Update on California bill AB 2109: It moves on despite the antivaccine movement

It just occurred to me that, even though there was news about it, I never mentioned what’s happened recently with respect to California bill AB2109. As you might recall, I wrote about this bill about four weeks ago. In brief, this bill, if passed into law, would require that California parents seeking a “personal belief” exemption for vaccines to meet with a physician and have a physician sign off on what is more or less an informed consent form stating that the parents had been informed of the risks and benefits of vaccines and, more importantly for purposes of the personal belief exemption, the risks (many) and benefits (virtually none) of not vaccinating. Parents would still be able to refuse to vaccinate by claiming that vaccines are against their “personal beliefs” (whatever that means). They just wouldn’t be able to do it by signing a form at school, no questions asked. In other words, the law would make it just a little more difficult to obtain a personal belief exemption, and that’s a good thing, because right now in California it’s easier to get a personal belief exemption than it is to actually have your children vaccinated. That means that it’s not just antivaccine parents who use the personal belief exemption but parents who aren’t antivaccine but are just too darned lazy or unconcerned to make sure their children are vaccinated.

It turns out that earlier this week, a hearing on AB2109 was held by the California Assembly Committee on Health. According to a local news report, the California Medical Association, the California Pharmacy Association, the Association of Physician Assistants, the California State Employees Association, the County Health Executive Association, as well as the doctors and dentists’ unions all lined up to testify in support of the bill. In addition, Health care workers lined up to endorse the bill, including doctors, medical students, and nurses, as well they should. After all, primary care doctors, especially pediatricians, understand the value of vaccination more than anyone; that is, with one rather despicable exception. Yes, we’re talking about Bob Sears:

“A free choice that is contingent upon finding another person to sign off on your free choice is not really a free choice at all,” said Dr. Bob Sears, a pediatrician.

Sears is against the law. He joined protestors on the Capitol steps Tuesday, to argue against the rule change.

On Facebook, Dr. Sears was a bit less…restrained:

THE FIGHT ISN’T OVER. Ya, we lost this battle, but we expected that and were praying for Divine intervention. We can’t give up. The more legislators we can keep against this bill, the less likely it will be to eventually make it off the Governor’s desk with a signature. So, every call matters!!! Start calling your Assembly person. Here is one thought on the meeting:

You saw the long parade of doctors all “conveniently” saying they would sign their patients’ exemption waiver. You know what this means? IT MEANS WE ARE BEING EFFECTIVE. WE’VE CALLED THE DEMOCRATS OUT ON ONE OF THE BIGGEST PROBLEMS WITH THE BILL. If this wasn’t a major problem, then the democrats wouldn’t have needed to bother with getting all those doctors up there and obviously and blantantly coaching them, each and every one of them, to say exactly the same thing. You’d think they’d at least try to make it not so obvious. This tells me that they are worried about this issue because they KNOW it’s an issue. This makes it obvious that it’s NOT a done deal. They know they might not win in the end, so they are fighting. That’s a good sign. Hats off to Dawn Winkler and everyone else for all the hard work. Keep it up!!!

Dr. Bob sounds a bit unhinged here, don’t you think? I mean, seriously. He’s using all caps and everything and combining it with paranoia. Does he have any evidence that legislators supporting the bill coached any of the physicians who testified in favor of the bill. Or that they somehow did anything questionable at all.

I also notice that Bob Sears is actually paying tribute to Dawn Winkler, thanking her for her efforts to combat the bill. Some of you might know who Dawn Winkler is, but for those of you who don’t I’ll refer you to a couple of posts I wrote about her nearly six years ago when I referred to her as an “antivaccine activist running for governor of the state of Colorado.” And that’s what she was at the time, too, a die-hard antivaccinationist spouting the most ridiculous pseudoscience and misinformation about vaccines. In fact, I have to wonder whether Winkler’s rubbing off on Sears. She’s pretty unhinged when she rants about vaccines. Now, “Dr. Bob” is starting to sound a little unhinged himself about vaccines. Maybe it was just the disappointment of having been trounced so nicely. Let’s see how he sounds compared to Dawn Winkler’s testimony:

Winkler, the California State co-director of the National Vaccine Information Center, and executive director of Health Advocacy in the Public Interest, said the bill was not about parents receiving more accurate information about vaccinations. “They already have that available,” Winkler said. “This is about parents’ rights, under the law. Why on earth should parents have to obtain more information about vaccinations and opt-out permission? This will interfere with the right to free education and the right to religious freedom. This bill poses a threat to freedom.”

So that explains what’s happened to Winkler in the six years since I last recall mentioning her. How appropriate. She’s with the antivaccine group the NVIC now, which makes perfect sense. I just didn’t know she had moved to California. In any case, Winkler can’t argue the science, as much as she thinks she can; so instead she retreats to overwrought “health freedom”-style arguments, particularly “parents’ rights” arguments. Here’s the problem: Parents’ rights are not absolute by any stretch of the imagination, nor should they be. Parents, for instance, are not allowed to deny their children life-saving medical care for a life-threatening disease. Remember Madeline Neumann? She was an 11-year-old whose parents relied on prayer instead of insulin to treat diabetic ketoacidosis. Madeline died, and her parents were prosecuted for second degree reckless homicide. Another child named Ava Worthington died when she developed bronchial pneumonia and her parents, belonging to a religion that eschews medical care, did not seek treatment. No, my point is not to advocate prosecuting antivaccine parents for neglect or abuse. Rather, it’s to point out that there is another being in the equation besides them. The child has interests that deserve protection. If anything AB2109 doesn’t go far enough in protecting those interests, but it’s better than the law as it stands now. Finally, “health freedom” means nothing more than the freedom of quacks from pesky government laws and regulations against their quackery, and “parental choice” means refusing vaccines based on pseudoscience.

Unfortunately, in this country, there is a widespread apparent belief that parents’ rights are the only rights that matter. As a consequence, in this country, we tend to grant parents wide latitude in making health care choices for their children. While in most cases this is appropriate, unfortunately, the law sometimes seems to bend over backwards to protect parents’ rights.

Particularly amusing (or it would be amusing if it weren’t so racist) is this objection to AB2109:

The unspeakable issue at the root of Pan’s bill is the influx of children from other countries into California’s public schools, who bring with them new strains of measles, mumps, chicken pox and flu bugs, among other communicable diseases. Children who have recently traveled out of the country also bring home infectious diseases.

It is not politically correct to address that problem. Instead the Legislature is proposing that everyone get vaccinated.

It’s no different that a teacher punishing the entire class because of one bad kid. The inability to single out the issue is the problem.

TRANSLATION: “It’s the wetbacks spreading disease, not our good, clean American children. Instead of restricting the Health Freedom of Real Americans, we should do something about them wetbacks, don’tcha think?”

No, I don’t think that’s a straw man, either, and, yes, as I said, it’s racist. Not only is this objection racist, but it’s almost certainly wrong. Most of the schools with the highest personal exemption rates are not in areas where there are a lot of illegal immigrants. Oh, no. They’re in Marin County and places where there are lots of upper middle class white people who’ve imbibed the antivaccine nonsense on the University of Google and developed the arrogance of ignorance that lead them to believe that they know more about vaccines experts who have spent their entire professional career studying vaccines.

There’s one final issue with this bill. I couldn’t find it mentioned in any of the news reports anywhere and the text of the bill doesn’t reflect this change, at least not yet, but apparently an amendment was added to the bill before it got out of committee that would allow naturopaths to counsel parents on the risks and benefits of vaccines and sign the exemption form under the supervision of a licensed physician. If this is true, it’s a disaster for the bill that will provide a loophole the size of an aircraft carrier for antivaccine parents. It’s something that really needs to be stripped from the bill before it’s voted on; failure to do so will render the bill much less effective, perhaps even nearly useless.

This brings up another issue, that of licensing naturopaths and giving them prescribing privileges (which naturopaths have in a limited form in California). Naturopaths have been waging a largely successful campaign to expand the number of states that license them and allow them prescribing privileges. They’ve been all too successful in rebranding themselves as a real alternative to physicians as primary care doctors. Because they have the imprimatur of the state through their licensure, they’ve achieved a level of respectability that is completely undeserved based on the rank pseudoscience and quackery they practice. Legislators do not realize this and hence most of them probably don’t know that naturopaths practice quackery. It probably seemed a perfectly reasonable compromise to the committee, given that one of the major objections of antivaccinationists to the bill is that, in its original form, it didn’t allow alternative medicine practitioners to sign the exemption form. Assuming the reports I’ve received are true and the Assembly did amend the bill to allow naturopaths to sign the exemption forms, it points to just how far reaching and corrosive to science-based medicine licensing naturopaths is.

In the short term, what needs to happen is that proponents of science-based medicine need to work to persuade the Assembly to strip the amendment from the bill that allows naturopaths to counsel patients on vaccine risks and benefits. It has been shown before that there is an association between seeing naturopaths and not receiving all recommended vaccines; there’s also an association between naturopathic care and catching a vaccine-preventable disease. So getting naturopaths off the list of health care professionals who can counsel parents about vaccines should be a no-brainer. Next, in the long term, the next effort must be to oppose licensure of naturopaths and to go beyond that, to roll back licensure of naturopaths in every state in which they are licensed. Such licensure serves no purpose other than to enrich quacks, and, based on the example of AB2109, it has far-reaching corrosive effects on medical policy. It needs to end.