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Cashing In On Fear: The Danger of Dr. Sears

I generally know what’s coming next when a parent asks about altering their child’s vaccine schedule: “I was reading Dr. Sears….”

Dr. Sears is a genius. No, not in an Albert Einstein or Pablo Picasso kind of way. He’s more of an Oprah or a Madonna kind of genius. He’s a genius because he has written a book that capitalizes on the vaccine-fearing, anti-establishment mood of the zeitgeist. The book tells parents what they desperately want to hear, and that has made it an overnight success.

Dr. Robert Sears is perhaps one of the best-known pediatricians in the country. The youngest son of Dr. Bill Sears, the prolific parent book writer and creator of AskDrSears.com, Dr. Bob has become the bane of many a pediatrician’s existence. He has contributed to his family dynasty by co-authoring several books, adding content to the family website, and making myriad TV appearances to offer his sage advice. But Dr. Bob is best known for his best-selling The Vaccine Book: Making the Right Decision for your Child. This book, or at least notes from it, now accompanies many confused and concerned parents to the pediatrician’s office. Parents who have been misled by the onslaught of vaccine misinformation and fear-mongering feel comforted and supported by the advice of Dr. Sears, who assures parents that there is a safer, more sensible way to vaccinate. He wants parents to make their own “informed” decisions about whether or how to proceed with vaccinating their children, making sure to let them know that if they do choose to vaccinate, he knows the safest way to do it. And for $13.99 (paperback), he’ll share it with them.

In the final chapter of his book (entitled “What should you do now?”), after reinforcing the common vaccine myths of the day, Dr. Sears presents his readers with “Dr. Bob’s Alternative Vaccine Schedule.” He places this side-by-side with the schedule recommended by the American Academy of Pediatrics and the CDC’s Advisory Committee on Immunization Practices. He then explains why his schedule is a safer choice for parents who chose to vaccinate their children. Without a doubt, the alternative vaccine schedule is among the more damaging aspects of this book. It’s the part that gets brought along to the pediatrician’s office and presented as the the plan going forward for many parents today. But the book is also dangerous in the way in which it validates the pervasive myths that are currently scaring parents into making ill-informed decisions for their children. Dr. Sears discusses these now common parental concerns, but instead of countering them with sound science, he lets them stand on their own as valid. He points out that most doctors are ill-equipped to discuss vaccines with parents, being poorly trained in the science of vaccine risks and benefits. He then claims to be a newly self-taught vaccine expert, a laughable conceit given the degree to which he misunderstands the science he purports to have read, and in the way he downplays the true dangers of the vaccine-preventable diseases he discusses in his book. He then provides parents with what he views as rational alternatives to the recommended vaccination schedule, a schedule designed by the country’s true authorities on vaccinology, childhood infectious disease, and epidemiology.

So what does Dr. Sears have to say, exactly, about the risks of vaccines, and just how out of touch is he with medical science and epidemiology?

VALIDATING THE UNTRUTHS

Public versus individual health

It is not uncommon for people to be confused about how public health measures relate to personal or individual health. With regard to vaccines, some feel that recommendations made “for the good of the public ” may not necessarily be for the good of the individual. Some feel that while they may understand the rationale for vaccinating on a societal level, they are unwilling or afraid to place the burden of potential vaccine risks on their child. Dr. Sears falls for this line of thinking, and leads parents to believe that certain vaccines protect the community but not the individual child. He gives polio as an example, stating that the risk of polio is zero, and that therefore the vaccine does not protect the individual child from disease. This, of course, is untrue. While new cases of polio no longer arise in the United States (thanks to the success of the polio vaccine) they still do in other areas of the world. As is true for many infectious diseases, imported cases and potential outbreaks are a quick airplane flight away. The more unvaccinated children we have, the more likely an imported case will lead to larger outbreaks of disease. So yes, vaccinating protects the individual child as well as the community at large. Ironically, polio would likely have been eradicated from the earth by 2002 had it not been for the propagation of a vaccine myth. In the impoverished Indian state of Uttar Pradesh (which, in the year 2000, accounted for 68% of all polio cases in the world), a myth that the polio vaccination campaign was really a government conspiracy to sterilize children prevented that campaign from accomplishing its true mission of ridding the world of this horrible disease.

Of course herd immunity, an epidemiological concept, is of vital importance to public health. We know that Dr. Sears understands at least this much, because he advises parents who fear giving their children the MMR vaccine not to tell their neighbors, lest too many parents develop similar fears. He warns that an increasing number of unvaccinated children will result in a resurgence of the disease. He couldn’t be more correct. Enlarging pockets of unimmunized and underimmunized children around the country have already resulted in outbreaks of disease. These vaccine-preventable outbreaks are just harbingers of worse outbreaks yet to come, should this trend continue.

Throughout his book Dr. Sears highlights common parental concerns about vaccines. He follows these not with fact-based discussions, but with subtle (and often not so subtle) words of reinforcement. For example, Dr. Sears often downplays the potential danger of vaccine preventable diseases, or the risk of infection for the unimmunized child. Although the book is rife with such misinformation, I will limit my discussion to just a few examples to give a sense of the distortions involved.

DTaP

In his chapter on the DTaP vaccine (against diphtheria, tetanus, and pertussis), in the “Reasons some people choose not to get this vaccine” section, Dr. Sears states:

In truth, tetanus is not an infant disease…Also, diphtheria is virtually non-existent in the United States. So, one could create a logical argument that a baby could skip the tetanus and diphtheria shots for a few years and be just fine.

tetanus in infant tetanus in infant

Infants with tetanus

Perhaps Dr. Sears is unaware that tetanus is indeed a disease of infants, and potentially of anyone. And to make the case that because diphtheria (or any infectious disease) is not endemic to the United States it is therefore not a threat to unimmunized children, betrays Dr. Sears’ naivete when it comes to basic principles of epidemiology and infectious disease. Epidemiology and history has shown us that when vaccination rates drop sufficiently, outbreaks of seemingly vanquished diseases return with a vengeance. Diphtheria is no exception. In the newly independent states of the former Soviet Union, declining childhood and adult vaccination rates against diphtheria have played a major role in a massive epidemic of that deadly disease. And as we see more and more pockets of unvaccinated children around this country, we are beginning to see the reemergence of horrific vaccine preventable diseases. Recent outbreaks of invasive Hib disease and of measles should remind us how important it is to maintain our herd immunity against these scourges of the not-so-distant past. Of course, Dr. Sears never challenges the unsupported concerns about vaccine risks. He simply restates these concerns, and then adds fuel to the fire, supporting the irrational fears that led to this growing trend of underimmunization.

Epidemiological missteps

Dr. Sears’ understanding of epidemiology and vaccine adverse event surveillance is startlingly poor. He purports to break new ground by doing the first ever statistical vaccine risk-benefit analysis for parents. Unfortunately, his calculations are meaningless as he misunderstands the most basic concepts, like cause-and effect, and fails to grasp the significance of vaccination rates in determining the likelihood of contracting a vaccine-preventable disease. Dr. Sears bases the risk of a child suffering a severe vaccine reaction on his analysis of VAERS data. VAERS (the CDC’s Vaccine Adverse Events Reporting System) is a passive surveillance system that everyone (doctors and patients alike) is encouraged to use anytime a vaccination is followed by an adverse event, whether or not they suspect the vaccine is the actual cause of the event. Being an open, voluntary, passive reporting system, VAERS is susceptible to fraud and abuse, as anyone can submit a report. The purpose of the system is to give a very broad look at possible unforeseen events related to vaccination. It is a screening tool, from which trends can be observed, possibly triggering true validated analyses. Raw VAERS data simply cannot be used to analyze the risk of vaccine reactions, because the data does not tell us anything about causality. Despite this, Dr. Sears and others continue to misuse VAERS data, representing it as a true estimate of vaccine adverse events. To quote the CDC,

The purpose of VAERS is to detect possible signals of adverse events associated with vaccines. Additional scientific investigations are almost always required to properly validate signals from VAERS and establish a cause and effect relationship between a vaccine and an adverse event.

But Dr. Sears uses VAERS data to come to the conclusion that “for about every 100,000 doses [of vaccine], one person suffered a severe reaction.” He fails to mention that VAERS data tells us absolutely nothing about the risk of developing a vaccine reaction, severe or not. He then takes this number and, by assuming every vaccine dose has the same risk attached to it of creating a severe reaction, determines that a child has a 1/100,000 chance of developing a severe reaction for each vaccine dose he receives. By inappropriately and misleadingly using VAERS data, Dr. Sears concludes that,

The risk that any one child will suffer a severe reaction over the entire, twelve-year vaccine schedule is about 1 in 2600.

He then calculates that,

The risk of a child having a severe case of a vaccine-preventable disease is about 1 in 600 each year for all childhood diseases grouped together.

And then asks parents the ultimate question, concluding with an example of his trade-marked, passive-aggressiveness,

Is vaccinating to protect against all these diseases worth the risk of side effects? That’s the million dollar question.

Of course, the answer is so overwhelmingly “yes” that it’s difficult to conjure up the energy to respond to Dr. Sears’ misleading analysis. Not only does he start his statistical sleight-of-hand by inappropriately using VAERS data, he then calculates the risk of acquiring a vaccine preventable disease using current disease incidence rates. What he doesn’t acknowledge is that those rates are predicated on current vaccination rates. The reason a child today is at low risk for contracting these diseases is precisely because our vaccination rates are so high!

Hib

Dr. Sears fails to mention that, while the incidence of severe invasive Hib disease is currently very low, it was actually common in the pre-vaccine era. In the years before the introduction of the vaccine in 1987, approximately 1 in 200 children below the age of 5 acquired invasive Hib disease. He admits that the vaccine is responsible for keeping the disease at bay, but then states,

HIB is a bad bug. Fortunately , it’s also a rare bug, so rare that I haven’t seen a single case in ten years…Since the disease is so rare, HIB isn’t the most critical vaccine.

If parents follow the extremely dangerous, backwards logic of Dr. Sears, we are certain to see the incidence of vaccine-preventable diseases rise, as we are now just beginning to see in the US. Rest assured, it doesn’t take long for a disease to reemerge once vaccination rates drop.

Measles

Dr. Sears’ discussion of measles consists of a series of downplayed statements. He describes the rash as one that “can look similar to rashes…of other diseases, so its not easy for a doctor, much less a parent, to recognize.” And he states that the disease is “transmitted like the common cold”. The clinical presentation of measles is striking and very difficult to mistake for any other illness. As I was taught during my residency, there’s no such thing as a mild case of measles. Every child with the disease is very ill appearing. And, while it is transmitted by respiratory droplets like the common cold, it seems the sole reason for making this statement is, again, to liken it to other, less dangerous viral infections. In answer to his self-posed question “Is measles serious?”, Dr. Sears replies,

Usually not. Most cases, especially in children, pass within a week or so without any trouble. However, approximately 1 in 1000 cases is fatal…Now that measles is rare, many years go by without any fatalities.

He then makes the astoundingly misleading statement,

The possible complications of measles, mumps, or rubella are very similar to the side effect of the vaccines themselves.

Because I can’t fathom he is that ignorant of the facts, I am inclined to believe that Dr. Sears is simply being deceitful. Here are the facts about the complications of measles:

  • One in 1000 cases of measles results in encephalitis, with a high rate of permanent neurological complications in those who survive.
  • Approximately five percent develop pneumonia.
  • The fatality rate is between one and three per 1000 cases.
  • Contrary to Dr. Sears’ statement, death is most commonly seen in infants with measles.
  • Subacute sclerosing panencephalitis (SSPE) is a rare complication of measles infection that occurs years after the illness in approximately 10 of every 100,000 cases.

Here are the facts about complications of the measles vaccine:

  • It causes fever and a mild rash in 5-15% of recipients.
  • 0.03% will have a febrile seizure – likely not a result of the vaccine itself, but simply a child’s individual predisposition to febrile seizures.
  • One in 10,000 children will have a more serious event following the vaccine, such as a change in alertness, a drop in blood pressure, or a severe allergic reaction.
  • Approximately 1 in 25,000 cases is associated with an asymptomatic drop in the blood platelet count, which quickly returns to normal without any consequences.

Dr. Sears uses reactions listed in the vaccine package insert as if they are true vaccine side effects. This is analogous to using VAERS data to draw conclusions about vaccine reactions, since there is no evidence that any of these are causally related. Most side effects listed in package inserts occur at the same rate as background or placebo rates. Nevertheless, Dr. Sears goes out of his way to reinforce parental concerns, even though the facts are right at his fingertips. The section entitled “Reasons some people choose not to get this vaccine”, that occurs at the end of each vaccine discussion, further reinforces parental fears by simply restating parental concerns with no attempt at setting the facts straight. In a box at the end of his discussion of the hepatitis B vaccine, he does attempt to explain the concept that temporality does not imply causality. Ironically, he states in this explanation,

Parents who have watched helplessly as their child develops neurological problems within weeks of being vaccinated will probably always be 100 percent convinced that the vaccine caused the problems. The fact that neurological complications are listed in the product inserts lends credibility to their case.

And so does Dr. Sears with the insidious, misleading messages he uses in his book. He concludes his discussion of causality with this confused statement,

I’m sure the truth of the matter is somewhere between causality and coincidence. Hopefully someday we will know for sure which side effects are truly vaccine related.

Of course we will never “know for sure” if every report of an extremely rare event following a vaccine is causally related or not. We continue to monitor trends and conduct rigorous surveillance, and follow that with sound epidemiological studies when concerns arise. This is why we can say, with good confidence, that these vaccines are extremely safe, and that Dr. Sears’ concerns and equivocations are misleading at best.

TOXIC SHOTS

Throughout his book, Dr. Sears discusses the common fears concerning vaccine dangers, never correcting when these fears are based on myth or misinformation. Rather, he presents them in a “we just don’t know enough” manner (even when we do), or as matters of fact (even when they’re not). Dr. Sears raises the concern in his book that the recommended schedule of childhood vaccines may pose a danger. He suggests that we just don’t know if the chemicals contained in the vaccines (which he lists in alarming fashion) may be too great of a burden for the developing child.

Thimerosal

In the very first page of the book’s preface, Dr. Sears tells his readers that he is “not going to discuss, at length, mercury or thimerosal in vaccines because, thankfully, these have been taken out of virtually all vaccines” (my emphasis). This is followed by more language that makes it clear he believes thimerosal wasa dangerous additive, and that the little remaining thimerosal in the vaccine supply (contained in one form of the influenza vaccine) is still a risk. Of course, we know that the thimerosal in vaccines was unlikely to ever have been a danger to children, but Dr. Sears uses the same old misinterpretations of the science and conspiracy theories to arrive at the conclusion that it was. In fact he point blank states that “vaccine manufacturers knew that we were overdosing babies with mercury, but no one in the medical community realized the possible implications for almost ten years.” This kind of fear mongering is no different than that spewed by the folks at Generation Rescue, and lacks any basis in science. In his section on vaccine ingredients, Dr. Sears (again, either naively or dishonestly) discusses the rise in the rate of autism diagnoses as possibly a result of thimerosal in vaccines. He cites the same tired and poor references (and an article from the LA Times) we’ve heard before from the likes of Jenny McCarthy, and then asks “so who do we believe?”. Again, that question is left hanging.

Aluminum

Of particular concern to Dr. Sears is the potential dangers of aluminum, which has become his new post-thimerosal villain. Although he worries aloud in his book that ”aluminum may end up being another thimerosal”,  Dr. Sears is unaware that such a comparison doesn’t exactly strike fear in the hearts of the scientific community.

Many vaccines contain aluminum as an adjuvant. An adjuvant is a substance that boosts the ability of a vaccine to induce an immune response. It acts locally at the site of injection, as a signal to the immune system, drawing a heightened response to the injected vaccine. Ironically, without adjuvants we would need a larger dose of the vaccine to induce an immune response. I doubt that would go over well in anti-vaccine circles.

Unfortunately, Dr. Sears’ concerns about aluminum are the result of a distorted reading of what is known about aluminum toxicity and the risk of vaccines in children. In discussing “controversial ingredients”, he states

…some studies indicate that when too many aluminum-containing vaccines are given at once, toxic effects can occur.

In fact, no such studies exist. He does correctly state that there is very little known about the pharmacokinetics of intramuscularly injected aluminum as it occurs in vaccine adjuvants, but he goes on to distort what we do know about aluminum toxicity into a rationale to fear our current vaccine supply and schedule. For instance, we know that aluminum has been blamed for producing neurotoxicity in some patients with renal failure on long-term dialysis, and in some extremely premature infants given prolonged courses of aluminum-containing intravenous nutritional solutions. But this is not comparable to the exposure of healthy infants to adjuvant-containing vaccines given intramuscularly on a few, discrete occurrences over a period of months. Similar to the way the safety data for methylmercury is often incorrectly applied to the ethylmercury in thimerosal (and incorrect inferences of toxicity made), Dr. Sears uses safety limits set for something else, and incorrectly applies them to the aluminum in vaccine adjuvants.

Dr. Sears uses the FDA’s maximum permissible level (MPL) of aluminum for large volume bags of intravenous fluids given chronically to premature infants (25 µg/L), and extrapolates it to adjuvant-containing vaccines. He also uses the number 5 µg/kg/day as the amount of aluminum found to cause toxicity in some premature infants receiving intravenous feeding solutions that contain aluminum. What he doesn’t mention is that the 25 µg/L number comes from studies showing that this concentration produces no tissue aluminum loading, and that it was chosen to allow room for other exposures. In fact, it is estimated that the aluminum in these intravenous feeding solutions accounts for only 10-15% of the total parenteral aluminum intake per kg body weight that premature infants receive in a given day while in intensive care. The number was set low to leave room for the other sources of parenteral aluminum these infants receive. Still, Dr. Sears uses this number as his standard against which he compares the aluminum content of vaccines. This is misleading for a number of reasons. First, the 25 µg/L MPL for parenteral feeding bags says nothing about the maximum amount of aluminum that can be safely injected. This is obvious as the number is expressed as a concentration, not as an absolute amount of aluminum. The average premature infant would likely receive 100 ml/kg/day of solution, and therefore roughly 2.5-5 µg per day of aluminum from this source. Again, accounting for only about 10-15% of the parenteral aluminum the infant would receive in a given day. Dr. Sears does acknowledge that the number isn’t a maximum permissible amount of aluminum for injection, but he uses it anyway stating, in essence, that it’s all we’ve got. But it isn’t all we’ve got, as we shall see in a moment.

The fact that these intravenous, aluminum-containing solutions are administered continuously over long periods of time, whereas vaccines are administered in discrete unit doses at intervals spaced out over time, is also not taken into consideration in Dr. Sears’ discussion. But his use of the FDA limits for intravenous feeding solutions is misleading also because it ignores the difference between intravenous and intramuscular or subcutaneous injection of aluminum, as in the case of vaccines. In fact there is evidence, which Dr. Sears must have missed in his exhaustive review of the literature, that the aluminum from vaccines behaves differently than intravenously administered aluminum, and that the body burden of aluminum from vaccines is not so concerning when placed in the context of the background body burden of aluminum.

One piece of evidence that the aluminum in vaccines is handled by the body quite differently than the aluminum in intravenous solutions comes from studies looking at the intramuscular injection of aluminum-containing adjuvants into rabbits. Rather than entering the blood stream directly and accumulating in tissues, as with intravenously injected aluminum, intramuscularly injected aluminum-containing adjuvants are first dissolved by organic acids in the interstitial fluids, and are then rapidly eliminated.

Another reassuring look at aluminum exposure from vaccines comes from an analysis by Keith, et al. from the ATSDR. They looked very closely at the the way in which all sources of aluminum exposure in the infant contribute to the total body burden of aluminum, including inhalation, oral, dermal, and vaccine exposures. They took into consideration uptake, transfer from the blood, release from the injection site, distribution patterns, and retention and elimination rates of aluminum. They used the Priest formula to assess the fate of aluminum once it has entered the body via any route.

  • R = 0.354dt−0 .32 (where R is the retained fraction, d the uptake dose in mg Al, and t the time in days following uptake. The equation is summed for repetitive intakes such as with multiple vaccinations.)

Comparison of the aluminum body burden from vaccines to that from ingested breast milk, in relation to the oral MRL for aluminum for infants at the 5th and 50th percentiles for weight, is shown in the figure below (taken from the original article). The analysis assumes injections of vaccines according to the following schedule, with the corresponding aluminum content:

  • Birth: Hep B (250 µg)
  • 2 months: Hep B + DTaP (1100 µg)
  • 4 months: DTaP (850 µg)
  • 6 months: Hep B + DTaP (1100 µg)
  • 12 months: DTaP (850 µg)

While this leaves out the PCV and Hib vaccines, only one brand of Hib vaccine contains aluminum, and the PCV vaccine contains only 125 µg of aluminum. Thus, this analysis accounts for the bulk of the aluminum that comes from the vaccine series.

Aluminum body burden

As can be seen in the figure, aluminum spikes occur on the day of injection, followed by rapid elimination within a few days. Despite slight and brief overlaps between the vaccine and MRL curves at the time of vaccination, the vaccine curves always fall between the dietary intake curves and the MRL curves. The authors conclude that, in the context of the overall body burden of aluminum with which infants are born and which is added to by ongoing oral, inhalational and parenteral sources, vaccines are likely to constitute only a minor, transient part.

While there is good reason to be confident that the aluminum in vaccines is not the dreaded neurotoxin Dr. Sears fears it is, in his book he suggests otherwise. His mantra is that there are now so many vaccines in the routine schedule that we are overloading our children’s bodies with toxic aluminum. This is neither borne out by the science, nor is it likely given what we know about aluminum and the way in which children are exposed via vaccinations.

Other scary sounding vaccine constituents

In addition to the hot-button concerns discussed above, Dr. Sears highlights a number of other vaccine constituents that “might be of concern to some parents.” In typical style, he doesn’t explain why these concerns are unfounded, but instead makes sure they are listed in alarming fashion so that parents can make there own “informed” decision about whether or not to be concerned. Again, many parents appreciate this approach as one that is non-condescending. What it really is, however, is deceptively lacking in scientific honesty.

  • Animal and human tissues – Dr. Sears lists items like “cow fetus serum” in  the What ingredients are in the vaccine sections of each vaccine he discusses. Because the reader doesn’t realize the absolute lack of importance to this fact, he is merely raising the specter of danger without truly informing. He mentions the issue of potential contamination with prions and the risk of transmitting mad cow disease, even though such a risk does not exist. Dr. Sears discusses the contamination of an early polio vaccine in the 1950′s with SV40, a monkey virus, as an example of the potential dangers of using animal and human cell cultures in vaccine manufacturing, although this actually posed no risk at the time. Here’s the gratuitous, completely uninformative way Dr. Sears concludes his section on Animal and Human Tissues, seemingly meant to shock and invoke fear, all under the guise of just giving the facts:

For review, here is a list of the various animal or human tissues used to make vaccines:

  • Human blood proteins (albumin)
  • Human lung cells
  • Human fetal lung cells
  • Human cell lines
  • Cow serum (the liquid part of blood)
  • Cow heart-muscle extract
  • Cow tissue extract
  • Monkey kidney cells
  • Guinea pig embryo cells
  • Chicken embryos
  • Chicken kidney cells
  • Chicken eggs
  • I’m certain this list is frightening to some parents, but it needn’t be. Unfortunately, Dr. Sears does nothing to honestly inform his readers.

    • Formaldehyde- Dr. Sears discusses what he considers to be the toxic properties of formaldehyde – that it’s carcinogenic and causes kidney and genetic damage. He follows this with:
    • I could not find information on injected formaldehyde. Fortunately, the amount in each vaccine is minuscule.

      Perhaps he could also have mentioned that formaldehyde is naturally present in the bodies of infants, at a level far greater than that contained in the vaccines they receive, and that formaldehyde does not appear to be carcinogenic to humans, or that animals injected with extremely large quantities of formaldehyde also fail to develop cancers.

    • MSG – The controversial nature of MSG is reviewed, and readers are reminded that “large quantities” can cause nervous system damage “similar to Alzheimer’s disease.” Again, he follows this with the fact that vaccines contain only trace amounts of MSG.
    • 2-Phenoxyphenol – The book informs us that this chemical causes reproductive defects, is an irritant, and can be found in nasty things like solvents. Again, Dr. Sears ends by stating that it’s found in “minuscule” amounts in vaccines.
    • Sodium deoxycholate – Another toxic substance, harmful to the eyes and lungs, found in minuscule amounts in vaccines.
    • Polysorbate 80 and 20, EDTA, Sodium borate, Octoxynol- For some reason these chemicals get a complete pass. Dr. Sears simply states that, in the tiny amounts found in vaccines, they are “considered harmless”. I’m not sure why these toxins are considered harmless in these trace amounts, while the others are not given this quick vote of confidence. Nor am I sure which authorities he is referring to who have made these declarations of harmlessness. Perhaps Dr. Sears is unaware that sodium borate is a chemical used in metal solder, as a laboratory buffer, has been banned as a food additive in Indonesia, and may cause liver cancer. And I’m surprised he didn’t mention that polysorbate 80 can increase the risk of blood clots, stroke, and heart attack. Perhaps he didn’t want to sound too alarmist.

    DR. BOB’S SELECTIVE AND ALTERNATIVE VACCINE SCHEDULES

    The final product of The Vaccine Book is the two schedules Dr. Sears proposes for different types of concerned parents. The Selective Schedule is offered to parents who “otherwise would have declined all vaccines”. For this schedule, Dr. Sears chooses vaccines he feels are the most important, because the diseases they protect against are either the most dangerous and/or the most common, and have the least severe potential side effects. The Alternative Schedule (the one I see most commonly) is intended for parents who want to vaccinate, but who have concerns about vaccine safety, a group he correctly describes as “growing in recent years as the media and the internet bring theoretical problems with vaccines to light.” This book, of course, is part of the mass-appeal stream of misinformation contributing to that growing trend.

    The Alternative schedule, as explained by Dr. Bob, accomplishes the following:

    1. It spreads out vaccines to give only one aluminum-containing vaccine at a time. This is done so “infants can process the aluminum without it reaching toxic levels”. Really? Can Dr. Sears cite the references for this scientific sounding rationale?
    2. It exposes infants to the chemicals of only two vaccines at a time. Similar to the above anti-scientific rationale, this is done to spread out exposure to “chemicals”, so the infant can process them without risk. In a statement that clearly reveals his lack of scientific understanding, Dr. Sears then states, ” …we don’t know whether this precaution is necessary, but it’s reasonable.” [Reasonable:  1 a: being in accordance with reason <a reasonable theory> b: not extreme or excessive <reasonable requests> c: moderate, fair <a reasonable chance> <a reasonable price> d: inexpensive 2 a: having the faculty of reason b: possessing sound judgment <a reasonable man>] No matter how you read it, reasonable it isn’t.
    3. It gives at most 2 vaccines at a time to limit potential side effects. Again, Dr. Sears states we don’t know if more simultaneous vaccinations leads to a greater likelihood of side effects, but concludes that it’s “a reasonable precaution.” We actually do know, contrary to very popular belief, that infants can easily handle all of the recommended vaccines, and then some.
    4. It begins with “the most important” vaccines. Dr. Sears would have his readers believe he has come up with a good schedule of vaccination based on giving vaccines that protect against the most serious diseases first. His readers would be better informed if they were told how the AAP/CDC recommended vaccine schedule is designed. How the country’s leading experts on vaccinology, infectious disease, and epidemiology determine which vaccines are most important and when they are best given – balancing when they are most effective at inducing an immune response and when the risk of disease and adverse disease outcome is greatest. Interestingly, the actual order of the real vaccine schedule is the same as Dr. Bob’s.
    5. “It delays shots for diseases that are usually fairly mild for infants”. He gives as examples hepatitis A and rubella. The first dose of both the hepatitis A and rubella vaccines are actually recommended at 12-15 months of age. They are not part of the vaccine series given in the first year of life. Further, Dr. Sears’ rationale for delaying rubella vaccine misses the point entirely. Rubella, while usually a mild illness, is not on the vaccine schedule because of the severity of the illness it causes. It is recommended because women infected (usually by children) during the first trimester of pregnancy, have a 50% chance of delivering a baby with severe congenital defects. The vaccine has been successful at nearly eliminated this horrific occurrence.
    6. “It delays the shots for diseases that a baby is extremely unlikely to catch during the first few years of life”. He gives as examples hepatitis B and polio. As I discussed earlier, this rationale uses flawed, backwards logic. Babies are at low risk for contracting polio because there is no home grown polio in this country. That is precisely because we vaccinate everyone in infancy. Without a susceptible host, the disease disappears. Unfortunately, because of religious opposition and other myths, the same cannot be said about every area of the world. As a result, we have yet to completely reign in this horrible disease. Although hepatitis B is not common in infancy as long as the infant’s mother is not a carrier (or infected) during pregnancy, it is still a risk. Prior to routine vaccination against hepatitis B, 18,000 children per year were infected. Half of these children did not contract it from their mother at the time of birth. Because the disease can be severe, chronic, and can lead to destruction of the liver or liver cancer, and because it can be spread through casual contact with contaminated objects like toothbrushes, it is recommended that all children get vaccinated as early as possible. Because the vaccine is so safe (it does not cause a hepatitis-like illness as Dr. Sears warns his readers), and it can be transmitted casually (it’s not just a sexually transmitted disease as Dr. Sear states), it is recommended during infancy.
    7. “It gives live-virus vaccines one at a time so that a baby’s immune system can deal with each disease separately”. Here Dr. Sears travels further from science than he does perhaps anywhere in his book. First, he refers to a live virus vaccine as a “disease”. This is either a serious mistake, purposeful deceit, or dangerous ignorance on his part. He discusses the potential dangers of giving the MMR vaccine as a combined vaccine, and recommends separating it into M, M, and R components and spreading them out over time. He then states that

      “it’s probably okay to give the combination MMR booster at age 5, when a child’s immune system is more mature [my emphasis].”

      First of all, we know the vaccine is effective at invoking a protective immune response when given at the recommended ages (12 months, and 4-6 years). The notion that multiple vaccines can somehow overwhelm an infant’s immune system indicates an absolute lack of understanding of how the immune system responds to vaccines, and is thoroughly refuted by science. I will not go into depth here discussing the enormity of the evidence refuting any causal association between the MMR vaccine and autism, nor discuss the apparent fraud that was perpetrated in the publication of the original paper the made this issue the phenomenon it has become. Others have exhaustively covered that topic. I will say that for Dr. Sears to perpetuate this extremely dangerous myth is deplorable. He has the audacity to pander to the fears of parents by stating,

      Splitting the MMR into separate components is thought by some researchers to decrease the risk of autism and other reactions, although medical science has not proven this to be so.

      I don’t know to whom he is referring when he writes “some researchers”. I do know (as should Dr. Sears) that there is not one shred of scientific support for the notion that a split MMR confers any benefit over the combination vaccine. It certainly can’t decrease the risk of autism, since the MMR does not cause autism. And there is no scientific evidence that it decreases the risk of any side effects. What it does do is increase the number of shots a child receives, increasing the time, expense, and pain involved. More importantly, it increases the amount of time a child is susceptible to disease. But the most damaging aspect of this kind of deceit, is that it further erodes society’s understanding and trust in science. Tagging the statement, “although medical science has not proven this to be so” at the end, does nothing to exculpate him from this offense.

    After explaining his alternative schedule, Dr. Sears cavalierly remarks that if he’s wrong about all of this, the worst case scenario is that “you risk really annoying your doctor because you’re trying to think outside the box.” I’ve just discussed the real harm of this schedule. Applying the positive expression “thinking outside the box” in an effort to cast a positive spin on it is disingenuous. Thinking outside the box can be a good thing in science. But, unless we’re talking about quantum theory, not as a way of understanding science itself.

    Dr. Sears claims to listen to parental concerns and to be impartial when it comes to whether or not, or how, to vaccinate. He says that, rather than tell them what to do, he prefers to give parents all the information they need to make their own, informed decisions. But instead of accurately discussing the science for concerned parents, correcting the pervasive vaccine myths and misinformation so prevalent in the media, on-line, and in our communities, he distorts, misinterprets, and misleads. Dr. Sears has either a very poor understanding of how to read the scientific literature, and of the scientific method itself, or he is intentionally misleading his readers. Either explanation indicates an unacceptable and egregious abuse of his public and professional responsibilities. Dr. Sears is not as blatantly anti-vaccine as others. In the beginning of the book he informs his readers that it “is not an anti-vaccine book” (his emphasis), and that other books over-emphasize the dangers of vaccines and do too much to scare parents. This is a nice set-up for the book, allowing parents to believe they are getting the straight, unbiased story from a doctor that really wants to inform. While Dr. Sears’ brand of fear-mongering is more subtle than some, it is at least as dangerous. Because of his family name and public persona, Dr. Bob has become one of the country’s most recognized pediatricians. And his plain language “parents know best” philosophy has attracted the admiration and trust of parents looking for authoritative validation of their fears, concerns, and beliefs. Unfortunately, Dr. Sears is good at repeating and reinforcing common parental fears and anti-vaccine myths, but is quite poor at reading the literature and understanding epidemiology. While he doesn’t overtly tell parents not to vaccinate, he certainly stacks the deck this way. In his discussion of each vaccine, his “reasons to vaccinate” section tends to downplay the risks of the disease. He “balances” this with a section called “reasons some parents choose not to vaccinate”. But I view this as simply his attempt to exculpate himself for being, in reality, an anti-vaccine spokesperson. For all intents and purposes, this gives parents every reason to feel confident that their rationale for not vaccinating is supported by sound reasoning. Dr. Sears rehashes and lends credence to the same debunked myths that have led to these parental fears in the first place, all under the guise of providing parents with “both sides” of the issue. Of course what he does is provide bits and pieces of good information alongside inaccurate and incorrect information, and asks parents to make an “informed” opinion.

    With his best-selling book (it currently ranks at #414 on Amazon) Dr. Bob, along with a growing platoon of other prominent anti-vaccine spokespeople, is leading parents into a trap that not only threatens their own children’s health, but the health of the entire nation as well. Already, this anti-scientific group-think has increased the number of children who are under or un-vaccinated, and has resulted in preventable death and disease. I hold Dr. Sears and the many vocal prophets of doom (like Jenny McCarthy, Paul Kirby, Robert Kennedy Jr., JB Handley, and Andrew Wakefield) personally responsible for the increasing prevalence of parental vaccine refusal and the ensuing return of vaccine preventable disease.

    Note: To watch a less subtle Dr. Sears discuss his views on vaccines, click on this link.

    Posted in: Book & movie reviews, Public Health, Science and Medicine, Vaccines

    Leave a Comment (61) ↓

    61 thoughts on “Cashing In On Fear: The Danger of Dr. Sears

    1. David Gorski says:

      Awesome summary. This should be required reading for pediatricians who have to deal with parents confused by Dr. Sears’ selective presentation and distortions.

      Maybe we should make this into a pamphlet.

    2. Matt says:

      I am very tired of people using “researcher” and “research” in confusing ways. Dr. Bob may have “researched” vaccines–as in book research. That doesn’t put him level with someone who has actually spent the time in the lab doing real research.

      Do you by chance mean David Kirby in place of “Paul” Kirby?

    3. Squillo says:

      Tremendous analysis.

      I like David’s suggestion. With your permission, will give to my pediatrician to add to his bulletin board of vaccine-related information.

    4. bcorden says:

      Thank you. Thank you. I wish I had the section on Hepatitis B this afternoon when a physician father and a physician mother questioned giving it to their soon to be delivered child. I hadn’t realized it was so easily transmitted to infants.

      In terms of dealing with refusal to vaccinate on a daily basis, at first I tried reasoning with people and giving them handouts and literature. I am convinced that they read what Dr. Bob writes but they won’t read what I provide. Then I realized that most parents who had tasted his honeyed words were not every going to be convinced. So, I have a rule: if parents do not want to accept the recommended vaccines and the recommended schedule, they will have to find another practice. I explain to them that I cannot risk having their un- or under-immunized child bringing a disease like pertussis or measles into my waiting room to infect other infants. I know, I am supposed to be understanding, but I don’t have time to do this anymore.

    5. superdave says:

      we need oral vaccines. I swear half the issue here is just that there is an inbred distrust of anything that pokes into your skin.

    6. David Gorski says:

      Dr. Sears is not as blatantly anti-vaccine as others. In the beginning of the book he informs his readers that it “is not an anti-vaccine book” (his emphasis), and that other books over-emphasize the dangers of vaccines and do too much to scare parents.

      Dr. Jay Gordon and Jenny McCarthy also reassure us time and time again that they are “not anti-vaccine.” We know otherwise.

    7. Michelle B says:

      Thanks for this excellent summary and yes, it needs to be made into a pamphlet! This is first time I have heard about Sears, what a disgusting person. It is one thing when non-medical professionals like McCarthy get it wrong, and another when a trained medical doctor gives in to sloppy thinking. He has absolutely no excuse to be so badly misinformed.

      corden, you are understanding–you understand the risks that these improperly vaccinated children pose to your patients. If I was practicing, this is what I would do also. I would also add that if they change their minds, I would be most happy to vaccinate their children properly.

    8. John Snyder says:

      bcorden: I can absolutely appreciate your stance with vaccine-refusing parents. I have opted to keep them in my practice as I think I am more likely to get them to vaccinate than others might be. I posted a sign the other day in my waiting room, referencing a recent local measles outbreak, asking parents of under/unvaccinated children to immediately notify the front desk as they enter, so that they can be removed from the waiting room. It makes it clear that they are a risk to the other families. We’ve reached a point at which it’s important for these parents to feel a bit ostracized, and for the other parents to feel some outrage.

    9. nolaskeptic says:

      This is a terrific article. I plan to forward links to every physician I know. I also think this article (in slightly summarized form) would be a great addition to the “book reviews” section in almost any pediatrics or family medicine journal. I hope Dr. Snyder will consider publishing it in a forum where it might reach more practicing physicians.

    10. nokomarie says:

      I am a nurse and I have always reacted badly to vaccines, cooked a fever, or seen double every time I have had a dose of much of anything. It takes numerous exposures for me to pick anything up and took a heavy double exposure to variccela for me to contract pox. I developed it when I was 35 when my kids had it the second time. Not nice.

      Even though I might hesitate to vaccinate myself, I have unhesitatingly vaccinated my children. If I get a vaccination, I need a day or two off for I will be quite ill. It is off of someone like me that these charlatans are basing their claims. You know DR. Sears and others surely do purvey the lie that everyone will react the same way I do and that simply isn’t true. If it were, people would not be able to take most drugs. Nevertheless, there is a flip side as in vaccines are in no way perfect.

      I think if one abstracted one’s head out of one’s own ass and looked at things, very nearly the entire issue of vaccines is one of control. Here comes the doc with the dripping needle to stab the kid in a painful shot that makes it scream. All for their own good, how dare they question it?

      Think about that and then re-think about the approach to vaccination. There is so much recent information out there that supports it. And the doctor him/her self should bone up on giving it. Do not pass everything off to the nurse as if it were nothing. It is not nothing, in an issue where you are meeting resistance back up everything that you do personally. So some kid kicks you in the jaw. Good, I hope it hurts until you learn to administer a shot better. Give the shot yourself and the yelling will die away but fast.

    11. Calli Arcale says:

      nokomarie, you suggest that doctors should change their approach so they a) don’t appear to be the doc with the dripping needle to stab the kid and b) don’t hand it off to the nurse, because it’s okay to get kicked in the jaw and the yelling will die away faster. You seem to contradict yourself, on the one hand blaming doctors for giving shots and then blaming them for *not* giving the shots personally. I also have some objection to your suggestion that it’s okay to get kicked in the jaw, and that it’s a good thing because you think doctors are all too incompetent to give a shot properly. I’ll have you know that all of my childhood vaccinations were performed by a doctor, and he did an excellent job. It really isn’t rocket science. And being kicked in the jaw isn’t something a health care professional should wish on anyone, least of all one of their colleagues.

      Of course it’s an issue of control for a lot of parents. That’s the same reason some parents get upset about public education. Blaming doctors for the narrow-mindedness of some parents isn’t helpful. I’ve seen doctors bending over backwards to give parents all the best information there is to explain why they are recommending vaccination. But it doesn’t seem to affect how often they are accused of being some b-grade horror villain, cackling over a “dripping needle to stab the kid”. Sure, there are jerk doctors. There are jerks in all walks of life. But you paint with an awfully broad brush when you suggest that it is entirely the fault of how doctors have approached vaccination. Part of me wonders if you’re just miffed at having to be the bad guy administering the shots, while me, as a parent, am glad that it’s the nurse administering the shots to my kids because this particular nurse is really good at it.

      While you’re at it, maybe you want to suggest that doctors start taking vitals and patient history, so you don’t have to do that either. After all, it’ll get them more in touch with their patients. And then they may realize they don’t need to pay for an RN or LPN and can get away with cheaper staff. Be careful what you wish for….

    12. durvit says:

      Some added detail on formaldehyde from HolfordWatch:

      Formaldehyde is a normal by-product of our own metabolism. Normal blood levels are 2.5ppm or 2.5mg/L (or 2.5 ug of formaldehyde per ml of blood) – compared to that, the amount in a vaccine is within limits, particularly given the half-life in blood of 1.5mins. If you consult vaccine formulations, the average amount to which an infant might be exposed on any one occasion is 0.2mg. Assuming the (not unreasonable) average weight of a 2-month-old of 11 lb (5kg) with a typical blood volume of 85ml/kg, the infant’s circulation usually works out at about 1.1mg, or x5 greater than the amount in a vaccine.

      If you consult vaccine formulations, the average amount to which an infant might be exposed on any one occasion is 0.2mg. Assuming the (not unreasonable) average weight of a 2-month-old of 11 lb (5kg) with a typical blood volume of 85ml/kg, the infant’s circulation usually works out at about 1.1mg, or x5 greater than the amount in a vaccine.

    13. Prometheus says:

      This needs to be emphasized:

      “…he [Dr. Sears] advises parents who fear giving their children the MMR vaccine not to tell their neighbors, lest too many parents develop similar fears.”

      In other words, don’t tell your neighbours so that your children can continue to freeload off of “herd immunity”. There seems to be an ethical lapse here, especially for a physician.

      Would he feel the same way about someone pirating his cable signal or using his hose to water their garden? I doubt it.

      Prometheus

    14. Versus says:

      Last year, there was a bill in the Florida legislature to allow parents to choose an altered vaccination schedule — I don’t know if it was Dr. Sears’s version but the idea was the same. It died in committee, thank goodness.
      I congratulate those doctors who won’t continue to see patients whose parents refuse to vaccinate them. I suggest a sign in your waiting room explaining this policy, which would also bring to the attention of waiting parents the risk of disease posed by unvaccinated children.
      If Dr. Sears gives this sub-par advice to parents in his practice, can’t he be disciplined by the state Medical Board? Turn him in!

    15. Sid Offit says:

      A few corrections:

      “tetanus is indeed a disease of infants”

      Where the Gambia? Not in America!

      In 1997, NT accounted for an estimated 277,400 deaths worldwide (1) but is rare in the United States. During 1995-1997, of 124 tetanus cases reported in the United States, only one occurred in a neonate (2,3).
      http://www.immunize.org/reports/report007.asp

      …and not because of vaccines but because of clean surgical instruments
      http://adc.bmj.com/cgi/pdf_extract/60/5/401

      ———–

      SSPE occurs in 10 of 100,000 cases

      Not really….

      http://www.emedicine.com/EMERG/topic163.htm
      Encephalitis
      Marjorie Lazoff, MD,
      Last Updated: September 12, 2005
      Measles produces 2 devastating forms of encephalitis: postinfectious, which occurs in about 1 in 1000 infected persons, and SSPE, occurring in about 1 in 100,000 infected patients.

      ——-

      Finally measles mortality is nowhere near 3 per 1,000 but more like 1-8,000

      ~500 dead (not from measles but related causes) out of 500,000 reported cases although due to the diseases mildness estimates are that there were 3-4 million cases per year most of which were unreported

    16. Sid Offit says:

      PS

      Measles mortality data courtesy of the CDC’s

      Epidemiology & Prevention of Vaccine Preventable Diseases 3rd ed. 1996 P92

    17. Chris says:

      Young Master Sid “Offit” (we know you took that name because of someone you despise), you really need to start taking those classes at that vocational college. It might help with this subject, and your lack of research skills.

      From Neonatal Tetanus — Montana, 1998:

      On March 21, 1998, a 9-day-old newborn, who had no previous medical problems, was taken to a hospital by her parents who reported a 10-hour history of an inability to nurse and difficulty in opening her jaw. Her parents also had noticed a foul-smelling discharge from her umbilical cord during the preceding 1-2 days. No other symptoms were noted by the parents. On admission, the newborn had trismus, increased general muscle tone, and hyperresponsiveness to external stimuli. The umbilical cord was covered with dried clay, which when retracted revealed a foul-smelling yellow-green discharge. Culture from the umbilical cord grew several anaerobic (C. perfringens, C. sporogenes) and aerobic (Staphylococcus, Streptococcus, and Bacillus sp.) bacterial species. NT was diagnosed based on the clinical characteristics.

      And Philosophic Objection to Vaccination as a Risk for Tetanus Among Children Younger Than 15 Years (it does include the previous case):

      Both neonates had umbilical infection, 1 after application of “healing” clay to the umbilical stump.13 Among the 13 non-neonatal cases, the source of injury was a puncture wound in 11 cases (73%) and blunt trauma in 2 cases. Eight of the puncture wounds were sustained on the foot when the child was outdoors. TIG was administered to 13 of 15 children. The median interval between the onset of symptoms and administration of TIG was 1 to 4 days (range: 7 hours to >15 days). ….Tetanus was associated with severe disease and complications, particularly among unvaccinated children. Eight children (53%) required mechanical ventilation. The median length of hospitalization was 24 days (range: 1–60 days). One of the 2 children for whom TIG was refused for religious reasons had complications of a perforated colon and prolonged hospitalization (Table 1, case 12). Children who were fully vaccinated experienced milder tetanus illness than the unvaccinated children (median: 2-day compared with 25-day hospitalization, respectively). There were no deaths.

      Due to the diligent work of folks like Dr. Sears and sycophants like “Sid Offit”, there will be many more children born without passive immunity to tetanus, and more cases of neonatal tetanus. The real fun thing about tetanus is that there is no herd immunity for it!

    18. John Snyder says:

      Sid Offit:

      Depending on your source, SSPE occurs in either 1 or 10 per 100,000 cases of measles. The most recent study (Bellini et al., 2005) looked at the risk of developing SSPE during the measles epidemic in 1989-1991, the one which nearly killed me. That study, which corrected for underreporting, put the risk of SSPE at 6.5-11 cases of SSPE/100,000 measles cases. It’s important to note that the risk appears to be highest in cases of measles acquired in the first 2 years of life.

      As for the measles mortality rate, 1-3 deaths/1,000 cases is the number cited by the CDC, and the range I cite above. You can download the CDC’s Pinkbook on measles here:

      http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas-508.pdf

    19. Chris says:

      Sycophants like to cherry pick:
      Acute measles mortality in the United States, 1987-2002.:

      Overall the death-to-case ratio was 2.54 and 2.83 deaths/1000 reported cases, using the NCHS and NIP data, respectively. Pneumonia was a complication among 67% of measles-related deaths in the NCHS data and 86% of deaths in the NIP data. Encephalitis was reported in 11% of deaths in both databases. Preexisting conditions related to immune deficiency were reported for 16% of deaths in the NCHS system and 14% in the NIP; the most common was human immunodeficiency virus infection. Overall, 90% of deaths reported to the NIP occurred in persons who had not been vaccinated against measles.

      Oh, and if you go into the CDC Pink Book Appendix G, you will find that the numbers of deaths per cases were indeed closer to one in a thousand before better surveillance of the 1980s. Though if you would think that is an acceptable number of fatalities for something as easily spread as measles, then you should not go into any medical care profession.

      The real Dr. Offit was there in Philadelphia during the 1990-1991 epidemic when several children who were part of anti-medicine churches died of measles:

      ONE DAY IN 1991, when Offit was a young attending doctor at CHOP, he was called in to consult on three or four patients. They were behind Plexiglas at the hospital’s intensive care unit….The parents of these children, Offit later learned, belonged to a church community in North Philly that practiced faith healing. None of the kids had been vaccinated against the measles or any other disease. Their parents didn’t believe in vaccines. This was unfortunate, because the measles virus is not really affected by human belief… It was too late. Offit saw those kids every day, as they slowly drowned in their own fluids.

      This is the man whose name you have decided to use as an ironic nickname. Someone who has seen real (and since this part seems important to you) American children die from measles. Something tells me you will never be a real medical assistant. I doubt if you will make it past the first required biology course (cherry picking is not allowed).

    20. Matt says:

      I posted a sign the other day in my waiting room, referencing a recent local measles outbreak, asking parents of under/unvaccinated children to immediately notify the front desk as they enter, so that they can be removed from the waiting room

      Our pediatrician used to have a separate waiting room for kids under 12 months. That way, the undervaccinated were separated from the vaccinate. Also, he had a sign on his front door telling people that if they had a new rash they should signal the receptionist and wait outside until someone did a preliminary evaluation on them.

      I really appreciated those efforts.

    21. David Gorski says:

      “Sid Offit” is an anti-vaccine troll who has been known to infest other blogs, in case anyone here had not encountered him before.

    22. Sid Offit says:

      Chris, where have you been? The medical assistant thing was a joke.

      Anyway using data from the 89-91 epidemic is problematic since most cases occurred in low income populations having risk factors not present in a larger, more representitive population. Additionally a dimunition of maternal antibodies due to widespread vaccination made infants more vulnerable in the 80s-90s. So mortality in a large population having maternal antibodies is 1-8,000 while mortality in a group living in poverty and having no maternal antibodies may be higher but during the 89-91 epidemic underreporting again made the disease seem more dangerous than it actually was

      http://www.ncbi.nlm.nih.gov/pubmed/7630992
      Although measles is a serious communicable disease which is almost completely preventable, cases of it among preschool-age children in this high incidence area were substantially underreported,especially by private physicians. Due to reporting bias, reported measles cases were representative of more severe cases than all the cases that occurred.

    23. Sid Offit says:

      Thanks Dave

    24. Chris says:

      I know. To understand my references to his education see this comment on Respectful Insolence:

      BTW, Sid, the mere fact that you are just now taking the COMPASS test tells me a lot about your general and scientific knowledge base (hint: neither broad nor deep).

      The fact that you are bragging about it tells me even more.

      (he claimed his score was “off the charts”, yet later someone who has had a child take the test reveals it only goes to a score of 99, and is basically a high school level test)

    25. Chris says:

      What joke?

      You mean your stupidity was a joke, along with taking the name of a real doctor who has done more to save children than you ever will.

      The only reference I got it was a joke was this comment:

      1st, I did get your joke about Westwood college. I figured it was your attempt at humor because I seriously doubt you would either qualify for entrance or survive your first semester. I thought it was very humorous! Touche’ there snappy!

      .

      That is because I tend to skim over your stupidity.

      Yes, I still believe you would never pass either the Compass test, nor pass a basic biology course.

    26. Sid Offit says:

      The real Dr. Offit was there in Philadelphia during the 1990-1991 epidemic when several children who were part of anti-medicine churches died of measles

      This is the man whose name you have decided to use as an ironic nickname. Someone who has seen real (and since this part seems important to you)

      Along with taking the name of a real doctor who has done more to save children than you ever will.

      Chris, what’s up with the man crush on Paul Offit???

    27. science-based humanist says:

      Thank goodness that the “skeptical parenting” blogosphere is growing. Your own David Goski is involved. It’s time for parents, as parents, to speak out about the dangers that pseudoscience is posing to children and families. Moms especially are so reluctant to “pass judgment” on other moms about the decisions they make viz their kids. Well, no more. Your right to raise your kid the way you chose ends right at the line where my kid’s health is endangered! Now if I can only find a less antagonizing way to communicate it :-)

    28. Chris says:

      Obvious Sid troll is obvious. Time to ignore. Need we say more?

    29. Khym Chanur says:

      Why would the group living in poverty have no maternal antibodies, while more representative groups would?

    30. Sid Offit says:

      Khym:

      The fact that they were living in poverty (in 1989-91) did not affect maternal antibodies. Weaker antibodies were a product of these mothers having be vaccinated as children

      Vaccine as a child = weak antibodies as a mom
      Measles as a child = better antibodies as a mom

      The more representitive groups I spoke about was from the pre-vaccine era when everyone from every socio-economic group got the disease naturally in childhood and therefore passed along the associated longer lasting maternal antibodies

    31. weing says:

      Give the current administration more time and we will all be in the poor house. If I understood Sid’s ramblings, only the upper classes count anyway.

    32. Chris says:

      And only if they are not in Africa.

    33. John Snyder says:

      Squillo:

      Permission granted.

    34. The Blind Watchmaker says:

      “Vaccine as a child = weak antibodies as a mom
      Measles as a child = better antibodies as a mom”

      What the F!@#????

      In the prevaccine era, immunity lasted in previously infected people due to boosting from exposure to wild-type virus. The same goes for chicken pox.

      The 2 dose series that we now use provides healthy immunity measured out to 10 years.

      Mom’s who had measles as a child and are not boosted with vaccine may actually be the ones with ‘weak antibodies’ as they are unlikely to be exposed to the wild-type virus….because of successful vaccination programs.

      BTW, the video linked at the end of the post is difficult to watch.
      Especially the Hepatitis B part. Sure, Hepatitis B is a sexually transmitted disease. He forgets about vertical transmission which results in a 90% chronic infection rate among infected infants, 15-25% of which will develop cirrhosis or die!
      http://www.perinatology.com/exposures/Infection/HepatitisB.htm

      Sure, many pregnant moms are tested for HepBsAg. They are not routinely tested for Anti-HepBc. This will miss those who are potential carriers. There may be a few false negative HepBsAg
      due to low levels among some chronic carriers.

      This is the reason we give Hep B vaccine to neonates before they even come home from the hospital. If the mom does not have a HepBsAg test done, then we even give the baby HBIg (Hep B immunoglobulin) as well.

      This was just one point that made me cringe. There were many more, but many of these were already disassembled in Dr. Snyder’s excellent post.

    35. The Blind Watchmaker says:

      What the F!@#????

      In the prevaccine era, immunity lasted in previously infected people due to boosting from exposure to wild-type virus. The same goes for chicken pox.

      The 2 dose series that we now use provides healthy immunity measured out to 10 years.

      Mom’s who had measles as a child and are not boosted with vaccine may actually be the ones with ‘weak antibodies’ as they are unlikely to be exposed to the wild-type virus….because of successful vaccination programs.

      BTW, the video linked at the end of the post is difficult to watch.
      Especially the Hepatitis B part. Sure, Hepatitis B is a sexually transmitted disease. He forgets about vertical transmission which results in a 90% chronic infection rate among infected infants, 15-25% of which will develop cirrhosis or die!
      http://www.perinatology.com/exposures/Infection/HepatitisB.htm

      Sure, many pregnant moms are tested for HepBsAg. They are not routinely tested for Anti-HepBc. This will miss those who are potential carriers. There may be a few false negative HepBsAg
      due to low levels among some chronic carriers.

      This is the reason we give Hep B vaccine to neonates before they even come home from the hospital. If the mom does not have a HepBsAg test done, then we even give the baby HBIg (Hep B immunoglobulin) as well.

      This was just one point that made me cringe. There were many more, but many of these were already disassembled in Dr. Snyder’s excellent post.

    36. The Blind Watchmaker says:

      Sorry, the beginning of the above reply was intended at Sid’s

      “Vaccine as a child = weak antibodies as a mom
      Measles as a child = better antibodies as a mom” remark.

    37. TsuDhoNimh says:

      @John Snyder saud, I posted a sign the other day in my waiting room, referencing a recent local measles outbreak, asking parents of under/unvaccinated children to immediately notify the front desk as they enter, so that they can be removed from the waiting room.

      If a kid walks in with measles, you can’t get it out of there fast enough to prevent the virus from being spread from an infected child to others.

      That stuff is contagious!

    38. Chris says:

      Dear Blind Watchmaker, the irony is that those mothers who believe the cracked logic of Sid are those who were vaccinated at least once with the MMR, since many were born after 1970.

      Also, most of the children who suffered in California with measles were from poor families whose parents most likely acquired measles as children (I started having children then, and I got measles naturally before the first measles vaccine). It also did not prevent a classmate of mine in the early 1960s when measles was going through my neighborhood from having to switch out of our school to the state school for the deaf.

    39. Sid Offit says:

      @Blindwatch maker

      “Vaccine as a child = weak antibodies as a mom
      Measles as a child = better antibodies as a mom”
      What the F!@#????

      Let me walk you through this very slowly so y-o-u c-a-n u–n–d–e–r–s–t—a—n—d

      http://pediatrics.aappublications.org/cgi/content/abstract/104/5/e59

      Women born in the United States after measles vaccine licensure in 1963 transfer less measles antibody to their infants than do older women. This may result in increased susceptibility to measles among infants.

      Conclusions. Infants whose mothers were born after 1963 are more susceptible to measles than are infants of older mothers

      http://www.jstor.org/pss/3863456
      Measles antibody titres were established in three groups of infants: children of vaccinated mothers, children of unvaccinated mothers and neonates born after different gestational periods. Lower measles antibody titres were observed in children whose mothers had been vaccinated, and these decayed to undetectable values earlier than in children whose mothers had not been vaccinated, and were assumed to have had natural measl

    40. Catherina says:

      Just a general thing on maternal immunity to measles. It is true that vaccinated mothers pass fewer antibodies to their children than mothers who are immune through disease. However, since maternal antibodies have a half life of 3 or 4 weeks, a titre difference of 2x gives the child of the mother who got sick with measles about 3 or 4 weeks of an advantage. Anti-vaccinationists like to make it appear that maternal immunity from “nacherally” immune moms protects infants for a year (or more if you nurse, blablabla), but we know that scores (don’t have a precise number here, but I seem to remember an -underreported- average of about 85 per year) of infants died of measles before the introduction of the vaccine, which points (if we assume a mortality of 1:1000) to at least 85’000 infants sick with measles every year in the US.

      Compare that with overall measles infections today and tell me which infant is better protected, the one in the prevaccine era that had to rely on her mom’s titres (little of which remains 3 or 4 months post birth) or the one who can rely on mom’s titres AND herd immunity.

      It is also important to point out that infants can have subclinical mealses (due to residual maternal antibodies) and STILL get SSPE (at a rate of up to 1:2000 if measles were contracted before age 2).

      I liked Dr Wilbert Mason’s comments on Bob’s board:

      http://www.askdrsears.com/forum/message.asp?id=52960

      The reason that Bob thinks measles are harmless is that he has never seen or treated a case, not one.

      Now are we all looking forward to his “The Autism Book” to be released next spring….

    41. AlexisT says:

      Small correction: Uttar Pradesh is not a small, impoverished village; it’s a large Indian state. Perhaps you meant a small village in Uttar Pradesh?

    42. John Snyder says:

      AlexisT:

      I did mean Uttar Pradesh which, as you correctly point out, is not a small village but the most populous state in India. It is also one of the most impoverished.

      Thanks for spotting this. I’ll make the correction.

    43. John Snyder says:

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      # The Blind Watchmaker on 01 Aug 2009 at 11:33 am

      @Sid,

      Touche. I suppose one snarky remark deserves another. I think, though, that I didn’t make my point. The data does show that natural infection in mom’s lead to higher titers than the vaccinated mom’s.

      My point is that in 2009, in the US, there is no wild-type virus in the community to boost the antibodies among people who had the disease as kids and lived. There is not a lot of data easily found on their current antibody levels. If a pregnant woman today had measles as a kid (most likely an immigrant or from an area with low vaccine rates), and she has been living here for at least 10 years such that she has not had exposure to the wild-type virus, then how does her immunity stack up to someone who has had the standard 2 dose series? The table that keeps popping up is from 1977 (Krugman S. Present status of measles and rubella immunization
      in the United States: a medical progress report.
      J Pediatr 1977;90:1-12.)

      We do not live in pre-1963 U.S. So I’m not sure what the point is? Are you arguing against the 2 dose series? This confers a 96% long term immunity. This has been studied in populations naive of the wild-type virus.

      Not to mention the near elimination of fetal rubella syndrome among babies born to the vaccinated moms.

    44. John Snyder says:

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      # Danio on 01 Aug 2009 at 12:09 pm

      @Catherina,

      The link to the forum didn’t work for the specific message you mention, but I did spend about 10 excruciating minutes perusing the forum in general. If more evidence were needed that Dr. Bob’s demurrals about not being anti-vaccine are bogus, reading his responses in his own forum should put all doubts to rest. Among other things, he’s still (as of 7/30/09) referring to Andrew Wakefield as a credible researcher and remarking on how “amazing things” can happen when an autistic child is treated for GI symptoms. And those are just his own contributions to the forum. The rest of it reads like the ‘Mothering” message board. Sears hasn’t just drunk the anti-vax Kool-aid, he’s neck-deep in it.

      Very nice article, Dr. Snyder, thank you for taking the time for such a thorough deconstruction.

    45. John Snyder says:

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      # John Snyder on 01 Aug 2009 at 12:32 pm

      @Danio:

      You’re right. Reading Sears when he addresses his flock directly is quite eye-opening. And if you haven’t yet seen the interview I link to at the end of my post above, you’re in for a nauseating treat:

      https://secure.techxpress.net/organicgreenmommy.com/index.php?p=ogm_tv&id=1451

    46. John Snyder says:

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      # Danio on 01 Aug 2009 at 12:58 pm

      I just watched it, and I’m now bleeding out of my eyes. His dismissive characterization of measles, mumps and rubella as a mild diseases for children is just chilling. I did have to laugh a little when he talked about how some vaccines are made using !COW BLOOD!!111 Considering how the OrganicGreenMommys of the world will react to this news, your characterization of Dr. Bob as a ‘genius’ is really spot-on.

    47. John Snyder says:

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      # Chris on 01 Aug 2009 at 1:14 pm

      Danio:

      I just watched it, and I’m now bleeding out of my eyes. His dismissive characterization of measles, mumps and rubella as a mild diseases for children is just chilling.

      Thank you for doing that, so that I don’t have to. I am still trying to wrap my mind on how it is okay to accept the at least one in a thousand chance of a very bad outcome for measles, mumps and rubella (anything from severe pneumonia, to deafness, blindness and death). While the chance of something very bad happening from the MMR vaccine is orders of magnitude less (and it does not include autism!).

    48. John Snyder says:

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      # Chris on 01 Aug 2009 at 1:14 pm

      Danio:

      I just watched it, and I’m now bleeding out of my eyes. His dismissive characterization of measles, mumps and rubella as a mild diseases for children is just chilling.

      Thank you for doing that, so that I don’t have to. I am still trying to wrap my mind on how it is okay to accept the at least one in a thousand chance of a very bad outcome for measles, mumps and rubella (anything from severe pneumonia, to deafness, blindness and death). While the chance of something very bad happening from the MMR vaccine is orders of magnitude less (and it does not include autism!).

    49. John Snyder says:

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      # Catherina on 01 Aug 2009 at 1:54 pm

      Danio (cool name btw) – here it is:

      Minimization of the effects of measles by Wilbert Mason MD – posted on 4/3/2008

      As a pediatric infectious disease physician I feel I must comment on statements made in your March 27th commentary on the New York Times article. First, you infer that the cases in San Diego did not constitute an outbreak (”…if you can call it that…”). This is a highly contagious infection that spreads by small droplets that remain suspended in a closed room for over an hour. Indeed, 4 of the cases acquired the infection just by being in the pediatrician’s office at the same time as the first case. Three of these were infants and one of them had to be admitted to the hospital for dehydration.
      Elsewhere you have observed that “all of the cases of measles passed without complications, as is usually the case with measles”. Let me share with you our experience with measles at Childrens Hospital Los Angeles during the measles epidemic in 1990. We diagnosed 440 cases between January 1st and June 30th. Of these cases 195 (44%) had to be admitted for one or more complications of measles. We documented the complications in all 440 cases and they included 63% with ear infections, 45% with diarrhea, 39% with dehydration, 36% with pneumonia, 19% with croup, and about 3% with other bacterial infections. Three children died all of pneumonia. Measles is not a trivial infection as you inferred. We would not be having a debate about vaccines at all if people realized the tremendous costs in suffering and human life we incurred before vaccines became available. To adequately protect a population against measles >90% of the population must be effectively immunized against the disease. If individuals defer vaccines as you suggest we will rapidly fall below that level putting large numbers of infants and children at risk of an outbreak if measles is introduced into the community. This is a free country but we should all feel some responsibility to our fellow citizens and their children.

    50. John Snyder says:

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      # MmeZeeZee on 03 Aug 2009 at 1:39 am

      “Vaccine as a child = weak antibodies as a mom”

      Oh, contraire.

      I have great antibodies, as I’ve had the MMR no fewer than six times, the most recent a mere two years before conceiving my first.

      We could always just immunize women who want to, but who have not yet, started trying to conceive a child.

      Thanks for the article and thanks to all the doctors that keep unimmunized, sick children out of their waiting rooms.

    51. John Snyder says:

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      # dt on 03 Aug 2009 at 6:15 am

      Sid, let’s leave the squabbling over the precise mortality figures for a moment. (Let’s even assume for now that they are a few as 1:8000 for measles, if you like).

      Now answer this just so we know where you stand: What is your recommendation regarding infant immunisation schedules? Do you concur with Sears? Are you against immunisation entirely? Pray tell.

    52. henry says:

      Thanks for a fact filled article.
      I believe that the real problem for many parents is not lack of information, but an information overload. I doubt that passing out a pamphlet with this information would be very helpful for most vaccine refusals. Vaccine refusal comes in a variety of forms and each one requires an individual approach. I cannot agree with the approach of asking these parents to leave one’s practice. This accomplishes nothing. Gaining enough of a parent’s trust to get them to change their world view is often a difficult task. And this is really what we are doing with the hard core vaccine refusals. There is some interesting work being done to try and further characterize the nature of vaccine refusals. I am hopeful that this will allow us to better address the problem. In the meantime, being informed, being willing to listen to parents, realizing that their fears are very real to them, and giving them information in a non confronting way has served me well.
      Again, thanks for helping me by providing me with more facts to discuss with my patients.

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