It’s not a secret to anyone who reads this blog that I have an incredibly low opinion of celebrity pediatricians who are, if not outright antivaccine, antivaccine-sympathetic or leaning antivaccine and use their authority as physicians to sow fear, uncertainty, and doubt (FUD) about vaccines. Without a doubt, chief among these pediatricians in this country right now is “Dr. Bob” Sears, author of The Vaccine Book: Making the Right Decision for Your Child. His book is a veritable object lesson in how to pander to the fears of vaccine-averse parents and make them feel special and superior for “thinking for themselves” and not going along with the “herd,” while basically advocating sponging off of herd immunity (or to “hide in the herd,” as he put it) while refusing to take even the tiny risk from vaccines to contribute to that herd immunity. He even tells antivaccine parents not to tell other parents about their fears, “lest too many parents develop similar fears.” If that isn’t a cynical example of pandering, I don’t know what is.
More recently, in the wake of the Disneyland measles outbreak, Dr. Bob has been doubling down on his antivaccine tendencies to reveal himself to be truly antivaccine, showing himself to be the master of the antivaccine dog whistle. When California bill SB 277, which would eliminate non-medical exemptions to school vaccine mandates, was introduced, Dr. Bob basically lost it and gave up all pretense of being provaccine, as he spread misinformation about vaccine cloaked in conservative/libertarian “health freedom” rhetoric. He became a prominent opponent of the bill. As the bill gained steam in the California legislature and its passage took on the air of inevitability, Dr. Bob became more and more radical, even to the point of going full Godwin over the law, likening it to the Holocaust. The odd thing is that, after the law finally passed, because all a parent needs under the for a medical exemption to school vaccine mandates is for a doctor to write a letter, Dr. Bob was in an excellent position to profit from the law by selling medical exemptions. This he rapidly proceeded do where he could. He also gave parents advice on how to avoid or bypass the requirement.
That is when last we left Dr. Bob, but what’s he’s been up to lately?
Well, a little over a week ago, Dr. Bob Sears and Melissa Floyd launched an antivaccine website the Immunity Education Group. I had never heard of Melissa Floyd before, although she has been mentioned in the comments of this blog before. She bills herself as a “data analyst” and testified in front of the California Assembly in opposition to SB 277 as a spokeswoman for the California Coalition for Health Choice (website). That in and of itself is not a good sign. It’s also odd that Dr. Bob would align himself with someone so blatantly antivaccine. Or maybe it’s not. This particular project could cause glasses to shatter all over California, so powerful are its antivaccine dog whistles:
It’s not just about what’s right… it’s about your right.
We support vaccination as an important and useful public health measure and acknowledge the benefits which vaccines have afforded us by reducing or eliminating many serious diseases. Yet, many concerned citizens do not want any medical interventions to become mandatory for the public, whether it be immunizations, psychiatric medications, antibiotics, or invasive medical procedures. Medicine is always a free choice, and informed consent is a right guaranteed by every international organization. American families are entitled to this right, and parents should always retain the right to make medical decisions for their children.
As I’ve said more times than I can recall, this is dog whistling, pure and simple. Notice the high-sounding rhetoric about “freedom,” “free choice,” “informed consent,” and, above all, “parental rights” to make medical decisions for their children. Note how Floyd and Dr. Bob state that parents should always retain the right to make medical decisions for their children. Alway? By their logic, children with cancer whose parents refuse to continue to treat them with life-saving chemotherapy should be allowed to make that choice, and Christian Scientists and other radical religions that eschew medicine in favor of the healing power of prayer should be allowed to treat diabetic ketoacidosis and pneumonia with prayer. Or what about parents who choose “natural remedies” over effective medicine, resulting in their child’s death? I doubt that they mean that. At least, I hope they don’t. However, I fear that they really do believe that children are, in essence, the parents’ property and their parental rights are absolute. They are not, even though conservative-leaning politicians speak as though they are.
The Immunity Education Group claims they are pro-vaccine (of course). So are they? What are they saying? What are they doing? What happens with the rubber hits the road? So I decided to look at the IEG Facebook page and at Dr. Bob’s page to see what’s been going on over the last month and a half. The first thing I noticed is that a couple of weeks ago Dr. Bob updated his suggested strategy for “navigating the new California mandatory vaccination law” (which it isn’t, given that no one’s forcing children to be vaccinated against their parents’ will. It’s basically a rehash of the disingenuous to dishonest advice Dr. Bob gave (and I deconstructed) in July, longer and more detailed. Clearly it’s his talking points that he’s developed since the bill passed. Here’s the dishonest part (well, one of the dishonest parts):
Bottom line, it is imperative that all families and doctors operate within the guidelines of the law and the standard of medical care. I would say that at this time there is no certain medical standard of care on this issue. That will evolve over time. We can all work together on this. There’s no reason whatsoever to go outside of the law, no matter how angry you are.
Here’s the problem. There is a standard of care. Every pediatrician (well, apparently every pediatrician other than antivaccine pediatricians like Dr. Bob) knows that. As an aside, it’s truly depressing to note that a Google search for “vaccine medical exemptions” turned up mostly antivaccine websites on the first page, although I was happy to see that this post by me was also there. There are generally three general classes of medical reasons for exempting a child from vaccinations:
- The child’s immune status is compromised by a permanent or temporary condition (i.e., the child is immunosuppressed, as by cancer chemotherapy). This is, however, only a contraindication for attenuated live virus vaccines; vaccines without live virus are not contraindicated in this situation.
- The child has a serious allergy to a vaccine component.
- The child has had a prior serious adverse event related to vaccination.
That’s pretty much it. Dr. Bob—shall we say—is quite creative at expanding that list.
Perusing the IEG Facebook page, I’m struck at how much it resembles other wretched hives of scum and antivaccine quackery, like Age of Autism, only toned down a bit. (The purpose of the group is, after all, seemingly political, and it would not do to look too loony.) For instance, IEG claims that the medical community denies that vaccine reactions happen, which is nonsense. The problem IEG has with what the medical community says has nothing to do with the medical community “denying” vaccine injuries. Rather, health issues that the antivaccine movement attributes to “vaccine reactions” are not in fact due to vaccines. I’m referring, of course, to autism, autoimmune diseases, sudden infant death syndrome, and other conditions that antivaccinationists routinely blame on vaccines despite a notable lack of evidence that they are actually due to vaccines. There are, of course, the usual dog whistles, posts with titles like MANDATORY VACCINATION: IS IT AN ISSUE OF PARENTAL RIGHTS OR THE RIGHTNESS OF VACCINES? (Nice all caps. Really grabs my attention.) Then there’s antivaccine propaganda from SafeMinds (search this blog if you are not convinced that SafeMinds is an antivaccine group). Disturbingly, there’s also a post gloating over how Assembly Bill 1117 died in committee. AB 1117 is a bill that would have given financial incentives through Medi-Cal to doctors who fully vaccinate their Medi-Cal covered patients by age 2. Yes, IEG objects to a plan that would encourage vaccination.
Most telling (to me at least, and also to Karen Ernst) is a post entitled CDC PRESS CONFERENCE: ARE THEY STIRRING UP A “WHICH” HUNT? First, let me just reiterate (I’ve been Tweeting about this and mentioning it on Facebook) that whenever I hear the term “witch hunt,” my skeptical antennae start twitching furiously, word play or not.
As I put it, “witch hunt” = criticism of someone I agree with and/or like for statements and/or behavior I agree with (or at least don’t disapprove of).
Contrast that to: Justified criticism = criticism of someone I disagree with and/or dislike for statements and/or behavior I disagree with and/or disapprove of.
In any case, the term “witch hunt” has become so commonplace, so devalued, and so casually thrown around to describe things that are not remotely on that level that it has become as meaningless as the use of the word “liberal” as an epithet. Dr. Bob’s use of it is no exception. First, he demonstrates his utter statistical ignorance through the questions he asked about a recent CDC teleconference:
The few items of interest in the CDC survey of 4 million kindergarteners from the 2014/2015 school year were these:
– The nationwide median vaccine exemption rate was 1.7% (exemptions for any and all reasons, including kids who were only missing one dose)
– The state with the lowest rate was Mississippi (0.1%) because they don’t have personal or religious exemptions – only medical; Idaho had the highest rate of 6.5%.
– MMR median vaccination rate for both doses was 94%
What does the word “median” mean? It’s not the same as “average.” Median just applies to the very middle number in a long list of numbers. So, the CDC didn’t actually report what the “average” exemption rate or the rate of MMR vaccination is. Why not? Why use the median, number, which doesn’t really tell us anything? Is the average higher or lower? That’s the useful number.
Seriously, how did this idiot get through medical school? How does he even function as a doctor? Certainly, he must not be able to evaluate what is and is not a good study. (That much is obvious any time he discusses science.) Dr. Bob, get thee hence to read this and this. After all, the mean and median are two of the most basic concepts in all of statistics, and if you can’t understand why one is more appropriate than others in different situations, you are incapable of intelligently discussing statistics and should just withdraw from such debates to avoid the sheer embarrassment.
Yes, the mean is the average, and the median is the “middle number” in a dataset. Both are designed to measure what is known as the “central tendency.” If you have a nice, symmetrical dataset following the classic bell-shaped (Gaussian) distribution, the mean and median will be the same, or at least close to the same. When the data values are clustered towards one end of their range and/or if there are extreme values (i.e., the data are skewed), the mean and median will be different. In this case, the average can be excessively influenced by a few outliers, making it less representative of the the majority of values than the mean. This is frequently true of datasets close to zero that consist of only positive numbers (such as vaccine exemption rates). There can be no values under zero (at least not meaningful ones) and the values above the mean often have a “long tail,” much longer than the tail can possibly be for the values below the mean. Under these circumstances, the median frequently provides a better representation of central tendency than average. It’s the same reason we often use median survival rather than mean survival for cancer studies; there is frequently a long “tail,” and the data are anything but Gaussian.
Jeez. I can’t believe that it’s even necessary to explain this to a fellow physician! The distributions the CDC was discussing were almost certainly highly skewed; hence, the median is a far better descriptor of central tendency.
Dr. Bob’s statistical illiteracy aside, why is he disturbed by this? I’m going to quote liberally:
But instead of only presenting data, the CDC took the opportunity to shell out some well-crafted propaganda with this statement: Parents should find out their local exemption levels to better understand where the pockets of unvaccinated children are that leave communities vulnerable. Sounded benign enough at the time. Even when I heard the questions from what they tried to portray as a randomly selected group of reporters (Associated Press, Wall Street Journal, ABC News, AAP News, and NBC), I didn’t quite get what was happening.
This morning, as I look back at my notes, and write this article, their true agenda becomes plain as day, and I have a sick feeling in the pit of my stomach. Here are the press questions which I now realize are way too coordinated and orchestrated to just be random thoughts from reporters, almost as it they were actually pre-planned (which I’m sure is not the case, right?). Instead of asking about data, vaccines, or infectious diseases, the reporter thoughtfully asked this:
– If parents were to get a hold of their local vaccine exemption data, what would they do with that information?
– Will states share exemption data with parents?
– Why doesn’t the CDC post state-by-state local exemption data for parents to see?
Do you see it now? This press conference wasn’t about disease information; it’s the beginning of a hunt for pockets of vulnerability. And, I gotta hand it to them, the CDC’s answer was sheer brilliance. “No, we’re not the bad guys. We won’t share the data. School vaccine laws and sharing exemption information is a STATE and local matter. We’re are staying out of that.” The quotes are my paraphrase of the CDC answer. But the CDC wrapped it up this this statement (my quotes again, but it’s almost word for word):
“We encourage parents to find out their local vaccine exemption levels so that they can work together to help everyone do what’s good for their community.” Yes, they actually said that. It sounded so righteous, useful, and proper yesterday. But when you look at the whole picture, I worry that it’s a portend of what’s to come.
Methinks Dr. Bob meant “portent,” as in the title of one of the better episodes in season one of Babylon 5.
Yes, Dr. Bob is worried about a “witch hunt,” which he, erroneously thinking his wordplay is clever, characterizes as a “which hunt,” as in which children are vaccinated and which are not. It’s all of a piece with his previously going full Godwin about SB 277 and predicting the coming of a modern day equivalent of the Jewish Star of David that Jews had to wear in Nazi Germany and its occupied lands, only this time to identify unvaccinated children. It’s as full of hyperbole as it is of risible ridiculousness.
In actuality, the real reason Dr. Bob doesn’t want district-, city-, and school-level vaccine exemption rates to be publicized is because such data will identify the pockets of Dr. Bob’s patients (and the patients of other antivaccine-friendly pediatricians like Dr. Bob) for all to see and thus potentially result in public pressure to bring the rates down. It’s also an unfounded fear, given that 21 states already tally numbers like these and I have yet to hear of mobs of pro-vaccine parents heading to schools and districts with high vacine exemption rates with pitchforks to round up nonvaccinating parents. I’m not even sure I’ve heard reports of even serious public shaming, especially since the data are collected in such a way that unvaccinated children can’t be identified. Heck, California has been publishing these data in such a way that researchers have been able to put together impressive comprehensive spatial maps of where pockets of low vaccine uptake are.
Sadly, Dr. Bob is as good at double-talk as he is bad at statistics, as Karen Ernst demonstrates so well. Give him time. He’ll become the new Andrew Wakefield. No, he’ll become the new “legitimate” Andrew Wakefield. He’s incapable of doing research even incompetently done; so you won’t see any retracted Lancet papers from Dr. Bob. You will, however, see Dr. Bob being increasingly blatant about aligning himself with hard core antivaccinationists.