The L.A. Times: Painfully false balance on antivax pediatrician Dr Bob Sears

Over the last few years, I’ve occasionally made the observation that the news media have improved in their coverage of vaccine-related issues. Back in the day, nearly 15 years ago, news coverage of vaccine issues used to infuriate me, because the journalistic trope of “balance” über alles would invariably rear its ugly head, with some truly facepalm-worthy consequences. In nearly every article or news story, the reporter would feel somehow obligated to include the viewpoint from a prominent antivaxer, be it J.B. Handley (way back in the day), Jenny McCarthy (starting around 2007), or even the Big Kahuna of antivaccine pseudoscience himself, Andrew Wakefield. Let’s also not forget a very prominent antivaccine pediatrician, “Dr. Bob” Sears.

You probably know Dr. Sears as the author of The Vaccine Book: Making the Right Decision for Your Child. It’s a book, that, under the guise of offering a “reasonable” path between the CDC-recommended vaccine schedule and antivaxers refusing vaccines altogether, is in reality a book chock full of antivaccine misinformation, distortions of information, and pseudoscience that cashes in on fear. Let’s just put it this way. Dr. Sears is a man who adamantly denies being “antivaccine,” yet has gone full Godwin at least once over vaccines, referencing the Holocaust in describing SB 277, the California law that eliminated nonmedical “personal belief exemptions” to school vaccine mandates.

So it caused me extreme annoyance yesterday to see in the L.A. Times an article by Melody Gutierrez entitled, Dr. Bob Sears’ views on vaccines have inspired loyal followers — and a crush of criticism.

I could tell right away from the headline and the Twitter thread posted by the L.A. Times that the article was likely to be a cornucopia of false balance about antivaccine pseudoscience in general and the most definitely antivax Dr. Sears in particular. I held out a little hope, knowing that the reporter usually doesn’t write the headlines (the editor does), but that hope was quickly dashed in just the first four brief paragraphs:

Dr. Bob Sears sits at a worn wooden desk near a cushioned exam table designed for pediatric patients. The room has only a few other trappings — small molds of a child’s foot and hand, hanging from a wall — that suggest the routines of childhood. And there is nothing to suggest the notoriety that trails in his wake.

But this office is a hub in a nationwide movement that the medical establishment contends is a threat to public health. Sears’ practice caters to parents the public largely labels as anti-vaxxers, people who no longer trust the scientists, doctors or government representatives who say vaccines are safe and that the risk of disease is far greater than the chance of an adverse reaction.

Parents travel from across the state to Sears’ family practice in affluent Capistrano Beach, all of them paying out of pocket for checkups. Some of them believe that vaccines caused a sudden allergic reaction or neurological change in their children; others question whether they should delay the standard vaccination schedule — or ignore it altogether.

Sears gives these parents something they desperately crave — a kind smile and an acknowledgment that it’s OK for them to trust their intuition.

Yes, Gutierrez’s profile of Dr. Sears is just what the headline suggested that it would be: A “balanced” portrait of a “brave maverick” bucking the system that is chock full of false balance and in the end portrays him in a more positive than negative light. It’s festooned with photos of Dr. Sears smiling in his pediatrics office, looking over a patient’s chart pensively, and looking all serious-like staring into the camera, with a photo caption reading, “Dr. Bob Sears is beloved by patients who go to him for vaccine exemptions and is derided by many medical and public health officials.” I lost count of the number of times I face-palmed reading this article and can only hope that no one at work today asks me why my forehead is still so red and irritated. (Should I tell them it was because of all the facepalming, which kept happening as I typed this post up?)

The false balance continues as Gutierrez described Dr. Sears’ Vaccine Book:

Among the most controversial of the family’s endeavors is Dr. Bob’s bestseller “The Vaccine Book: Making the Right Decision for Your Child,” first published in 2007. In the book, Sears, who was first licensed to practice medicine in 1996, writes that parents who are leery about the number of shots their children receive in their first two years of life have more choices than most pediatricians offer.

Get the shots. Delay the shots. Or simply skip the shots. Just know the risks and make a decision that’s right for your family, Sears wrote. His mantra: It all comes down to parental choice.

“Every other vaccine book either gives you all the negatives about vaccines and tells you not to do them, or it gives you only the positives, with a little asterisk footnote about the negatives,” Sears said during an interview. “My book was the first neutral one and [it] allowed parents to kind of formulate their own decisions.”

The book offers an alternative schedule to vaccination, which, Sears argues, could decrease the likelihood that a baby’s immune system is overloaded. Sears contends there is not enough research on the long-term effects of the schedule recommended by the Centers for Disease Control and Prevention. He acknowledges, however, there is no medical research indicating his own schedule is safer.

See? Dr. Sears isn’t antivaccine? He’s just reasonable, unlike all those “vaccine zealots.” He’s willing to listen to parents’ concerns and basically do whatever they want, up to and including giving them a book based on his misinterpretation of science (or on no science at all) that has tormented science-based pediatricians for 12 years by giving vaccine-hesitant and antivaccine parents talking points to pepper their pediatricians at as they refuse to vaccinated their children.

Also in his book, Dr. Sears basically urged parents who don’t want to vaccinate to “hide in the herd,” telling parents who don’t vaccinate not to tell their neighbors about their fears of vaccines, lest those parents become afraid too and fail to vaccinate, leading to further degradation in herd immunity and increased risk of measles in the unvaccinated. Basically, Dr. Bob cynically urged vaccine-averse parents to mooch off the herd immunity maintained by those who do the responsible thing. Of course, the problem with that approach becomes obvious when vaccine uptake rates fall below levels needed to maintain herd immunity, as we are seeing in all too many communities today. As I asked at the time: What can Dr. Bob do when the herd becomes too thin to hide in anymore?

Perhaps what stood out to me about this article most of all is how Gutierrez seems to have downplayed the most damning aspects of Dr. Sears’ history. Yes, she mentions that the Medical Board of California had disciplined Dr. Sears and is currently investigating him again for writing dubious vaccine exemptions:

Sears is under investigation by the Medical Board of California for vaccine exemptions he wrote in 2016. That investigation, which was announced in June, comes as Sears is currently on a 35-month probation issued by the medical board for committing gross negligence, a decision made after Sears wrote a letter in a court case siding with the mother of a 2-year-old boy who did not want her child to receive any more vaccines over the objections of the father.

The mother in that 2014 case said her son went limp and couldn’t pass urine or stools after receiving shots at another doctor’s office. Sears said the judge in the case upheld his opinion, but the medical board said Sears failed to obtain “basic information necessary” to determine if the child should skip all future vaccines. Sears settled the case by accepting the probation, but did not admit wrongdoing.

Sears’ probationary status means that he must have another doctor review his files occasionally. But he’s still able to see patients and write medical exemptions to vaccines.

Too bad this critical piece of information about Dr. Sears isn’t mentioned until two-thirds to three-quarters of the way through the article. Waiting so long to mention that Dr. Sears is not only under medical board sanction but is being investigated yet again by the board only serves to feed the overall impression in the article that Dr. Sears is the “brave maverick” being persecuted by The Man for telling uncomfortable truths. It’s a false impression, of course, and Gutierrez probably didn’t intend it that way, but that’s sure how ti comes across.

Of course, as I’ve discussed many times before, Dr. Sears was one of the leaders in not only opposing SB 277 in California but in helping parents get around the law once it went into effect by writing dubious to bogus medical exemptions based on antivaccine pseudoscience rather than actual, scientifically and medically accepted indications for exemptions from school vaccine requirements. Basically, within a couple of months after Governor Jerry Brown signed the bill into law in 2015, Dr. Sears was already taking to Facebook to help explain how to get around the requirements of the law.

By 2016, he was on the antivax seminar circuit in California telling parents how to obtain medical exemptions, even appearing side-by-side with a homeopath pushing homeoprophylaxis for “immune boosting.” Homeopathy, of course, is so ridiculous that I like to refer to it as “The One Quackery To Rule Them All.” Around that time, a divorced parent whose wife had gotten medical exemptions for their children from Dr. Sears sent me copies of the exemption letters for both children. Basically, all his spouse had had to do to obtain it was to fill out an online history form and, of course, pay a fee of $180 per child. No wonder the medical board started looking into Dr. Sears’ practices, and—voilà!—Dr. Sears wrote medical exemption letters based on a family history of autoimmune disorders.

Ultimately, as the Gutierrez notes, Dr. Sears was disciplined by the Medical Board of California. His practice was put under supervision. This action didn’t just come about only because Dr. Sears had written a bogus medical exemption (although that was one of the complaints), as the case dated back to 2014, before SB 277 was even passed. In addition, the board found that Dr. Sears had also engaged in some mighty sloppy doctoring when he didn’t document a complete neurologic examination in a child with persistent headache after head trauma.

Oddly enough, although I knew about the new complaint against Dr. Sears from June this year, I never blogged about it. So let’s take a look:

In the case filed last week, the medical board said Sears issued improper exemptions for two siblings who were both seen by the doctor in May 2016, each with the chief complaint of “vaccine exemption.”

The first patient, a 7-year-old boy, suffered from psoriasis and had a family medical history of inflammatory bowel disease as well as autoimmune, psychiatric and neurodevelopmental disorders — none of which qualified the child to be excused from vaccinations for the duration of his childhood, according to the medical board.

The boy’s sister, whose age is not mentioned in the complaint, also received a vaccination exemption from Sears based on a review of her family’s medical history, and her own health, which involved having a bee sting allergy, a viral infection and feeding difficulties.

The board said the girl’s childhood-long vaccine exemption, which was based on her family history alone, was “a simple departure from the standard of care.”

I can’t be sure that these are the same children, but they sure sound like the children whose father had written to me about Dr. Bob’s issuing of medical exemptions. I remember having urged him to file a complaint to the Medical Board of California over how Dr. Sears treated his children and his having said that he already had filed such a complaint. Whether these are the same children or not, I’ll be very interested in the outcome of this particular case. (I’m also very curious why it took two years for the medical board to file charges.) It also has a bearing on SB 276, the California bill that would, if enacted into law, allow the California Department of Public Health to monitor medical exemption rates of schools and of doctors who issue more than a few of them a year, thus shining a light on doctors like Dr. Sears selling medical exemptions to antivaccine parents, who could then be investigated by the medical board.

Antivaxers hate this bill because state scrutiny would—shall we say?—discourage doctors like Dr. Sears from writing exemptions that are not medically or scientifically justified, and doctors like Dr. Sears hate it because it would cut of a lucrative revenue stream that they’ve been enjoying since SB 277 passed. To be fair, Gutierrez does allude to this, although not as bluntly as I just did, when she mentions that SB 276, if passed into law, would greatly affect how Dr. Sears practices, although she also included Dr. Sears denying that he would run afoul of the law.

But back to this horrible article. One useful tidbit of information in the article is that the whole Sears pediatrics brand is rotten to the core with antivaccine misinformation, at least if you believe what Dr. Sears says:

Sears said that at first, his father discouraged him from writing a book on vaccines, saying it was too controversial, but added that he “has come around now to pretty much agreeing with most of my ideas.” His brother Jim, Sears said, “semi-agrees quietly.”

Jim Sears said it can be difficult to see his brother cast as dangerous or self-serving. He said Bob is research-driven, often highlighting the latest study on general pediatric care and leaving it on Jim’s desk.

“I’m a little more sensitive to public opinion than him,” said Jim Sears, who is two years older than Bob but notes that his younger brother managed to finish medical school first. “He doesn’t care what people think.”

Jim Sears, who focuses on nutrition and weight loss, said it can be uncomfortable when someone approaches him at a public speaking event and confuses him for the vaccine book author.

“I have to correct them that I’m the TV doctor,” he said with a laugh.

If Dr. Jim Sears even just “semi-agrees” with his brother, he has no business being on a TV show dispensing health advice. As for “Dr. Bob” being “research driven,” I can only laugh. Being “research-driven” would involve actually paying attention to the totality of medical evidence and what it has led the pediatrics community to conclude about vaccines. What Dr. Sears does is not “research-driven,” except that you might say that it’s driven by “research” that is designed to fuel motivated reasoning by cherry picking studies that support his antivaccine fear mongering. Otherwise, he couldn’t say things like:

During the interview in his office, Sears said the vaccine can cause brain injuries and autoimmune diseases, making it “biologically plausible” that here is a link to autism. He added that research has neither proved nor disproved that vaccines can be attributed to an increase in autism rates. (Experts say the increase can be tied, in part, to greater awareness and changes in diagnostic criteria.)

Such assertions of a link, which stem from a now discredited paper co-written by Andrew Wakefield, a former British doctor, in 1998, have been widely refuted.

Offit said Sears uses language that incites fear, telling parents that science has yet to prove that vaccines don’t cause autism when there is no reason to believe that they do.

“You can never prove never … it’s not the way the scientific method is constructed,” Offit said. “So, [scientifically speaking] we can’t say MMR doesn’t cause autism, even though 18 studies in seven countries involving hundreds of thousands of children shows you are at no greater risk of getting autism if you got that vaccine or didn’t. People like Bob Sears take advantage of the fact that science can’t be definitive.”

Sears contends that Offit is stretching the limits of science.

“He’s right, the studies don’t demonstrate a link,” Sears said. “But he likes to conclude we know vaccines don’t cause autism and I like to conclude that we don’t know yet.”

Also note the infuriating way that Gutierrez has framed this whole conversation. She has presented Dr. Sears’ antivaccine pseudoscience as, in essence, equal to the statements of someone who is a real vaccine expert rather than a pseudoexpert, Dr. Paul Offit. She presents what Dr. Sears says; it’s refuted by Dr. Offit, and then she presents Dr. Sears’ response, letting him have Just because Dr. Sears finds something “plausible” does not make it so.

That being said, I would have explained it a bit differently that Dr. Offit. I would have pointed out that, yes, science can never absolutely, positively, 100% prove a negative, such as that vaccines don’t cause autism, but scientists sure as hell can provide an estimate of the likelihood of a causal relationship. In the case of vaccines and autism, the scientific evidence is of such a large quantity and quality involving so many children that the failure to find a “signal” suggesting a link between vaccines and autism is evidence sufficiently strong that we can confidently conclude that the likelihood that vaccines cause autism is so tiny as to be, for all practical intents and purposes, zero. To claim otherwise is to stubbornly cling to a discredited hypothesis.

Of course, to Dr. Sears it’s all a conspiracy:

The media has gotten so much wrong about him and the debate over vaccines, he added. “They’re now a tool of the government to get agendas out there. And, they are no longer fairly serving the people the way they should be as a neutral entity.”

Says the pediatrician who sells medical exemptions based on scientifically unsupported “reasons.” But note the conspiracy mongering. The titles of some recent episodes of his podcast, The Vaccine Conversation, are very telling: “The REAL Reason We Are Seeing More Measles,” “Censorship: Are the Vaccine Thought Police Finally Here?” and “Do Vaccines Actually Make You Healthier?”

Antivax Twitter was, unsurprisingly, mostly supportive:

Not surprisingly, pro-science Twitter was not pleased:

And it’s true. It did take Gutierrez until around two-thirds of the way through the article to mention that Dr. Sears had not only been sanctioned by the Medical Board of California but is under investigation again. That’s quite a long time to wait before letting the reader know something very important about the subject of your profile.

Sadly, Gutierrez doesn’t get it:

Sorry, Ms. Gutierrez, your article is naive at the very least, somewhat fawning, and full of the sort of bothsidesism that results in the communication of a distorted view of what the science says.

Look, I get it, though. You even admitted it. “Brave mavericks,” although they are nearly always cranks, are inherently interesting to a lot of people. Melody Gutierrez would hardly be the first reporter or documentarian to fall under the spell of a charismatic crank who is worshiped by other cranks and detested by the medical establishment. Andrew Wakefield, for instance, has been the subject of a documentary (The Pathological Optimist) by respected filmmaker Miranda Bailey. True, Bailey did at times try to reveal Wakefield’s flaws by just letting him be Wakefield, but the film struck me more as hagiography than critical review, a couple of scenes excepted, with some scenes clearly staged to make Wakefield more sympathetic. The film even concluded with scenes of a sweaty Wakefield wearing a tank top chopping wood on his property to take out his frustrations over his “persecution” interspersed with news reports about the backlash over his antivaccine propaganda film disguised as a documentary VAXXED having been accepted into the Tribeca Film Festival in 2016. More recently, a Daily Beast reporter fell prey to the same tendencies to produce a profile of antivaxer Del Bigtree that read more like a celebrity profile of a rising star of the antivaccine movement more than anything else.

As I said, when you profile a crank, be he an antivaxer, HIV/AIDS denialist, climate science denialist, or whatever, studiously claiming that you’re not taking a side, as Gutierrez claims to be doing, virtually always ends up in essence taking a side, and it’s not the side of science. Bailey fell into that trap—hard—when she made her documentary about Wakefield. Gutierrez appears to fall into that same trap by affecting a very assiduous “both sides” position. Reporters love to do profiles on famous people who are both loved and reviled because it’s interesting. For instance, the poster for The Pathological Optimist featured a photo of Andrew Wakefield with the words “Liar, healer, monster, savior” pasted over his face. See? Interesting and dramatic, right?

Gutierrez does a variation of the same thing to conclude her article:

During hearings on SB 276, opponents — many of them parents toting children they say were harmed by vaccines, hung on Sears’ every word as he testified before lawmakers. When Sears interrupted lawmakers to counter what he believed were false claims by supporters of the bill, the crowds packed into the room would call out, “Let him speak!” Afterward, Sears was greeted like a celebrity on a par with another staunch vaccine critic — Robert F. Kennedy Jr. Some of the parents shook Sears’ hand and thanked him for his commitment to the cause, others excitedly pointed him out and snapped his picture. He is their doctor, even if he doesn’t treat their children.

At each step of the legislative process, as the bill was passed by committee after committee, Sears has returned to Sacramento to fight against the bill, navigating crowded Capitol corridors where he is called both an “opportunist,” and “a saint.” And it’s unlikely you’ll find middle ground between the extremes.

Just as the headline says, it’s loyal followers versus criticism. It’s the brave maverick doctor fighting the system. It’s the narrative of an opportunist versus a saint. The problem is that, by framing Dr. Sears’ story that way and refusing to take a side regarding what he is, Gutierrez implies that either possibility is an acceptable view of Dr. Sears. The problem, of course, is that the science disagrees and doesn’t care what Dr. Sears’ followers think of him, any more than the measles virus cares if you’ve “boosted your child’s immune system naturally.” Gutierrez’s article is the same sort of “balanced” coverage that has helped sustain the myth that vaccines can cause autism. It’s a throwback to the sort of reporting that was very common when I first started blogging, the sort of bothsidesism that I had thought largely gone. Apparently, unfortunately I was too optimistic.