Friday, December 31, 2010

Ho! How did I miss this?

A poster asked in the comment section of our blog, whether the index patient in the San Diego measles outbreak had been a patient of "Dr. Bob" Sears. I recalled that Bob had been asked that directly on his board:
San Diego meales outbreak by San Diego mommy - posted on 3/26/2009

Someone told my that the child who started the San Diego measles outbreak last year was one of Dr Bob's unvaccinated patients. Is that true? That is so sad for the families affected by the outbreak, especially for the babies that were too young to be protected by the vaccine.
and Bob had answered in his usual flippant and evasive manner:
Ya, she wanted the MMR, but I wouldn't give it to by Dr. Bob - posted on 3/27/2009

So, it's totally my fault that the outbreak happened.

No, seriously, I do know who the family is and have interacted with them. I'll leave it at that, since it doesn't actually matter if they were actually my patient or not.

Seth Mnookin, the author of the soon to be released "The Panic Virus" pointed me to an Orange County Register piece that is much more candid than Dr. Bob:
An unvaccinated 7-year-old boy traveled to Switzerland and unknowingly contracted the virus. Almost 100 children (including babies who were too young for the MMR vaccine) were quarantined or hospitalized after they were exposed at the pediatrician’s office, Whole Foods or day care. In all, 11 children caught the measles. As it turns out, the boy who spread measles is a patient of Dr. Bob Sears
(my bold)

Dr. Bob himself downplays the severity of the situation in his 2008 blog by saying:
The recent measles outbreak (if you can call it that) in San Diego last month,
(my bold)

Fact check for Dr. Bob:
A recent study by researchers on the role of vaccine refusal in this outbreak was staggering: 839 people were exposed, 11 additional measles cases were reported (all in unvaccinated children); one infant, too young to be vaccinated, had to be hospitalized. At a time when the state of California is in devastating financial straits, it cost San Diego serious health care dollars: $10,376 per case, for a total of $124,517 (and the hospitalized infant's bill was nearly $15,000). Forty-eight children too young to be vaccinated were quarantined for several weeks, meaning parents had to miss work and wages at an average cost of $775 per child.

In his blog, Dr. Bob claims:
Fortunately, all cases passed without complications, as is usually the case with measles.

Lost in the depth of his own board is the reality check by Wilbert Mason, MD
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.

Thank you Dr. Mason, that says it all, really, about the irresponsible behaviour of Dr. Bob Sears (and the patients' parents who believe him).


  1. Good post. Will share this. "Dr." Bob is a wold class denialist ass that is pushing a dangerous agenda. His ilk need to be slapped up side the head with reality, hard!

  2. Thank you - I am really surprised that no one has sued him yet. Health insurance companies in Germany did debate asking their money back from two non-vaccinating anthroposophical doctors after a big measles outbreak in 2000. Bob is *so* lucky that no child has had lasting damage (so far, we know that onset of SSPE can be a decade after the measles). My ethical problem is that anything I wish upon him would be triggered by a severely sick child and I cannot really wish for that.

  3. Also, listen to this from minute 12:30

  4. from minute 27 you get a description of a 10 month old baby who caught the measles in his doctor's waiting room and got so sick, he dropped from 18 to 12 pounds in weight within 5 days and he was so dehydrated that it took an hour to get an IV in. The parents had to take a month off work to care for their severely sick baby. Does Bob count that as "passed without complications"?!

  5. and from about 31:30 they interview Dr. Bob and mention that he is the Switzerland index case's pediatrician.

  6. None of this matters to Dr. Bob, though. He's too busy saving people (from the illusory evils of vaccines, of course).

  7. And here I thought he was busy carving his niche as the parents'-fears-friendly doctor, ensuring plenty of clients for his private pediatrician's practise (it is totally cool to spread out vaccines at up to $200 per vaccine visit, you know - see - or maybe I am just cynical - Happy New Year, Todd :)

  8. @Catherine

    "it is totally cool to spread out vaccines at up to $200 per vaccine visit, you know"

    Hey, if I was a physician in private practice and had a near or total lack of ethics or conscience, I'd do the same thing. Sadly, I have a conscience and so will never strike it rich at the expense of others.

    Happy New Year to you, as well!

  9. It was the San Diego 2008 measles outbreak that really woke me up about the social-justice aspect of high vaccine uptake for pediatric infectious disease.

    Many middle-class & lower families are getting by with parents having more than one job each, many without benefits such as paid sick leave etc.

    At least one infant day-care facility was closed for quarantine. In other words,I suspect that one or the other parent had to take unpaid time off from work to provide child care they had previously paid for, because the child care facility was quarantined. I suspect that the "average cost" to the families obscured the potential financial ruin to some families.

    As far as "anthroposophical doctors" I believe there are very few in the US. What we do have is Waldorf (Steiner) schools, mostly private (ie, fees are paid by parents, not the state). The Waldorf schools have extremely low vaccine uptake rates and have been the focal points for vaccine-preventable disease outbreaks. What is worrying is that there is a movement to fund Waldorf schools with state funds ("charter schools"). Historically, the Waldorf charter schools exhibit the same pattern of very low vaccine uptake.

  10. Liz - Waldorf Kindergartens and schools are the focal points of outbreaks in Europe, especially German speaking countries. One Austrian school managed to rake up over 170 cases (amongst a school population of about 300) within 3 weeks, so more than 3x the annual measles cases in the entire US with one millionth of the population (probably not a fair comparison, since the pupil would have been much more closely packed, but still...).

    I wonder how many of the US Waldorf parents are fully aware of the totally potty (to cite David Colquhoun) Steiner philosophy behind the schools and the vaccine refusal. Real Steiner followers *want* their children to contract measles and other rashy diseases as a means to "shed miasms" and support the "Menschwerdung" (becoming a human). There are rumours of measles parties (so get togethers with the expressed purpose of infecting children), which, at least in Germany would be punishable with a fine up to 25K Euros. I wish someone would pull this through and I am genuinely surprised that there have been law suits (I assume) following the San Diego outbreak.

    If the parents were consequential, they would also sort out the black crayons from their children's art kits, would only let them drawn one picture per day, not learn to write their name before they are 7 and also not eat potatoes before then. Not getting their children their MMRs is about as potty as that...

  11. Great catch Catherina. No wonder Dr. Bob is playing down the definition of outbreak; one wonders his role in the recent CA pertussis outbreak as well. Now, if the index measles case was his patient, wouldn't it stand to reason that the infants infected in the physician's office was the Sears' practise?

  12. Here in the UK - and I assume also in USA - to disclose whether somebody is your patient or not is a breach of the duty of confidentiality owed to a patient by a doctor.

    I am a pro-vaccine advocate; there are lots of good reasons to criticise antivaxxers, but maintaining patient confidentiality by refusing to disclose whether somebody is their patient is not one of them.

  13. By a doctor to a patient, I meant, of course...

  14. Penglish - that is a good point, he may be preserving doctor-patient confidentiality.

  15. "Great catch Catherina. No wonder Dr. Bob is playing down the definition of outbreak; one wonders his role in the recent CA pertussis outbreak as well."

    We'll know this week, as the CDC presents preliminary findings from an investigation into California's whooping cough outbreak at a national vaccine conference in Washington, D.C. this week.