Wednesday, December 1, 2010

Evidence trumps blanket statements (or whack-a-bob)

I have a number of other blogs planned, but this little gem needed treating first. On The Vaccine Book discussion forum, a poster asked a couple of days ago:
Dr. Bob - the other day you answered a question for me regarding titers and MMR. You mentioned that immunity could last up to 10-15 years. Someone had a follow up question as follows:
does that mean that we would have to re-vaccinate when child is 14 or older? (Having been originally vaccinated at age 4). Will the one MMR not last a lifetime? Or would we just check titers again after the ten to fifteen year mark?
These are very relevant questions, given the dangerous MMR recommendations that Dr. Bob spreads on his board and blog. Here is his answer:
I'd check titers. It's fairly unpredictable and individual as far as how long titers will stay positive. You could check every 5 years starting around age fifteen. OR, knowing that the diseases are so rare, you could just not bother after checking at fifteen. MOST adults have lost their imunity, and no one checks (unless a person's occupation requires it, or during pregnancy for rubella).
Wow - there is so much wrong with that, lets take in in bits:

I'd check titers.: Yes, you would, as a doctor in private practice, that sounds like a very attractive way forward. Not sure how appealing this is to parents and children, though.

It's fairly unpredictable and individual as far as how long titers will stay positive.: It is funny he should say that, when the current Dr. Bob recommendation is to vaccinate children once with MMR when they are four since that is sufficient then ("for State requirements", in the small print).

You could check every 5 years starting around age fifteen.: A blood draw and expensive titers (not sure how expensive, but his vaccine visits cost $80 to $200) every five years, mmh, ok.

OR, knowing that the diseases are so rare, you could just not bother after checking at fifteen.: Dr. Bob logic at work. I have called him a public health threat before - here is a quick recap of one of the reasons why:
Why are M, M, and R rare? Because of the 2xMMR vaccine policy in developed countries.
What will happen if everyone followed Dr. Bob's recommendation? M, M, and R would resurge - his 1xMMR vaccinated patients would provide the ideal breeding ground. Dr. Bob's home visits for measles patients do not come cheap.

MOST adults have lost their imunity: That one left me almost speechless. Luckily, while Bob's anonymous sycophants were busy name calling, cbe did a minute of research:
the evidence? by cbe - posted on 11/30/2010
All the evidence I see for rubella and measles says adults have MAINTAINED their immunity. Where is the evidence on the other side?

Is it "rude" to ask for that evidence? Here we see measles immunity of 81-89% of adults and higher...and these are in birth cohorts that DID NOT receive the 2 dose schedule. So we know that many of these individuals are not immune because the 2 dose schedule came into effect later.

this study looks at mumps 21 years after 2 dose vaccination. 70%+ immune. This is consistent with what SM is saying about mumps being the least effective part of the vaccine. BUT even here Dr Bob's assertion that "most" are not immune is not playing out in the numbers. I assume "most" would mean at least 50% + 1.

93%+ canadian mothers were found to be immune to rubella:

Again 90%+ immune to rubella:

I can show tons more for measles, too.'

But where is the evidence that most adults have lost immunity?
That was easy, right? Turns out that Dr. Bob had never invested that minute:
Hey CBE - thanks for the info by Dr. Bob - posted on 11/30/2010
I haven't looked at this research. I was answering simply on the general belief among the medical community that most vaccines don't last into adulthood. Since I don't do adult medicine, I've never had to counsel parents through this type of information and I've never actually looked it up. It looks like you are right about the MMR titers though - it seems that they do last into adulthood for more people. Thanks for pointing that out. I appreciate you doing so in a straightforward, respectful manner - very adult of you.

I haven't looked at this research.: now that was blindingly obvious.

I was answering simply on the general belief among the medical community that most vaccines don't last into adulthood.: I was answering simply on the general belief I didn't bother to look up the evidence before I posted utter nonsense in the forum (there, I fixed that for you).

Since I don't do adult medicine, I've never had to counsel parents through this type of information and I've never actually looked it up.: So Dr. Bob doesn't consider the consequences of his "alternative vaccination schedule" for his patients when they become adults? Wow.

This anonymous poster expresses their frustration:
Cath, This is bizarre to me - if the diseases are by - posted on 11/30/2010
"so rare" as Dr. Bob says, and most adults have lost immunity, then why do we bother vaccinating at all? It seems that older kids and teens would be at much MORE risk from mumps and measles, and we would want to make sure that they remained immune to these diseases all through adulthood. If adults have lost immunity, aren't babies at risk from adults from than from children? Where is the ratinale in this thinking?
as does this:
I don't think SM posted a rude comment at all by - posted on 11/30/2010
The thinking is illogical to expect parents to keep checking titers every five years, or not check at all since most of us are not immune anyway! I think for myself, it makes no sense at all to keep checking titers, when I know with almost certaintly that immunity will "wear off" after 5-10 years or so according to Dr. Bob. If we know that immunity from MMR wears off after several years, how can we safely get by with just one dose? I want my children to be protected when they are older and more prone to serious risks from measles and mumps. Same feeling with chickenpox. I think we will do one MMR at age four, and check titers once soon after to make sure it worked, then the second dose at age 12, before puberty. This was the old recommendation from AAP, since these diseases are MORE dangerous as kids pass adolescence, and they wanted to insure immunity into the later years.
and this:
Then if someone is going to make money by - posted on 12/1/2010
by offering that advice as an "expert" on the topic in print form, shouldn't they be willing and able to look up accurate information about said topic? Particularly if offering blanket statements? That is more rude than any attacks I've seen.

This site is a money-making venture.

No further comment needed.


  1. I really don't get the "check titers" mentality. How will that protect a kid from the disease?

    On my pertussis blog post during Vaccination Awareness week I got one guy who questioned why I would want an eighteen year old son vaccinated with Tdap. He still didn't get it when I explained that my son also has a severe genetic heart condition. Perhaps I needed to explain even more fully that the enlarged heart muscle is right next to an already damaged mitral valve and that coughing would cause the muscle to block the valve causing sudden cardiac death.

    He never did come back and explain how getting titers every so often was better than getting the Tdap. Perhaps that is because he did not have a good way to protect the placebo group in the often requested "vax/unvax" study.

  2. Exactly Chris. Not only that but how many parents are going to follow through with titre checks every 5 years or so. And, titres are not trivial, it's a blood draw that is stressful and many insurance companies will probably not reimburse for titre checks. The sad part is that parents really do want to do what is best for their children and feel as though they are but are being very misguided.

    But here is the real problem, he is rectally-sourcing his recommendations with no regard for the scientific evidence and the overall public health. He is more concerned with being Dr. Feelgood than he is for the short and long term ramifications of his wonky assertions. I witnessed the evolution of his MMR recommendation going from bad to worse when Merck announced they were eliminating production of the monovalent vaccines:

    Instead of being responsible, reviewing and accepting evidence he never did to begin with and sucking up his error, he decided that 1 MMR at 4 years old was a nifty idea instead. In general, this is the pattern that measles, mumps and rubella epidemiology follows: unvaccinated children >>> adults with 1 vaccination >> adults with 2 vaccinations. It doesn't take a genius to figure out what is going to happen some years down the road even if a small percentage of parents follow his advice now. He gives lip service, not solid medical advice.

  3. He is just doing it to sell books and titer tests. I am glad that we are not the only ones that notice that tiny fact.

  4. Wow, Dr Bob's getting as bad as Dr. Jay. I'm glad that it appears parents at the forum are beginning to realize that Dr. Bob talks out his ass.

  5. Hi Kim, the Sears' will always have their devoted followers but I think that through the years, many parents have tossed a Sears' book or two across the room in disgust. When you just make stuff up as you go along, it catches up with you and you will inevitably blunder as he does, repeatedly.


    In case there was any doubt where Dr. Bob sources his recommendations:

    I recommend that parents skip the MMR altogether in their next kids if autism is (or WAS!) in the family. So, I'd skip it. The diseases are so rare that the risk is minimal. (I have to add, though, that the diseases ARE rare because most people are vaccinating). But I like to minimize risk factors for autism in siblings whenever possible.

    This, in answer to someone whom he has convinced you only need one dose of MMR at four years old, no booster dose and rely upon high uptake of MMR from everyone else.