Respectful Insolence

You may remember a couple of months ago, I took Dr. Bob Sears to task. Dr. Bob, as you may recall, wrote a book that has become the bane of pediatricians everywhere, namely The Vaccine Book: Making the Right Decision for Your Child. In this book, Dr. Bob, while oh-so-piously proclaiming that he is “not anti-vaccine,” lays down in his discussion of childhood vaccines a credulous treatment of many anti-vaccine canards in a sort of “I don’t believe vaccines cause autism, but…” sort of fashion. When last we saw him on this blog, Dr. Sears had decided to let his anti-vaccine freak flag high and utterly destroy any vestige of medical or scientific credibility that he had by actually writing a post for that bastion of anti-vaccine propaganda, that fully owned subsidiary of Generation Rescue, namely Age of Autism. As I wrote at the time:

What interests me more than his science-free “alternative” vaccine schedule is why Dr. Sears agreed to write an essay for AoA. The reason I’m so curious, of course, is that Dr. Sears clearly craves respect and legitimacy. He says over and over again that he is “not anti-vaccine” and neither is his book. He was clearly very offended when Dr. Offit lumped him in with the anti-vaccine movement, just as Dr. Jay Gordon acts oh-so-wounded when I describe him as an apologist for the anti-vaccine movement if not an anti-vaccine advocate himself. Clearly, Dr. Sears is not happy being on the outside and craves the respect of his peers.

I have bad news for Dr. Sears: Being associated in any way whatsoever (other than as a staunch opponent) with the anti-vaccine cranks at Generation Rescue and AoA (and, make no mistake, AoA is nothing than a propaganda arm of Generation Rescue) is about as good a way of destroying whatever medical or scientific credibility you might have had left as I can think of. Really. You might as well start publishing your work in JPANDS and presenting at Autism One. No, it’s worse than that. You might as well start writing posts for The Huffington Post. No, wait. Skip the Huffington Post. That’s not anti-science enough. Instead go straight for WorldNet Daily. Heck, skip WND and go straight for the Weekly World News or start hanging out with the Geiers in their basement lab in Silver Spring. After agreeing to write a post for AoA, you might as well, because you’ve just put a bullet in the head of whatever remnants of medical credibility you had left (metaphorically speaking, of course).

Really, writing for AoA is just that bad; it’s just that full of cranks. There’s an old saying: “If you lie down with a dog, you risk waking up with fleas.” Right now, Dr. Sears should be feeling a bit of an itch coming on.

It turns out that Dr. Sears’ book was even worse than I thought. Pediatrician and skeptic Dr. John Snyder has actually read Dr. Sears’ book. In response, he’s written the most comprehensive takedown of The Vaccine Book that I’ve ever seen. Read it; learn from it; love it; send it to your pediatrician; send it to any parents who think that Dr. Sears has a clue what he’s talking about.

Comments

  1. #1 Pablo
    July 31, 2009

    The simple answer on Dr Bob is this: We know that he is increasing the disease risk for children (and society). He admits it.

    Meanwhile, despite all his “it sounds reasonable” there isn’t one whit of evidence that suggests that his “alternate schedule” is any safer than the recommended schedule. Not one bit of evidence that it is safer.

    Come on, show the evidence that there are fewer reactions, or that immunity is better, or whatever you imply the benefits are. He can’t do it.

    So in the end, the only reason for his “alternate schedule” is to make these parents feel better. But we do so at the risk of increasing the chances for disease in their kids and others. Sorry, we don’t put our kids at risk just to make them feel better. It’s bad medicine.

  2. #2 benandcoopersdad
    July 31, 2009

    @Pablo: Here’s the problem. As long as skeptics and medicine take the stance that making parents feel better is not a worthy goal, then something like a quarter of parents in the US will try to alter their kids’ vaccination schedule in some way. It’s great that we can see Dr. Bob and the anti-vacc-ers as dangerous, but if we don’t accept that most people make decisions based on emotions instead of logic, if we don’t find a way to assuage the fears of parents, we’re just peeing into the wind. So yeah, we need to find a way to make them feel better about sticking to a vaccine schedule. Honestly, how much comfort will it be to say, “I told you so.”

  3. #3 joannalh
    July 31, 2009

    Awesome. I’m bookmarking the post for future use when people tell me they’ve “done their own resesarch”.

  4. #4 Dave
    July 31, 2009

    Superb. I hadn’t read that blog before, which is a loss for me.

    I liked his discussion of the stupid Sears argument that it’s not all that important to vaccinate against diseases that are now rare because of vaccination. I came up with an analogy, which I think (or hope, anyway) is valid. Suppose we could get people in the US to wear seat belts in their cars 98% of the time. Automotive fatalities would then drop to a small fraction of their current values. At this point, some the “it’s now a rare disease” nitwits would start arguing that we don’t need to use seat belts any more, because automotive crash fatalities are now relatively rare.

  5. #5 The Blind Watchmaker
    July 31, 2009

    BTW, the video linked at the end of Dr. Snyder’s 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.

  6. #6 navi
    July 31, 2009

    @ The Blind Watchmaker

    Your comment regarding Hep B reminded me of and old man railing that I protect my 18 month old, now diagnosed autistic, from those evil vaccines, explaining they give babies shots before they even leave the hospital! I smiled and moved on, blissfully unaware it wasn’t some rare crackpot opinion at the time, and proud that my little boy was vaccinated. The thing is, his autistic symptoms were actually very much evident at 18 months old. He regressed after running at 15 months. I doubt that man recognized them either, since he was simply walking with his mother at the time (didn’t start being a flight risk until later). I just didn’t know they were autism. I’m still very proud my beautiful boy is vaccinated.

  7. #7 DLC
    August 1, 2009

    I’m still trying to figure out why delaying or passing on vaccinations is going to keep your child from being autistic when compared to the regular vaccine schedule.

    Orac: as Winston Churchill once said: If you have an important point to make, don’t try to be subtle or clever. Use a pile driver. Hit the point once. Then come back and hit it again. Then hit it a third time – a tremendous whack.!”
    Keep hitting the point, I’ll keep holding your coat.

  8. #8 DebinOz
    August 1, 2009

    Re herd immunity:

    “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.”

    This sentiment from a medical professional is an absolute disgrace.

  9. #9 Matthew Cline
    August 1, 2009

    According to this response by Dr. Sears:

    My comment on “not sharing your fears with your neighbors” was an attempt at humor, while trying to teach a very important point.

    Not having read the book, I’m not sure where the humor in the statement is.

  10. #10 Orac
    August 1, 2009

    Dr. Sears’ “defense” of his comment is the lame “I was only joking” defense. I highly doubt that he was. If he was, he was almost certainly being literal. He knows that decreasing the vaccination rate will increase the risk of outbreaks of infectious diseases with the increased risk correlating with how low the vaccination rate falls. If his select, indulged clientele are to continue to sponge off of herd immunity, he knows that the vaccination rate mustn’t fall too far and that the number of parents refusing to vaccinate must remain relatively low–with his patients being that select group who get all the benefits of herd immunity without taking even the most infinitesimal risk to achieve it. Here’s what Dr. Sears said in context:

    I agree with Dr. Offit here. Herd immunity is very important. I state the argument in the book that “the good of the many outweighs the good of the few.” Nowhere in the book do I encourage parents to “hide in the herd.” Again, Dr. Offit’s words, not mine. I clearly state (as Dr. Offit quoted) the danger to our country if too many people don’t vaccinate. My comment on “not sharing your fears with your neighbors” was an attempt at humor, while trying to teach a very important point.

    I call bullshit. What was Dr. Sears doing by warning parents “not to share their fears with their neighbors because if too many people avoid the MMR, we’ll likely see the diseases increase,” if not winking and nodding to let parents know that they should “hide in the herd” and not tell anybody but the trusted few freeloaders?

    You know, I used to think that Dr. Sears was just misguided and scientifically illiterate. Now, after reading Dr. Snyder’s review, I think he’s cynical and calculating. I think he knows exactly what he is doing in appealing to fear.

  11. #11 Lisa
    August 1, 2009

    …..I’m still trying to figure out why delaying or passing on vaccinations is going to keep your child from being autistic when compared to the regular vaccine schedule……

    The immune response is healthier when exposed to less stimuli at one time. Most people would never be exposed to the diseases measles, mumps and rubella all in the same day. When you artificially over-stimulate the immune system it can cause many other immune mediated diseases.

  12. #12 Jennifer B. Phillips
    August 1, 2009

    The immune response is healthier when exposed to less stimuli at one time. Most people would never be exposed to the diseases measles, mumps and rubella all in the same day. When you artificially over-stimulate the immune system it can cause many other immune mediated diseases.

    [citation needed]

    And while you’re preparing a list of sources to augment your impressive knowledge of immunology, please be sure to put the number of antigens contained in vaccines in context with the number of antigens encountered by the average ambulatory , nose-picking, dirt-eating, orally fixated infant/toddler in any given day. Thank you.

  13. #13 Sid Offit
    August 1, 2009

    @Jenn

    I don’t know what your feeding your kids but mine don’t eat dirt

  14. #14 Enkidu
    August 1, 2009

    @ Sid Offit

    I guess your kids never crawled around outside in the yard? What a shame for them. Hands in dirt –> hands in mouth is a given at the infant/toddler stage.

  15. #15 HCN
    August 1, 2009

    Sid said “but mine don’t eat dirt”

    So you are one of those sMothers! The ones who never let their child outside, play in the yard or play in a sandbox. You have completely fumigated the house to keep any and all insects out of the house and any bit of outdoors you allow your child to be in (yes, once my toddler saw the his baby brother who was just crawling try to nom on an insect). Heaven forbid you should ever let your kids outside to deal with the real world (like when one son as a preschooler used to pick up gum from the sidewalk to chew, turns out he is a very healthy soon to be college freshman).

    That is why you don’t care about vaccines, you keep your kids hermetically sealed! You are one of those helicopter parents I met at the university freshman parent workshop. Scary. Oh, wait… you may actually home school for college too!

  16. #16 Jennifer B. Phillips
    August 1, 2009

    @Sid,
    that’s unfortunate, because they’d probably have healthier immune systems if they did.

  17. #17 Chris
    August 1, 2009

    Since it is common knowledge among real parents that kids will and do eat stuff from the floor, I will now assume that Sid the Troll is not a parent.

  18. #18 Kelly Grissom
    August 1, 2009

    @Jenn

    She said ‘over-stimulate’. I take that to mean for example, giving 5 vaccines at one time to a 6 month old. That does not mean over-stimulation by antigens, but to other factors in the vaccine itself.

    btw I grew up on a farm…dirt is good for kids :)

  19. #19 Kelly Grissom
    August 1, 2009

    @Jenn

    She said ‘over-stimulate’. I take that to mean for example, giving 5 vaccines at one time to a 6 month old. That does not mean over-stimulation by antigens, but to other factors in the vaccine itself. I could see that was an answer to someone else’s question about why some people think they need to delay vaccines. No need for such a snotty reply to something not understood.

    btw I grew up on a farm…dirt is good for kids :)

  20. #20 Sid Offit
    August 1, 2009

    @ Chris

    There’s nothing edible on my floor

    @Jenn

    You’re “healthier immune systems” link seems to link vaccines with allergies. Is that possible??????

    ScienceDaily (Sep. 9, 2007) — A little dirt never hurt. But in today’s super-clean world, vaccinations, anti-bacterial soaps, and airtight doors and windows are keeping dirt and disease-causing germs at bay.
    While staying germ-free can prevent the spread of disease and infections, leading a cleanlier lifestyle may be responsible for an increase in allergies among children.

  21. #21 Jennifer B. Phillips
    August 1, 2009

    Well Kelly, your understanding of immunology seems on a par with Lisa’s, so perhaps you could explain the difference in the immune response to an ‘antigen’ vs. ‘other factors in the vaccine itself’, catalogue the contents of those ‘five vaccines given to a six month old’ (and perhaps contrast this with the content of available vaccines given to 6 month olds 20 years ago), and, finally, describe how any of the above relates to autism, which was the topic of the original question Lisa responded to.

    Yes, I know Lisa was answering someone else’s question, specifically DLC @ 7 (although I read DLC’s comment as both rhetorical and incredulous) about the ‘need to delay’. I contend that Lisa’s answer is scientifically invalid. Indeed, the ‘something not understood’ to which you refer seems to lie principally with you, she, and others who speak ignorantly about ‘overwhelming’ the immune system with too many vaccines. I’ve been around this controversy long enough to recognize most of these canards, and my tolerance has long since evaporated. If calling out the absurdity of these claims makes me ‘snotty’, I can live with that.

  22. #22 drcharles
    August 1, 2009

    Great link, thanks Orac. I recently referred a friend of mine with vaccine concerns (for his child) to your blog so that he could read some of your posts. Do you have one comprehensive, summary-type post defending the wisdom of vaccination and refuting the misconceptions as well as acknowledging the small risks? If not, you should cobble one together from your prior postings. Let me know, thanks!

  23. #23 Dr. P
    August 1, 2009

    @19; No what she said was the immune response is healthier when challenged less at one time, followed by the statement that we would not be exposed to measlse mumps and rubella on the same day normally;there was no mention of ‘other factors’, implying antigen.@ 20,No. There’s no real link to vaccines and allergies.And since you are actually being exposed to antigen with tha vaccines you’d be hard pressed lumping it in with antibacterial soap as making the world bereft of exposure.Even if you took the tack that the response isn’t as brisk, it would take a disingenuous troll to assume that this difference would explain the phenomena you’re describing without any data to back that up.But then….

  24. #24 Dr. P
    August 1, 2009

    @ 22, drcharles, there’s a great parents corner website at aap.org that gives a few summaries with video,if you’ve not already been there

  25. #25 Chris
    August 1, 2009

    Sid the troll:

    There’s nothing edible on my floor

    Yep, just as I thought… there have never been any kids in your house!

  26. #26 Dawn
    August 1, 2009

    It wasn’t the stuff on my floors that was the problem (although the kids would eat paper, dust bunnies, etc)…it was all the darn SAND from the sandbox and beach my kids liked to eat. Changing the diapers on a child who loved to eat sand was a challenge, if you didn’t want to wipe the skin raw to get the sand off. They also were normal children who picked their noses. played on public swing sets, and ran around outside barefoot. We never had antibacterial soap in the house (and still don’t), yet my kids were/are rarely ill. They do wash their hands with regular soap and water before eating – usually.

    Both have been fully vaccinated. I think they were exposed to more antigens going to daycare then they ever got in a vaccine.

  27. #27 Kelly Grissom
    August 1, 2009

    21 RE Well Kelly, your understanding of immunology seems on a par with Lisa’s, so perhaps you could explain the difference in the immune response to an ‘antigen’ vs. ‘other factors in the vaccine itself’, catalogue the contents of those ‘five vaccines given to a six month old’ (and perhaps contrast this with the content of available vaccines given to 6 month olds 20 years ago), and, finally, describe how any of the above relates to autism, which was the topic of the original question

    This is not my opinion. This is what I thought that other person meant. She was talking earlier about the load of chemicals in the body. You knew I was referring to her words. So please, dont put words in my mouth.

  28. #28 Lisa B.
    August 1, 2009

    12, 19, 21 and 23

    You are all incorrect. I was answering the rhetorical ‘why?’ I was responding to #7′s question as to what a parent was made to believe to make them think they needed to delay immunizations. I hear that delay comment from parents all the time. I am a Public Health officer in the Air Force. We implement all the policies on vaccination, and we are constantly questioned by parents.

    (Lisa B, I am #11, but there is another Lisa comment, not me.)

  29. #29 Kelly Grissom
    August 1, 2009

    Sorry, we share email at work, and I couldnt reply back.

  30. #30 Jennifer B. Phillips
    August 1, 2009

    I’m not sure how many Lisas I’m addressing in this thread, or where Kelly comes into it all, or if the Lisa here is the same Lisa who is posting similarly-themed comments on the ‘Autism Quackery’ thread, but here goes:

    Kelly @ #18 and 19 (with enhanced snottiness) said:

    She said ‘over-stimulate’. I take that to mean for example, giving 5 vaccines at one time to a 6 month old. That does not mean over-stimulation by antigens, but to other factors in the vaccine itself.

    and then at #27 said:

    This is not my opinion. This is what I thought that other person meant. She was talking earlier about the load of chemicals in the body. You knew I was referring to her words. So please, dont put words in my mouth.

    It is unclear from your #18/19 what your opinion is, but the example you chose, discussing the number of vaccines given to an infant and alluding to other ‘factors’ in the vaccine that aren’t antigens but could have some mysterious effect on the immune system, as well as the original comment at #11 relating to the nonexistent link between vaccines and autism are chock full of antivax-speak. Forgive me if I misinterpreted you, but I still find it difficult to read as a neutral comment. Moreover, it’s pretty rich of you to accuse me of putting words in your mouth when your entry into this discussion consisted of telling me how to interpret someone else’s comment.

    LisaB@28:
    so what, you’re playing devil’s advocate? Presenting anti-vax logic in response to that question when you don’t actually believe it to be true? Again, I have assumed you were the same ‘Lisa’ who has been active on the ‘Autism Quackery’ thread, and if that is in error I apologize. This misapprehension (if in fact you are not her) definitely colored my responses to you on this thread. IF you do not actually subscribe to the opinion presented as your own in comment #11, I’d recommend adding some more snark or sarcasm tags or something next time so that other commenters can distinguish you from people who passionately believe every word of this patent nonsense. The antivax corollary to Poe’s Law definitely applies here.

    Peace.

  31. #31 bozzy
    August 2, 2009

    “I don’t believe vaccines cause autism, but…”

    This one is my favorite. It’s used frequently and always shows true intent. For example:

    “I’m not a racist, but that (insert racial slur here)…”

  32. #32 Monado
    August 2, 2009

    Antigen exposure from all vaccines recommended for childhood immunizations:
    1900: 200
    1920: 200
    1940: 200
    1960: 3220 (approximately)
    1980: 3040 (approximately)
    2000: 125

  33. #33 Carl Witty
    August 2, 2009

    @4, Dave, I don’t think that’s a very good analogy… automobile fatalities don’t really have much to do with “herd immunity”.

    How about this analogy?

    There have been many cases throughout history where most of a large city burned down. However, modern building codes combined with better fire departments have mostly eliminated this threat… your house is not very likely to catch fire from a neighbor. Since fires are now often localized to single buildings, maybe we should loosen up the building codes and cut funding to the fire department.

    (Unfortunately, I didn’t do any research for this analogy, so I’m not actually sure that the story is true.)

  34. #34 Chris
    August 2, 2009

    Carl Witty:

    However, modern building codes combined with better fire departments have mostly eliminated this threat… your house is not very likely to catch fire from a neighbor.

    Your analogy might be helped by the building codes that require smoke alarms. Smoke alarms contain a very teeny tiny bit of radioactive material, like Americium-241. I knew someone in college who was freaked out by this and disliked the very idea of smoke alarms, especially since the university installed several in the dorm. This guy was someone who also freaked out at the dormitory’s microwave oven, which has a completely different kind of radio wave (though he was happy as a clam inhaling cannabis smoke which glowed heat radiation in the pipe!).

    We tried very hard to tell him that there was such a thing as relative risk, but it fell on deaf ears. We then lost touch with the guy. Pity, I wish I could have talked to him when that same dormitory caught fire a couple of years later with no loss of life because of those smoke alarms!

    (the building suffered smoke damage, and during the damage remodel the university then installed a sprinkler system possibly because a similar fire in another university did cause several deaths… here is an interesting thing, doing a Google search I can find a bit on the Aquinas Hall fire in Providence College started by a hair dryer that killed ten women, but nothing on the fire in University of Washington’s Lander Hall started by a student falling asleep in the TV lounge with a lit cigarette)

  35. #35 Dr. P
    August 2, 2009

    @ 28 Read my post again at #23;I understood your response to # 7 and was paraphrasing your response to illustrate to Kelly that no one brought up other factors to that point and wasn’t objecting to what you posted. No offense. Patrick

  36. #36 sirhcton
    August 2, 2009

    Should Dr. Bob Spears be entitled the concern troll of the anti-vaccine movement?

  37. #37 FreeSpeaker
    August 2, 2009

    Monada, I need a cite for:

    Antigen exposure from all vaccines recommended for childhood immunizations:

    1900: 200

    1920: 200

    1940: 200

    1960: 3220 (approximately)

    1980: 3040 (approximately)

    2000: 125

    Thanks…

  38. #38 Lisa B.
    August 2, 2009

    @35 Dr. P, no offense noted. I guess I never learned ‘snarky’ as someone pointed out. It probably wouldn’t serve me well when good communication with civilians, soldiers, and interpretations for other countries are needed.

  39. #39 Todd W.
    August 4, 2009

    @drcharles

    Do you have one comprehensive, summary-type post defending the wisdom of vaccination and refuting the misconceptions as well as acknowledging the small risks?

    In addition to the AAP and CDC, I’ve put together some info that focuses mainly on the myths and misinformation put out by the likes of Age of Autism/Generation Rescue, David Kirby, Jenny McCarthy, etc. Click on my name to get there, or go to antiantivax (dot) flurf (dot) net.

  40. #40 All Please Read
    August 4, 2009

    I am very sorry. It appears from the emails between my daughter and her lap top carrying friends at Space Camp that they have joined a few of your discussions. I do not know which threads, but some of you may have been communicating with 8yo girls who would, and I quote, “die for science”. Apparently,your site came up through a search engine, and it appears from the emails that they purposely chose what they perceived to be your opposing side, so they could practice debating.

    I truly apologize for any inconvenience this has caused, and the camp counselors have been notified to cease this activity immediately. After reading some of the comments they have been privey to, I myself am disturbed. Hopefully, they will stick to the facts and no name calling. I will immediately be in search of a science based discussion website appropriate for 8yo science lovers.

    Sincerely, Maria

  41. #41 DT
    August 4, 2009

    @FreeSpeaker.
    The info on antigens in vaccines is in Paul Offit’s paper found here:
    http://pediatrics.aappublications.org/cgi/content/full/109/1/124
    See Table 2.

  42. #42 div77
    July 5, 2010

    How odd that this website says science blog. I came here looking for information, but even the article had no scientific information-just catty personal attacks and opinions which are so jaded and snotty that there is, in fact, nothing scientific about them. I guess scientists need sewing circles for venting, too. It beats watching jerry springer, I suppose.

  43. #43 Travis
    July 5, 2010

    Yawn, tone trolls are boring. Just clicking on a few links in this posting finds lots of information directly discussing the science. The post this one is referring to does that. Sears has been dealt with in detail many times on this site, not every posting has to repeat all the discussion of his bad science.

  44. #44 Chris
    July 5, 2010

    div77, then you missed the basic point: To go to the referenced article and read that! No go read Cashing In On Fear: The Danger of Dr. Sears and tell us what you learn.

    Did you learn about what happened with diphtheria when the Soviet Union dissolved? What other diseases are increasing?

    What does Dr. Snyder say about VAERS? Hib? Measles? Thimerosal? Aluminum?

    Actually, I believe div77 is a drive by troll who did not even read the article he is commenting on, nor the reference article.