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

Dr. Robert Sears has to be one of the most irresponsible pediatricians on the face of the earth, if not the most irresponsible. Many of you might recall that a little more than a week ago “Dr. Bob” posted a borderline unhinged rant on Facebook aimed at his own patients, who, quite reasonably, were calling him about the measles outbreak going on in southern California right now and asking him about the measles vaccine. It was entitled Measles Epidemic . . . NOT!, and his response boiled down to, in essence, “get the vaccine if you’re worried, but there’s no real reason to worry.” He also downplayed the significance of the measles outbreak in a fashion completely unbecoming a pediatrician (or physician of any kind).

Apparently, Dr. Bob is feeling the heat over his irresponsibility and his passing the buck when it comes to physician responsibility, in which he basically says, “Hey, don’t blame me. Get the vaccine if you want it. I won’t stop you.” It’s obvious, because he felt obligated to post a followup entitled Orange County Measles Epidemic . . . Not (yet, anyway)! It so demanded a heapin’ helpin’ of not-so-Respectful Insolence that I decided to forego (for the moment) commenting on the latest CDC figures on autism, which (as usual) are causing a huge stir in the antivaccine crankosophere. Besides, the new autism figures might be better suited to a—shall we say?—more analytical post at my not-so-secret other blog location early next week.

In the meantime we have Dr. Bob. Just like last time, I’m going to post the whole thing, so that you can see it in all its cranky glory (also, I want a record in case it disappears down the ol’ memory hole):

Wow. Who would have thought that a few simple sentences in my last post would cause such an uproar? If you missed it, check it out below. All it says is “don’t panic. If your child hasn’t had a measles vaccine, you can get one now. If you don’t feel comfortable with it, don’t panic, because there are only seven cases (at the time).” That’s it.

But it’s interesting what people took from it:

Some people seem to believe the post advises people to not get the vaccine, which the post clearly doesn’t say. The post says get the vaccine, or don’t – it’s up to you. I guess what the vaccine militants wanted me to say, instead, is that every single person, without fail, should get the vaccine no matter what. Some have attacked me for starting a measles outbreak seven years ago in my waiting room, which is false because no one with measles has ever even been inside my office (except for one child about 15 years ago who came down with a live measles infection from the vaccine, which is pretty rare but known to happen); so much for journalistic integrity for whoever wrote that (to be fair, most journalists do have integrity).

Some took my post to say that the MMR vaccine causes autism. WTF? The post doesn’t even include the “A” word.

Oh, and some thought my post said measles is harmless. My post didn’t even comment on the severity of the disease at all. Of course measles is sometimes harmless. It’s a tough disease. It’s no fun at all. The measles chapter in the book makes that very, very clear. My mistake though – I didn’t reiterate that in the post. So, for the record, measles CAN be very serious. It RARELY causes severe complications though. Almost everyone who catches measles here in the U.S. will be fine. You’ll be sick for a week, need to be quarantined, then you’ll be fine. IF your case is typical. BUT, in a small percentage of cases, even in the U.S. where we don’t have Vitamin A deficiency and protein malnutrition, complications can occur. About 1 in 1000 may die from it (studies vary – some say 1 in 3000, some say 3 in 1000). We haven’t had a measles death in the U.S. in over 10 years. But you know what? We will someday. May be this year. May be next. May even be here in the O.C. Every death from a vaccine-preventable disease is tragic. I’ve never said otherwise. So, just to make a few of you pro-vaccine militants happy, there you go. Measles can be bad. In developing countries with malnourished children, it’s even worse. But for most, it’s a harmless disease. Old pediatric textbooks call measles a harmless and routine disease of childhood. IN DEVELOPED, WELL-NOURISHED COUNTRIES, for most people, that’s true. But not for all.

Finally, some love to blame me for the outbreak. As if people aren’t getting the MMR vaccine because of me. In the measles chapter of the book, AND in my alternative vaccine schedule, the MMR vaccine is very clearly listed at 1 year and 5 years. I very clearly recommend the vaccine in the book. The post was simple – there’s a small outbreak, don’t panic. Get the vaccine or don’t. Up to you. Perhaps I should have said, “It’s really NOT up to you. It’s your social responsibility to get your children fully vaccinated so you don’t infect others. That way, NO ONE would ever need to have measles.” Keep reading – more on this later.

So, now we have about 21 cases in Orange County. We all knew it wouldn’t stop at seven. In my last post I gave a heads up that we’d see more. I thought maybe a few more, and didn’t think it would jump to 21. But it did. 5 cases are children, all unvaccinated. 5 are healthcare workers exposed to patients. They were vaccinated when younger, but the vaccine had worn off. As for the other 11 cases, I don’t know. Those details weren’t disclosed. But they are adults, according to the public health department notice. The outbreak won’t die out until everyone who’s been exposed either gets infected (which will be a very small few) or doesn’t, because they’ve been immunized or their immune system fights it off. Most outbreaks nationwide are restricted to a small number. The largest outbreaks from last year (58 in New York and 20 in Texas) occurred because the exposures were in large groups of unvaccinated people. Here in the O.C., almost everyone is vaccinated, so we are unlikely to see such a large outbreak. But it WILL extend a bit more. Who knows what the final number will be? But in the absence of a large unvaccinated group, it isn’t likely to spread much more than it has now. IF it hits a particular school or group where many are not vaccinated, it will likely spread through that group.

Finally, a message to those who chose to not get the MMR vaccine. I would still say don’t panic. The chance that your child will be caught up in this small outbreak is still very low. I understand your reasons for not wanting the vaccine. Every parent is required to read the CDC-mandated list of side effects to every vaccine before it is given. And the list of side effects to the MMR vaccine is quite daunting, and would scare any parent. You’ve probably read this list and opted out of the vaccines. The CDC handout tones it down a bit, but the MMR vaccine product insert doesn’t. And that’s what is spelled out in the measles chapter of the book. I simply list the side effects as described in the vaccine product insert. So, if any mandatory vaccine militants are going to be mad at me for that, then what you are really saying is that parents should NOT receive informed consent about this medical treatment. They should NOT be informed of the risks of a vaccine; they should just be reassured that the risks are small, they don’t need to worry their pretty little heads about the details, and just go ahead with the vaccine. If that’s how you feel, then you are justified in being angry with me. For the rest of you who like to follow proper medical procedure and medical ethics, you provide informed consent for vaccinations. Allow the parents to be involved in this decision. Some will decide NOT to vaccinate; this puts their child at a small risk of disease, and it poses a risk of their child spreading the disease to other unvaccinated or too-young-to-be-vaccinated or those-who-got-vaccinated-but-it-didn’t work (I don’t think that was grammatically correct), but parents have that right to make that decision.

If we could guarantee that every single dose of MMR vaccine would be harmless to every child who received it, then we could be justified in making the vaccine mandatory. Since that’s not the case, we must allow parents to decide. Bottom line: if your child has had one vaccine, then there is a 95% likelihood that he or she is protected. If two doses, it’s about 98 to 99%. So, you’re in good shape. You likely have nothing to worry about. Unfortunately, as we’ve seen in this outbreak, some adults will lose their immunity, and may catch the disease. If you decided to not get the vaccine yet, then you have a decision to make. Read all the pros and cons. Understand the side effects of the vaccine as well as the disease. Consider the importance of public health protection. If you were planning to have your child get the vaccine at some point anyway, but you were waiting until an older age, maybe now’s a good time to consider it. But the outbreak is still small enough where you don’t have to rush into it. If you decide against the vaccine, the disease risk is still acceptably low. Stay tuned.

And, on a completely unrelated note, the CDC just released new autism rates: 1 in 68 kids, and 1 in 42 boys. I still have to process this, and will blog next week. But don’t worry: it’s not a REAL rise. It’s just a pretend rise. Or, it’s not rising at all – it’s ALWAYS been 1 in 42 boys, right?

Actually, Dr. Bob is only half right about this being “completely unrelated.” Yes, the measles vaccine is completely unrelated to autism prevalence. However, autism prevalence rates are anything but unrelated to measles outbreaks. It is the unfounded fear that vaccines in general, but the MMR vaccine in particular, are a major cause of the “autism epidemic” that feeds the antivaccine movement and leads to pockets of low MMR uptake, which in turn lead to susceptibility to outbreaks very much like what we are seeing in southern California right now. So Dr. Bob doubles down on his previous idiocy about the MMR vaccine and measles outbreaks. He even admits part of the reason why, blithely saying that he only expected a “few more” cases and is shocked that it’s actually higher. So he frantically tried to downplay the severity by trying to minimize the impact of unvaccinated children on outbreaks, hence is “IF” gambit, in which he admits that “IF” measles finds its way into one of the schools with low MMR uptake then an outbreak can happen there. Once again, he conflates the overall high uptake in Orange County with no need to worry about outbreaks because of herd immunity, dismissing the pockets of low uptake as being, in essence, not important.

Unfortunately for Dr. Bob (and everyone else living in Orange County), there are a lot of schools in Orange County with low vaccine uptake, below the level necessary for herd immunity. Just take a look at this news report from 2009, which reports that in south Orange County, 16 of the 38 elementary schools in the Capistrano Unified School District had high enough exemption rates to be at risk. In nearby Saddleback Valley Unified School District, a quarter of the elementary schools have similarly high exemption rates.

Guess where Dr. Bob practices? You’ve got it: Capistrano Beach. At the time, I said: When the outbreaks begin, they’ll start in California. And so they are: Right near where Dr. Bob practices. Of course, correlation does not equal causation, but there’s no doubt that Dr. Bob’s antivaccine views fit in very nicely with the views of his affluent clientele. They come to him because he is sympathetic to vaccine-averse parents, and in turn Dr. Bob’s vaccine-averse clientele likely reinforces his tendency to cater to their views, thus amplifying them. In fact, if you want to see the scope of the problem in southern California, take a gander at this handy-dandy Google map included with the news story. Worse, vaccine exemptions are on the rise in California.

So, basically, Dr. Bob’s message is: Don’t worry, be happy, and if you’re worrying and not happy get the vaccine. Just don’t bother me about it anymore. Oh, and you nasty pro-science vaccine supporters out there are big meanies for pointing out that Dr. Bob is irresponsible. Oh, no, he says. He’s giving “informed consent,” such that it’s worth repeating the paragraph:

So, if any mandatory vaccine militants are going to be mad at me for that, then what you are really saying is that parents should NOT receive informed consent about this medical treatment. They should NOT be informed of the risks of a vaccine; they should just be reassured that the risks are small, they don’t need to worry their pretty little heads about the details, and just go ahead with the vaccine. If that’s how you feel, then you are justified in being angry with me. For the rest of you who like to follow proper medical procedure and medical ethics, you provide informed consent for vaccinations. Allow the parents to be involved in this decision. Some will decide NOT to vaccinate; this puts their child at a small risk of disease, and it poses a risk of their child spreading the disease to other unvaccinated or too-young-to-be-vaccinated or those-who-got-vaccinated-but-it-didn’t work (I don’t think that was grammatically correct), but parents have that right to make that decision.

Of course, my issue with Dr. Bob derives from how he actually doesn’t give proper informed consent. Instead, he gives what I like to refer to as antivaccine “misinformed consent” that massively exaggerates the risks of vaccines and downplays the risks of the measles. Always. He’s built his entire public career out of developing an “alternative” vaccine schedule that is not based in any science or clinical evidence, all based on overestimating the risks of vaccines and underestimating the risks of the diseases vaccinated against. Get a load of the fetid pile of dingos’ kidneys Dr. Bob lays down about measles not being that bad in which he says that “only” somewhere between 1 in 3,000 or 3 in 1,000 people will die of the disease. One wonders what level of death and disability would be sufficient to be a cause for concern to Dr. Bob! It doesn’t seem to concern him in the least that “someday” we’ll have another measles death in the U.S., at a time that he describes as, “Maybe this year. Maybe next. May even be here in the O.C.” Sure, Dr. Bob says at the end that “measles can be bad” and that “every death from a vaccine-preventable disease is tragic,” but his entire petulant, dismissive attitude to the severity of the measles and parents’ justifiable concern about a measles outbreak happening in Dr. Bob’s own backyard, which he couples that with a statement that in developing countries it’s worse and that “almost everyone who catches measles here in the U.S. will be fine,” tell another story. I don’t know about you, but a disease that can kill as many as 3 per 1,000 of the people who get it is a pretty concerning disease to me. One notes that Dr. Bob also fails to mention that perhaps 1 in 20 children who get the measles will develop pneumonia and that 1 in 1,000 or so will develop encephalitis, while if a pregnant woman catches the measles it can lead to miscarriage, premature birth, or a low-birth-weight baby.

Dr. Bob whines that he was mischaracterized. I don’t think so. In fact, Dr. Bob clearly says, “The post says get the vaccine, or don’t – it’s up to you.” All of which is a cop-out, particularly when Dr. Bob fails to put things into the appropriate context. His claim that he “recommends the vaccine” at age one and five doesn’t get him off the hook, as his “alternative” schedule leaves children at riks for a much longer period of time than the CDC schedule. So instead Dr. Bob whines that the “vaccine militants” wanted him to say that “every single person, without fail, should get the vaccine no matter what.” Not quite. We just want him to do what a responsible physician would do and urge people to get the vaccine, unless there are medical contraindications to it. Not “no matter what.”

Looking at the brain dead comments after Dr. Bob’s post, congratulating him for a “great post” and saying how “we all had the measles when we were kids, and we’re fine,” it’s half tempting to say that Dr. Bob’s patients and fans and he deserve each other. Unfortunately, the parents of Dr. Bob’s patients, under his influence, through their failure to do the medically responsible thing both for their own children and for society, endanger us all—starting in southern California. As Paul Offit reminded us yesterday, we seem to have forgotten just how bad the measles can be. After an excellent run of no deaths from measles that really doesn’t need to end and could go on for the foreseeable future if not for pockets of antivaccine sentiment leading to low MMR uptake, Dr. Bob, while sanctimoniously preaching “informed consent” and “parental rights” is contributing to our one day soon once again seeing children dying from the measles. Meanwhile, he shrugs his shoulders, denies responsibility, and says, “Hey, don’t blame me. We’ll always have the measles, and children sometimes die from it.”