The Israel Ministry of Health cracks down on antivaccine doctors

One thing I’ve never been able to understand is how an actual physician can be antivaccine. In particular, I can’t understand how pediatricians can be antivaccine. The science is so overwhelming that vaccines are safe and effective and do not cause autism, autoimmune diseases, diabetes, sudden infant death syndrome (SIDS), or any of the other evils for which antivaxers blame vaccines. It is also undeniable that vaccines are the single greatest triumph of preventative medicine ever devised by the human mind and have saved countless humans from morbidity and death from infectious disease. A physician who is antivaccine clearly has a major flaw in his understanding of science, and a physician who acts on his antivaccine views by not recommending vaccinations and/or, even worse, diagnosing children with the fake diagnosis of “vaccine-injury,” “vaccine-induced autism,” etc. and treating them for it are quacks who should not be practicing medicine. That’s why I think the Israel Ministry of Health has the right idea:

Israel’s Health Ministry is considering taking significant steps against eight doctors who encourage their patients not to be vaccinated.

Four of the eight have already been summoned to the Health Ministry for clarifications and the other four are expected to be called in next month. Considering the cases of measles that have broken out in Israel, the Health Ministry has recently decided to ratchet up its fight for vaccinations, including exercising special powers. This has sparked a debate in the medical community around the question of how to protect public health without silencing legitimate minority opinions.

(I’ll quote fairly generously from this Haaretz article because it’s behind a paywall, although I could read it clicking on it from a Facebook link.)

I will admit that the bit about “legitimate minority opinions” irked me. Antivaccine pseudoscience is not a legitimate minority opinion, at least not from a medical perspective. It’s an opinion, but one so divorced from medicine, science, and reality as to have forfeited all right to be taken seriously. However, I’m all for investigating antivaccine doctors, however, particularly if they steer parents away from vaccinating. To me, that’s failing to practice according to the accepted standard of care So are the “treatments” for “vaccine injury” that many of them use as well. Indeed, these treatments are quackery. Any doctor who practices based on antivaccine beliefs should not be practicing medicine.

That’s why I agree wholeheartedly with this:

“As part of your work as a doctor you have made recommendations that go against the vaccination guidelines and even suggest postponing vaccinations,” attorney Eyal Hacco, joint chairman of a Health Ministry committee formed to prevent the public from being misled, wrote to the eight doctors. Hacco informed them that giving such advice, which goes against professional practices in Israel and the rest of the world, could put children, adults and those around them at risk, and that it “misleads the public and endangers health,” Hacco wrote.

I can’t help but note that in New York City is in the middle of its worst measles outbreak in decades. That outbreak is centered in communities of haredi, or ultra-Orthodox Jews, where:

Through the fall, traveler after traveler arrived in the ultra-Orthodox Jewish communities of New York from areas of Israel and Europe where measles was spreading. They then spent time in homes, schools and shops in communities where too many people were unvaccinated.

Within months, New York State was facing its most severe outbreak of the disease in decades, with 182 cases confirmed by Thursday, almost exclusively among ultra-Orthodox Jews. Health officials in New Jersey have reported 33 measles cases, mostly in Ocean County, driven by similar conditions.

In these communities, it’s reported that many are resistant to cooperating fully with health authorities and reporting promptly when someone falls ill. The outbreak among ultra-Orthodox Jewish enclaves in Brooklyn and other boroughs is related to vaccine hesitancy and antivaccine views in Israel as well. What’s driving the Israel Ministry of Health’s drive to crack down on antivaccine doctors is a major ongoing measles outbreak in Israel, where, not coincidentally, some of those travelers are traveling between New York and Israel. Indeed, last year there were 2,700 cases of measles, with over half the cases being in the Jerusalem region. There have been deaths, as well, such as the death of an 82 year old woman and a toddler infected by his parents. As in New York, the outbreak appears to be centered around in haredi communities.

The reasons why ultra-Orthodox Jews don’t vaccinate in Israel are more complex than in New York, with a shortage of pediatric nurses playing a major role:

But Dr. Hagai Levine, secretary of the Israel Measles Elimination Committee, attributed the outbreak in Israel mostly to a shortage of pediatric nurses and the complicated logistics of raising a large haredi family.

“There is nothing explicitly religious causing these outbreaks, and vaccination refusal is rare,” he emphasized.

Levine blamed the Israeli government, saying the number of nurses who provide health care in well-baby clinics, which give vaccinations and track children’s development through age 6, needs to be increased.

“In Jerusalem, where most of the measles cases are occurring, a nurse that used to treat 100 children is now responsible for 200 children. She doesn’t have the time to track down all the children whose vaccinations are overdue,” Levine said.

In Israel, ultra-Orthodox families average eight children and tend to live in close quarters, a perfect situation for the spread of a disease as highly contagious as measles. There are also different sects within haredi society, some of which vaccinate at a high rate, some of which refuse to vaccinate and don’t want any connection with the government. The outbreak is so bad that in November the CDC issued a level 1 travel alert urging travelers to Israel to make sure they are vaccinated with the MMR before traveling there.

In any event, the eight doctors being targeted by the Israel Ministry of Health were identified easily by complaints from other doctors, parents, and organizations that oppose the antivaccine movement based on behavior and social media posts, in other words, the same way you can identify antivaccine doctors here, such as “Dr. Bob” Sears and Dr. Paul Thomas. Who are these doctors? Surprise! Surprise! There be homeopaths here:

The eight doctors are the pediatrician and homeopath Dr. Chaim Rosenthal and his partner in a homeopathic and natural medicine clinic Dr. Nicole Ezrahi; pediatrician and homeopath Dr. Noa Tor-Frenkel; family doctor and homeopath Dr. Liora Uriel; pediatrician Dr. Yiftah Broza and pediatrician Dr. Amir Anisfeld; doctor and homeopath Dr. Boaz Ron; and Dr. Gil Yosef Shahar, the doctor and owner of the Rambam Medical Center.” One of the eight responded in writing to the summons pledging to refrain from further advising people against vaccination.

Dr. Noa Tor-Frenkel? Hmmm. I’ve heard that name before, or at least part of it. Remember Moshe Frenkel? He used to be faculty in the integrative medicine program at M.D. Anderson years back, but now he runs an “integrative oncology” practice in Texas. He was also big into homeopathy, having published during his time at M.D. Anderson a truly awful in vitro study of homeopathy and breast cancer and recently published a howler of an article, Is There a Role for Homeopathy in Cancer Care? Questions and Challenges, to which his answer was yes. I wonder if there’s a relationship.

One of the doctors tried to deny being antivaccine:

Dr. Rosenthal, who came to the ministry with his lawyer, called the atmosphere in the conversation “germane and fair.” Rosenthal said he wanted to make clear that he is not “among the ‘opponents of vaccination’ but rather the ‘cautious’ about vaccinations.” He stated: “I am neither for nor against. But I think that it is a very serious matter to inject babies with these materials and this requires caution. There is no truth here. There is study of the subject and a personal decision. I give my information and experience and I stress in every lecture or web post that it does not conform to the ministry guidelines. I say it is not backed up by research, but by my experience.”

Rosenthal said that he does not publish or disseminate his idea or lead public opinion on the matter. “Some of my lectures were recorded by participants and put on YouTube, and interviews in the media always came from media outlets that approached me; and never on my initiative,” he said.

Yes, this is the old, “I’m not antivaccine, but I say antivaccine things, like, “It is a very serious matter to inject babes with these materials and this requires caution.'” Then he offers what must be the Israeli version of the quack Miranda warning, “My views aren’t supported by science or the Israel Ministry of Health, but I think you should avoid vaccinating anyway based on my anecdotal experience clouded by confirmation bias.”

Of course, I can’t resist getting a dig in here at the Israel Ministry of Health for this:

“The damage that such doctors do is enormous, because their statements are perceived by the public as medically and scientifically valid because they are doctors,” a senior Health Ministry official told Haaretz. “In fact, they are doctors practicing homeopathy and in meetings we had with them they are unable to support their claims scientifically. Our mistake was not taking action against some of them two years ago already.”

They’re frikkin’ homeopaths! Of course, they can’t support what they do with science and evidence! Why are homeopaths being allowed to practice? I know, I know, they’re physicians, too, but any physician who is also a homeopath is by definition a quack in my book.

In any event, I’ve discussed doctors who are antivaccine on numerous occasions, and after all these years, I still can’t understand why such doctors exist. True, many of these doctors are not pediatricians, but some are, and they are the ones who provide plausible cover for antivaxers. It’s entirely appropriate for the Israel Ministry of Health to act against them. I just wish state medical boards in the US would do the same thing. Because of the First Amendment, they couldn’t stop these doctors from spewing their antivaccine misinformation, but they damned well could make sure that they don’t practice medicine based on it.