about. But this post doesn’t really do that. I think that the main purpose of this post was to give parents a glimpse into where I think the situation now stands and where it is going from the viewpoint of the political machine of mainstream medicine. It was really just designed to inform. By understanding how the “man” thinks about this issue, it should help everyone who is trying to go against “the man” be more effective in their efforts. I intended it to be helpful to those who are fighting for change in the vaccine system.

Even though he washes his hands of the task of giving his expert opinion to patients, choosing instead to fill their heads full of misinformation and then “let the parents choose,” to Dr. Sears, it’s all about fighting the power, maaaan! It’s all abousticking it to The Man, as represented by all those stodgy physicians and scientists, as well as the CDC and AAP. In the meantime, he’s just sayin’, ya know, that that’s what the authorities in charge of the vaccination program are thinking. Of course, he’s utterly wrong when he says that vaccine policy wouldn’t change if hard scientific evidence of a link between vaccines and autism were ever found. In fact, the thimerosal example should be enough to shut Dr. Sears up. Even though there was no hard evidence that thimerosal in vaccines was causing autism or any other problems, the CDC and AAP’s vaccine committee recommended removing it based on the precautionary principle. We all know how well that worked out, don’t we? A decade of antivaccine activism culminating in Jenny McCarthy (thus far).

The only accurate thing Dr. Sears says in his comment is that his post didn’t give parents anything to do or act on or to be educated about. It was a weaselly waffle, in which he deployed the logical fallacy of argumentum ad ignorantium hither and yon in order to make it sound as though vaccines are really, really dangerous and then “leaving it up to the parents” to decide. Such disingenuousness is disgusting. Dr. Sears must know full well that if he convinces parents that vaccines are dangerous or just puts enough doubt into their minds, they won’t vaccinate.

Letting his antivaccine freak flag fly high, indeed!