You’re banning me!

Like so many of you, I have been banned from Dr. Bob Sears’ Facebook page. While it isn’t headline-making news, I wanted to write about the comment that got me banned because it highlights, once again, that Dr. Bob is anti-vaccine.

The problem began when he posted something on his Facebook page that stirred in me the inability to stay silent:

“DEATH IS THE ONLY LEGITIMATE VACCINE EXEMPTION . . .”

. . . said the former doctor of one of my patients-to-be. I kid you not. My wife, Cheryl, who manages the office, sometimes picks up the new patient messages on our voicemail. She never has me listen to any of them because, well, that would be stupid. But she grabbed me the other day and said, “You have to listen to this. You’re not going to believe it.”

I didn’t. Believe it, that is.

A mom actually called our office and said she needed a new pediatrician because her old one wouldn’t even discuss vaccine medical exemption with her. Now, of course, that part’s believable. There are hundreds of thousands of doctors nationwide who won’t even discuss these exemptions. And if they choose not to offer informed consent for invasive medical treatments for their patients, that’s their decision. It’s also a patient’s right to leave their care.

But this doctor took it a step further. Well, a giant leap further. The message on our phone actually was “My doctor said death is the only legitimate vaccine exemption . . . and I disagree. So I’m looking for a new doctor.”

I can’t wait to hear the whole story. I hope this patient comes in soon. We’ll see if we can find something in her child’s medical and family history that qualifies for an exemption short of death.

Dr. Bob

Everyone I have spoken to has two reactions to this post.

  1. That sounds like something that never happened.
  2. Does that mean Dr. Bob is going to sell this woman an illegitimate medical exemption?

But my reply actually gave Dr. Bob the benefit of the doubt:

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“I hope that when this parent comes in, you share with her that the contraindications to vaccines are discrete and that if her child does not fit into any of those contraindications, she is not eligible for a medical exemption.”
I also directed Dr. Bob to the list of contraindications to vaccines. This comment does not attack Dr. Bob nor does it treat him or anyone else disrespectfully. It simply points out that there are only so many contraindications to vaccines, and that a medical exemption outside those contraindications is inappropriate.

It is possible the reason for my ban was the only other comment I left on that thread. Unfortunately, I did not get a screen shot, but it was in reply to a woman who was replying to my friend’s comment, a reply filled with references to Thalidomide and smoking as proof that vaccines are terrible. Here is her reply to me:

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I cannot imagine I was banned for pointing out that Thalidomide was never approved by the FDA (fun Women’s History Month fact) or that measles and chickenpox parties, like smoking, used to be acceptable health practices, but now that science has moved on, they no longer are.

But it is significant to me that the commenter above, and others like her, were left on the page to comment freely. The woman above, for example, began her reply to my friend with this dig about her as a mother and about how she gave birth:

Do you have biological children? If so, did you have them without any drugs? If you do, or did then that true bond would not allow you to push for all these vaccines and boosters in your flesh and blood. Other countries have excellent scientists who are against so many vaccines in such a short time. I bet you only had a fraction of the vaccines that babies are subjected to these days

Yes, you read that correctly. If you had a pain-free birth, you don’t love your children and that’s why you vaccinate them.

That comment, along with the mountain-loads of misinformation posted by Dr. Bob’s fangirls, was left untouched and uncorrected by Dr. Bob because it plays into the fear of medical interventions and other doctors he promotes in order to drum up his own business and grow his own brand.

Do me a favor, friends, and call him on it–because I no longer can.

 

 

 

Why You Shouldn’t Shop for Medical Exemptions

Recently, filmmaker Leslie Manookian wrote a post for vaccine hesitant parents about how to pester physicians into giving them an inappropriate medical exemption. This interest in medical exemptions stems from the newly passed law in California that eliminates all non-medical exemptions. Parents who are now too scared to vaccinate their children are forced to make some tough choices. (Well, tough for them because of their misperceptions of the risks of diseases and vaccines.) They can either vaccinate their children or homeschool them.

Anyone following the anti-vaccine movement can understand how an otherwise reasonable but vaccine-hesitant parent feels about this choice. For them, the choice feels like deciding between certain death or certain economic doom. After creating the fears about vaccines, woopreneurs like filmmaker Leslie Manookian (and Bob Sears) have stepped in to capitalize on this fear by offering parents a way out of the vaccinate-or-homeschool conundrum. Thus Manookian’s “How to Claim a Medical Exemption in CA.”

Of course, the decision to shop for a medical exemption is unwise. To get a greater understanding about medical exemptions and how unwise they are, I asked two friends to weigh in. I talked to Dr. Anna Saporito, a family physician from New York, and Dorit Reiss, a professor of law in California.

Manookian claims:

More and more research is showing that individuals with a variety of conditions and genetic mutations are more susceptible to vaccine reactions.

These conditions and disabilities include already existing or a family history of previous vaccine reaction, eczema, food and environmental allergies, asthma, gut issues such as Crohn’s and IBS, autoimmune disease such as diabetes, lupus, MS, rheumatoid arthritis, ASIA, and others, chronic ear, sinus, strep or other infections, Lyme disease, PANDAS, POTS, learning disabilities, speech delay, ADD, ADHD, autism, seizures, bipolar, schizophrenia, thrombocytopenia, genetic variance, impaired methylation, detoxification impairment, and more.

Of course, most of us recognize this claim as fishing for an exemption. After all, can you imagine asking a doctor to forego vaccines for your child because he is prone to strep throat? (Why isn’t there a vaccine for that?) My supposition about this laundry list was right, according to Dr. Saporito, “There are actually very clear guidelines written by the ACIP and CDC outlining medical contraindications for vaccines.” You’ll notice that almost everything listed in Manookian’s litany is missing from the CDC’s guide to who cannot be vaccinated. In fact, many are actually listed on the CDC’s Commonly Misperceived as Contraindications list, including autoimmune diseases (such as diabetes, lupus, MS, etc.). Other items on her list are not included because learning disabilities and neurodevelopmental disorders are not contraindications to vaccines.

Manookian moves on to claim that parents can demand allergy and genetic testing before being vaccinated (with the assumption that something will pop and be used as reason for a medical exemption.) Again, Dr. Saporito notes that this approach is not warranted:

There is no evidence that genetic testing would provide any useful information in the prediction of vaccine reactions. Allergy testing might make sense, but not genetic testing. (If SCID [severe combined immunodeficiency] is suspected, that should be tested for, but usually that diagnosis is already known.) The American Association of Allergists and Immunologists have great guidelines about allergies and vaccines.

It is important to note that the American Association of Allergists and Immunologists’ document discusses how to test for allergies to vaccines after a vaccine is administered. It is not a standard of care to test children without a history of allergies for possible allergic reactions to vaccines they have never received.

Finally, I asked Dr. Saporito her stance on parents shopping for doctors who are more willing to provide medical exemptions for conditions that are not contraindications and whether or not family physicians are more likely to provide a spurious exemption:

The science is quite clear that vaccines are safe. I have vaccinated myself and my own child for this reason. I find it suspect that the doctors who offer this “service” of vaccine exemptions often do no take insurance. It seems there is more of a profit motive than a motive towards public and personal preventative healthcare, something I signed up for when I took my medical oath. In fact the AAFP [American Academy of Family Physicians] just this month came out against non-medical exemptions for vaccines.

From a medical perspective, the answers about medical exemptions to vaccines are as clear-cut as the case for vaccines themselves. However, I did want to find out about a legal perspective. What could happen, legally, to a parent or a doctor who presents a school district with a spurious medical exemption to vaccine requirements?

Dorit Reiss, who is becoming the foremost legal expert concerning vaccine issues, told me:

Manookian’s post is assuming someone can just pressure or get a doctor to give an exemption on false premises. First of all, I think doctors can and should consider reporting parents who are asking them to act dishonestly. The physician’s signature on a medical exemption should be based on true concerns/facts.

A parent getting a medical exemption based on things that don’t justify it doesn’t deserve the exemption.

But what about the doctors? What issues might they face if they become a mill for false medical exemptions?

The reality is that the doctor can probably get away with some of that. There is no mechanism in place for oversight now, and if doctor only gives a few, no one will look.

If a doctor is suddenly giving a lot of medical exemptions, there are a number of things that can happen. First, the Department of Health can try denying them as unjustified – which will probably be challenged in a court, and the department might lose. Second, the Department can bring a complaint with the medical board – and prove the problem. Third, the law can be changed to provide a penalty for abuse.

The doctor has to specify the conditions for exemptions. If a doctor is found to have lied, that could be a reason for disciplinary action.

Arguably, if a doctor provides an argument based on something that clearly shouldn’t be a contraindication that’s also reason for potential action. Most of the conditions Manookian lists aren’t caused by vaccines and are not contraindications. For example, a doctor choosing to help a parent not to protect a child with asthma from pertussis is arguably violating their responsibility.

The legal issues surrounding inappropriate medical exemptions for vaccine requirements, but there is enough gray area that parents should reconsider shopping for a family physician who will give them an exemption when none is warranted. Of course, the greatest disincentive to seeking an inappropriate medical exemption is the consequence of disease for a child left unprotected.

For a parent who has fallen prey to anti-vaccine scare tactics, skirting ethics and the law might seem a risk worth taking, but the real risk comes from the diseases that have historically sickened, maimed, and killed children.

Stealing from Dr. Bob

It’s hard not to be sarcastic about Dr. Bob Sears. His work promoting untested alternative vaccine schedules and stoking fears about vaccines (and autism and gluten and so forth) doesn’t seem to be enough for Time Magazine.

Dr. Sears writes: "DR PAN STOLE MY AWARD."
Dr. Sears writes: “DR PAN STOLE MY AWARD.”

Of course, Dr. Bob is joking. He’s always joking. That one time when he wrote a highly sexist Facebook post about how mothers and fathers parent differently?  “And to avoid offending both of you dads who read my blog, realize that this is a satirical poke at an unjust and inaccurate stereotype that has been unfairly thrust upon us men (insert emoticon that depicts me winking at moms everywhere).”

It’s always just satire–a joke with a winking emoticon. And so we can be assured that this, too, must be satire. Dr. Bob can’t really see himself as a hero of vaccination, can he?

After all, what is his record? According to Dr. Bob, he is pro-vaccine:

I give vaccines every single day in my office. I am pro-vaccine and understand that vaccines work and have reduced and eliminated many serious diseases. And that’s not just spouting a party line – I firmly believe that, and that’s why I give them in my office.

If the threshold for a vaccine hero is someone who does what every single other pediatrician and family physician in the country does, then all the doctors that give vaccines are heroes. And there is some merit to that, but it would be hard to feature them in Time. It would be an awfully thick magazine.

Of course, Dr. Bob doesn’t want to be remembered for preventing infectious diseases. He wants to be remembered for being nice to parents. He likes making parents like him (thus the sexist satire–oh wait). In a HuffPo article, Dr. Bob claims that he is one of the few doctors who respect parents by giving in to their fears and creating an alternative vaccine schedule for them. The need for doctors like him is apparently so great that he’s created a list of doctors who will eschew science in order to elicit warm fuzzy feelings from parents:

I’ve been creating a growing list of Vaccine Friendly Doctor’s on my website who WILL listen and respect these patient’s wishes and who will provide an alternative vaccine schedule for patients who want to vaccinate differently.

Earlier in that article, he claims that the AAP recommends creating alternative vaccine schedules for parents. This claim, of course, is untrue, as a recent statement about on-time immunization from the AAP shows: “There is no ‘alternative’ immunization schedule. Delaying vaccines only leaves a chil​d at risk of disease for a longer period of time; it does not make vaccinating safer.”

So actually, Dr. Bob isn’t doing what every pediatrician and family physician across the country is doing. Almost all of them (save those listed by Dr. Bob) are following a standard of care and AAP guidelines by giving those vaccines to their patients on time. And for patients who are nervous or hesitant, they are still recommending on-time immunization and doing their best to navigate parental fears while being aware of the needs of the child to be protected against disease. That last part, where we protect children, is lacking from Dr. Bob’s insistence that we respect parents’ fears.

Still, Dr. Bob bravely runs a Facebook page–wait, two Facebook pages, and writes his books and sells his supplements. Meanwhile, Dr. Pan, stealer of magazine hero awards, has not sold supplements. While being one of those doctors who follows the standard of care and the AAP guidelines, Dr. Pan, a state Senator, has also taken on legislation amidst outbreaks of measles to prevent future outbreaks and create healthier, disease-free schools.

Dr. Bob earns profits from his books and his supplements. Dr. Pan, meanwhile, received death threats from anti-vaxxers. He is facing efforts to recall him from office. Anti-vaxxers have portrayed him as Hitler. In fact, some of Dr. Bob’s supporters have gone full Godwin on Dr. Pan:

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On the other hand, Dr. Sears has used the California legislation to travel the state, speaking to parents about ways to circumvent the law. Dr. Gorski uncovered evidence suggesting Dr. Sears might be selling illegitimate medical exemptions for vaccines at these events:

At one point, a woman approached and told Dr. Bob that her pediatrician whom she otherwise liked would not issue an exemption, asking if he would see her for a one-time visit. His response? “I would be happy to provide that service.” He also confirmed that a one-time medical exemption visit is $180 and that he’d be willing to issue such an exemption and send the child back to his primary pediatrician.

In short: the legislation Dr. Pan crafted based on best medical practice earned him taunts, threats, and recall efforts. But this legislation that Dr. Bob opposed has earned him more earning potential.

While he might be joking, Dr. Bob’s assertion that Dr. Pan “stole” something from him has the kernel of truth that all satire (good or bad) has. Dr. Pan didn’t steal any prestige or accolades from Dr. Bob, but he did steal some publicity that would have been profitable to cash in on. Perhaps for that we can be glad.

Anti-Vaccine Petition Fails Gloriously

Anti-vaccine activists fail to accurately assess science as often as they fail to assess their public image. Remember when you learned in junior high that before you ask a parent for something, you should be reasonably certain you know how they are going to respond. Some anti-vaccine leaders never learned that lesson.

In that vein, they petitioned the White House to ask them to “PROHIBIT ANY LAWS MANDATING THE FORCE AND REQUIREMENT OF VACCINATIONS OF ANY KIND” (all caps theirs). They were pretty excited in February when they collected a quarter of the signatures they needed in five days. Things were looking up for woefully misnamed crazy pants organizations like VacTruth.

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But six months later, oh the gnashing of teeth as their bubble has burst. Can you believe that the White House is relying on the CDC and not hashtaggers and YouTubers for medical information, citing science instead of conspiracy theory? Their reply to the anti-vaxxers was, in essence, no. Because science.

And what’s more, you should actually vaccinate your children. Yes, you, anti-vaxxer. Vaccinate your children.

We all have a role to play. Vaccinations are one of the great triumphs of science and public policy, and we should make their benefits available to everyone.

As the Surgeon General makes clear, “Vaccines are safe and effective ways to prevent disease and death. They are necessary. They save lives.”

And as the President himself said earlier this year, “There is every reason to get vaccinated, but there aren’t reasons to not.”

If you’re concerned about your health, the science is clear: Vaccinate yourself and your children.

For more information about vaccination, please visit www.vaccines.gov.

Thanks, Obama. No really, thanks. That is glorious.

But the anti-vaxxers do not think so. In one public anti-vaccine Facebook group, members use dehumanizing and ableist language to bring home the point that vaccine are terrible. Evidence of racism within that group is discussed here. And then they went full on crazy, claiming that the White House is fill of not-humans (“I do not even think this is a HUMSN BEING! Has to be an alien, robot or some kind of android !”) and that that the response was evidence of government fascism:

He’s a liar. I grew up in an era where all children got measles, and I never heard of anyone dying. He’s not a medical consultant. He’s a political shill working for wealthy corporations. He’s disgusting. No government has a right to madate medical procedures. What he says isn’t even based on medical science. He doesn’t represent the people or their best interests. He represents fascists.

Which smacks of the tactic you may have employed in junior high: when you get the answer you didn’t want, throw a fit.

The Jerks in Section 108

Sometimes it is easy to forget just how normal vaccinating is when we hear so many stories about vaccine refusal. But in almost all communities, the majority of parents vaccinate their children, and it is most often a crushing, 99% supermajority who bring their kids in to get shots and to stick it to preventable disease. But what does this really look like? Let me give you a metaphor.

Let’s say we are watching a Minnesota Twins ballgame at Target Field. (I’m only there for the hotdogs, truth be told.) In the middle of the third inning, for no reason in particular, a plane flies over head and drops thousands upon thousands of slips of paper on the stadium. These papers litter everything – seats, staircases, the field. It absolutely overwhelms the capabilities of the stadium workers, and people who were watching the game realize that they are going to have to help to pick up the paper, too.

Pretty much everyone begins to pick up so that the game can resume quickly. With 40,000 people sitting in the stadium, everyone just needs to do a little bit to get everything back in order. And 99% of people are happy  to clean up.

But 1% of those sitting there do not buy it. Some of them are afraid of cleaning up, some are convinced that the paper is supposed to be there, and some just don’t want to. The question for today is not what motivates these refusers to opt out. The question is, what do the numbers look like, and what real impact can they have?

This guy would totally pick up paper at the ball field.
This nice man would definitely help pick up litter.
With 40,000 people sitting in the stands, 400 people represent our refusers. Target Field has approximately 200 sections, so if we spread them out, we would have two refusers in each section. Two refusers out of 200 people is not a big deal. (Besides, some of them might be refusing for legitimate reasons, like disability.) We can work around them. We can pick up their slack, sometimes without even noticing that they are refusing to contribute.

But what if the 200 people were clustered together? What if they were all sitting in two sections – the jerks in section 108 and 330 who sit and wait for the game to begin again. Some would argue that we shouldn’t care about them because they can sit in their own litter if that’s what they so choose to do. That is all well and good, except that paper flies. It doesn’t care that it was dropped in with the jerks in section 108. It will drift to section 107, and the people sitting there will have to deal with cleaning up, again, even though they had already done their share.

10392388_709682292485048_8274048065663319563_nThe implications of vaccine refusal are similar. We can deal with a couple of children who cannot be immunized or even one whose parents don’t want to immunize her because most of us are already doing the work. We know we are handling it, for the most part, because our children are not getting measles. In fact, thousands of children were exposed to measles at Disneyland at the beginning of this year, and did not get it.

We get into trouble when this refusal clusters into communities. Those clusters allow the spread of disease, and it is made worse when people in those communities are quiet and make it seem like refusing is the norm.

The big difference between picking up paper at Target Field and vaccinating your children is that de-littering your baseball section is something other people can see you doing. People sitting out are obvious because they are just sitting there.

A vaccinated child looks just like an unvaccinated child. Most people have no idea whether they are living in a cluster of refusal or a supermajority of immunization, and they have no idea because very few people are actually talking about how happy they are to vaccinate their children.

What if we made it obvious? What if we found ways to work immunization into conversations in ways that assumed that we are all doing our part, since since most of us are doing our part? We aren’t the jerks in section 108, and our neighbors usually aren’t, either.

Don’t Use Your Religious Beliefs to Endanger Your Community

Talking about vaccines as we come off Memorial Day and consider what people have sacrificed in the name of freedom only seems natural. I figure as long as I am mixing patriotism and vaccines together, I might as well add a discussion about God.

People who know me know that I am a religious adherent–the type who even goes to church on Sundays. I believe that people should be allowed to exercise their religious beliefs freely as long as they do not harm others. Most arguments against a religious exemption focus on this last bit: not harming others. Vaccine refusal puts both a child and her community at risk for harm, and ought not be protected by the right to practice religion freely.

People who are religious often feel nervous, however, with the idea of eliminating a religious exemption to school vaccine requirements. Even if they vaccinate their children and want others to do the same, they might worry that giving no exemption on the basis or religious belief will, at some point down the line, be used to limit their free practice of religion. It’s a fair worry, but one that I think is short-sighted.

In fact, the way I see things (as a non-lawyer and a non-scientist), religious exemptions to vaccine requirements weaken religious freedom in the United States. Currently, forty-five states in this country offer a vaccine exemption based on religious beliefs. (I happen to live in one of the states which does not offer an exemption based explicitly on religion, which delights me.)

The way that these religious exemptions are granted differs wildly from state to state. Some states, like Florida, allow unvaccinated students to attend if parents fill out a form that indicates that vaccines are somehow against their religious beliefs. Such a cavalier use of religious beliefs is a threat to anyone who holds any religious belief because religion is not a blank check to opt out of community responsibilities. Can you imagine if you were pulled over for speeding, and you told the officer that as a Lutheran, you sincerely believe that limiting speed is something the state should not impose on you?

If the religiously affiliated play the religious beliefs card too often, we would deserve to have our freedoms closely scrutinized. After all, why should a Methodist be able to send her unvaccinated child to school when an Atheist cannot? (And Agnostics should be able to speed if Lutherans can!)

In the case of religious exemptions, the scrutiny is fair. Which major religious faiths, as a matter of doctrine, advise their adherents to avoid immunization? People often point to Christian Science as the religious that forbids vaccination, but during a round of compulsory smallpox immunization, the founder of Christian Science, Mary Baker Eddy, advised her followers to follow the laws and submit to vaccination. So supporting a religious exemption is not really about allowing the free practice of religion as much as it is allowing people to believe misinformation about immunization and use their religious beliefs as a defense. When the science so clearly supports immunization, such a cynical use of religious beliefs ought not to be supported by law.

Other states, like New York, make it more difficult to obtain a religious exemption. There, a school has the right to accept or reject a religious exemption. In some cases, courts have been called in to rule on whether or not a religious belief was sincerely held in regard to opting out of immunization requirements. Dina Check was one such mother whose religious exemption was denied by the school because her religious belief was deemed insincere, and the court upheld this decision.

When people claim rights based on religious belief, they also potentially subject themselves as to the sincerity of their belief. This sincerity testing has all sorts of potential ramifications legally, I am sure, but even practically–I am not certain how to test whether or not someone sincerely believes something. And I fear handing over to the courts the power to adjudicate on how sincerely someone believes anything.

If we want religious freedom (or freedom from religion), we need to be careful about which rights we ask for on behalf of our religion. Protecting anti-vaccine parents who want to claim religious beliefs against vaccines is not carefully protecting religious rights. It is protecting the right to opt out of protecting a child and a community against diseases that harm children and other vulnerable people. And there’s nothing particularly religious about that.