I've said it before, and I'll say it again. I don't much like "Dr. Bob" Sears. Actually, I rather detest the guy. The reasons are obvious. There isn't an antivaccine trope Dr. Bob won't repeat in the service of pandering to the vaccine-averse parents base who bring him patients. They're all there in his The Vaccine Book: Making the Right Decision for your Child and have been thoroughly deconstructed by pediatricians (and others) ranging from Paul Offit to John Snyder, the latter of whom quite appropriated dubbed Sears' book to be cashing in on fear. Basically, at ever turn, Sears either subtly (or not-so-subtly) downplays the dangers of vaccine-preventable diseases and exaggerates (or makes up) risks of vaccinating. His book is rife with misinformation, including common antivaccine tropes such as "too many too soon" and fear mongering about aluminum-containing adjuvants and the mercury-containing preservative thimerosal in vaccines. In other words, it is not a reliable source of information on vaccines, and that's putting it mildly.

Yet, all the while denying that he's antivaccine even as he spews antivaccine misinformation, "Dr. Bob" Sears has built quite the empire for himself as the "vaccine skeptic" pediatrician. His parents' patients apparently adore him, because he indulges their fears and is either too spineless or too cynical to tell them they are based on pseudoscience or believes the pseudoscience himself. Maybe it's a little of both. Meanwhile, he practices in southern California, one area where there have been significant measles outbreaks because of the pockets of children who are either unvaccinated or undervaccinated. Hilariously, when parents who had trusted Dr. Bob's vaccine advice started calling his office late last winter, concerned about the measles outbreaks raging around him, Dr. Bob basically told them, "Don't worry, be happy" and get your child vaccinated if you're too wimpy to accept such a "tiny" risk. Oh, and stop bothering him about it. It was a truly monumentally slimy passing of the buck.

So it was with trepidation that I approached an article that appeared over the weekend about Dr. Bob in the LA TIMES entitled Vaccination controversy swirls around O.C.'s 'Dr. Bob'. It was actually not too bad, as they say. It also provided me perfect blog fodder for today, because I spent most of the weekend out visiting my wife's family at a reunion, which means I like a subject that actually doesn't require me to comment (much), at least today. It'll make a good change of pace.

First up, is a piece of information that I hadn't expected:

While the vast majority of physicians are troubled by the anti-vaccination movement, Sears, 45, lends a sympathetic ear. About half his patients forgo vaccines altogether. To others, he offers "Dr. Bob's" alternative and selective vaccination schedules, which delay or eliminate certain immunizations.

No, I wasn't surprised to learn that Dr. Bob turns a sympathetic ear to the antivaccine movement. That's his business model. I was surprised that half of his practice is completely unvaccinated. I figured that most of Dr. Bob's practice probably followed his "modified vaccine schedule" (which is not based on any science) and a relatively few of his patients were completely unvaccinated. Silly me for giving even Dr. Bob the benefit of the doubt. Any pediatrician who allows and encourages half of his patients to be completely unvaccinated is committing outrageous malpractice, in my book, and does not deserve a medical license because he is a danger to the public.

However, the part of the article I wanted to focus your attention on is this gem from Dr. Bob:

"I do think the disease danger is low enough where I think you can safely raise an unvaccinated child in today's society," he said. "It may not be good for the public health. But … for your individual child, I think it is a safe enough choice."

In other words, Dr. Bob knows that he can get away with it if half his patients don't vaccinate, as long as those other suckers children are vaccinated. Basically, he is telling his patients to "hide in the herd," taking advantage of herd immunity that occurs in highly vaccinated populations to protect those who can't be vaccinated. It's a breathtakingly cynical strategy, encouraging his patients's parents to be parasites, with no sense of social obligation whatsoever. Indeed, he even wrote: “I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.” Guess what's happening now.

Besides being cynical, this is also a very short-sighted and ultimately dangerous strategy. It can work for individual children, but not if lots of other parents start doing the same thing. In other words, Dr. Sears' strategy is one that depends upon there always being relatively few children who remain unvaccinated. Now, with the unfortunate popularity of the antivaccine movement, particularly in the area where Dr. Bob practices, there have developed pockets of unvaccinated or undervaccinated children sufficiently large that herd immunity has broken down, leading to measles outbreaks. It's tempting to laugh at the discomfiture of antivaccine parents who had been assured by Dr. Bob that they could "hide in the herd" (obviously he didn't use those words) safely and Dr. Bob's exasperated "don't blame me, get your kid vaccinated if you're so worried" response, were it not for the fact that it is children who are being harmed through Dr. Bob's irresponsible message.

That's why I agree with Dr. Paul Offit on this one:

"We eliminated endemic measles in the U.S. in 2000. It's now 2014 and we're at 400 cases. Why?" Dr. Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia, said in an interview in June. The number of cases has since risen to nearly 600. "Because people listen to Bob Sears. And, frankly, I blame him far more than I do the Jenny McCarthys of this world. Because he's a doctor. And he should know more."

Exactly. In his own, much smaller, way, Dr. Bob has the potential to do far more harm than anyone like Jenny McCarthy. Think of the harm Dr. Oz does. Misuse of one's medical degree confers a false sense of authority. Unfortunately, physicians are just as prone to the Dunning-Kruger effect—maybe even more so!—than the general populations when they wander outside their area of specialty. Dr. Bob isn't an immunologist or pediatric infectious disease expert; yet he plays one in Capistrano Beach. No wonder patient zero of a 2008 measles outbreak was one of his.