Quoth “Dr. Bob” Sears: Poor, poor pitiful me, you stupid people

CheeseWhine

Poor, poor, pitiful Dr. Bob.

For those of you not familiar with him, I’m referring, of course, to Robert “Dr. Bob” Sears, MD, the antivaccine-sympathetic (or, more appropriately, antivaccine-pandering) pediatrician in Capistrano Beach, CA (between Los Angeles and San Diego in Orange County) known for his Vaccine Book, a veritable font of antivaccine misinformation gussied up as a “reasonable” middle ground. Too bad it’s not.

In any case, in the wake of the Disneyland measles outbreak, Dr. Bob has found himself under a lot of criticism, along with our “good buddy,” the other famous antivaccine-pandering pediatrician, Dr. Jay Gordon. As well they should! The majority of the measles cases thus far have occurred in the unvaccinated. More importantly, the association of this outbreak with Disneyland gives this story legs. It’s drawn international attention of a very negative kind on how the antivaccine movement has spread misinformation and frightened parents, thus contributing to declines in vaccine uptake, which in turn have led to pockets of vaccine uptake sufficiently low as to permit, facilitate even, outbreaks of vaccine-preventable diseases. The heat has come down particularly hard on certain antivaccine-friendly pediatricians in the area, such as our old friend Dr. Jay Gordon in Santa Monica and, of course, Dr. Bob Sears in Capistrano Beach, right in Orange County itself. I took Sears to task last time for having downplayed previous measles outbreaks, treating the parents of his patients condescendingly by basically waving them away and telling them to get the damned shot if they’re worried but stop bugging him.

I exaggerate, but not by much.

In fact, on Friday, Dr. Bob cracked. Well, actually, it was the first time he cracked. There was a second time yesterday. But let’s start with the first time. You might have seen this before, but it’s worth covering, particularly as a prelude to covering his second meltdown yesterday. (You can always skip his first meltdown and leap straight to his second if you like.) So let’s go.

On Friday, Dr. Bob posted this update on the Disneyland measles outbreak on his Facebook page entitled “JUST HOW DEADLY IS MEASLES?” In it, Dr. Bob strives mightily to convince his readers that the measles is no big whoop. I’m reprinting the complete text, in case Dr. Bob has second thoughts and sends his Facebook post below down the old memory hole, not to mention for the benefit of those of you who don’t have Facebook accounts:

The full text of Dr. Bob’s little rant follows:

What makes measles so scary? What is it about measles that spreads fear and dread through our population? Three things, in my opinion, set it apart from most infectious diseases that make us afraid: 1. It’s untreatable, and it has a high rate of complications, so we are at its [sic] mercy, 2. It’s been virtually eliminated from the U.S., so we aren’t used to it anymore, and 3. It’s potentially fatal.

Now, let’s play two truths and a lie. Two of these statements are true, and one is not. Well, the one that is not is technically true, but it’s not true in all practical terms.

1. Untreatable? Correct. There is no anti-viral medication that will help, so we just have to stand by as the disease runs its course. We are powerless, and that creates fear. We don’t want to take a risk with something which we have no way to mitigate or control. The only thing that may make measles less severe is high dose Vitamin A therapy (which is approved by the WHO). But that’s not an anti-viral med; it just helps us fight it off a little better.

Complications? Ear infection is the most likely complication – treatable. Pneumonia is next – also treatable. Ya, you don’t want those things to happen, but they are treatable. Encephalitis? That’s much worse. Fortunately it’s extremely rare in well-nourished people (see below).

So, the lie is that measles has a high rate of serious complications. It doesn’t. It CAN, but it rarely does.

2. Eliminated? Virtually. Over the past 20 years we’ve sometimes only had 50 cases a year. Sometimes 150. Nobody knows measles anymore, and when we are ignorant of something unfamiliar, we fear it until we understand it.

Ask any Grandma or Grandpa (well, older ones anyway), and they’ll say “Measles? So what? We all had it. It’s like Chicken pox.” Ask a twenty-five-year-old mom with two young kids, and she’ll scoop up her kids and run away from you for even mentioning the M word.

If you understand measles, you wouldn’t fear it. Respect it.

I do acknowledge that it’s a public health nightmare in that it takes a lot of effort and money to contain these outbreaks. And it causes a lot of people to get tested, quarantined, or treated with preventive immune globulin shots. It’s no joke. But, those efforts are largely because we are trying to contain it, not because it’s going to kill everybody. So, not fear – respect.

3. Potentially fatal? Technically true, but herein lies the lie. It’s been publicized as “the deadliest of all childhood fever/rash illness with a high rate of complications.” Deadly? Not in the U.S., or any other developed country with a well-nourished population. The risk of fatality here isn’t zero, but it’s as close to zero as you can get without actually being zero. It’s 1 in many thousands. Will someone pass away in the U.S. from measles one of these years? Tragically yes. That will likely happen to one person. It hasn’t happened here in at least ten years (or more – I don’t even know how many years we have to go back to find one). When that happens, it will be extremely tragic.

But will it spread through the U.S. and kill people left and right? No. Does measles do that in underdeveloped countries? Sadly, yes. It kills countless people worldwide every year. So, that’s how health officials can accurately say it’s so deadly. They don’t have to tell you the whole truth, just the part of the truth that they want you to believe.

Measles can also be serious for young infants, just as many diseases can. It can also be serious for immunocompromised people, just as all illnesses. It can also cause pregnancy complications, just like many infections can. Measles isn’t unique in these risks. But they are risks nonetheless.

So, fear measles? No. Not in the U.S.. Respect measles? Yes. Take appropriate precautions with it. But don’t let anyone tell you you should live in fear of it. Let’s handle it calmly and without fear or blame.

“Without blame”? As in, “Don’t blame me for the consequences of what I’ve been saying and doing for all these years”? Nice try, Dr. Bob. You’re not getting off that easily, nor will you be so easily allowed to shift the blame to the parents who listened to you rather than your own words and behavior. In fact, Dr. Bob’s reminded me of so much of an antivaccine meme originated at The Vaccine Machine, a virulently and unfortunately popular Facebook page run by the equally virulent and antivaccine Robert Schecter (known on my not-so-super-secret other blog as Sid Offit) that’s dedicated to trashing vaccines and spreading antivaccine pseudoscience that I just had to post it here:

measlesharmless

Yes, notice how Dr. Bob even invokes a variant of the “argumentum ad Brady Bunchium” fallacy when he mentions how “grandma and grandpa” poo-poo the measles as being “just like the chicken pox” and dismiss it with, “We all had it,” an attitude that he compares to that of a 25-year-old mother who’s never seen the measles before and therefore fears it because she doesn’t know it. It’s a rather clever inversion of the argument frequently used by pro-vaccine bloggers that points out that the reason parents don’t fear vaccine-preventable diseases anymore—the usual example used being polio—is because they’ve never personally witnessed the death and complications these diseases used to cause. In retrospect, I’m actually a bit surprised Dr. Bob didn’t mention the infamous “measles” episode of The Brady Bunch, actually. Come on, Dr. Bob. Let it out! You know you want to!

On that note, after having read Dr. Bob’s treatise above, I’d like you to go and read Marcella Piper-Terry’s initial response to the Disneyland measles outbreak from January 8 entitled “Measles at Disneyland!” Can you tell the difference between the Dr. Bob and a raving antivaccine loon like Piper-Terry? They are, in fact, making very similar arguments. Other than Piper-Terry’s longer post, with calculations designed to make you think that measles was never a big deal, Dr. Bob is using exactly the same arguments without adding the calculations, in particular the key argument being that measles in developed countries is not a threat, only in those “other” people in Third World countries who aren’t as developed as we are because, you know, we’re superior. Measles doesn’t kill very many of us compared to those poor, blighted savages! (I exaggerate, but, I contend, only a little.) He dismisses complications of measles as being “treatable” and therefore of little consequence. In fact, he makes it sound as though a measles-associated ear infection is equivalent to measles-associated pneumonia, dismissing them both as “treatable” with a jaunty, “Ya, you don’t want those things to happen, but they are treatable.” Never mind that many, if not most, cases of measles-associated pneumonia require hospitalization, many also requiring an ICU stay. As Dr. Roy Benaroch sarcastically puts it in his post entitled “Dr. Sears continues to salute our children with his middle finger“, many parents would indeed consider an ICU stay “somewhat of an inconvenience.” (I like Dr. Benaroch’s style.)

Think of it this way. According to the CDC, before the vaccine, 48,000 people a year were hospitalized for the measles; 4,000 developed measles-associated encephalitis; and 400 to 500 people died. By any stretch of the imagination that was a significant public health problem, and the introduction of the measles vaccine in 1963, followed by the MMR in 1971, made it much less so. As Dr. John Snyder reminded us five years ago responding to Dr. Sears making the same arguments in his book, measles is not a benign disease, regardless of what popular culture thought of it 50 or 60 years ago.

Of course, even Dr. Bob has to concede that measles-associated encephalitis is a Very Bad Thing, but he dismisses the risk with an equally jaunty rejoinder that encephalitis is “extremely rare in well-nourished people” (i.e., his well-off patients at whom his Facebook post is aimed). As for death, Dr. Bob’s message is, “Don’t worry, be happy.” After all, according to him, the risk of fatality is “as close to zero as you can get without actually being zero,” or one in many thousands. Funny how Dr. Bob (and the antivaccine activists to whom he panders) dismiss a possibility of death of this magnitude as being of no consequence; yet, a one in a million chance of Guillan-Barre disease after the meningococcal vaccine (or a one in several hundred thousand risk of severe reactions to vaccines in general) is completely unacceptable. Indeed, if you accept at face value Dr. Bob’s grossly-exaggerated estimate for a severe vaccine reaction of one in 100,000, by Dr. Bob’s own definition, the risk of severe reactions to any given vaccine is even lower than “as close to zero as you can get without actually being zero.” Even if you accept Dr. Bob’s even more ridiculously inflated estimate that the risk that “any one child will suffer a severe reaction over the entire, twelve-year vaccine schedule is about 1 in 2600,” I can’t help but note that we’re now in the range of the likelihood of a child with measles dying due to this disease in the United states. To Bob, the risk of these vaccine injuries is unacceptable, but a similar or much higher risk of death if a child catches the measles is just the cost of doing antivaccine business. According to Dr. Bob, yes, sooner or later a child is going to die of the measles—and won’t that be so tragic?—but it’ll likely only be one.

Hypocrisy, thy name is Bob Sears.

If Bob Sears weren’t such a worthless excuse for a pediatrician when it comes to promoting misinformation about vaccines, I’d almost feel sorry for him. Almost. He is, however, a perfect example of what the phrase “hoist with his own petard” means. Dr. Bob has for years made a profitable career for himself as the “reasonable” face of the vaccine-averse, painting himself as not like all those other loony antivaccinationists out there but rather as a reasonable pediatrician taking a “middle way” and “listening to parents.” Now the consequences of the ideas Dr. Bob has promoted are starting to become apparent, with measles outbreaks becoming increasingly common right on his home turf, leading the parents of his patients to ask him what to do now that the low vaccine uptake encouraged by him are facilitating measles outbreaks like the most recent one in Disneyland. They are asking him for guidance, and he’s fobbing off the responsibility on them, telling them just to “get the vaccine” and if you “don’t want the vaccine, accept the risk.” Nice.

Apparently Dr. Bob hit a nerve. Or, more accurately, the bloggers and writers criticizing him hit a nerve in Dr. Bob. I say this because yesterday, Dr. Bob took to Facebook again to whine, whine, whine. He wrote a post entitled a bitter and sarcastic PUBLIC SERVICE ANNOUNCEMENT: GET YOUR VACCINE. Compared to Dr. Bob’s first little rant, in this new little rant, Dr. Bob comes off as a petulant child, annoyed that anyone would question him. As with his first post, I’ll reprint this one in full as well, in case Dr. Bob decides to send this embarrassment down the old memory hole. First, here’s the post:

Now here’s the full text:

So, I broke one of the cardinal rules of infectious disease journalism, a rule that I didn’t know existed, but in hindsight is now as obvious as the nose on my face (ya, I was teased a lot about that as a kid). Apparently, the rule is this: When one writes anything about a vaccine-preventable disease, one MUST, without fail, include a statement reminding people to get that vaccine; failure to do so will be interpreted as a declaration against said (or NOT said, I guess) vaccine. People are generally stupid, so one must remind them frequently about vaccines.

So, when I posted a very brief discussion of the disease measles on Friday, which, in no way, claimed to be a complete discussion of all the issues, but failed to remind people there’s a vaccine (because everyone probably forgot about the vaccine, I know), what I was really saying in secret, if you read between the lines, is “don’t get the vaccine.” At least, that’s how stupid people took it.

I know I know. My mom taught me never to use the “S” word. But isn’t it ok to use when people really are stupid? I don’t know. You decide. Oh, and since I did mention the “M” word in this post, let me also remind everyone that there is a vaccine against measles. Get it.

Oh, and just to be complete, since I mentioned the “S” disease as well, let me remind you that there is a vaccine to prevent stupid. If you haven’t gotten it already, you should.

One wonders whether Dr. Bob would like some cheese with his whine.

Really, if Dr. Bob wants to learn how to be sarcastic without being petulant and whiny, Orac can teach him. It’s the very essence of not-so-Respectful Insolence, when required. And, boy, does Dr. Bob require it. Think about it. Dr. Bob is upset that he’s been called to task for not having recommended the MMR vaccine in the midst of an outbreak of measles! Seriously. Is it possible for a pediatrician to be more irresponsible?

Is it also possible for anyone to build a bigger straw man and then set it aflame with, yes, burning stupid? Here’s a hint for Dr. Bob. We didn’t interpret your little rant last week as telling people not to get the vaccine. We interpreted it (quite rightly) as a pathetic attempt to convince people that the vaccine is irrelevant because measles isn’t such a bad disease. Dr. Bob tried his very hardest to convince his readers that measles is just a mild childhood disease that can’t hurt the offspring of the oh-so-painfully health conscious parents who bring their children to him, those “well-nourished” kids who couldn’t possibly suffer the worst complications of measles, such as pneumonia, encephalitis, and even death. As you saw above, for Dr. Bob, those complications aren’t for well-off white crunchy residents of his southern California bastion. Oh, no. Only those “other” (usually brown) people get it.

Because, you know, ear infections and pneumonia are the same. “Ya, you don’t want those things to happen, but they are treatable.”

Dr. Bob’s arrogance is also monumental. Think about it. He’s basically calling everyone who to him “misinterpreted” what he said stupid. One would think that Dr. Bob would remember the first rule of being a writer: If your readers “misinterpret” what you say, first look to yourself. Don’t blame the reader first. Consider first and foremost the possibility that didn’t write it well enough or clearly enough. Nine times out of ten, it’s the writer’s fault if so many readers misunderstand his message.I try to live by that rule. If I write something that’s widely misunderstood, something whose message clearly doesn’t get through, the first person I blame is myself. If you can’t get your message across clearly, you aren’t a good writer.

Dr. Bob is not a good writer. Yes, it’s extreme arrogance on his part to blame his readers first for not understanding the spectacular wisdom you think he’s imparting to them. I realize that Dr. Bob thinks his post was tongue-in-cheek, but, as any decent writer knows, doing satire (or even just a tongue-in-cheek article) is hard. It’s difficult to do it so that it doesn’t come off as whiny or excessively sarcastic. Dr. Bob just couldn’t pull it off.

Of course, Dr. Bob’s real problem is that his critics, including myself, understood his message all too well. In fact, his failure to mention the measles vaccine at all in his post last week was very, very telling. Indeed, if you take last week’s post by Dr. Bob in context with his previous writings, it’s very clear what he meant. After having dismissed his patients’ parents’ concerns about measles outbreaks earlier this year basically by telling them to “get the damned vaccine if you’re worried” and then to shut up and take the risk if you don’t, Dr. Bob’s doing everything he could to argue that in the US the measles is no big deal made his intent very clear, particularly when, as he realizes this week, he also failed to encourage his readers in the least to get the vaccine in the middle of a measles outbreak.

Overall, the message wasn’t so much that children shouldn’t get the vaccine. Rather, the message was that the vaccine doesn’t matter because measles isn’t so bad. This was an incredibly irresponsible message in the middle of an outbreak, and any pediatrician who makes such an argument is a crappy pediatrician. It’s tempting to throw it back at him and conclude that Dr. Bob is stupid, but I know that he’s not. He’s made his bed, and now he has to lie in it. The reason skeptics and practitioners of science-based medicine view him as antivaccine is because his every public utterance tell us that he is.