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

Dr. Robert Sears (a.k.a. “Dr. Bob), author of The Vaccine Book: Making the Right Decision for Your Child, is definitely antivaccine. His mouth may say, “No, I’m not antivaccine,” but his actions say, “Yes, yes, yes!”

There, I finally said it. I’ve been flirting with saying it that bluntly for some time now, but have been tending to avoid it. I really didn’t want to conclude this about “Dr. Bob,” but, sadly, he’s left me no choice. What else can I conclude from his actions over the last three months, when he’s clearly solidly allied himself with the worst elements of the anti-vaccine movement? First, back in June Dr. Bob wrote a truly nonsensical post for the anti-vaccine propaganda blog Age of Autism entitled If A Vaccine/Autism Link is Proven, Will Vaccine Policy Change?, which I duly eviscerated. In it, he fantasized that one day a definite link between vaccines and autism will be found and speculated that it wouldn’t make any difference in government policy and advocacy of vaccines. In Dr. Bob’s view, so entrenched in its ways are scientists and the government that they would conclude that autism is an acceptable risk. Most ridiculously, he betrayed an either ignorant or willful misunderstanding of science by complaining that the burden of proof should be on scientists to demonstrate that vaccines do not cause autism, apparently unaware that science can never absolutely prove a negative, only demonstrate an extremely low likelihood that there is a link, which is what it has already done. At the time, I noted that, while Dr. Bob craves above all else the adulation of his readers, a close second is his craving for his “alternate vaccine schedule” (nicely deconstructed by John Snyder) to be taken seriously by physicians and scientists. That’s why I pointed out that one way to virtually guarantee that you will not be taken seriously is to start writing posts for the crank blog Age of Autism.

The second thing you don’t want to do if you want to be taken seriously by the medical and scientific community is to agree to be a speaker at a conference of anti-vaccinationists sponsored by that “venerable” anti-vaccine organization the National Vaccine Information Center. Trust me on this one. Getting on stage with “luminaries” of the anti-vaccine movement like Andrew Wakefield, Barbara Loe Fisher, Kim Stagliano, and, to top it all off, that woo-meister supreme, Gary Null sure won’t do accomplish that, but Dr. Bob seems to think that it will, given that he’s going to be speaking at a conference with the aforementioned anti-vaccine activists, the ever-nutty David Ayoub, plus chiropractors who seem to labor under the delusion that there is any role for chiropractic in treating autism and homeopaths who are, like all homeopaths, just deluded about their preferred remedy.

But there’s one thing that, above all else, you, really, really, really don’t want to do if you want to be taken seriously by the scientific and medical community. Can you guess what it is? Sure, I knew you could. If you want to be taken seriously by the medical and scientific community, you do not–under any circumstances–start blogging your “skepticism” about the current vaccine schedule on that repository of quackery and anti-vaccine propaganda, The Huffington Post.

Which is exactly what Dr. Bob did yesterday, excreting a turd of logical fallacies and pseudoscience entitled Vaccines And Autism: What Can Parents Do During This Controversy? The stupid in there is so concentrated, under such high pressure, that it’s going to turn into diamonds of ignorance, which is undoubtedly why Age of Autism is promoting it.

Dr. Sears sets the stage:

The debate over vaccine safety rages on, with no clear end in sight. On the one side is a medical establishment made up of hundreds of thousands of doctors, researchers, infectious disease specialists, vaccine manufacturers, the FDA, the Centers for Disease Control and Prevention, and our government, who all insist that vaccines are safe and everyone should comply with the standard recommended vaccine schedule. On the other side is a growing number of parents, and a small but growing number of physicians, who are questioning vaccine safety. Caught in the middle are the 5 million couples who have a baby every year and are faced with the decision of whether or not to vaccinate.

Uh, not exactly, Dr. Bob. While you’re correct that we have hundreds of thousands of doctors, researchers, infectious disease specialists, the FDA, the CDC, and our government assuring us that vaccines are safe, there is also something that Dr. Bob doesn’t mention right off the bat that he should have mentioned: The science. That’s right; even though Dr. Bob seems to be “framing” the “other side’s” argument as an argument from authority, in reality it is the science that drives the defense of vaccines as safe. What we really have is mounds upon mounds of science on the side of vaccines versus a small number of cranks, anti-vaccine advocates, pseudoscientists, quacks, and cranks (some of whom straddle more than one of these categories), who are ideologically opposed to vaccination; blinded by pseudoscience; or making money off of “biomedical treatments” for autism that claim “vaccine injury” as the basis for autism. (Again, many of these straddle more than one of these categories.) Dr. Bob is correct about one other thing, though: It is the parents who are caught in the middle. Most do not have a sufficient background in science, medicine, or epidemiology to recognize the fallacious arguments made by the anti-vaccine contingent for their sheer, stinking, steaming bogosity. I feel sorry for them. I really do. The lies of the anti-vaccine movement can sound convincing if you don’t have enough background knowledge to see through them, especially when they suggest a threat to your child.

Like a politician campaigning on a populist platform, Dr. Sears further buffs his “I’ll fight for you” cred by giving a bit of background. He portrays himself as “self-educated” on vaccines, while coming to the radical conclusion that:

…vaccines are effective and generally safe for most children, but that there is a small risk of a serious reaction. This may not seem like any great revelation, as most people agree that vaccines do work (although not 100%, and in some cases as low as 85%), and that most children seem to handle them just fine without harmful effects.

Well that’s mighty nice of you to admit that vaccines are safe. So far there is nothing new there, but Bob can’t resist painting himself as a brave maverick doctor bucking the status quo, Speaking The Truth To Power, and Being Down With The Parents in a way that all those apparently pharma shill, vaccine zombie pediatricians supposedly aren’t:

The reason I viewed my conclusion as significant was that back in the 1990s, the party line within the medical community was that vaccines do not cause severe reactions. Reports of seizures, encephalitis, autoimmune reactions, bleeding disorders, and neurological injuries were just coincidence. Vaccines can’t cause that. Now we know differently, and the medical establishment has acknowledged that such reactions can be attributed to vaccines (just read any vaccine product insert). So the party line has changed to the opinion that such severe reactions are so rare that the general population doesn’t (and shouldn’t) need to worry about them. But every parent is still going to worry that their one individual baby is going to be one of those statistics. And that’s an understandable concern.

Pretty radical, Dr. Bob. Except that it’s a straw man. It has always been recognized that there are a small number of serious adverse reactions to vaccines. In fact, early on in the history of vaccination, occasionally severe reactions were noted to the smallpox vaccine. Contrary to Dr. Bob’s spin, that there are occasional severe reactions to vaccines is not a revelation. Read, for example, Arthur Allen’s Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver. It describes complications from smallpox vaccines. Read Paul Offit’s–yes, that Paul Offit–The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis. The point is not that there aren’t rare serious reactions to vaccines; there are. Indeed, that’s the very reason why the Vaccine Court was created over 20 years ago, in order to fairly compensate those injured by vaccines. Yet, Dr. Bob presents this as though it were some sort of revelation that he and he alone (well, maybe he and the other brave maverick doctors) has discovered and that public health authorities won’t admit. The real argument being made against the anti-vaccine movement is that vaccinating is safer than not vaccinating. Vaccinating is safer than the diseases vaccinated against. It is a point that is apparently beyond Dr. Bob’s ability to grasp.

It is here, after he mentions Andrew Wakefield as though he were anything more than an incompetent, biased scientist in the pocket of trial lawyers suing for “vaccine injury” who also almost certainly falsified data, that Dr. Bob descends into the deepest black hole of stupid that I’ve ever seen him fall into. Apparently, the supernova of stupid had already occurred and collapsed into a black hole. Or maybe Dr. Bob took care of both the creation of the black hole and the feeding of it with even more stupid. Be that as it may, here comes something that may hurt your neurons to read, a veritable gravitation wave of blithering idiocy producing a massive wave of neuronal apoptosis if you’re not prepared for it, sucking all intelligence into Dr. Bob’s black hole of stupid.

You were warned. Here it is:

Ultimately, I believe the vaccine/autism question cannot be answered until a very large, prospective, randomized, double-blind, placebo-controlled study is done that compares the rate of autism in a very large group of vaccinated versus unvaccinated children. That type of study is the gold standard of medical research, and until that study is done this issue cannot be put to rest for many parents; there will continue to be doubt in many parents’ minds about the safety of vaccines. I know that there are dozens of studies that show there is probably no link between vaccines and autism, and virtually every doctor, government official, and vaccine manufacturer is very quick to point that out. But parents just don’t believe it. And they won’t believe it until the type of large study I describe above is done. But that research is many years away. Millions of parents need to know what to do with their babies now. Here is my solution: vaccinate, but do so in a manner that lowers the risks.

That’s right. You heard it correctly. Dr. Bob has apparently actually bought into the concept of a “vaccinated versus unvaccinated” trial. But he did even worse than that. He bought into the idea of a prospective, randomized, double-blind, placebo-controlled study. But not just a prospective, randomized, double-blind, placebo-controlled study, but a “very large” prospective, randomized, double-blind, placebo-controlled study. Any such study would be utterly and completely unethical. No IRB would ever approve it–and rightly so, because it would violate the very tenets of clinical trials ethics in that there would be reasonable presumption of clinical equipoise. In other words, there is no way that any informed scientist could claim that, to the best of our ability to know, the two groups would be subjected to roughly equal risk. No, the placebo control group would be left unvaccinated and completely vulnerable to vaccine-preventable diseases. Children in the control group would fall ill from not being vaccinated; some might even die. That’s about as unethical as it gets in human subjects research.

If Dr. Bob doesn’t know that, he is too ignorant of the very basics of human subjects research to be spouting off about it. He needs to be called out for this. Loudly. Really, this is Human Subjects Research 101. Indeed, knowing about the concept of clinical equipoise is arguably the prerequisite for Human Subjects Research 101. On the other hand, if Dr. Bob does know just how unethical such a “vaxed versus unvaxed” trial would be, then he is cynical beyond belief, throwing out the excuse that parents won’t be convinced that vaccines do not cause autism by anything less than a randomized clinical trial of “vaxed versus unvaxed” and using that as a justification for his “alternate” vaccine schedule “until such a trial is done.” While I hope that the former is the explanation for Dr. Bob’s saying something so monumentally disturbing to anyone involved in clinical research (like me), I tend to vote for the latter. Presuming the former would mean that Dr. Bob has to be even more mind-numbingly ignorant than Vox Day, who once proposed the very same thing, an RCTof vaccinated versus unvaccinated children. Come to think of it, even J. B. Handley doesn’t try very hard to argue for an RCT of vaccinated versus unvaccinated children any more. Not really. Even he understands that it would never fly because it is unethical, even if he doesn’t really accept the reasons why it is unethical.

Word to Dr. Bob: If you’re suggesting something (or even using something in a rhetorical sense) that Vox Day advocates and even J. B. Handly realizes won’t fly, you have sunk to a new low. Sadly, so has Dr. Jon Poling, father of Hannah Poling, who chimed in the comments:

You are correct that a vax-unvax study must be done to answer the open autism question once and for-all. Your summary of the Wakefield-Offit piece also astutely points out that while Wakefield acknowledges scientific uncertainly with his hypothesis, Offit is dogmatic that vaccines are always safe.

Geez. Not you, too, Dr. Poling! Surely you know that a vax-unvax study of the type described by Dr. Sears would be profoundly unethical, on the order of the Tuskegee Syphilis Study. Don’t you? You do, also know, that doing an epidemiological study of vaxed versus unvaxed children would be far more complicated and expensive than the anti-vaccine movement lets on and, more importantly, that there is no good scientific justification for it, as I explained in depth here. If you don’t, you should. As for Dr. Poling’s comment about Dr. Sears’ analysis of Matt Lauer’s story on Andrew Wakefield, this is what Dr. Bob said:

This is a little pet peeve of mine, and this closed-minded attitude really came across when watching Dr. Offit’s comments, and Brian Deer’s, for that matter. They are so certain they are right, and that vaccines are completely safe, case closed. Whereas, Dr. Wakefield admits that he doesn’t know whether he’s right or wrong regarding MMR and autism, but he believes we should keep looking. He’s open minded, and open to the possibility he may be wrong in the long run. He just wants to make sure.

No, Dr. Offit and Brian Deer are certain that Wakefield is a fraud, an incompetent scientist, and I agree with their opinion of him. Wakefield’s “science” is not to be trusted. It’s crap. Wakefield, on the other hand, oozes the unctuous poise of the con man, trying to appear “reasonable” on TV when his actions over the last decade tell a different story. His last decade does not tell the tale of a man who is “open-minded” and “just wants to make sure.” If that were true, he wouldn’t have ignored the concerns of researchers working for him about false-positive PCR tests for measles in the gut.

On the other hand, for all the cesspit of misinformation he laid down in this steaming, stinking turd of a post, Dr. Bob is sort of correct about a few things. Sort of. For example, there are indeed dozens of studies failing to find a link between vaccines and autism–at minimum, many dozens. Also, virtually the entire public health establishment, including doctors, scientists, the government, vaccine manufacturers, and public health officials, does accept that vaccines are safe and effective–based on those many “dozens” of studies, natch! Finally, such a large prospective, randomized, double-blind, placebo-controlled study as described by Dr. Bob is indeed “years” away–as in never. Unless we as a nation have a radical “reimagining” of our current ethical concepts that govern human subjects research–and not for the better or more stringent, I might add–such a study will never be approved by any IRB or board responsible for human subjects protection. Nor should it ever be.

Dr. Bob is wrong about one thing, though. While he is correct that there are parents who don’t believe that vaccines don’t cause autism, where he is incorrect is in his charmingly naive belief that even a large prospective, randomized, double-blind, placebo-controlled study of vaccinated versus unvaccinated children were done and its results definitively showed that vaccines do not cause autism. The mountains of existing evidence haven’t convinced these parents already; more evidence, no matter how high quality from a scientific standpoint (albeit of incredibly dubious clinical trial ethics) is highly unlikely to convince them. Just look to the example of Sallie Bernard of SafeMinds. In a misguided effort to be “inclusive,” investigators consulted her in the design a very large epidemiological study looking for a link between thimerosal-containing vaccines and adverse neurodevelopmental outcomes. When the study was resoundingly negative, not at all what Bernard wanted, she didn’t believe it and started attacking it.

It is in order to assuage the fears of these parents whose fears cannot be assuaged by reason and science that Dr. Bob goes on to repeat his evidence-free advocacy of a “slower,” “alternate” vaccine schedule. If you have a child with autism, Dr. Bob suggests that any further children you might have shouldn’t get the MMR vaccine, saying:

Although the science is overwhelmingly in favor of no link between MMR and autism, until a large-scale study is done in the manner I suggest above to really prove there is no link (or as close to “proof” as we can come), parents with autism in their family already should be cautious. But what about the other 99% of families without a child with autism? If your child has any of the risk factors associated with autism, such as severe food allergies, chronic diarrhea, any form of early developmental delay, or a strong family history of autoimmune disease (as revealed this month in Pediatrics), the MMR should be at least postponed until these problems resolve. Again, no science, just a precaution.

Oh, well, at least Dr. “Bob” Sears admits that the science is overwhelmingly in favor of no link between the MMR and autism. He even admits there’s no science behind his recommendations, but he makes them anyway! After all, he don’t need no steeenkin’ science. He’s Dr. Bob, Brave Maverick Doctor, who really and truly cares so very, very deeply about your child! Unfortunately, so eager is Dr. Bob to be seen as the “brave maverick doctor” by parents who think there is a link that he makes evidence- and science-free recommendations to delay or even skip important vaccines–just until a study that can never ethically be done is done, that is.

If that isn’t anti-vaccine, I don’t know what is.