Dummheit 5

Some of the biggest news in the medical and vaccine worlds right now is that southern California pediatrician Bob Sears is at risk of losing his medical license for exempting a toddler from all vaccines for the rest of his childhood without adequately documented medical reasons. And if that were the only thing you knew about Sears — or about the complaint — it may seem a relatively minor offense.

But in fact, writing a potentially spurious medical exemption — while serious in itself given the medical notes he wrote — is just the tip of an iceberg in the sea of Sears’ alleged medical negligence and harms to public health. Known as a vociferous, and vitriolic, critic of both California’s mandatory vaccination law SB 277 – promoting “vaccine choice” – and the CDC’s recommended immunization schedule, Sears has made a name for himself by fear-mongering about vaccines while creating and promoting an “alternative vaccination schedule” that skips and/or delays vaccines that are crucial to protecting children from vaccine-preventable illnesses. The very low immunization rates in Southern California, where Sears practices, has been noted as a contributor to the Disneyland measles outbreak in 2015.

The specific charges Sears faces in this complaint are gross negligence, repeated negligent acts and failure to maintain adequate and accurate records, brought by complainant, Kimberly Kirchmeyer, the executive director of the Medical Board of California. According to the accusation, disciplinary actions if Sears is found guilty of the charges run from a public reprimand — little more than a slap on the wrist — to suspension or revocation of his medical license. A spokesperson for Sears responded to requests for a comment with a statement that Sears is not commenting at this time on the charges.

But the charges involve much more than writing a vaccine exemption letter. According to the accusation, Sears failed to test the same toddler for neurological problems after the child was hit on the head with a hammer and failed to investigate alleged vaccine reactions that, if they did occur, would have been life-threatening. He also prescribed garlic for the child’s ear infection despite there being no evidence of its effectiveness. Such departures from the medical standard of care prompt questions about what other ways Sears might be practicing negligently beyond this complaint.

“My guess is that things like this go on every day in his office,” said John Snyder, MD, FAAP, a pediatrician in private practice in Amherst, Massachusetts. “I hope this complaint opens his records up for scrutiny, and I think an investigation should be done in to the kind of exemption processes he has in his office.”

What the accusation, if true, reveals about Sears is that his lack of reliance on the evidence or standard of care may extend beyond vaccines. The complaint describes a 2-year-old known as “J.G.” who first visited Sears on April 3, 2014. The toddler’s mother told Sears that following the child’s 2-month vaccines, J.G. “shut down stools and urine” for 24 hours, and then that J.G. went “limp ‘like a ragdoll’ lasting 24 hours and not himself for up to a week after 3-month vaccines.” [No vaccines are routinely recommended by the CDC at 3 months old unless it’s a missed 2-month vaccine.]

Ten days later, Sears wrote a letter “excusing J.G. from all future vaccinations,” listing as reasons “that the patient’s kidneys and intestines shut down after prior vaccination and that at three months the patient suffered what appears to be a severe encephalitis reaction for 24 hours, starting approximately ten minutes after his vaccines.”

The many problems with Sears’s reaction, Snyder said, are “mind-boggling” and “chilling.”

“Let’s assume that reaction occurred after the vaccine — never mind whether the vaccine caused it — that’s a pretty profound reaction,” Snyder said. “For any thinking clinician, the first thing you would do is get the data to support this.” Yet Sears does not appear to have sought medical records regarding such serious medical problems. He also did not appear to conduct a physical examination — an egregious act of negligence, Snyder said, unless he did examine the child and then inexplicably did not document it. “To not do that either means the whole thing is fabricated or he just is negligent in his duties as a provider for this patient,” Snyder said. “His reaction wasn’t, ‘I’m going to investigate this.’ It was, ‘I’m going to write a letter.’”

In his letter, Sears also appears to have expanded upon the mother’s description without evidence to support it. “Shut down stools and urine” became “kidneys and intestines shut down,” and “limp ‘like a rag doll’ became severe encephalitis, a life-threatening condition that would certainly involve a visit to the hospital. Snyder said a doctor would not write “kidneys and intestines shut down,” unless perhaps it was explicitly intended to avoid technical terms for a lay audience; he would write “renal failure and ileus.”

“But he can’t write renal failure because he doesn’t have any proof or evidence that the kid has renal failure,” Snyder said. “If your intestines really shut down, to have ileus and renal failure, that’s shock.”

Snyder also noted that it’s not uncommon for parents to come in saying their child didn’t “act like themselves” or were “limp like a ragdoll” or “limp like a noodle” — and that’s hardly reason for exempting a child completely from all vaccines, ever again. If the mother meant something more serious than the typical figure of speech, due diligence would require a comprehensive investigation.

“Either this whole thing is a fraud, or, just as bad, he’s doing very poor work on behalf of his patients by not investigating and finding out what actually happened,” Snyder said. “No matter how you slice it, this is horrible.”

In addition, no published research documents renal failure or ileus as vaccine reactions, and encephalitis would not occur 10 minutes after vaccines were given. And without knowing which vaccines might have caused any reaction that did occur, a doctor following the standard of care would not exempt a child from all vaccines, he added.

“That means he can never get any vaccine of any kind ever? That makes absolutely no sense,” Snyder said. “There is no medical circumstance where you would say that,” he said, adding that even immune-compromised children who have undergone an organ transplant are eventually able to get some vaccines.

After writing this unusual letter, however, Sears did not include it in the child’s medical records, the reason for the charge of failure to maintain adequate medical records and, again, a mind-boggling decision to Snyder…

J.G. came to Sears on June 23, 2014 primarily complaining of a headache after having been “‘hit on head with hammer’ by Dad” two weeks earlier. In addition, “A mention is made of a split lip prior to hammer incident without any additional history. A physical examination indicates, ‘no residual marks now.” Yet Sears does not conduct any neurological testing or record any assessment with a treatment plan.

“That’s just incredible,” Snyder said. Typically, physician notes should include “an incredibly detailed history, including social and environmental history, and then an incredibly detailed history of the event — how did it happen — and then a very detailed physical exam, including the neurological exam,” he said. “This would be a potential abuse case, so you would be looking at every inch of this kid’s body. Then you would give a very detailed assessment of your thinking and your plan — what are we going to do about this.”

Yet none of that occurs. The patient’s chart does include an “Emergency Response Notice of Referral Disposition” occurring June 25 — presumably a contact with child protective services — that resulted in “Allegations cannot be substantiated – case closed.”…

While Sears’ fans, who celebrate him as a champion of “vaccine choice,” have been showing their support to the point of martyrdom, his history of harming public health before this complaint is already well-documented: Dozens of studies show increasing pockets of low immunization coverage and use of school vaccine exemptions that his advocacy has enabled or abetted. Meanwhile, pediatricians across the U.S. have spent incalculable hours trying to reassure their patients about the CDC’s vaccine schedule following the publication of Sears’s contribution to the Sears Parenting Library, The Vaccine Book, in 2011.

Although Sears did not invent vaccine fears or hesitancy, he irresponsibly legitimized those fears and created a groundswell of parents seeking to use the “alternative vaccination schedule” he invented without relying on any evidence than his own feelings. The real-life consequences of children receiving fewer vaccines has been an increase in outbreaks and children’s “needless suffering,” according to Paul Offit, co-inventor of the rotavirus vaccine, director of the Vaccine Education Center and a professor of pediatrics in the Division of Infectious Diseases at The Children’s Hospital of Philadelphia…

Sears’ schedule, on the other hand, relies on no evidence, as Sears himself has admitted. It is simply the schedule he made up and called an “alternative schedule,” a term which did not exist in the public lexicon until the publication of his book. Despite the book’s fear-mongering over vaccine ingredients and anti-vaccine claims that have been debunked, however, it has now sold more than a quarter million copies, frightening countless parents with its falsehoods and misinformation.

http://www.forbes.com/sites/tarahaelle/2016/09/11/dr-bob-sears-could-lose-license-for-medical-negligence-not-vaccine-choice/#3a557be17d17