Pulling a Doctor Bob

When I first heard from local friends that the anti-vaxxers in their lives were all atwitter about Dr. Bob and talked about how much they loved him, I assumed they meant Dr. Bob Sears, the Orange County pediatrician who takes a supposed middle ground to sell books that frighten parents away from vaccines.

My heart sank when I discovered that my home state has its own Dr. Bob. (Seriously, does every state have a Dr. Bob?) Like the California Dr. Bob, the Minnesota Dr. Bob Zajac seems to care more about how the parents of his patients feel about vaccines than how to protect their children against vaccine-preventable disease. His website explains how much he cares about these parents’ feelings:

Our philosophy at New Kingdom Pediatrics is to know the current recommendations for vaccination of children (based on the Academy of Pediatrics and the Centers for Disease Control and Prevention publications) and to share that information with the parents.  We then focus our efforts in supporting the parent for choices they wish to make based on the information provided.  We do not judge parents, we do not exclude parents from our practice, and in fact we embrace the opportunity for a true partnership in any vaccine or vaccine-preventable illness discussion.  We believe there is some benefit to vaccination, and believe there are known/unknown risks with vaccines… but more than anything we also believe in parent choice.  We typically have a Notary on site to notarize any forms for parental conscientious objection to vaccines, and sign medical exemption forms for children who have had reactions to vaccination.  All recommended vaccines are now available and provided within our clinic.

See how much emphasis he puts on supporting parents and not judging parents? Certainly every parent who brings questions about vaccines to a pediatrician deserves support in a non-judgmental way. But then they deserve actual answers based on the science.

Parents who visit Minnesota Dr. Bob don’t get answers. They get some vague response about vaccines having “some benefit” and then a shrug about “known/unknown risks.” Why would a parents in his practice choose to vaccinate if the philosophy centers on how the parents feel more than helping the parents understand the real, actual answers that science has give us about vaccines?

Well, obviously the parents don’t vaccinate because they have a notary on-site to sign vaccine exemption forms. This seems an unnecessary convenience if the expectation is that parents would vaccinate.

I was going to leave this Dr. Bob alone because his practice is obscure and he is not a member of the AAP. I had assumed he was insignificant in the realm of anti-vaccine coddling doctors. And I had assumed wrong. It turns out, he is publishing a book with Kate Tietje, music teachers turned anti-vaccine mommy blogger and woo-entrepreneur (woo-preneur?).

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For those who do not know Modern Alternative Mama’s Kate Tietje, she is indeed anti-vaccine. In fact, the menu of her blog has an entire vaccine section, which includes a response to us “vaccine propagandists”:

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And yes, I do chuckle that she included a response to “Growing Up Unvaccinated,” in which she leads with the statement that she cannot prove whether or not the post is real–a nod to the conspiracy-believers who think that the author was a secret CDC operative writing for us.

In another post on her blog, Tietje callously brushes off the treatment of Hib, a bacterial infection that can cause sepsis and meningitis: “Typically, Hib requires hospitalization and a 10-day course of antibiotics, and possibly a combination of a couple different types.  Most people recover without incident, although Hib is serious.” Oh, is that all?

All of her fear-mongering leads her readers to her shop, where she offers helpful books like “A Practical Guide to Children’s Health” for $17.95. That’s the real purpose of her blog, after all. To turn a profit.

Why would a pediatrician from suburban Minnesota align himself with a homeschooling mother whose background is in music education? Why hitch his wagon to a blogger who primarily writes recipe books?

Of course, I cannot know this Dr. Bob’s intentions. But I have to speculate that “Being Dr. Bob” means to placate the fears your patients have gleaned from the internet in order to sell your own books. In the meantime, I’d like to suggest to Minnesotans that if they want vaccine information from a Dr. Bob, that they instead opt for Mayo Clinic’s Dr. Bob Jacobson, who won’t sell you a book, but will carefully and kindly examine the evidence with you.

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This is a Publicity Tour, Not a Public Service

I have been to a couple of hearings concerning immunization bills, and I have listened to and sent parents to many, many more hearings. I have heard the most passionate, intelligent, and well-respected doctors and nurses try to convey to lawmakers in minutes the complexity of our vaccination program and the importance of high immunization rates. These healthcare professionals who testify on the public health side are from in-state and work directly with the children and parents who are affected by vaccine rates. They are the people who, when bills working to raise rates do not pass or die, must intubate infants with pertussis, admit children to intensive care during measles outbreaks, and put children on ECMO machines when influenza attacks.

In other words, these doctors nurses testifying for tougher vaccine laws do so because they have seen children in their communities suffer, and they want to prevent more suffering. These are not people whose names you would know. They don’t make any money from their appearances in front of legislative committees. Their testimony brings them no further glory.

And then we have those who testify on behalf of the anti-vaccine contingent. Take Robert Kennedy, Jr., for example. In his latest stop, he is going to New York to persuade them not to make the meningitis vaccine mandatory. He claims that the vaccine contains too much mercury. And although he is an environmental lawyer and finds that experience relevant, it is clear he doesn’t understand medicine or public health. His stop might be unremarkable, except that he has also testified in front of legislative bodies in Vermont, Illinois, and Oregon.

Another example of an anti-vaxxer willing to travel to testify against immunizations is Dr. Toni Bark, whom I watched testify in Minnesota (where she was schooled on misusing a local doctor’s research.) She has also testified in Texas and Vermont, and there is talk of her traveling to other states to testify as well.

Part of me takes heart that being anti-vaccine is so rare that the same expert must be flown from place to place to testify. After all, the pro-vaccine forces need only look to their local hospital, university, or health department to find someone who both thoroughly understands the value of vaccines and is passionate enough to give their expert opinion to lawmakers. Apparently anti-vaxxers are not so lucky.

But the other part of me is annoyed. Much of the anti-vaccine belief system is predicated on an assumption that a conspiracy exists to suppress the evils of immunization so that the very many people involved can profit from the near universal usage of vaccines. This conspiracy means that all the doctors, nurses, research scientists, public health officials, and pharmaceutical company employees in the world aren’t in it to save lives. They are in it for cash. Thus the admonition from the anti-vaccine lines to “follow the money.”

Every time I see RFK Jr. or Toni Bark or whomever travel to yet another state legislature, I do follow the money. And I note that Kennedy has a book out–on the topic of thimerosal, of course! He has also been heavily promoting a pseudo-documentary which implicates thimerosal, which has been removed from childhood immunizations, in autism. Meanwhile, Toni Bark has her own horrible pseudo-documentary, starring multiple people with online supplement stores. When I follow the money, I realize that all this fear of vaccines is being used to sell me something. Movies! Books! Supplements!

It comes down to this: public health advocates find local people with expertise to educate lawmakers about bills. Anti-vaccine activists fly in profiteers on publicity tours to promote the very fear that sells their wares. The worst part is that their efforts are sometimes successful.

The Anti-vaxxers Might Wish that What was Lost had not been Found

The anti-vaxxers went wild after the recording of the Minnesota Senate hearing regarding an immunization bill (SF380) was lost. They had brought Dr. Toni Bark (who runs a website called SkinandchocolateDOTcom and recently helped release an infomercial-disguised-as-documentary) whose testimony was long. And that’s the end of my positive description of her testimony. Actually, one pro-vaccine advocate told me they heard a senator at the hearing say to an anti-vaccine organizer that they should never have her testify again because she was so unimpressive. Yet, the anti-vaccine word was that the recording was purposely hidden because her testimony was good and a threat to all things pro-vaccine. I don’t know whether or not they are rejoicing, though, at the found recording, which can be found here and on the Minnesota legislature website. If I were them, I would be particularly embarrassed at this exchange between Senator Carla Nelson and Dr. Toni Bark, where Senator Nelson questions how Dr. Bark could point to Minnesotan Dr. Greg Poland‘s research to support her position. I will transcribe the important part (about one hour in) here:

Sen. Nelson: My question, Dr. Bark…is you’ve referenced Dr. Gregory Poland and his study The Paradox of Measles, and I couldn’t tell exactly from your testimony if you were indicating that he was in opposition to this bill or support.

Dr. Bark: Oh, I don’t know how he would feel about the bill, all I know is…I have no idea how he would feel about the bill. So I spoke to him when I was writing my papers for my medical, my graduate school program which is a two year program in medical science and disaster medical management, and I focused on vaccines in that two years, and he has written extensively about measles outbreaks and talks about the paradox of measles and he’s not the only one. There’s mathematical biologists who actually because it’s a live viral vaccine and you shed and there’s going to be about 15 to 20 percent of the population that might not get an antibody response from the vaccine and then we know from certain outbreaks that even with an antibody response, you are not necessarily protected. So the mathematical biologists, and Poland has agreed, state that you can never eliminate measles and that, in fact, part of the reason because of what was said before is that women who didn’t have measles as children do not impart the same immunity. The immunity to their infants does not last as long, and so we tend to see measles in a vaccinated population going from a younger age and an older age, and not the normal age that you would normally see. So it is kind of complex, but he does, it’s the paradox of measles because the paradox does seem that most people with measles have been vaccinated.

Sen. Nelson: Madam Chair and Dr. Bark, well, I did just get off the phone with Dr. Greg Poland.

Dr. Bark: Oh wow!

Sen. Nelson: Because I had visited with him about this bill myself. It was a very important bill, and I know he is an expert on measles vaccines particularly. So, I will just tell you what he reiterated to me on the phone now. He is not in favor of mandated vaccines, except in certain cases such as healthcare workers, something like that. But this bill does not mandate vaccines.

Dr. Bark: Right.

Sen. Nelson: So we want to be very clear about this. It does not mandate vaccines. He also talked a little bit about the paradox in measles, and talking as a scientist, how exactly, as you said, he doesn’t believe that measles will ever be eradicated, for maybe all the reasons you said. But he also said that sometimes people who oppose the vaccines will pick out one sentence in the scientific study and extrapolate it to mean things that it does not mean. So he did say that he does support certainly informed exemption, such as this bill is, and his closing comment to me was also the first part is what you said, but perhaps not the second. He said that measles is the most contagious disease that we know, and yet we found that fear and ignorance is more so. So I just wanted to clarify the record on that Madam Chair. 

This exchange is, of course, full of anti-vaccine misinformation and smacks of anti-vaccine desperation in the Gish Gallop Dr. Toni Bark provides. I could do an in-depth analysis of how the measles vaccine does not shed or how most people who contract measles during an outbreak are unvaccinated, but I think the fact that she tries to hang on the words of a pro-vaccine doctor in his own state, to his own state senator, shows just how insulated and clueless the anti-vaccine movement is. That and the fact that they had her testify again in Vermont. Cue sad trombone.