Monday, September 12, 2016

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.


  1. For UC Hastings law professor Dorit Reiss, the meaning behind Sears’ case is clear: “We’re not just going to stand by and let you give unjustified exemptions and prevent children from being protected from these diseases.”

    But vaccination skeptics both in California and nationally expressed alarm at the action against Sears, fearing it marks the beginning of a witch hunt against doctors and others who object to the state vaccination schedule.

    "They’re using Dr. Sears as an example — a shot across all the doctors’ bows,” said Rebecca Estepp, who is part of an advocacy group that opposed the new vaccine law.

    One group, called Oregonians for Medical Freedom, called on the medical board to drop the case against Sears and “respect the sanctity of the doctor-patient relationship,” and declared Monday “Stand With Sears Day.”

    Dr. Jay Gordon, a Santa Monica pediatrician who also opposes stricter vaccine laws, called the medical board’s action an attack on a physician’s ability to judge whether a patient should be exempt from a vaccine.

    Gordon said he has known Sears for years and called him “seriously dedicated to the health and welfare of children.” Gordon said that although the state found fault with Sears for notes it considered incomplete, many doctors use similar shorthand.

    “I know that somebody could challenge my medical exemptions, but I’m complying with the letter of the law and the spirit of the law and I’m very bothered by this,” Gordon said. “For all I know, I’m the next person they’re planning to pursue.”...

    The new law strengthening vaccine requirements was inspired by an outbreak of measles that began in December 2014 at Disneyland and left more than 100 children and adults sick in California, seven other states and two other countries. It was the worst measles outbreak in California since 1991, fueled by the number of parents who declined to vaccinate their children, experts concluded.

    Measles also broke out in Orange County in spring 2014, infecting 22 people. In 2008, a 7-year-old unimmunized boy triggered a measles outbreak in San Diego after he returned, infected, from a family trip to Switzerland, spreading the disease to children at school and a doctor’s office...

    Dr. Richard Pan, a pediatrician and state senator who sponsored the law, said the Sears case is about alleged negligence — not that Sears gave the exemption.

    “In the end, you need to show that you’ve demonstrated due care,” Pan said, “that you’re acting based on the best interests of the patient.”...

    Experts say there are many legitimate reasons for a patient to be exempted from a vaccine: an allergy to gelatin or latex, for example. But legitimate medical exemptions to vaccines are backed up with evidence, they said.

    Two of the nation’s leading pediatric infectious disease specialists say they cannot think of any reason why a 2-year-old boy should receive a sweeping recommendation against all future vaccines for the duration of his childhood.

    “This doesn’t make any sense,” said Dr. James Cherry, a UCLA research professor and primary editor of the Textbook of Pediatric Infectious Diseases. Even children with cancer can safely get certain vaccines, he said.

    “The vaccines are all made differently. They’re all based on different biological principles,” said Dr. Paul Offit, infectious diseases expert at Children’s Hospital of Philadelphia. “I can’t understand how a physician could conclude that a person shouldn’t get any vaccines” for the rest of childhood.

  2. A national speaker who believes there are links between vaccines and autism told a group of Somali-American parents Sunday night that they should choose whether to vaccinate their children by weighing risks and benefits. He also said the government has lied in its previous vaccine research and that the danger of measles is overstated.

    About 90 people met at Safari Restaurant in Minneapolis to hear Mark Blaxill, an editor of a website about what it calls “the autism epidemic,” present information on measles outbreaks, autism rates and what he said were the fraudulent results of a 2004 study by the U.S. Centers for Disease Control and Prevention on the link between autism and vaccines, a theory that health officials have debunked…

    Blaxill’s visit comes in the midst of Minnesota’s second measles outbreak in seven years. As of Sunday morning, there were 32 cases of measles in Minnesota, including instances in Ramsey and Stearns counties as well as Hennepin County, where the majority are concentrated.

    The Minnesota Department of Health says “all Minnesota children 12 months and older who have not received a measles, mumps and rubella (MMR) vaccine should get it now.”

    Public health officials have said vaccination rates among Somali-Americans have fallen in recent years as more parents opt out due to autism fears.

    Minnesota Department of Health officials have been trying to reverse the drop in immunization rates among that demographic through education, relying on community leaders to build trust and overcome doubt…

    Twenty-eight of the confirmed cases have been among Somali-American children under age 5, all of whom are unvaccinated or not fully vaccinated against the highly communicable disease.

    Blaxill — who says that he’s not anti-vaccine — also explained Minnesota law and how parents can opt out of vaccinations, providing forms and access to a notary public for parents. Several nonprofits advocating parental choice in vaccinations were present, including the Minnesota Vaccine Safety Council, Health Choice and National Health Freedom Coalition.

    Others in the audience forcefully disputed the idea that vaccination causes autism, including a group of pediatricians.

    Dr. Sheldon Berkowitz, who works at a Minneapolis clinic that treats many Somali-American patients, said Blaxill minimized the seriousness of measles.

    “They’re our families,” said Paula Mackey, who works at the same clinic. “[Somali parents] are just trying to do what is right for their children, and this misinformation is hurting them.”

    Attendees Sunday night had varied opinions about vaccines and autism, despite the fact that any link has been thoroughly discredited by the scientific community.

    Measles can be dangerous, said parent Ikram Mohamed, but the illness only lasts a short time.

    In contrast, “Autism is not a curable disease,” said Mohamed, as several Somali-American mothers in the front row cheered her on.

    Courtesy of a colleague