Categories
Antivaccine nonsense Medicine Politics

Dr. Bob Sears vs. Seth Mnookin: Measles outbreaks, AB 2109, and lacking the courage of one’s convictions

It would appear that Dr. Bob Sears, author of The Vaccine Book, is in the news again. Specifically, he’s brought himself back into the spotlight by publishing in that wretched hive of scum and quackery, The Huffington Post, a fallacy-filled attack on a bill in California, AB 2109, designed to tighten up the process for obtaining philosophical exemptions from vaccination requirements for school entry and improving the process of informed consent for parents seeking such exemptions. In this, Dr. Sears has solidly aligned himself with the worst elements of the antivaccine movement. Sadly, it is not the first time he has done so. This time around, however, an interesting little sidelight has come up that has revealed just how disingenuous and deceptive Dr. Sears can be, as you will see. But here’s a little background, for those of you not familiar with Dr. Sears.

Pretty much anyone who has an interest in issues related to vaccines, particularly regarding the antivaccine movement, has probably heard of Dr. Bob Sears. The reason, of course, is that Dr. Sears (or “Dr. Bob,” as he likes to be called), is the author of a book touting an “alternative” vaccine schedule. His book, The Vaccine Book, is the bane of pediatricians everywhere practicing science-based medicine, because many vaccine-averse parents use it as a justification for “questioning” or otherwise refusing to follow currently recommended vaccine schedule. Dr. Bob likes to present himself as somehow being more reasonable, and less “extreme” than the “two sides” in the “vaccine debate.” For example, here is an excerpt from his book:

But now almost all parents have worries about vaccines. In the old days most parents simply followed their doctor’s advice and automatically got their children vaccinated. But today, virtually every parent has heard that there may be some side effects and problems with vaccines, and parents are asking questions. The problem is, no one is giving complete answers. Or rather, they are giving one-sided answers. Either your doctor is telling you that all vaccines are perfectly safe and you have nothing to worry about, or your neighbor is telling you all vaccines are evil and deadly and you are crazy to vaccinate. So you find yourself with many unanswered, or inadequately answered, questions. You don’t want your child to catch any serious illnesses, so you want to vaccinate. But you want to know what the potential risks and side effects are. You want to make an educated decision. That’s what this book is all about. It is my goal to give you a balanced look at the pros and cons of vaccination.

Notice how Dr. Bob places himself between what he incorrectly represents as “two extremes.” He’s not like those dogmatic antivaccinationists at all! Oh, no! He’s not like that crazy neighbor telling you that all vaccines are “evil and deadly.” But neither is he like that apparently dogmatic pediatrician who refuses to recognize any risks whatsoever from vaccines. Oh no! He’s far more reasonable. His is a “middle way,” threading the needle between loony antivaccinationism and rigid, authoritarian medicine touting “one size fits all” solutions for your–yes, your!–children and refusing to recognize that your child is a special little flower that requires “individualized” vaccination.

The problem, of course, is that pediatricians such as what he describes exist primarily in the fevered paranoid imaginings of the antivaccine movement. Worse, Dr. Bob uses the logical fallacy known as argumentum ad temperantiam, also known as middle ground, false compromise, gray fallacy and the golden mean fallacy. This fallacy implies that the positions being represented are extremes of a continuum of options, that such extremes are wrong, and that the “middle ground” must be correct. It’s a very seductive fallacy, because whenever people see arguments in which two seemingly extreme positions are presented, their first tendency is to look for compromise by “splitting the difference” and assuming that the correct answer is somewhere in the middle. Yet such is not always the case, particularly in matters of science. For instance, the correct scientific position is not somewhere between that of anthropogenic global warming denialists and everyone else or somewhere between what creationists claim and what evolutionists know from science. Likewise, the correct answer regarding vaccination is not somewhere in the middle, between the claims of antivaccinationists and what real scientists say about vaccination. Yet, that’s the game Dr. Bob plays, giving credence to discredited claims about vaccines promoted by the antivaccine movement. It’s not for nothing that Dr. Paul Offit and others consider Dr. Bob to be, if not antivaccine, at least flirting with the antivaccine movement.

All of this is why what Seth Mnookin writes about Dr. Bob is quite telling when he asks the question about Sears, Bob Sears: Bald-faced liar, devious dissembler, or both? In it, Mnookin reveals Dr. Bob’s version of the truth to be rather fluid regarding his involvement with “patient zero” for the measles outbreak that occurred in San Diego in 2008. The reason this came up is after Dr. Bob’s attack on AB 2109 because a commenter, in order to illustrate the consequences of not vaccinating and argue that Dr. Sears, either wittingly or unwittingly, promotes beliefs that have negative health consequences asked asking Dr. Bob about the patient believed to be responsible for the San Diego outbreak, using Seth Mnookin’s account in his book The Panic Virus as his source. This led Dr. Bob to respond:

I will set the record straight. I was NOT the pediatrician who saw the measles patient and let him sit in my office. As far as I know, that occured in a San Diego pediatrician’s office. I don’t know whose. I was not involved in that at all. I haven’t read Seth Minooken’s book, NOR have I ever even spoken with Seth. So I’ve no idea what he’s said about me in his book. I actually had no idea that any of you were even wondering about this. No one’s brought it to my attention before this. I heard something about some journalist writing a book about vaccines, but hadn’t bothered to read it.

In response, frequent commenter here lilady challenged him:

Really, Dr. Sears?

Is this the same Dr. Bob Sears who appeared on the Dr. Oz Show? How about commenting on this video (at 1:00 minutes into the Part 4 “What Causes Autism” Show), Dr. Sears. Dr. Ari Brown stated succinctly to you that she believed the young patients infected by measles were your patients.

http://www.doctoroz.com/videos/what-causes-autism-pt-4

You never “corrected” Dr. Brown and you quickly changed the subject. Why did you not deny that your patients were involved in the outbreak and…why did you change the topic, Dr. Sears?

We all await your explanation.

That explanation was:

Of course I remember the show, and her comment. BUT, she wasn’t accusing me of being the pediatrician that the measles patient went to see when he had measles and sat in his waiting room. She simply stated that that child was my patient (which is correct, but they didn’t come to see me during the measles illness). She was baiting me, and suggesting that the fact that that family had decided against the MMR vaccine long before they ever became my patients was MY fault. I wasn’t about to give her the satisfaction of acknowleding her comment.

What I was referring to by the statement “I had no idea” was that I never knew anyone, much less a supposedly respected reporter, was spreading the FALSE rumors that I was the pediatrician involved in the outbreak. I have simply been the family’s pediatrican over the years, but I practice far away from them, so they went to a local ped for THIS problem. Anyone who has written or suggested otherwise printing false information.

Talk about not owning up to one’s actions! Dr. Bob “empowers” and supports antivaccine parents in their decision not to vaccinated, and then he whines when it is pointed out that one of his unvaccinated patients was the nidus for a major measles outbreak.

All of this brings us to Seth Mnookin’s post from yesterday. Mnookin pointed out that Dr. Bob’s pandering to the antivaccine movement went so far as to advise “hiding in the herd” (i.e., taking advantage of herd immunity for measles) and, even worse, to say to parents hiding in the herd, “I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.” In other words, Sears on the one hand excuses parents who do not vaccinated and on the other hand advises them to be parasites taking advantage of herd immunity provided by parents who were willing to take on the responsibility and risks of vaccination to protect their children at zero risk to their children and telling them not to encourage others to do the same because it would degrade herd immunity and eliminate the advantage of being a parasite!

In light of Dr. Bob’s advice, pointing out that Dr. Bob’s patient was probably the vector responsible for starting a measles outbreak in San Diego was a legitimate point. It serves to emphasize that Dr. Bob’s arguments have consequences. That’s why it’s a joy to see Mnookin take Dr. Sears down a peg or two by pointing out that Dr. Bob is either dissembling or lying:

Sears’s involvement with patient zero was not some sort of secret: It was also reported in a December 19, 2008 episode of This American Life, in the middle of an interview with Sears himself. (You can hear that part of the broadcast–“That’s Dr. Bob Sears. … Dr. Bob, as people call him, is also the doctor for the non-vaccinating family that went to Switzerland”–here. For people interested in the whole show, Sears comes in just before the the 34-minute mark.) It was also reported in Sears’s hometown newspaper, The Orange County Register. I wasn’t the first person to write about it, and I wasn’t the last-but for some reason, Sears has decided now is the time to speak out about this-and he’s doing so in the comments of his latest Huffington Post vaccine scare-mongering lunacy.

Mnookin also points out that Sears is attacking a straw man by railing against him for having allegedly allowed the child with measles to sit in his waiting room with other children. Neither Mnookin, any of the commenters in HuffPo, nor anyone else accused Dr. Sears of that. They merely pointed out that it’s been widely reported, and apparently acknowledged by Dr. Sears himself, that patient zero for the San Diego measles outbreak was a non-vaccinating patient of Dr. Sears. That’s it. It was Dr. Bob who either jumped to the conclusion or disingenuously attacked a straw man that he was being accused of having let a child with measles spread the disease to his other patients. He wasn’t.

One wonders if Dr. Bob has a bit of a guilty conscience. In fact, the final bit of his most recent comment sure does sound that way. One of Dr. Bob’s arguments agains AB 2109 was that doctors would refuse to sign the form. He uses the mention of his non-vaccinating patient who sparked a measles outbreak as a cue to rant (and I do mean rant):

PLUS, I WOULD LIKE TO THANK YOU, AND SOME OF THE OTHER NEGATIVE COMMENTORS TO MY BLOG, FOR HELPING TO PROVE MY POINT. It seems that when a doctor’s patient chooses not to vaccinate, then catches one of the diseases, IT BECOMES THE DOCTOR’S FAULT? SO, WHY WOULD DOCTORS TAKE FURTHER RESPONSIBILITY AND LIABILITY FOR THEIR PATIENTS’ DECISION AND SIGN THEIR NAME TO THE EXEMPTION FORM? That’s my point; I appreciate you furthering my cause against AB2109.

It’s rather amusing how, when challenged, Dr. Sears reverts to writing like one of my more wingnutty commenters, complete with lots of ALL CAPS. Here’s a hint to Dr. Sears: Although the (very) occasional word or phrase in ALL CAPS can be used effectively to add emphasis, it’s a tool that needs to be used very sparingly. To do otherwise is to look like a ranting loon, which is what Dr. Bob looks like above. There’s a reason why one of the Flame Warriors is referred to as ALL CAPS and it is pointed out that ALL CAPS is the Internet equivalent of shouting, in which “from a tactical point of view, too much shouting alerts other Warriors to the opponent’s verbal WEAKNESS and emotional EXCITABILITY.”

Be that as it may, it would appear that Dr. Sears is a coward as well in that he doesn’t have the strength of his own convictions. Think about it. He advises parents who refuse the MMR not to tell others about it so as not to degrade herd immunity. If he really believed that the MMR is not safe enough, then why on earth would he not trumpet it to the world and advise the parents of his patients to do the same? He “supports” parents who don’t vaccinate; yet he says he won’t sign simple forms for them confirming that he has counseled them about the risks and benefits of vaccines. That’s all that AB 2109 asks him to do; yet he blames fear of liability for his decision. I have one question: Has any physician in this country ever been successfully sued for malpractice after one of his patient suffered from a vaccine-preventable disease on the basis that he supported the decision of the parents not to vaccinate or advised them not to? I’m certainly not aware of one. Truly, it bears repeating: Dr. Sears doesn’t have the strength of his convictions.

Unfortunately, Dr. Bob joins the list of pediatricians who have found fame, validation, and a bit of lucre pandering to the antivaccine movement. Like many of them, he does not see himself as being antivaccine, and maybe he isn’t, at least not the way luminaries of the antivaccine movement such as Barbara Loe Fisher, J.B. Handley, Sallie Bernard, Andrew Wakefield, and the like are antivaccine. He does, however, give credence to their views and, by using false balance to present fears about vaccines based on pseudoscience, making him very much a part of the problem.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

372 replies on “Dr. Bob Sears vs. Seth Mnookin: Measles outbreaks, AB 2109, and lacking the courage of one’s convictions”

Quoth Dr. Sears:

She was baiting me, and suggesting that the fact that that family had decided against the MMR vaccine long before they ever became my patients was MY fault.

Once they did become his patients, he presumably reviewed the child’s medical history, saw that the child wasn’t vaccinated against measles, and then advise them to get him the measles vaccine. Or can MMR only be administered while the child is in a certain range of ages, and the child became a patient once that age range had passed?

The truth usually lies somewhere between between the extremes, but between usually means much closer to one end than the other.

Perhaps Sears sounds like a wingnut because he is one. He is just a smooth talking wingnut with a following.

On the Dr Oz video, Dr Ari Brown was merely describing the scenario where an unvaccinated patient with measles had infected other vulnerable patients in a doctor’s waiting romm, and added that she thought these were “Dr Bob’s patients”.

That’s hardly “baiting” – it was the expression of an opinion which Dr Bob could easily have corrected there and then if it was wrong, yet he chose to quickly change the subject when given the immediate opporunity to refute the claim.

Dr Bob’s prevarication on Huffpo in response to Lilady if anything makes his explanation less credible, and his responses to Seth Mnookin reveal him to be either dishonest, or to have an appallingly bad memory. Which is more likely, I wonder?

As Orac says, Dr Bob displays rank cowardice for not being able to admit his advice has consequences.

At least with the regular anti-vax nutters, oops, I mean ‘pro-safe vaccine’ nutters you can admire the resolve that they have, as delusional as it is. This guy changes his mind more than Tony Abbott. (Sorry for the Aussie Political Reference, I’m sure someone will appreciate it!

If Dr. Bob was a serious pediatrician, I wonder if he counseled (the family travelling to Switzerland – knowing the kids were vaccinated) that they may want to go ahead & get the MMR, due to the prevelance of measles in that country?

If he isn’t “anti-vaccine” and the kids were obviously older, and given his own “public” opinion that vaccines are okay, just on an alternate schedule, why wouldn’t he do his job and make that recommendation?

Here’s where the rubber meets the road – and where his problem lies, too many of his supporters are 100% anti-vaccine & jump down his throat when he says anything that isn’t the “party line” against vaccines.

This is the same problem you find at AoA – they can’t say a single good thing about vaccines (not even when confronted with rabies), because too many of their supporters are invested in the “vaccines are 100% evil.”

It does back them into a corner & makes them appear that much loonier, in the face of reasonable arguments.

Certainly in the UK you can have the MMR vaccine at any age. My husband just had it, because we weren’t sure he actually had full protection from all three diseases (when we were kids MMR didn’t exist) and he travels a lot in Europe for work.

Anyway…
“Mnookin pointed out that Dr. Bob’s pandering to the antivaccine movement went so far as to advise “hiding in the herd” (i.e., taking advantage of herd immunity for measles) and, even worse, to say to parents hiding in the herd, “I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

This is a morally disgraceful and disgusting attitude to see from a qualified doctor.

Mnookin also points out that Sears is attacking a straw man by railing against him for having allegedly allowed the child with measles to sit in his waiting room with other children. Neither Mnookin, any of the commenters in HuffPo, nor anyone else accused Dr. Sears of that.

Emphasis mine. I did accuse him of that and he knows that I did but he’s afraid to utter my name. When Dr. Brown stated she thought that children involved in that outbreak were his patients and he acknowledged that, it wasn’t a stretch to assume that the transmission occurred in his waiting room. In fact, given his evasion on the subject until continually pressed and his blatant lie about not knowing who Seth Mnookin is and his contact with him, I’m not convinced the transmission didn’t occur in his waiting room.

@Lawrence:

If Dr. Bob was a serious pediatrician, I wonder if he counseled (the family travelling to Switzerland – knowing the kids were vaccinated) that they may want to go ahead & get the MMR, due to the prevelance of measles in that country?

It seems unlikely that he did, since if he did do that he would have said “I recommended that they get their kid the MMR vaccine, but they ignored my recommendation”. Unless that would be a violation of HIPAA? But presumably him revealing that the child wasn’t vaccinated against measles when the family became his patients didn’t violate HIPAA, so I don’t think that would be a violation either.

ScienceMom @8 — Notice that Sears misspelled Mnookin’s name (“Minookin”) in his comment on HP. This could be an innocent typo, but it’s also possible that he did it deliberately to bolster his claim that he didn’t know who Mnookin was.

I wonder if Seth Mnookin is starting to undeerstand better why many are not so keen on his “building bridges” attempts with the wackaloons.

Howe do reach out to folks who are so bloody slimey and dishonest? It’s not like Dr Bob is unusual in that regard.

@ palindrom, I would chalk it up to sloppiness; Bob isn’t the sharpest tool in the shed for reasons in addition to poor grammar and spelling. He knows damn well that I wrote about the index case being in his waiting room but that and his lie about knowing who Seth Mnookin is is his refusal to acknowledge any criticism. He’s tried to go head to head with me and has failed miserably, showing his ignorance of all of the scientific disciplines he blathers about in his vaccine books and articles. He knows he is out of his league so instead ignores challenges and hopes they will just go away.

@palindrom,
Edging a wee bit close to conspiracy there with the Mnookin/Minookin thing. Sears has shown well enough that he is quite capable of lying when it suits him and instructing his patients to, in effect, do the same.

I would believe typo and lies and leave it at that. There is so much more fundamental crap to aim at with Sears.

My daughter had 3 pedatricians in the first practice we took her to, and then we moved to another state where she sees 2 pediatricians in one practice. Out of the 5, 4 pediatricians have told us that vaccines are completely safe and risk-free. This was the last actual quote: “Other than a little soreness at the site of injection, there just aren’t any risks with vaccines. Not at all.” One of them did discuss risks with me and he felt the benefits clearly outweighed the risks, which I think is reasonable. I read Dr. Sears’ book and it helped me make my decision to get all the vaccines. I ignored that idea of getting them one at a time, because that seems silly (don’t we all get exposed to multiple germs most any day? I never understood why that is supposed to be dangerous). I wish that the pro-vaccine scientists would stop claiming that only idiots say there are no risks to vaccines. The pediatricians say that, and it’s reasonable for a parent to trust their doctor and believe it. If they were honest about the concept of risks being outweighed by benefits, I think parents could understand that and would stop having the expectation that vaccines should be risk-free.

Jennifer,
You are correct of course that the peds should be more upfront but there is a risk with that as I’m sure our commenting peds will attest.

If you give most people the idea that there is a very small risk, an infinitesimally small risk, you raise their alert status and then have to spend time explaining what small is and there is usually no time in today’s modern practices to do that effectively. The risk approaches zero and the benefits are enormous. I guess 4 out of 5 peds interpret that for their patients as zero risk for high benefit.

Jennifer – every time my kids have been in for vaccination, we have been given information sheets about the vaccines they were given, which included a discussion of the risks involved. Heck, ours even included the incidence rates for all the side effects.

Didn’t you get something like that?

I must say, Dr. Sears is definitely not the “sharpest tool in the shed”. I met him several years ago and he seemed to be quite feeble minded. In fact, his wife, Martha Sears, was always behind him, whispering into his ear to keep him focused. I think Dr. Bob is just the figure head to the Sears dynasty which includes his wife and son, who appears on “The Doctors” TV show.

Marcia – don’t forget his dad, Dr Bill Sears, who made a big name for himself back in the 70s with breastfeeding advocacy. Bob is trying to live up to that, but just doesn’t have the insight of his dad.

What’s his son like? I knew there was a Sears on the Doctors, but didn’t know it was Bob’s son.

OMG, Mindy, you’re right!! I was thinking of Bill! Is Bob the one on the Drs.??

Michael Hughes – I got the reference and it is accurate – the mad monk reminds me a bit of the classic anti-sciencer. Worrying really as he was once the Minister for Health.

Let’s not forget.

However, I am a cancer surgeon, and I do not treat children;

And according to this guy, herd immunity is…

Basically, when a sufficiently large percentage of the population is vaccinated against a disease, even those not immune to the disease obtain a measure of protection against infection because the immunity of a large percentage of the population prevents the infectious agent from being readily spread from person to person.

Notice how this bozo applies herd immunity to vaccination only. This guy really need some serious whipping.

OMG, Mindy, you’re right!! I was thinking of Bill! Is Bob the one on the Drs.??

No, Bob is not on the Drs as far as I am aware. It COULD be Bob’s son, but I don’t know.

But *tertium non datur*, Dr Bob!

We have to remember though that Dr Bob is covering himself because there is always the possiblity of a legal suit now or from a future case. I wonder what he believes in his heart of hearts if he questions the safety of vaccines _enough_ that he doesn’t inform patients about their benefits: I imagine that he doesn’t accept the mountains of evidence that led medical associations and most other scientists to accept the schedule, indeed it sounds as if he must be questioning the scientific method itself- he just can’t *say so* ( because he’s covering his a-s). Like Janus, he turns one face to his adoring fan base and another to the world of videotape and written records.

On the other hand, anti-vaxxers who don’t have his worries can out their innermost rabble-rousing disease promoter. Mike Adams, Loe Fisher or Blaxill-Olmstead aren’t going to be sued for their so-called instructional material on their websites or their rants that influence public opinion- it couldn’t be traced unless one of them specifically marketted a supplement that claimed it would eliminate the need for vaccines by jumpstarting immunity et al which they *almost* do … And while woo-meisters create and hawk products they similarly cover their a-ses with the ‘Quack Miranda’ and other fine print legalese.

I just couldn’t *resist* posing questions to Dr. Bob at Ho-Po, again…still in “moderation”.

According to Dr. Sears, only the index case was his patient. I asked Dr. Sears to clarify if his one patient’s two siblings, who were infected, by the index case, were also his patients.

I prefaced my second question with the phrase “…you owe it to your patients and your readers here…” to explain why you were *mistaken* about the contact you and your office staff with Seth Mnookin.

Also, I asked him not to reply in “all caps”, because it is undignified and not professional.

See, my *slumming* at the Ho-Po and at the AoA, really are *worthy* activities.

You have to give Dr. Bob some credit, unlike Jake and the Neverwrong writers at AoA he at least engages negative comments instead of just deleting them.

Interesting how he jumps so quickly to trying to deflect blame. I mean, he is their doctor, ostensibly, so if he permitted them to remain unvaccinated without significant challenge (and I think that is very likely to be the case), doesn’t he at least share some of the responsibility? He has a duty to uphold the standard of care, although it seems like in this case, he is ideologically incapable of doing so. (If anyone wants to point me to direct evidence of his advocating vaccines to his patients, they’re welcome, but I’m not going to stand on one foot.)

IANAD, but ethically, he seems like he’s on shaky ground, and, judging by how defensive he is, he knows it, too.

If Dr. Bob was a serious pediatrician,[…]

If Orac was only a … [insert ambition]

@MikeMa
Exactly. It’s like how people are more afraid of plane crashes than car accidents – for some reason, a smaller risk of something bad happening sets off more alarm bells in our brains than a larger one.

I think it’s also a sort of backlash to the antivax movement – like, you’ve got these people who take every single risk, real or imagined, and blow it way out of proportion, so it’s easy to see why you’d want to avoid ‘throwing them a bone’.

For your listening pleasure:

Sears appeared on the Gary Null Show ( I do recall at least one nausea-inducing comment he made about statistical acumen of the show’s host): of course all of this balderdash is lovingly archived at Progressive Radio Network- and probably 6 other places – I found: Nov 19,2009.

@ lilady:

While I applaud your slumming activities, might I make a few suggestions?:

make sure that you have really good boots as you’ll be wading through great loads of crap and other detritus,

watch *where* you post – i.e. avoid the most adamant anti-SBM- you wouldn’t want your e-mail et al around-( ways to circumvent that or so I’m told- *ahem*!) be careful because some might track your RL identity. You don’t want that ( e.g. Ren, Lee, Todd et al)

“In light of Dr. Bob’s advice, pointing out that Dr. Bob’s patient was probably the vector responsible for starting a measles outbreak in San Diego was a legitimate point. It serves to emphasize that Dr. Bob’s arguments have consequences.”

Orac, Dr. Bob’s patient WAS the vector, for starting a measles outbreak in San Diego.

Here is the MMWR report about the 12 case measles outbreak:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a3.htm

I seem to recall, but can’t say for certain (perhaps Science Mom or Catherina could help) that Dr. Bob has admitted in writing that his altered schedule has no scientific basis. Can anyone confirm that (get a screen capture, if it’s still around)?

I am disgusted by the craven, money-grubbing attitude of Dr. Bob Sears, he of the fearmongering anti-vaccien book and the baby slings and whatever else he wants to attach his family’s famous name to. He’s what all the folks who delay vaccines for no reason around here quote to back up their arguments. He also “consults” on a variety of baby food products, including my daughter’s favorite cereal puffs and yogurts. I would like to avoid buyign them because it would put more money in this horrible man’s pockets, but they’re the only brand she’lll eat.

Marry Me, Mindy, I agree with you. Unlike Jennifer, every single time my daughter got a shot, they gave us sheets listing all the side effects of various vaccines and then made us sign a form saying we’d read the sheet. When she got the MMR and varicella, the doctor also talked to us about the likelihood of her getting a rash afterwards.

The rash was the worst side effect she ever had from a vaccine, aside from a little soreness at the injection sites.

Here is the MMWR report about the 12 case measles outbreak:

Let’s see how will SBM fare against common sense.

[…]cough, coryza and conjunctivitis[…]high fever 104°F (40°C) and generalized rash.

Yet…

No isolation precautions were instituted at the doctors’ offices or hospital facilities.

I call that an iatrogenic measles transmission. Common sense wins!

@lilady

An interesting quote from that MMWR report, emphasis mine:

The San Diego import-associated outbreak, affecting exclusively an unvaccinated population and infants too young to be vaccinated, serves as a reminder that unvaccinated persons remain at risk for measles and that measles spreads rapidly in susceptible subgroups of the population unless effective outbreak-control strategies are implemented.

I second Denice’s advice on where to post. As for me, the cat is out of the bag. If someone doesn’t know where I’m coming from and what I do for a living, it’s because they’re not trying hard enough. Except for the lab. That one no one is going to figure out no matter how hard they try. Maybe. Or my other job, too. Or the fourth one that I have “seasonally”, if you know what I mean.

@Todd W.
I remember such an admission but IIRC it was from Dr Jay, not Sears. He may also have said as much of course…

Unlike Jennifer, every single time my daughter got a shot, they gave us sheets listing all the side effects of various vaccines and then made us sign a form saying we’d read the sheet.

Well, as far as we know, Jennifer also got those sheets. She was just relaying what the doctors said.

@Chris – it does beg the question, and I too, would be interested to see what either (or both) Dr. J & Dr. B would say when asked.

Bill of the Baby Book fame is husband of Martha and dad of (and practises with)

Bob (the “alternative scheduler”)
Jim (is a doctor and plays one on TV)

and of Pete, who runs his own doctors practise and seems to keep out of the vaccine discussion

and 5 further kids, at least one of whom also sells Juice Plus…

Why has the loquacious lilady suddenly become mute? Where is this “isolation protocol” for measles that she brags all the time? Oh here it is….in your face!

Silly Orac.

There is no responsibility to vaccinate to ensure one does not catch an illness then have others catch it from him or her. As such, whether Dr. Sears had anything to do with the “index case” (ooohhh, scary) is of no import.

It is worth reviewing the MMWR report of the measles outbreak, as alluded to above.

Dr Bob has apparently accepted that the index patient was one of his own patients. That said, and unless the CDC are lying, then Dr Bob did have the patient in his waiting room where onward transmission occurred. All onward transmissions can reliably be laid at his door.

The index patient was an unvaccinated boy aged 7 years who had visited Switzerland with his family, returning to the United States on January 13, 2008. He had fever and sore throat on January 21, followed by cough, coryza, and conjunctivitis. On January 24, he attended school. On January 25, the date of his rash onset, he visited the offices of his family physician and his pediatrician. A diagnosis of scarlet fever was ruled out on the basis of a negative rapid test for streptococcus. When the boy’s condition became worse on January 26, he visited a children’s hospital inpatient laboratory, where blood specimens were collected for measles antibody testing; later that day, he was taken to the same hospital’s emergency department because of high fever 104°F (40°C) and generalized rash. No isolation precautions were instituted at the doctors’ offices or hospital facilities.

The boy’s measles immunoglobulin M (IgM) positive laboratory test result was reported to the county health department on February 1, 2008. During January 31–February 19, a total of 11 additional measles cases in unvaccinated infants and children aged 10 months–9 years were identified. These 11 cases included both of the index patient’s siblings (rash onset: February 3), five children in his school (rash onset: January 31–February 17), and four additional children (rash onset: February 6–10) who had been in the pediatrician’s office on January 25 at the same time as the index patient. Among these latter four patients, three were infants aged under 12 months. One of the three infants was hospitalized for 2 days for dehydration; another infant traveled by airplane to Hawaii on February 9 while infectious.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a3.htm

@Thingy troll:

One has to actually suspect measles before one can isolate a patient with it.

Dr Bob, despite his vast experience of vaccination-preventable diseases (he must see quite a few, seeing as how he persuades parents to forgo vaccination), seems to have somehow misplaid what should have been a very low index of suspicion for measles in this patient (Not vaccinated against measles…Check; Recent travel to a country rife with measles…Check; Characteristic rash….Check). He completely missed the measles diagnosis, thinking it was scarlet fever.

Way to go Dr Bob!

@ Ren:

While I use two of my four real names, I deliberately chose my ‘nym so that any ‘seekers’ might run into some very interesting ladies who live all over the English-speaking world and do rather interesting work- even involving trade and fraud.
Thus, I can speak my mind freely through layers of smokescreen and do my part. Without worrying about some pain-in-the-a-s private eye wannabe ringing at my door.

All onward transmissions can reliably be laid at his door.

The patient stayed longer in the hospital without any isolation.

One has to actually suspect measles before one can isolate a patient with it.

Idiot! You don’t work in the setting so STFU! lilady knows, she’s quiet.

Cough, coryza and conjuctivitis? How could anyone miss the measles triad, especially in an unvaccinated patient? Remember and don’t forget this pretender, measles is a clinical diagnosis.

Has anyone missed me while I was offline?

Here is the classic SFB Troll posting about “Its hospital experience” and about isolating a suspect measles case patient in a hospital. Kudos to Todd W. for posing the question at the SFB Troll and for persistence:

http://respectfulinsolence.com/2011/07/joe_mercola_plays_the_religion_card_agai.php

182

Todd W.,

Ah, so before you enter any room, you wait outside until at least two hours has passed since anyone went in? You mean you aren’t actually looking for “red flags, signs and symptoms” like you said earlier? You’re just waiting for hours before entering any enclosed space and running out if someone that might be infected comes in. Got it.

Hahaha. Because you’re too dumb to realize that I have already answered that question that I have to doubt that it will be measles because of your lack of evidence. But instead, you shifted to being obtuse by extrapolating red flags, signs and symptoms to the fantasy “room”, the timer clock I used as an example is to verify that you don’t really care about who went into that room at an earlier time.

No, I don’t use any timer because I don’t need to. We only use that in the hospital for terminal disinfection of the room previously occupied by a known infectious patient.

Seems a pretty paranoid and time consuming way to live one’s life, but hey, if it works for you…

No you’re the one who is being paranoid. Again practice what you believe. Where’s your timer?

Posted by: Th1Th2 | July 14, 2011 11:42 AM

WHAT HOSPITAL SFB THINGY TROLL?

WHAT JOB IN WHAT HOSPITAL SFB THINGY TROLL

Time to “terminally disinfect” delusional, ignorant, disease-promoting, health-care-professional-wannabe SFB Troll.

There is no responsibility to vaccinate to ensure one does not catch an illness then have others catch it from him or her.

No one has any ethical responsibility to avoid from placing others at risk by their actions or inaction–that’s really your position?

Is this a general principle or one you’re narrowly applying to imunization? Does one actually have an ethical responsibility to operate a motor vehicle in such a way that you’d don’t willfully put other drivers at risk, or can one freely drive, at night, northbound in the southbound lanes on an interstate, with headlights and running lights off without responsibility for your choice not to obey the rules of the road?

Catherina is right. Bill Sears is the author of the The Baby Book, a big promoter of breastfeeding and the individual (along with his wife) who coined the term “attachment parenting.

Three of his sons are also doctors: Bob, Pete and Jim. They are all listed as coauthors on his book The Portable Pediatrician (not to be confused with Dr. Laura Nathanson’s book of the same name). Jim and Bob are listed as coauthors on the latest edition of The Baby Book. Jim is the one on the Doctors, I think.

In addition to the numerous books on overlapping subjects (each book often refers you to yet another of their books), the Sears have really learned how to make money off their name through product endorsements, nutritional supplements, etc. Check out all their products in their store at askdrsears.com. They have their name on everything from baby carriers, to baby lotion, to cups, plates and spoons, etc. It is over the top to mean. They are a brand, and not just authors.

How about this lilady, why don’t you write them up, I mean find that children’s hospital and call their attention for their embarrassing negligence.

Now it’s time for you to be useful once in a while.

JGC, it’s difficult for me to understand how you and or your compatriots continue to bring up such bad analogies. When you drive you are ACTING. As such you cannot act in such a way as to put others at risk. Reckless driving (you actually have a car) is not permissible. Not getting a vaccine is a non-action. Not vaccinating puts no one at risk since the the bugs are out there already – if they weren’t you could not catch anything. The only time you have a responsibility is when you know you have an illness.

No one has any ethical responsibility to avoid from placing others at risk by their actions or inaction–that’s really your position?

YES, that’s REALLY my position. Actions are circumscribed when they violate the rights of others, not solely because they might put someone at risk. After all, even safe driving puts others at some degree of risk.

Marry Me, Mindy–
They do have those CDC vaccine info sheets at my daughter’s pediatricians office. They don’t give them out automatically, but they do dig them out when I ask–it was always the medical assistant who got them out for me, and I don’t really feel like whipping it out to confront the pediatricians or anything…
I respect and like her two doctors and it may be true what someone said about how they feel that saying “no risk” is more or less accurate as far as not wanting parents to get overworried about small risks. And of course, they are in such a hurry! The one pediatrician at our old home who discussed the risks always spent 20 minutes or more answering our questions, but most doctors seem to want to spend no more than 5 minutes in the room, and that’s for the whole well-child check. I think it would take more than 5 minutes to just discuss the cobcept of risks and benefits and convey how rarely the risks happen. I feel like the whole vaccine debate is so polarized. Some of my friends and relatives think I’m insane for vaccinating but most do vaccinate. And one does that Dr. Sears idea of making her poor kid get every shot separately all spread apart. One of my relatives sent me a link to a site claiming the smallpox vaccine had been ineffective! WTF? But I feel like the pro-vaccine people can seem just as wacko. One site claimed that if your healthy child in the U.S. gets measles, the risk of death is equivalent to that of a child who’s a refugee under age 5 with vitamin A deficiency, but that’s in no way true. Some claim that before the measles vaccine parents didn’t feel attached to their children until after they’d had the measles, and I know that’s not true either (not for my 4 grandparents anyway!).

I see Robert is still at odds with an epidemiological term. I’m not surprised. He probably gets all sorts of bothered when someone uses “pachyderm” instead of “elephant”. Silly, silly, Bob. It must be horrible to live angered at big words all the time.

Sid, people are acting when they don’t vaccinate: They walk, they eat, they breathe, and they incubate viruses.

Dyslexic Gray,

[…]people are acting when they don’t vaccinate: They walk, they eat, they breathe, and they incubate viruses.

People who remained unvaccinated and uninfected do NOT incubate viruses they don’t have.

Don’t bother with Th1Th2, she is still unaware that it’s possible for infections to exist outside of vaccination. She actually admitted on multiple occasions that it is possible for an infection to have no symptoms, but still believes she can simply identify all infected people on sight. Simply put, she cannot form the most basic of logical connections, that a small child or a cat probably could.

Not getting a vaccine is a non-action. Not vaccinating puts no one at risk since the the bugs are out there already – if they weren’t you could not catch anything.

Meaningless sophistry. Being a “non-action” doesn’t absolve you in any way. And not vaccinating does increase the risk of others catching the disease, so the second quoted sentence is Not Even Wrong.

(really, I’d hoped for something other than a drunken freshman semantic argument.)

When you drive you are ACTING. As such you cannot act in such a way as to put others at risk.

When you choose not to confrom with recommended childhood immunization you’re also acting.

Reckless driving (you actually have a car) is not permissible.

Why not? According to you if I ‘actually have a child’ I have no responsibility if I place others at risk by failing to comply with the recommended immunization schedule. Why then if I “actually have a car” should I have any responsibility for placing others at risk by failing to comply with established rules of the road?

Not getting a vaccine is a non-action.

Two things. First, this is false: electing not to comply with and/or applying to have one’s child exempted from routine immunization is itself an action.

Second, why in the first place are you presuming that one has no responsibility for harm done to others as the result of inaction, but only as the result of action? If I run you down in that actual car am I off the hook if I explain it wasn’t an act of running you down but rather inaction re: hitting the brakes?

Not vaccinating puts no one at risk since the the bugs are out there already – if they weren’t you could not catch anything.

False statement again: not vaccinating places others at risk–those who for other reasons including age, immunodeficiency, allergies to components in the vaccine, etc.–by compromising herd immunity and by the act of choosing to remain a potential vector for transmission of those “bugs that are out there already”.

The only time you have a responsibility is when you know you have an illness.

So if I owned and operated a hotel I’d have no responsibility to install fire alarms, overhead sprinklers, emergency lighting, fire doors, extinguishers,etc. or to inspect them regularly to ensure they were working properly, except when the building was actually on fire? (This is your field, i believe–is that what you were taught?)

YES, that’s REALLY my position. Actions are circumscribed when they violate the rights of others, not solely because they might put someone at risk.

What right, exactly, would I violate by driving the wrong way at night with no headlights or running lights on, at 90 mph on a major interstate? I mean, since it has nothing at all to do with the fact that that I’m placing others at risk of injury or death as a consequence…right?

After all, even safe driving puts others at some degree of risk.

But not driving safely doesn’t violate their rights–agreed? Therefore I have no responsibility to drive safely, even if I have an ‘actual car’–agreed? And since it doesn’t violate their rights, only places them at risk, your initial distinction between actions and inactions is meaningless–agreed?

Don’t feed trollboy. The second you respond he goes ape with more garbage. It is more fun to pretend it is not here and as they say “howl at the moon”

Don’t bother with Th1Th2, she is still unaware that it’s possible for infections to exist outside of vaccination.

Here coochie coochie….

What in the hell are you talking about. How do you think disease is caused?

Sounds like you’re a n00b. Anyway, there’s the natural infection and there’s the vaccine. Happy now?

I thought Gray was just dyslexic. I was wrong. He’s a dyslexic n00b.

@Sid

While the safe/reckless driving analogy does involve action, rather than inaction, the point of the analogy is the choice being made. If you prefer, then there is the seat belt analogy, which I’m sure you don’t care much for.

Wearing a seat belt is an action. Not wearing a seat belt is inaction. Wearing a seat belt reduces your risk of injury in an accident. Not wearing a seat belt increases your risk (or, rather, keeps it at a high baseline) of injury in an accident. Wearing a seat belt reduces the risk of injury to others (i.e., your body does not become a projectile that can harm someone else). Not wearing a seat belt increase the risk of injury to others. Wearing a seat belt carries a small risk of injury (e.g., lacerated abdomen or strangulation). Not wearing a seat belt carries no risk beyond those already mention.

Now, apply that to vaccines. Getting vaccinated is an action. Not getting vaccinated is an inaction. Getting vaccinated reduces your risk of infection and, thus, injury from a disease. Not getting vaccinated increases your risk (or maintains a high baseline) of infection and injury (or death) from disease. Getting vaccinated reduces the risk of passing infection on to, and thus harming, other people. Not getting vaccinated increases the risk of passing infection on to, and thus harming, other people (a risk that is certainly much higher than the equivalent argument with seat belts). Getting vaccinated carries a small risk of minor reactions (e.g., local pain or swelling) and a much, much smaller risk of serious reaction (e.g., anaphylaxis). Not getting vaccinated carries no risk beyond those already identified above.

In the end balance, getting vaccinated, just like wearing a seat belt, is an action that improves your own chances of a good outcome as well as improving the potential outcomes of others. Inaction in either case results in an increased overall risk to both self and others.

Now, using your logic, you have absolutely no ethical responsibility to buckle up, even though, by your inaction, you are increasing the risk to others because you become a potential projectile. Similarly, if you do not vaccinate, then you become a potential vector of disease transmission that otherwise would not exist.

In short, you’re a self-centered, morally and ethically bankrupt, dimwitted loon who couldn’t philosophize his way out of a wet, rice-paper sack.

Meaningless sophistry. Being a “non-action” doesn’t absolve you in any way.

Talk about not isolating an infectious measles patient. GTFOH!

And not vaccinating does increase the risk of others catching the disease, so the second quoted sentence is Not Even Wrong.

By not having the infectious agent will increase the risk of others catching the disease how?

In short, you’re a self-centered, morally and ethically bankrupt, dimwitted loon who couldn’t philosophize his way out of a wet, rice-paper sack.

Todd – I was about to dismiss your comment as tl;dr, so I appreciate that you summarized it conveniently such that I didn’t have to read it.

Following the line of reasoning which puts the index case in Sears’ waiting room / office and where other patients in that environment were subsequently infected, what liability does Sears have with respect to:
A) Index case received bad medical advice relative to immunization
B) Subsequent infections were liable to Sears’ negligence
C) Subsequently infected victims also received bad medical advice relative to immunization

Can he be successfully sued?
Can he be sanctioned by a medical board?

Lying in public is almost commonplace but for someone to do so to cover his medical ass ought to have some penalty surely.

From “Dr. Bob”:

” Either your doctor is telling you that all vaccines are perfectly safe and you have nothing to worry about, or your neighbor is telling you all vaccines are evil and deadly and you are crazy to vaccinate.”

“Dr. Bob” seems to think that doctors – apart from himself and another “Dr. First Name” that I’ll not name – tell their patients that vaccines are “perfectly safe”. Strange that our paediatrician gives us a full page of warnings and possible complications to sign before every jab. Even my internist does that. It seems to contradict the reassurances of “perfect safety” that “Dr. Bob” seems to think are part of routine care.

Leaving that aside, we also have to consider that – given the “serious complication” rate of the MMR vaccine – usually cited as “less than 1 per ten million” – that in the US population (currently a bit over 300 million) that would mean no more than 30 people among those currently alive would have had a serious complication from the MMR jab. If you want to be extra fastidious and point out that there are two jabs in the MMR series, that climbs to 60.

There are currently (as of the 2010 census) about 74 million people under the age of 18 (i.e. the population generally seen in a paediatrician’s office) in the US, so we could expect to see no more that 15 (worst case) MMR complications in that population.

Taking this a bit further, let’s imagine that an insanely busy paediatric practise could have no more than 8000 individual patients (seeing one unique patient every 15 minutes, 8 hours a day, five days a week, fifty weeks a year), so the annual chance (assuming each patient is seen only once) of seeing an serious MMR complication would be 0.0008 (0.08%), so even after “thirty years of clinical experience” in such an unreasonably busy practise, a doctor’s chance of seeing a single case of serious MMR complication would be less than 2.5%.

On the other hand, there were 213 cases of measles last year (2011), which is the highest number in the past five years (including the 2008 outbreak year). It could be that “Dr. Bob” was wrong about the ability to “hide in the herd”.

Especially if you’re a patient of his.

Prometheus

Comments are closed.

%d bloggers like this: