When a doctor stops behaving like one

You’ve probably heard of the Hippocratic Oath, an oath taken in one form or another by the majority of graduating medical students in the United States. One of the major tenets of the oath is the principle of beneficence: do no harm, prevent any harm, relieve any harm. A physician, and basically anyone who has decided to devote their life to medicine, is morally, ethically, and even legally bound by this principle. They must not cause any harm through their medicine, or take reasonable steps to not cause it. They must prevent their patients from being harmed, or take the reasonable steps to prevent said harm. And they must relieve any harm being caused to their patients, or do the reasonable thing to bring about this relief. I threw in the reasonable clauses there because physicians and other healthcare providers can only do so much. Patients are in many ways responsible for their actions, but it is up to the provider to give proper guidance and counseling based on all the available evidence.

All the available evidence on the MMR vaccine (the vaccine against measles, mumps, and rubella) is that it works very, very well and is very, very safe. Any person getting both doses of the vaccine is over 99% likely to be immune against measles. As an epidemiologist, when I’ve investigated outbreaks of measles in the literature, I’ve found that very rarely are there vaccinated people in the group of those who are sick. In my personal experience, I am yet to find a vaccinated person with measles. (Mumps is another thing. The vaccine seems to wane when it comes to mumps.) So the vaccine is 99% effective. But is it safe?

Yes, yes it is. Despite any claims to the contrary, there are no links between the MMR vaccine and any of the ailments exaggerated by the anti-vaccine crowd. It doesn’t cause autism. Very, very few people get more than a local reaction to it. Rarely does it cause encephalitis, but that clears up on its own. In short, the vaccine has prevented measles cases in orders of magnitude greater than any injury it has caused. I will bet my life’s savings on the vaccine any day of the week over a bout of measles. With modern medical technology, measles is less of a killer than it was before the vaccine, but you still don’t want to get it. It can be crippling, incapacitating.

To recap so far: Vaccine good. No vaccine bad. Thus, based on the principle of beneficence, healthcare providers must recommend and give the MMR vaccine to their patients to prevent a harm called measles, especially when there is an outbreak of the bug going on in their vicinity.

One physician in the United States who graduated from Georgetown University is Robert “Bob” W. Sears, MD, FAAP. He went through medical school and must have learned about immunology, virology, and maybe even some epidemiology. He is board certified in pediatrics. If I were a betting man, I’d bet that he knows all about the Hippocratic Oath and about beneficence. It’s just that (to me) he acts like he doesn’t, or like he doesn’t understand the things he should have learned in college and medical school, and beyond. Why? Because of his stance on vaccination.

“Dr. Bob” wrote a book called “The Vaccine Book: Making the Right Decision For Your Child“. The title is innocent enough to make you think that maybe he is for vaccines but just wants them spaced out. Maybe he knows something we don’t? After all, he is a board certified pediatrician. The trouble with his book is that he gets a lot of things wrong. Don’t take my word for it. Take the word of Dr. Paul Offit, a pediatrician himself, vaccine researcher and developer:

“Sears wants parents to use the information he has provided to make their own decisions about whether to vaccinate their children. “I have offered you all the information you need to make this decision,” he writes, “but I have held back from actually telling you what to do. I want you to formulate your own decision without letting my opinion sway you one way or the other.” Unfortunately, Sears, who wants parents to make informed decisions, has written a book that will largely misinform them.”

And take the word of the world’s authorities on vaccination science.

Still, you might be inclined to think that Dr. Bob is not anti-vaccine. After all, he’s not saying that you should stop vaccines altogether. He just wants you think that you can delay the administration of them because… Because something. I don’t know why. There’s no real reason to do so; No scientific reason, anyway.

Let’s stop here quick for an update on the return of measles to the United States. According to the California Department of Health, there have been 32 confirmed cases of measles this year, compared to only three last year. Ten of this year’s cases are in Los Angeles alone. If this isn’t an outbreak, I don’t know what is. And I know my outbreaks, I’m an epidemiologist and I’ve taught epidemiology. But Dr. Bob has a different take on this outbreak. To him, it’s not an outbreak at all:

Click to enlarge

Click to enlarge

Here’s the text:

“Measles Epidemic . . . NOT!

Why is it that every time there are a few cases of measles, everyone panics? I just don’t get it. So, here’s the situation in the O.C., where I live and practice. Seven cases. Seven. That’s 7. Not 700, not a million Seven. So, why do people panic? Here’s one reason: the ^$#@*&%&*$# media. News reports go out stating that there are outbreaks of measles, and everyone needs to be concerned. Everyone is quick to blame those who don’t vaccinate, AND those who don’t vaccinate start to panic. We’ve gotten dozens of calls to our office with people wanting to know if they should come in for the vaccine.”

I do wonder if Dr. Robert “Bob” W. Sears is acting like a physician and recommending the vaccine to his patients in a time of a measles outbreak in his state, under the principle of beneficence? What kind of specialized knowledge does Dr. Bob have that the California Department of Health doesn’t to assure his patients that there is no outbreak of measles in the state, though there are ten times more cases right now than this same time frame last year? If anyone has answers to these questions, let me know. I’m not asking them rhetorically. This is a pediatrician, a board certified physician, blowing off information from public health authorities. It is in the public’s best interest to know if one of the physicians charged with taking care of the public’s children is not acting like a physician and more like an anti-vaccine activist.

But, then again, we don’t need to look far to see if Dr. Bob is anti-vaccine:


Click to enlarge

Well, if he is not anti-vaccine, then I’m the Prime Minister of Burundi. I mean, he is the administrator of a goddamned anti-vaccine, private Facebook group. So has he been lying when he says he’s not anti-vaccine? Probably. I’d have more respect for the man if just came out of the anti-vaccine closet and proudly proclaimed to be anti-science, like other medically-trained healthcare providers have. Then we wouldn’t have to play this game of exposing Dr. Robert “Bob” W. Sears to the world for the anti-vaccine activist that we see in him.

26 thoughts on “When a doctor stops behaving like one

  1. Ok. First, I will say that I am FOR vaccinations. But, I am also FOR my right to choose. This in itself brings up even more controversy. I take my child to the doctor for broken bones and illness that will not subside. I get my kids vaccinated.
    Dr Bob is crucified because he may support not to vaccinate. These people that are not vaccinating their children have already decided to NOT vaccinate their children. They sought out someone to tell them it was ok, or just that it was their choice. They needed someone to validate their decision.
    For such an important decision, it really rests on the parents to get ALL of the facts. I don’t think doctors, in all of their wisdom, have all of the answers and shouldn’t be required to take a stance one way or the other. The human body is way too complex.

    • The choice to not vaccinate is not based on reason. It is based on fear, lies, deception. Studies after studies, since Jenner’s smallpox vaccine, have shown vaccines to be safe and effective. Those that are not are removed from circulation or not approved at all. Are there injuries? Sure, but the number and severity fall way short of any injuries by the actual diseases. Dr. Bob is anti-vaccine. There is no question of this anymore. He is the administrator on Facebook of an anti-vaccine group. His statements about vaccines can’t be interpreted as anything but anti-vaccine by reasonable people.
      Yes, you do have the choice not to vaccinate, but we, the society with which you’ve made a social contract, have the choice to impose penalties on you for not wanting to keep us all safe. It’s like in England during the Blitz. Go ahead and turn on your lights during a raid, but woe be unto you for risking all of us getting bombed.

    • You haven’t as yet, given us any reason for your opinions about vaccines. Have you any sources that you could link to, to explain why you don’t trust your physician and the body of scientific proof about vaccine safety and the ability of vaccines to prevent serious, sometimes deadly, vaccine-preventable-diseases?

      Having your child(ren) vaccinated according to the Childhood Recommended Vaccine Schedule protects your child(ren) and protects infants and children who are too young to have been fully vaccinated and infants and children who have medical contraindications for receiving certain vaccines.

      I just don’t understand why parents who are not educated in immunology, bacteriology and virology would put their own youngsters and innocent babies and children at risk.

  2. Pingback: When another doctor stops behaving like one | The Poxes Blog

  3. What do you know?

    A remarkable statistic:

    California allows permanent medical exemptions (PMEs). Only about 10 percent of Orange County schools enroll children with PMEs, and typically they run from 1-4 students per school. Overall in Orange County, the rate of PMEs is 0.3%.

    Oddly enough, one school in Orange County has 16 children out of a kindergarten class of 78 with PMEs, accounting for 13% of all of the medical exemptions in Orange County. It’s Palisades Elementary in Capistrano Beach. According to Health Grades, Sears Family Pediatrics is the only pediatric practice in Capistrano Beach. Of course, it’s Southern California, where people blithely drive all over for everything.

  4. Great article and I agree wholeheartedly. One thing though – benifecence means ‘do good’ essentially, ‘do no harm’ comes under non-maleficence..

    • From the Belmont report on human subjects research (and generally applicable to medical treatment):

      “Persons are treated in an ethical manner not only by respecting their decisions and protecting them from harm, but also by making efforts to secure their well-being. Such treatment falls under the principle of beneficence. The term “beneficence” is often understood to cover acts of kindness or charity that go beyond strict obligation. In this document, beneficence is understood in a stronger sense, as an obligation. Two general rules have been formulated as complementary expressions of beneficent actions in this sense: (1) do not harm and (2) maximize possible benefits and minimize possible harms.”

      But, yes, non-malfeasance can be seen as a corollary or a complement to beneficence.

  5. Well said, sir. Well said, indeed.

    I have several patients in my practice who will not vaccinate their children and despite the countless times I have counselled and provided evidence showing the safety of vaccinations, I cannot break down those walls.

    We need more blogs like yours.

    Thank you!

  6. Sears behaved like a small child yesterday when he whined about people calling his office because they wanted to vaccinate their children. And then he can seem to distinguish outbreak from epidemic.

    There is no scientific basis for the “alternate” vaccine schedules of Sears. None. He just made them up and there is no date as to their safety and efficacy.. As a pediatrician I’ve seen plenty of families start one of his schedules and fall very behind on the ir child’s vaccines, and many more families won’t vaccinate thanks to his anti-vaccine books and facebook page. Sears is a disgrace to pediatrics. I hope more pediatricians call him out.

  7. He wrote the forward to the Thinking Moms Revolution antivax/autism book. If that’s not a fluffy tail disappearing down the rabbit hole I don’t know what is…

  8. The only question I have is, *why* do these people retain their medical license in their state of residence and business?
    This is most certainly grounds to revoke their medical license, as they are a menace to the entire society at large!
    We give physicians the privilege to police their own ranks and frankly, that seems to be failing. We have physicians running pill mills, we have anti-vaccination physicians, all malpracticing medicine and only the pill mill physicians are removed from practice after law enforcement arrests them.
    If our physicians cannot police their own ranks, perhaps it is time for the legislature to do it for them.

    Then, we’d finally be rid of quackery from the graduates of our nation’s medical schools.

    • I don’t know enough about doctors disciplinary proceedings, but I know lawyers’ are very lax and lenient about penalizing lawyers. Professions defend their own?

      • Professions police and defend their own.
        However, that falls down when comparing an attorney and a physician, for if an attorney is corrupt or inept, people may lose money, someone may go to prison. If a physician is corrupt or inept, thousands can pay with their very lives from narcotic addiction, infectious disease and more.

        • I’d be careful not to overstate this comparison. I agree with your basic point, but remember that incompetence by an attorney can ruin a life, and that it competence by a doctor doesn’t always kill. Both can have very, very bad repercussions, though I agree that it’s more likely to be life or death with doctors.

          I used the attorney comparison simply because I’ve actually read studies about bar discipline, but not about medical boards discipline.

          • Fair enough. I recall a case in my state were a handful of judges ended up being disbarred after being convicted on accepting bribes to convict hundreds of children, who were then sent to privately operated juvenile detention facilities.
            One mother confronted one of the convicted jurists on the courthouse steps during a press conference, making it clear that that jurist ruined her life after her son committed suicide after an unjust conviction.

            • I remember that – which means I know which state you’re from, and sorry – we taught it as part of a discussion of ethics. A horrible, horrible case.

              • Imagine my shock, as I didn’t learn of it until a while after I redeployed home to the US.
                Regrettably, to some, ethics involves the worship of the almighty dollar, to other deficient folks, to defective ideology. Neither are sustainable in any form of civilized society.

  9. You’re absolutely right, of course.

    Your opening does remind me of a Simpsons episode in which Homer is about to be operated on by the incompetent TV doctor “Dr. Nick” Riviera; Homer. In fear for his life, Homer implores Dr. Nick: “Remember your hippopotamus oath!”

    There’s something about those first-name doctors that gives one pause.

  10. I appreciate this. I’m growing to dislike Dr Bob more and more as I feel he is losing site of what medicine is and appropriate recommendations to be made. I also don’t like his guidelines for when to see a doctor very much. Seems like many of his “now time to call the doctor are aimed to cut down the called or visits to his clinic instead of collaborating with your healthcare provider

  11. I’m actually glad that Dr. Bob put that rant on his Facebook page and we have screen shots for posterity.

    Dr. Bob also provides a link on his webpage for parents who don’t want to vaccinate their children…a list of hundreds of medical doctors, naturopaths and other assorted quacks who are “vaccine friendly doctors”.


    IMO, the parents of prospective patients should screen a doctor for their vaccination policy and stay away from doctors who are “vaccine friendly”.

  12. He’s certainly not in any way correcting or limiting the anti vaccine posts on his Facebook page statement mentioned above. The only comments deleted were the ones criticizing him.

  13. Dr. Offit has said it succinctly–what is the scientific basis for Dr. Sears’ schedule? I had to live through measles (kindergarten), rubella (fourth grade) and mumps (seventh grade). I was miserable during each illness, I missed school and activities, my parents’ and grandparents’ lives were interrupted and worst, I had the risk of an even more serious illness with each of these. And now there’s a safe and effective vaccine? Bring it!

  14. Pingback: After all this time, Dr. Bob Sears finally tips his hand on vaccines, part IV – Respectful Insolence

Comments are closed.