Defending Dr. Bob Sears: On the affinity between "integrative medicine" and antivaccine views

It’s been nearly three weeks since we learned that the Medical Board of California had initiated disciplinary proceedings against the most famous antivaccine physician not named Andrew Wakefield. I’m referring, of course, to “Dr. Bob” Sears, author of The Vaccine Book: Making the Right Decision for Your Child and creator of an “alternate” vaccine schedule that “spreads out the vaccines.” Unfortunately, it’s a book that’s been very influential, in particular promoting the idea of “too many too soon” and claiming that delaying vaccines will reduce a child’s risk of autism. Basically, the medical board accused Sears of failing to live up to the standard of care in two instances with one patient: Not doing a detailed neurological examination when she presented to him with history of headache two weeks after having been supposedly hit on the head with a hammer by her father and writing a letter supporting a medical exemption to school vaccine mandates based on a rationale that was not based in science and not accepted as the standard of care. Since then, antivaccine activists have rallied around Sears and portrayed the impending disciplinary hearings against him as “persecution.”

Of course, “Dr. Bob” has a long history of pandering to the antivaccine movement, a history I’ve documented extensively right here on this very blog. For example, he’s likened SB 277, the new California law that eliminates nonmedical exemptions to school vaccine mandates, to the Holocaust, basically going full Godwin on it and letting his antivaccine freak flag fly. I was also surprised that the Medical Board of California didn’t actually look at Dr. Sears for his more blatant selling of medical exemptions, including exemptions based on an online form.

So it amuses me to see the latest volley fired to defend Dr. Bob from the nefarious depredations of the evil Medical Board of California. It comes from Jennifer Margulis, PhD, who claims that long history of antivaccine posturing. If you don’t believe me, just check out her website, which is chock full of posts “standing with Sears” and promoting Andrew Wakefield’s antivaccine conspiracy propaganda piece VAXXED. So, not surprisingly, her defense of Dr. Bob invokes the views of some rather dubious physicians. First, she begins by quoting the charges against Dr. Bob, where the board points out that the “standard of care requires that a physician evaluating a patient for possible reaction to vaccines obtain a detailed history of the vaccines previously received as well as the reaction/reactions that occurred” and that, based on that information, “the physician should provide an evidence-based recommendation for future immunizations.” This is, of course, perfectly true, and it’s pretty darned obvious that if the the board’s list of charges are correct Dr. Bob failed in that.

Not according to Margulis:

But, say several doctors and supporters of Sears, according to the Medical Board’s own documentation, this is exactly what Sears did.

When Sears saw the toddler for the first time on April 3, 2014, he was told by the boy’s mother that her son had had two concerning vaccine reactions.

The boy “shut down stools and urine for 24 hours with 2 month vaccines and [was] limp ‘like a ragdoll’ lasting 24 hours and not himself for a week after 3 month vaccines.” In a letter dated April 13, 2014, excusing J.G. from future vaccines, says Sears indicated that “the patient’s kidneys and intestines shut down after prior vaccination and that at three months the patient suffered what appears to be a severe encephalitis reaction for 24 hours, starting approximately ten minutes after his vaccines, with lethargy, limpness, and poor responsiveness.”

“Based on the symptoms the child suffered after previous vaccinations (as described by the mom in the accusation), I would say Dr. Sears was being grossly conscientious,” asserts Shira Miller, M.D., a Los Angeles physician who is board certified in internal medicine and has been practicing medicine for 14 years via e-mail.

I dealt with that claim before the second time I discussed Dr. Bob’s impending disciplinary proceedings before the board. To summarize, when confronted with a new patient whose mother claims she had a serious vaccine reaction such as what was described in the records, a competent and responsible pedaitrician would look into exactly what vaccines the child had before the alleged reaction and, if possible, obtain the patient’s medical records to see exactly what form the alleged reaction took. Heck, a truly “grossly conscientious” pediatrician would have picked up the telephone and given the pediatrician who cared for the patient at the time of the claimed reaction a quick phone call. After all, if the reaction were as dramatic as claimed, most likely the pediatrician would remember it and would have reported it to the VAERS database. From the documentation available, we know that Dr. Bob did none of these things. He just wrote a letter of support for a vaccine exemption because the mother wanted one, requesting exemption for all vaccines. Even if the child did have a truly serious reaction to a vaccine, that doesn’t necessarily mean she should have been exempted from all vaccines. It might, but it might not. Dr. Bob didn’t even try to figure it out.

I had never heard of Dr. Shira Miller before; so I did a quickie Google search, which brought up her website. I expected a family practitioner, but what I got was an “anti-aging” doctor who runs the Integrative Center for Health and Wellness. She appears to specialize in menopause, particularly “bioidentical” hormones, “anti-aging” medicine, and, of course, “holistic” medicine. Her profile states that she has practiced “integrative, functional, alternative, holistic, nutritional, wellness, age management, and anti-aging medicine since 2006.” Of course, functional medicine is pseudoscience involving making it up as you go along.

Next up:

Deborah Gordon, M.D., an Ashland, Oregon, family physician who has been practicing medicine for 30 years, including five years in California, agrees. Gordon says the kind of reaction described by J.G.’s mother was “absolutely cause for concern.” A three-month-old baby who remains limp for 24 hours immediately after being vaccinated, Gordon says, is suffering from a neurological insult.

“That shrieking cry or high fever isn’t because the spot of the vaccine still hurts,” Gordon points out. “It is because an inflammatory reaction is going on in the child’s system, including in the brain.”

Um, no. A three year old remaining limp for 24 hours after being vaccinated, if that is indeed what happened, does not necessarily suffer from a neurologic insult. The differential diagnosis is much longer than that, but Dr. Gordon zeroes on on the one thing she can think of as a cause. I checked out Dr. Gordon’s website as well. She’s big into diet to treat disease, which is not a bad thing, if her approach is evidence-based, but somehow I doubt it is, even without delving far into her website. Why? Because she embraces homeopathy, working with a naturopath to provide homeopathic care to Ashland, OR. From my perspective, any physician who embraces the quackery that is homeopathy automatically forfeits pretty much all credibility in any other medical area. After all, if Dr. Gordon’s mind is so “open” that she can administer homeopathic remedies, I have to wonder how “open” it is to other forms of pseudoscience—almost certainly very. No wonder she thinks that Dr. Bob acted responsibly.

I could go on and on, but let’s see who else “stands with Sears”:

Basically, they all repeat the same tropes that I’ve discussed before, claiming that what Sears did was not gross negligence because they basically believe whatever they’re told by parents. I’m rather surprised Margulis couldn’t scare up an actual pediatrician or two to “stand with Sears.” After all, there are antivaccine-friendly pediatricians out there like Dr. Bob. I mean, wasn’t Dr. Jay Gordon available? Of course, the reason why the tropes are the same is because there’s been a set of talking points that’s solidified since the charges against Sears were first made public and after antivaccine blogger Levi Quackenboss first enumerated them a few days later.

Of course, one of the reasons Margulis’ article caught my attention is not because a lot of antivaccine docs are disturbed by the Medical Board of California actually doing its job and trying to put a stop to Dr. Bob, who is, as far as I am concerned, a menace to public health in California. Rather, it’s to show the affinity between “integrative medicine” and antivaccine views. There isn’t a single mainstream physician—especially a mainstream pediatrician—defending Dr. Sears’ behavior. It’s all “integrative” physicians practicing woo like functional medicine, homeopathy, and a whole lot of other dubious medicine. They’re the only ones defending Dr. Sears. That’s just another thing that should disturb you about “integrative medicine.” The proponents of integrative medicine sitting in their ivory towers of academia will swear up and down that integrative medicine is not antivaccine, but damned if a survey on the ground doesn’t suggest otherwise.

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Basically, they all repeat the same tropes that I’ve discussed before, claiming that what Sears did was not gross negligence because they basically believe whatever they’re told by parents.

Even a certain fictitious doctor knew better.
"Everybody lies." - Dr Gregory House.

By Julian Frost (not verified) on 27 Sep 2016 #permalink

Regarding Jay Gordon being available, I'm guessing Jay only goes with "top tier" media venues and not bottom feeders like Margulis, as he already weighed in for Sears in a September 27th LA Times article ( http://www.latimes.com/local/lanow/la-me-sears-vaccine-20160909-snap-st… ):

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

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

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

We can sure hope you're the next one the CAMB pursues, Jay, and believe me, we do

Of course, the quack doctors are lining up and puffing up to support Sears. This is where I roundly condemn the national AAP and every damn California AAP chapter for not having the spine to condemn Sears for all the damage he has done to vaccination rates as well as all the illness and death he has caused contributing to VPD outbreaks in California, where 16 infants have died from pertussis since 2010 and 20% of those with measles have been hospitalized. To all my fellow pediatricians out there who are just "too busy" to speak out or think that someone else will do it--if you have even the slightest bit of conscience, you need to be the one to speak out on this. Given that the AAP annual convention is less than a month from now in San Francisco, this would be a GREAT time and place for you to speak out.

By Chris Hickie (not verified) on 27 Sep 2016 #permalink

*Wakefield interlude*

Sorry to be picky, but Wakefield is not, and has never been, a physician. Okay, he may have spent a few months in training when he could have been called a physician, but from his time as a junior he was a surgeon - using the British title of "Mr", and then he became an academic researcher in gastroenterologist, contractually prohibited from clinical work.

It's quite interesting that neither he nor his wife, who was also put through medical school at public expense, couldn't get away from patients quick enough. From training she moved to work for the Medical Defense Union, which shields doctors against their patients.

It's also an interesting debating point as to whether he's even entitled to call himself "doctor". In Britain, medicine is a graduating degree - bachelor level - unlike in the United States, where it is indeed a doctorate, pursued after a prior degree, often a science. A very few British doctors are, in fact, MDs, but most (including Wakefield) aren't (or, in his case, wasn;t). For these people "doctor", in this context, is a traditional courtesy, or honorary, title for a medical practitioner. Since he is no longer a medical practitioner, it's hard to see on what basis he calls himself a doctor.

*end interlude*

By Brian Deer (not verified) on 27 Sep 2016 #permalink

2 comments.

First, if I'd had a kid "shut down" kidneys and bowels for 24 hours at 2 months, or be "limp like a ragdoll" at 3-4 months, I'd have been in the ER with my baby. NOT looking for another pediatrician. This is why I doubt those stories. The parents always have horrible tales at three months the patient suffered what appears to be a severe encephalitis reaction for 24 hours, starting approximately ten minutes after his vaccines, with lethargy, limpness, and poor responsiveness.. 10 minutes after vaccines and the MD office let you go home? Or, if you'd left the office, you didn't turn around and go back? Or to an ER? REALLY???

Then, just a snarky comment: Shira Miller, M.D., a Los Angeles physician who is board certified in internal medicine and has been practicing medicine for 14 years via e-mail. Considering she's a quackery MD, I read this as practicing medicine via email... :)

@MI Dawn

I read it that way, too.

@Chris Hickie

So, Jay Gordon, MD, FAAP (gotta include all those letters in there, dontcha know), basically admitted that he keeps substandard records, as well?

she pontificates that “I have not seen any evidence that he committed negligence.”

This may be technically true. I suspect Dr. Kimmel has been looking the other way.

Deborah Gordon, M.D., an Ashland, Oregon, family physician who has been practicing medicine for 30 years, including five years in California

The name may be a coincidence, but are Deborah and Jay related?

Shira Miller, M.D., a Los Angeles physician who is board certified in internal medicine and has been practicing medicine for 14 years via e-mail.

I agree with MI Dawn: The writer dropped a comma, and hilarity ensued.

By Eric Lund (not verified) on 27 Sep 2016 #permalink

A. Well, Dr. Jay Gordon spoke up against the charges and in defense of Dr. Sears.

B. I think, but may be misremembering, that Dr. Miller testified against SB277.

C. Dr. Sears not only didn't check, but the mother's descriptions became something more extreme in his own letter. A basis for that change would be nice.

By Dorit Reiss (not verified) on 27 Sep 2016 #permalink

Sorry to be picky, but Wakefield is not, and has never been, a physician. Okay, he may have spent a few months in training when he could have been called a physician, but from his time as a junior he was a surgeon – using the British title of “Mr”, and then he became an academic researcher in gastroenterologist, contractually prohibited from clinical work.

Sorry, but in the US, that is a distinction without a difference. In the US, a surgeon is a physician—even Wakefield. A delicensed physician, but a physician nonetheless. As a surgeon myself, I happen to be highly irritated at this British distinction. I pointedly will not accept or use it when I am in the US (as I am now) and will only grudgingly accept it when I happen to be a guest in the UK or other countries where such distinctions are considered standard, because "when in Rome do as the Romans do." (I don't have to like it.)

Otherwise, 'Murica, dammit! :-)

I agree with MI Dawn: The writer dropped a comma, and hilarity ensued.

Dang, I missed that. Hilarity ensues, indeed.

@MI Dawn and @Todd W: This is exactly how I read the statements as well. Everything about this situation is very murky and unclear. As Orac mentions, all it would have taken on Dr. Bob's behalf was a quick phone call to the old pediatrician to settle things up. He couldn't even do that. Perhaps the mother really even believed her child was having a severe encephalitis reactions (but seriously, not go to the ER, or right back to the hospital? Very, very, very odd to me.)

Even if the mother was right about her child's reactions-although I HIGHLY doubt it- it was still Dr. Bob's responsibility to further investigate the claim, which he clearly did not care to do. At its most benign, this guy just seriously sucks at his job and completely deserves to be reprimanded. A more sinister take would be that this man is willfully shirking his professional duties while simultaneously endangering public health.

By Missylulu (not verified) on 27 Sep 2016 #permalink

Maybe I missed something, but is there evidence of an prior pediatrician who was ever consulted by the parent(s) about the child's supposedly having a systemic shutdown* for 24 hours after vaccination? Or are we supposed to think Mama just hung around clucking while her child was supposedly exhibiting such grievous clinical signs?

By the way, my favorite defense of Sears comes from an antivax poster in another forum, who argued that Sears was prevented from conducting a neurologic exam on the child (after hearing he was hit on the head with a hammer and suffering headaches) because Sears isn't a neurologist, and would have been liable for malpractice for even doing such an exam.

By this impeccable logic, an internist cannot do a rectal exam because he's not a urologist or gastroenterologist.

*this is a major part of the story that smells to me. What documented vaccine reactions include complete gastrointestinal and renal shutdown for 24 hours, after which function magically returns?
**fans of the antivax literature are hopefully enjoying the latest paper by the Geiers (David is the lead author on this one) which argues a link between hepatitis B vaccination and obesity, and could be subtitled: Thimerosal Makes You Fat.

https://www.ncbi.nlm.nih.gov/pubmed/27583238

By Dangerous Bacon (not verified) on 27 Sep 2016 #permalink

Dr. Cammy Benton, featured heavily in this article, has been a personal acquaintance of mine for years. It was she who got me interested in the anti vaccine movement when she started posting articles from greenmedinfo and mercola on her Facebook page several years ago. She also embraces homeopathy, claiming it cured her daughter of some GI issues when the med staff of Levine Children's Institute in Charlotte was unable to do so. And she loves naturopathy, claiming there's no real difference between their training and our MD training. Over time I engaged with her pseudoscience more and more on Facebook. She was almost never able to give a well reasoned defense of her beliefs, did not seem able even to do a pubmed search, claimed that vaccines cause autism, etc. Basic logic seemed to elude her. Not surprisingly, she eventually "unfriended" me, but not before her sister, a local community college teacher who lives in the county where I am a family doctor, threatened to undermine my practice. Very disturbing behavior. I remain bewildered by how someone can abandon their education and embrace pseudoscience so completely.

By Mary Russell (not verified) on 27 Sep 2016 #permalink

People tell weird stories about what happens to them and their kids, especially in relation to healthcare. I learned this lesson early on, because my mother had a tendency to dramatise everything. She went to a period of changing doctors because they would "disrespect her", "not even look at her symptoms", or even "tell her, after looking at her across room, that she would die in six months time".

So I wouldn't be surprised at all if the mother of that kid conflated "baby is a little constipated" with "shut down completely" and "baby is sleepy today" with "limp like a ragdoll". Or maybe something more weird.

By irenedelse (not verified) on 27 Sep 2016 #permalink

*sheer went through a period

By irenedelse (not verified) on 27 Sep 2016 #permalink

Damn it, autocorrect! "She went through" ><

By irenedelse (not verified) on 27 Sep 2016 #permalink

DB:Or are we supposed to think Mama just hung around clucking while her child was supposedly exhibiting such grievous clinical signs?

Of all the things that suggest this story is a lie, that detail is the one that stands out. I can't think of a single person who I know who wouldn't be setting new speed records to the emergency room if that happened to a kid in their care. Also, why did she go to Dr. Sears when her husband hit the kid (if it happened) rather than the emergency room or calling the police?

By Politicalguineapig (not verified) on 27 Sep 2016 #permalink

@ irenedelse:

" People tell weird stories...."

Right.
And many of them show up at AoA, TMR etc.

By Denice Walter (not verified) on 27 Sep 2016 #permalink

I am not a doctor, and I've not had children...I don't think you're supposed to hit them with a hammer.

Also, why did she go to Dr. Sears when her husband hit the kid (if it happened) rather than the emergency room or calling the police?

As I understand the timeline, the alleged incident with the hammer occurred some time before the mother first took the kid to Dr. Sears, so that was not an emergency situation at the time of that visit. Several of us, on the earlier thread, speculated that the CMB's action might be based in part on Dr. Sears failing to report abuse (namely this incident) as required by law. It's also possible that she didn't think the issue was serious enough to rate a trip to the emergency room, and didn't want to involve the police (she may have reasonably believed it was an accident, if it only happened once or this was the first time it happened; alternatively, she might have been in denial).

Or, as you suggest, the incident may have been fabricated, or she was the guilty party. We strongly suspect from the case record that there is a custody battle in progress here, and false accusations of child abuse are one of the weapons crazy ex-spouses have been known to use (my sister, who married a man with a crazy ex-spouse, knows this firsthand).

By Eric Lund (not verified) on 27 Sep 2016 #permalink

If the CAMB has initiated disciplinary proceedings against Dr. Bob, who would have started this process? Would it not have to be a formal complaint to the CAMB from one of the parents/guardians of the child in question? I would think that at the very least the CAMB would need consent to have access to the child's medical records. If not, how would the CAMB get any information on the child to try to prove their case?

In the 'keeping the argument square' department:

proponents of integrative medicine sitting in their ivory towers of academia will swear up and down that [it] is not antivaccine, but damned if a survey on the ground doesn’t suggest otherwise.

It's not a survey. It's a small handful of cherry-picked anecdotal examples offered by a completely disreputable quack.

First, In formal logic terms, there are two division/composition fallacies at work - what is true of some part (anti-vax quacks who call themselves "integrative" practitioners) is not necessarily) true of the whole ("integrative medicine"), and what is common among the whole (all providers who employ the "integrative" rubric) is not necessarily true universally within that domain (in this case, any specific academic advocates of "integrative medicine').

Second, the formal logic isn't necessarily useful anyway, as it rests on a dubious assumption: that the label "integrative medicine" marks out any actual thing in the world with some set of concrete material characteristics. Which is to say, you can't reliably ascribe any consistent meaning to a buzzword*, which is clearly what "integrative medicine" is as used by the sources quoted by Margulis. There is no warrant to assume that the "integrative medicine" promoted or practiced by these Friends of Dr. Bob would be recognized as even remotely similar to their own concepts by officials at institutions recently criticized here for 'integrative quackademics' such as Stanford and UCSF (to stick to CA).

Or to paraphrase Lincoln, the 'quackademic' would likely aver, 'calling yourself an 'integrative physician" doesn't make you one'. And I'd add, "if anti-vaxers claim to be operating under any sort of rubric, you can pretty much guarantee that's a bogus appropriation, and in it's proper home, that rubric means something different and incommensurable' e.g. the anti-vax version of 'science'...

_____
* "an important-sounding usually technical word or phrase often of little meaning used chiefly to impress laymen"

By the way, my favorite defense of Sears comes from an antivax poster in another forum, who argued that Sears was prevented from conducting a neurologic exam on the child (after hearing he was hit on the head with a hammer and suffering headaches) because Sears isn’t a neurologist, and would have been liable for malpractice for even doing such an exam.

So Sears could avoid a malpractice suit by either referring the child to a neurologist or doing nothing
.
He chooses to do nothing. That's absolutely brilliant.

It’s not a survey. It’s a small handful of cherry-picked anecdotal examples offered by a completely disreputable quack.

You want more? Be careful what you ask for...

There is no warrant to assume that the “integrative medicine” promoted or practiced by these Friends of Dr. Bob would be recognized as even remotely similar to their own concepts by officials at institutions recently criticized here for ‘integrative quackademics’ such as Stanford and UCSF (to stick to CA).

Not true. Cammy Benton and Lonna Larsh, for instance, have the dreaded "ABIHM"" after their names, which means they're diplomates in integrative and holistic medicine and likely board certified in that specialty. That, BTW, is the same board certification originated and promoted by that king of quackademia himself, Andrew Weil at the University of Arizona.

http://scienceblogs.com/insolence/2013/07/24/a-board-certification-in-i…

I realize the board is highly dubious, having explained why myself on multiple occasions, but it is being promoted in academia as a way of emphasizing who are the "true" integrative doctors and it is basically accepted by most in integrative medicine, even if it means very little elsewhere.

Actually, Cammy is board certified in integrative medicine, the body headed by Marc Hyman which has a presence at major academic centers. Speaking personally and having been privy to conversations among her Facebook integrative medicine colleagues, they recognize practitioners at Cleveland Clinic, etc., as their own.

By Mary Russell (not verified) on 27 Sep 2016 #permalink

EL: I can't think of any incidents where delaying treatment of a possible head injury is a reasonable reaction. Even if she believed it was an accident (How? Anyone who has even the most minimal experience with hammers knows they need to be immediately secured) or was in denial, waiting til the next appointment to mention it, suggests that she doesn't care about the kid much at all. I mean, a case could be made for criminal neglect here.
Also, the renal thing bothers me, because that's a pretty critical system and renal problems rarely resolve on their own, especially in kids.
I guarantee that most parents would be haunting the emergency room if their kid had kidney stones- and that's the mildest thing I can think of that can go wrong with the renal system. (And I use mild advisedly, as I understand kidney stones are fairly excruciating.)

By Politicalguineapig (not verified) on 27 Sep 2016 #permalink

"From my perspective, any physician who embraces the quackery that is homeopathy automatically forfeits pretty much all credibility in any other medical area."

I can't agree more!
Anyone providing medical care that recommends such pseudoscience to me has services terminated immediately.

Howinhell does someone get all of the way through medical school and still believe in this crap? I mean, this is up there with a physicist believing in faeries and elves (and not the atmospheric phenomenon).

Just to weigh in on the Wakefield medical status issue for a mo -
In the UK the term physician is reserved for those who are members or fellows of the Royal College of Physicians. Other doctors get known by whatever their affiliation is - a surgeon if they are surgeons and fellows of the Royal College of Surgeons, a general practitioner if they are menmbers/fellows of the Royal College of General Practitioners, and so on.
I appreciate that in the US doctors of all persuasions tend to be called "physicians", hence one's primary care physician and so on.
I think that when in Rome, do as the Romans do.

However, "doctor" is not a protected term, even in the UK, and although Wakefield has been stripped of his medical license to practice in the UK, he stilll retails his medical qualification and can still call himself a "doctor". In this instance Brian Deer is incorrect.

OK, so paediatrics wasn't my field, but I did work in child and adolescent mental health...We knew that, while we needed to take what parents said seriously, we also needed to thoroughly examine what we were told by parents.

I give 2 examples: Family A swore blind that their child had been given a diagnosis of ADHD elsewhere in the country and so could we please prescribe methylphenidate (Ritalin) for him;

Family B swore blind that their child had been given a diagnosis of ADHD elsewhere in the country and so could we please prescribe methylphenidate for him.

Unusually for the UK system, in neither case could we find any trace of any supporting letters with the local GP, and even after I did a load of detective work (tracking down GP practices and likely diagnosing services in the claimed areas) I could not come up with anything to support the claims.

Thus we re-assessed...Kid A indeed DID meet the criteria for a diagnosis of ADHD and was thus treated for it. Kid B most definitely did NOT meet the criteria, and in assessing I discovered that the family had previously lived in an area where dealing in methylphenidate as a "speed" substitute was so rife that the local CAMHS psychiatrists would only prescribe a week's worth at a time (this was in the pre-atomoxetine days)...

Regarding the AAP meeting - I see Paul Offit has a presentation on "Talking to Parents: Strategies for Addressing Vaccine Hesitancy" on both Saturday and Sunday.

Maybe he can raise the issue of "Vaccine hesitant paediatricians"?

@ dingo199 #29: If questions are taken at the end of his presentation, the topic could be raised. Not sure how the AAP would take it or allow it. In 2012, I corresponded with the AAP about purchasing a booth in the exhibit hall to promote vaccine advocacy, including rallying physicians to get the AAP to speak out against Sears and Gordon. I was told by the AAP that any mention of the AAP in print or by mouth at my booth would get me and my booth expelled from the NCE.

By Chris Hickie (not verified) on 27 Sep 2016 #permalink

In case anyone is wondering, Tina Kimmel has a PhD from Berkeley in "Social Welfare." Her thesis title was "The milk of human kindness: Social welfare and breastfeeding policy in the United States"

She might be an expert in social policy, but her medical expertise (including that for breastfeeding) is lacking, as evidenced by the first paragraph of the abstract of her thesis

Mother’s milk nourishes perfectly (MMM comment: except for not always being an adequate source of Vitamin D, but hey, it can still be perfect with imperfections) ; it is a miraculous substance (MMM - "and then a miracle occurs..." - The Far Side approach to PhD thesis) . Formula is a poor substitute which causes short and long-term disability and infections, chronic diseases, (MMM- baseless now, but only questionable in 2007) plus other health effects for both mother and infant, including death. (MMM - death of infants from formula? Or improper use of formula?) There are also troubling psychosocial consequences of formula use, including lower intelligence (MMM - the IQ effect is about 3 points on average, and decreases as the level of control in the study increases), poorer maternal-infant attachment (MMM - got a measure of that? no), and possibly increased child abuse.(MMM - use of formula increases child abuse? Yeah, you don't understand correlation vs causation)

Total lactivist.

By Marry Me, Mindy (not verified) on 28 Sep 2016 #permalink

Be careful about trashing breastfeeding, or Jay Gordon will pop in to castigate you (he is a Certified Lactation Consultant or somesuch).*

*for some reason, this achievement reminds me of Groucho Marx requesting the song "Somewhere My Love Lies Sleeping" with a male chorus.

By Dangerous Bacon (not verified) on 28 Sep 2016 #permalink

However, “doctor” is not a protected term, even in the UK, and although Wakefield has been stripped of his medical license to practice in the UK, he stilll retails his medical qualification and can still call himself a “doctor”. In this instance Brian Deer is incorrect.

I have to admit, one of the things "our side" frequently tries to do that irritates the crap out of me as a doctor is to deny, based on his loss of his medical license in the UK, that Wakefield is a doctor/surgeon/physician or whatever term you want to use for him based on your country of origin. No, he's still a surgeon/physician/doctor. That hasn't changed. He still passed medical school and whatever other training is required in the UK to be a gastroenterologist and is still entitled to the title of "doctor." What he is no longer entitled to do is to practice medicine, which is why I often call him a delicensed doctor or physician.

I also forgot to mention something above that probably needs clarification for my UK friends and readers: Contrary to the case in the UK apparently, in the US gastroenterologists are not considered surgeons, but internists. Gastroenterology is a subspecialty of internal medicine, and gastroenterologists do a medicine residency before going on to do a gastroenterology fellowship. I realize it might be confusing, given how procedure-based gastroenterology can be and how many endoscopies many GI docs do, but that is the way it is in the US. Gastroenterologists are certified by the American Board of Internal Medicine, not the American Board of Surgery.

He still passed medical school and whatever other training is required in the UK to be a gastroenterologist and is still entitled to the title of “doctor.”

It may irritate the crap out of you, but the fact of the matter is that use of the title is regulated state-by-state. Until 2015, Maine Statute title 32, § 3270 included the provision that "[t]he prefixing of the title 'Doctor' or the letters 'Dr.' or the appending of the letters 'M.D.' by an individual to that individual's name or the use of the title of doctor or physician in any way by an individual not licensed as described is prima facie evidence that that individual is purporting to practice medicine or surgery contrary to this section."

Under our Royal College system for the sub-division of medics, Wakefield ended up in the Royal College of Surgery hence previously having FRCS after his names. I believe he was also a Fellow of the Royal College of Pathologists at one point, there not being a Royal College of Gastroenterology. I am not sure if other gastroenterologists might belong to other Royal Colleges, such as Physicians or even Paediatrics.

The "Mr" or "Dr" thing is historical, going back to the days of barber-surgeons, who did not have a medical degree, hence being "Mr", while physicians did have a medical degree and so were "Dr".

Regulation for all falls under the remit of the General Medical Council.

@Dangerous Bacon #32--I think he's a certifiable lactivist. I'd bring lots of popcorn if I could ever have Gordon and Dr. Amy Tuteur in the same room for a debate.

By Chris Hickie (not verified) on 28 Sep 2016 #permalink

I don’t think you’re supposed to hit [children] with a hammer.

Sometime everything looks like a nail.

By herr doktor bimler (not verified) on 28 Sep 2016 #permalink

To add to Murmur's comments: Of course being British it became a class thing with surgeons being superior to mere doctors, as evinced by them being able to call themselves doctors but not doing so. This was exactly the same with vets in the UK who have only just now voted to allow themselves to use the term Doctor. I don't like it because it downgrades my having obtained a PhD, but ha!

Dr Hickie -- if we could ever get Sears and Dr Tuteur in the same room, we could sell tickets.

By shay simmons (not verified) on 28 Sep 2016 #permalink

Further clarification on my post 35

Gastroenterologists over here mostly belong to the Royal College of Physicians, those specialising in paediatric gastro would belong to the Royal College of Paediatrics, so I am not completely clear why Wakefield was a surgeon, unless the training has changed since he did it, which is always a possibility.

@Murmur #41
Wakefield went through surgical training and got his FRCS, but specialised in surgical gastroenterology. He then drifted, via research, into the realm of becoming an "expert" paediatric developmental neurologist, so he would have us believe.
Since he didn't get his MRCP (member of Royal College of Physicians) exams, he was never a "medical" gastroenterologist.

PS Earlier I said Wakefield "retails" his medical qualification.
I meant "retains", but perhaps my typo was truly a freudian slip.
I am not aware he is trying to flog off his degree, but it wouldn't surprise me, seeing how much he appears to like money.