Israel's Health Ministry is considering taking significant steps against eight doctors who encourage their patients not to be vaccinated.

Four of the eight have already been summoned to the Health Ministry for clarifications and the other four are expected to be called in next month. Considering the cases of measles that have broken out in Israel, the Health Ministry has recently decided to ratchet up its fight for vaccinations, including exercising special powers. This has sparked a debate in the medical community around the question of how to protect public health without silencing legitimate minority opinions.

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“As part of your work as a doctor you have made recommendations that go against the vaccination guidelines and even suggest postponing vaccinations,” attorney Eyal Hacco, joint chairman of a Health Ministry committee formed to prevent the public from being misled, wrote to the eight doctors. Hacco informed them that giving such advice, which goes against professional practices in Israel and the rest of the world, could put children, adults and those around them at risk, and that it “misleads the public and endangers health,” Hacco wrote.

The eight doctors are the pediatrician and homeopath Dr. Chaim Rosenthal and his partner in a homeopathic and natural medicine clinic Dr. Nicole Ezrahi; pediatrician and homeopath Dr. Noa Tor-Frenkel; family doctor and homeopath Dr. Liora Uriel; pediatrician Dr. Yiftah Broza and pediatrician Dr. Amir Anisfeld; doctor and homeopath Dr. Boaz Ron; and Dr. Gil Yosef Shahar, the doctor and owner of the Rambam Medical Center.” One of the eight responded in writing to the summons pledging to refrain from further advising people against vaccination.

The committee had no real difficulty in finding the eight physicians, because it received many complaints from other doctors, parents and organizations that fight against non-vaccination. The committee is now completing the task of collecting information including posts and videos published on social media by the eight, their interviews in the media, lectures they gave and documents involving “vaccination consultation” that were given to parents.

If the health minister decides that these materials show “conduct unbecoming a physician,” he has the power to take a variety of steps, the most serious of which is withdrawing the physician’s license to practice medicine.

The letter summoning the physicians for clarifications asks them to bring with them "reports of patients or children ‘harmed by vaccinations’ whom you claim to have treated” as well as full details of homeopathic treatments offered to these patients.

Dr. Rosenthal, who came to the ministry with his lawyer, called the atmosphere in the conversation “germane and fair.” Rosenthal said he wanted to make clear that he is not “among the ‘opponents of vaccination’ but rather the ‘cautious' about vaccinations." He stated: "I am neither for nor against. But I think that it is a very serious matter to inject babies with these materials and this requires caution. There is no truth here. There is study of the subject and a personal decision. I give my information and experience and I stress in every lecture or web post that it does not conform to the ministry guidelines. I say it is not backed up by research, but by my experience.”

Rosenthal said that he does not publish or disseminate his idea or lead public opinion on the matter. “Some of my lectures were recorded by participants and put on YouTube, and interviews in the media always came from media outlets that approached me; and never on my initiative,” he said.

Swimming against the tide

The medical history in Israel is brief but stormy when it comes to outbreaks of endemic diseases, including malaria, whooping cough, measles, mumps and polio. But what is unique to the current crisis is the magnitude of the clash between the medical establishment and opponents of vaccination.

Last month, for example, the Health Ministry activated clause 19 of the public health code (1940), which allows the ministry to compel vaccination. This clause had only been imposed twice from the establishment of the state through last August. Children who had not been vaccinated against measles were also banned from educational institutions in the community of Harish and in the settlement of Bat Ayin in the West Bank.

“The damage that such doctors do is enormous, because their statements are perceived by the public as medically and scientifically valid because they are doctors,” a senior Health Ministry official told Haaretz. “In fact, they are doctors practicing homeopathy and in meetings we had with them they are unable to support their claims scientifically. Our mistake was not taking action against some of them two years ago already.”

But in spite of the anger against doctors who encourage parents not to vaccinate their children, there is lively debate in the medical community as to how to deal with them. The answer is unclear to the question of where the line runs between a doctor who holds anti-establishment or subversive opinions and a doctor who is harmful to public health. In December a meeting was held in the ethics bureau of the Israel Medical Association, and a position paper is soon to be published entitled “The physician who swims against the tide.”

“The phenomenon of doctors swimming against the tide has a long history and is an inseparable part of the development of medicine. There are countless instances where, thanks to a single physician, medicine discovered that it had made a mistake along the way,” said Dr. Tami Karni, chairwoman of the ethics bureau. One example is Dr. Ignaz Semmelweis, who in the mid-19th century discovered that doctors should wash their hands when going from one birthing mother to another,” when he realized that not doing so turned out to be a dramatic cause of infections, Karni explained. “And so it is very important to maintain a free spirit among doctors and researchers. Our position paper talks about balances,” she added.

The position paper soon to be published states that if a physician holds an opinion that contradicts accepted opinions, he or she must prove it using accepted research tools, collect data and discuss it in forums and scientific and medical conferences. Karni says she is sure that if clear and persuasive scientific evidence were presented about damage or lack of efficacy of vaccinations, the medical world would accept it.

According to Karni, sharing ideas like this directly with the public without holding in-depth medical discussion, is harmful “There are basic rules that must be kept," she said. "If the accepted and official position is that non-vaccination endangers life, and a physician prevents this treatment, without having gone through accepted forums, he causes damage." Physicians with alternative ideas who appear in the media should state clearly the accepted practice, and that his or her opinion is the exception, Karni said. “And if in the midst of an outbreak of disease, while the system is dealing with saving lives, one should think well whether this is the time to wage this struggle,” she added.