“Dr. Bob” Sears: Perfecting the art of the antivaccine dog whistle

Dog_whistle

Oh, no, here we go again.

In fact, before I get started, I feel obligated to show this clip, saying, just when I thought I was out, they pull me back in again:

Yes, I know I’ve used this clip on multiple occasions before over years. However, sometimes it’s just so completely appropriate to how I’m feeling about a topic I’m about to write about that I just don’t care and have to use it again. This is one of those times. I’m referring, of course, to Robert, “Dr. Bob” Sears, MD, the antivaccine-friendly (if not fully antivaccine) pediatrician from Capistrano Beach who has lately been digging himself in deeper and deeper over the rapidly expanding Disneyland measles outbreak that started over the holidays. I’ve been hitting the topic of the Disneyland measles outbreak fast and furious over the past, both here and at my not-so-super-secret other blog, that, quite frankly, I was getting tired of it, particularly after Dr. Bob’s petulant whine the other day in which he complained about how mean skeptics have been to him over his utterly inane mutterings on his Facebook page trying to “reassure” his patients that the measles just isn’t that bad a disease. (Wrong.) I was looking for a nice bit of tasty quackery to deconstruct or a good scientific study to write about, when people started sending links to this post on Facebook:

Here we go again. I figured I might as well just give in and finish out the week on this topic. I can start fresh next week.

And, yes, that’s Dr. Bob, who had just written a sarcastic diatribe against “stupid people” that tried to be tongue-in-cheek but failed utterly, seriously entitling his post: WHEN WE STOP LISTENING TO EACH OTHER, WE LOSE OUR HUMANITY. One of my readers who sent it to me told he recommended vodka while reading it. Unfortunately, I have to give a talk and lead a workshop discussion tomorrow morning. Even though the groundwork and slides are done, vodka tonight is out of the question. So I settled for a nice brown ale. Very refreshing, and perfect for a cold winter night. So join me as we wade in. Because this is one of Dr. Bob’s longest posts ever, I’m only going to selectively quote from it, unlike past posts, where I quoted the whole thing. Sorry, people who don’t have Facebook accounts.

First off, he tries to position himself as the voice of reason telling people to “calm the F- down!”, the Rodney King lamenting, “Can’t we all just get a long?” Try to keep the rising tide of bile in your stomach from getting past your epiglottis as you read this opening volley:

Why does the vaccine debate have to get so ugly? Why are some people on both sides of the issue so harsh to each other? Why can’t we all just get along? If the Beatles were still around, I’m sure they’d write a song. I don’t know if they’d call it “We All Live in Two Separate Submarines” or “Lucy in the Sky With Red Spots All Over.” Whatever it would be, the chorus would include “Everybody Calm the #$*@%!& Down.”

If both sides could calm down and start listening to each other, everybody would be able to get along.

Sadly, no. No, we probably wouldn’t. The reason is simple and is known as irreconcilable differences. You see, we on the pro-vaccine side have listened to the antivaccine side. We’ve listened to them ad nauseam. The problem is that, nearly always, they’re spouting pseudoscientific quackery that is completely resistant to evidence, science, and reason. Indeed, that’s why I, at least, no longer even attempt to persuade the hard core antivaccinationists. Doing so is simply an exercise in frustration, every bit as much as trying to deprogram a cult member. What I hope to do, and have had some success at times in doing, is persuading the fence sitters, parents who have heard the pseudoscience of the antivaccine movement and have become frightened enough to consider not vaccinating. The idea is to counter the pseudoscience, not to win friends and influence people among the antivaccine movement.

The most frustrating thing about Dr. Bob’s little invitation to join hands and sing Kumbaya is that there are parts where he shows just glimmer of actual insight but just can’t bring himself to take the next step. To be honest, it’s hard for me to tell if this is just posturing on his part or if it’s really what he believes. Probably a little of both, but I can’t tell which is which. In fact, he states bluntly that “I firmly believe that vaccines do work” and “they do provide immunity.” He even says, “I do believe that vaccination is immunization.” So far so good. Then he immediately bends over backwards to emphasize how “imperfect” this immunity is:

I don’t believe it’s perfect immunity, and neither does anybody else on the pro-vax side. Some vaccines provide a very high level of immunity, like 99%. Some really suck, like this year’s flu shot. DTaP vaccine is somewhere in between – maybe 85 to 90%, but it wanes quickly. To say that vaccines don’t work at all is incorrect, in my opinion.

OK, so different vaccines have different efficacies, and this year’s flu vaccine is a bit of a dud compared to past years. We know this. Dr. Bob even recognizes the reason why antivaccine activists try to downplay the efficacy of vaccines:

How do anti-vaxers attack these goals? By claiming that vaccines don’t work. If vaccines don’t work, then all the pro-vaxer attempts at disease prevention are fruitless, and the anti-vaxers don’t pose any risk because the vaccines they didn’t get wouldn’t have helped anyway. This makes pro-vaxers understandably angry.

So what does Dr. Bob do? He invokes the fallacy of the Golden Mean, in which it is assumed that the correct answer to a controversy always lies somewhere between the two extreme views, although he does it by casting doubt on the efficacy of vaccines, just not as badly as antivaccinationists do:

But what’s tough is that some vaccines wear off quickly, within just a few years, as is the case with the whooping cough portion of the DTaP. Many 4 to 5 year olds are susceptible before they get the booster, and many 8 to 11 year olds even more so. That doesn’t mean the vaccine doesn’t work well for a couple to three years after the initial series and each booster. To say that vaccines don’t work doesn’t accomplish anything useful, in my opinion. I’ve studied so much data that show vaccines work, and I am convinced. That’s why I offer them in my office. If I didn’t think they worked, I wouldn’t bother.

He’s actually fairly clever here, but he might be too clever by half. He’s saying that vaccines work, in the hopes that those supporting science-based medicine will take him seriously and think that perhaps he’s not an antivaccinationist after all. At the same time, he’s casting doubt on the efficacy of vaccines by emphasizing the shortcomings of certain vaccines. It’s basically an antivaccine dog whistle, a notice to his antivaccine patients that he’s really one of them, regardless of what he said earlier in his post.

He then reinforces his identification with the antivaccine movement by saying that most of them, like him, believe vaccines work too. The real reason they are hesitant, according to him, is because they “aren’t willing to risk the side effects, but they do acknowledge that they at least work.” Of course, at this point, someone making an honest effort to understand both sides would point out here that the risks of vaccines are so infinitesimally tiny that it simply makes no sense not to vaccinate. He doesn’t go there. Instead, he says that severe vaccine reactions are rare while implying that maybe they’re not so rare after all. First up:

Now for the other side, because there are always two sides. How do the non-vaxers feel? I think that their number one issue is this: They want a choice. They don’t want to be forced into a medical treatment they are not comfortable with. That’s probably the number one freedom that they want preserved. IF vaccines were 100% harmless to every single person that got them, I think that we could insist on vaccination. BUT because they are not, because occasional severe and even fatal vaccine reactions do happen, it is unethical to force them on anyone. Yes, I know they are safe for MOST people, but not for all.

Of course, what is totally lacking here is any sort of risk-benefit consideration. By any conceivable stretch of the imagination, vaccines are far safer than the risk of illness. Moreover, Dr. Bob misrepresents the situation. He describes “forced vaccination,” but there is no such thing as forced vaccination in this country. Really, there isn’t. There are vaccine mandates that require certain vaccinations before children are allowed in school or day care, and these serve a very reasonable societal purpose, namely to prevent outbreaks in institutions where lots of children are packed together. Non-vaccinators or antivaccinationists don’t have to vaccinate, but their children pay a price. They can’t attend school or be in day care. Of course, these vaccine mandates are more porous than the average sponge, the rise of religious and “personal belief” exemptions having made not vaccinating and still getting your kid into school as easy as signing a form in some states, but antivaccinationists object to even these often toothless mandates. And Dr. Bob, through his use of another antivaccine dog whistle (“forced vaccination” instead of “school vaccine mandate”) and painting the issue as one of personal freedom, just as many antivaccinationists do, is letting antivaccinationists know that he’s really one of them.

To hammer that point home, Dr. Bob immediately starts harping on the risks of vaccination. He does it in a manner that uses another antivaccine dog whistle, in which he says these reactions are “rare, but…” This is then interspersed with claims that it is really doctors who are close-minded because they were raised not to believe that serious vaccine reactions even exist! I kid you not!

Behold:

Back in the 70s and 80s, when severe (but rare) vaccine reactions began to be reported, victims were crying out for help and no one was listening. The medical community was in complete denial that severe vaccine reactions were even possible. These victims were ignored. A generation of doctors were trained that severe vaccine reactions can’t happen. So, it’s taken many many years, but now almost everyone in the medical community agrees that they CAN happen. They aren’t common, but they can happen. They are still some naysayers, however, who use pseudoscience to demonstrate that those who have severe vaccine reactions have genetic problems which would have eventually caused the same problems anyway, given time. The vaccine just happened to trigger the problem sooner, or triggered it coincidentally. Yet the vaccine isn’t the cause. So, these naysayers continue to make victims and their families angry and up in arms. Those doctors are the minority, but they are a vocal minority, and families are worried that more and more doctors will once again believe that severe vaccine reactions can’t happen. And, will that lead to forced universal vaccination? Such parents are worried it will. So, families who feel their children are victims of a vaccine reaction will continue to be very vocal, as they should be. As long as the right to choose is threatened, which it currently is in the back rooms of the legislatures in most states, vocal anti-vax parents will continue to fight back.

So many antivaccine dogwhistles, so little time. That bit about “genetic problems which would have eventually caused the same problems anyway, given time”? That’s a straw man argument aimed at discussions of the Hannah Poling case and mitochondrial disorders and/or at Jasmine Renata, a young woman who died after the HPV vaccine, almost certainly due to an inherited cardiac conduction problem. Doctors who are “trained that severe vaccine reactions can’t happen”? He’s almost certainly referring to pro-vaccine champions like Dr. Paul Offit, caricaturing their views beyond recognition. Straw men this enormous can be seen from space when set aflame with burning stupid, and set this straw man ablaze Dr. Bob does, after which he then repeats the antivaccine dog whistle about “forced universal vaccination.” His empathy with the paranoid fears of antivaccinationists that there will soon be jack booted thugs from the government coming to vaccinate their children against their will is the loudest blowing on the whistle yet, particularly when coupled with his reference to nefarious secret cabals meeting in the back rooms of state legislatures.

Dr. Bob then asks how “pro-vaxers” can respond (rhetorically, of course), and answers the question by telling them, “Acknowledge that bad vaccine reactions can happen, that’s how. Stop trying to tell these parents and their children they are wrong. Have a little empathy.” More dog whistling. “Pro-vaxers” do acknowledge that bad vaccine reactions can happen.” The problem is that “bad vaccine reactions” do not constitute what antivaccinationists claim they do. They do not include autism. They do not include neurodevelopmental disorders. They do not include most of the evils attributed to vaccines by antivaccinationists. The vast majority of claimed cases of “vaccine injury” are not, in fact, actually due to vaccines. Certainly, as I’ve documented more times than I can remember, “vaccine injury” does not encompass autism, but most antivaccinationists believe that it does. Another whistle sounds when Dr. Bob dismisses the “pro-vax vocal minority” who won’t “have a heart” or show empathy. He even tries to turn the pro-vaccine against each other by trying to urge the “quiet, majority pro-vaxers” to “get louder about it.”

Yeah, that’ll work.

At the end, while seeming “reasonable,” Dr. Bob keeps those antivaccine dog whistles blowing. In fact, in the end, he goes a bit beyond that, making it very clear where his sympathies lie. He tries to accuse “vaxers” of a double standard in which they lambaste antivaccinationists for “hiding in the herd” (Dr. Bob’s term is appropriate here), taking no risk but gaining the benefit of herd immunity, as though “pro-vaxers” actually claim vaccines have no risks. I have never seen such a claim. I have only seen explanations why what antivaccinationists consider to be “vaccine injury” are not. Yet, Dr. Bob twists that into a straw man and then twists it again into a straw man pretzel saying that “pro-vaxers” claim there is no such thing as a vaccine injury. It is intellectual dishonesty more naked than even most antivaccine loons.

It’s also a cynical appeal to “rights” that all antivaccinationists who use it know will appeal to Americans:

A final bit of food for thought. Let’s talk about rights. Which right is more important, the right to not get sick with a disease or the right to make health care decisions for yourself and your child? The way I see it, the diseases were here first. They are ubiquitous to our world. Whether created by God or by evolution, they are here. They are the status quo. Because we have invented a medical treatment to try to change the status quo, yet that treatment can cause harm to a very small percentage of people, it is my belief that we shouldn’t force anyone into accepting this treatment. Life happens, death happens. It’s terribly tragic when death happens before it’s time. Nobody wants anyone to die. And no one wants their child to suffer a severe vaccine reaction. So, it is my opinion that ethically speaking, we must give precedence to what the status quo was or is, that diseases exist and cause some casualties, and those who decide they want to take part in the disease prevention can enter into vaccinations by their own free choice.

The stupid, it burns. It goes beyond setting a gargantuan straw man aflame with burning stupid into the realm of forming a black hole of stupid so dense that all medical knowledge threatens to be sucked in beyond its event horizon.

To call this thinking “muddled” is to be far too kind, the naturalistic fallacy at its most mind-meltingly boneheaded. Dr. Bob is seriously arguing that, because the bacteria and viruses that cause diseases were “here first” they are the status quo, and that ethically we must give precedence to the status quo? On what planet? The exact same “logic” (such as it is) could be used to justify letting parents fail to obtain medical care for their children for treatable diseases because, you know, those bacteria that caused the children’s pneumonia were there before us and penicillins and some other antibiotics demonstrably cause severe allergic reactions in a small number of children. Besides, by Dr. Bob’s “logic,” those bacteria causing pneumonia are the status quo. Life happens. Death happens. Shit happens. No big whoop. Time is a flat circle.

Dr. Bob probably thinks this is profound. It’s anything but. He is, however, as always, a master of the antivaccine dog whistle.