My topic yesterday was When doctors betray their profession. In my post, I talked about some very unethical doctors representing tobacco companies in lawsuits against them seeking compensation for death and injury due to smoking, as well as to doctors and scientists peddling pseudoscience and quackery representing claimants in the Autism Omnibus action several years ago, in essence supporting the scientifically unsupported idea that vaccines cause autism. The reason I brought this up was to show doctors behaving badly in "conventional" and not-so-conventional medical-legal situations. Unfortunately, that's not all the physician shenanigans that go on. Indeed, a reader of mine (who wishes to remain anonymous) attended a recent vaccine "open house" in Culver City, CA on July 16 and provided me with an account of the goings-on there. This particular antivaccine event was remarkable because it featured a frequent topic of this blog, antivaccine pediatrician Robert "Dr. Bob" Sears. It was a meeting advertised on Dr. Bob's Facebook page a week ago, in which he promised:

We'll discuss how SB 277 will affect your family next year, what you can do about it, and what efforts are being made to overturn the new law. Learn what your options are and understand which children will be exempt from the new vaccine requirements. Join me, Eric Gladen, Melissa Floyd, and others for an eventful informative discussion and Q and A. See you there.

Dr. Bob, you remember, is famous for writing a "skeptical" vaccine book beloved by the antivaccine movement. More recently, he's been a vocal critic of SB 277, even going so far as to take a cue from the whackjob wing of the antivaccine movement and sarcastically suggest that its passage would lead to, in essence, nonvaccinating parents and children being forced to wear the vaccine equivalent of the yellow Star of David that the Nazis forced Jews to wear for easy identification and ostracization. Yes, Dr. Bob went full Godwin over SB 277, after a history of blowing the antivaccine dog whistles such as "freedom" and "parental rights."

SB 277 is, of course, the recently passed California law that will eliminate religious and personal belief exemptions (PBEs) to school vaccine mandates. It is a law that I had never thought possible before, particularly in California given that California is ground zero for the antivaccine movement in the US, particularly affluent areas in the Bay area, Hollywood and Santa Monica, and Dr. Bob's neck of the woods in Capistrano Beach, just north of San Diego, where Dr. Bob caters to just such a clientele. Assuming the notes I was given are accurate (and I have no reason to believe they are not), it shows Dr. Bob behaving just as badly as any of those tobacco company expert witnesses trying to deny that it was most likely tobacco that caused head and neck cancer in plantiffs suing tobacco companies. Basically, Dr. Bob gave a workshop to parents on how to keep on avoiding vaccinating while at the same time making, in essence, a pitch for business from nonvaccinating parents looking for a physician to write a letter recommending a medical exemption. This should not be surprising, given that Dr. Bob has of late been letting his antivaccine freak flag fly more. Indeed, at the recent conservative/libertarian confab known as FreedomFest a week and a half ago, Dr. Bob debated Ron Bailey on the issue of whether vaccines should be mandatory. Basically, he played Julian Whitaker's role from a similar debate hosted by FreedomFest three years ago; i.e., the antivaccine side.

In any event, the antivaccine town hall in Culver City started with a long PowerPoint presentation full of antivaccine misinformation and errors that was over an hour long. Dr. Bob didn't give this presentation, and my reader didn't say who did. It doesn't matter much, anyway, because Dr. Bob was clearly the star of the show and spoke next. After stating how much he hates the law and acknowledging how much all the attendees hate the law, he got into his main topic, namely how to comply with the law without vaccinating. From the notes I'm adapting and turning into my usual jaunty prose, his talk was chock full of misinformation and disingenuousness. You can get some idea of the sorts of things Dr. Bob said by checking out this Facebook post from three weeks ago. His talk basically stuck to the same outline, with some additions that perhaps he didn't want to put in writing.

First, if you don't think Dr. Bob is antivaccine, consider this. He started out by referring to autism as a "known side effect" of vaccines. It is not, and he knows it. If he doesn't know it, he is utterly incompetent in evaluating evidence or was cynically pandering to his audience. Take your pick. He also told the audience that the American Academy of Pediatrics will issue guidelines about medical exemptions, but that it will be "much narrower than" what he does. (Surprise! Surprise!) Anyone want to guess whether he'll be even more looser in issuing exemptions than Dr. Jay Gordon will be? My guess is that he will, as Dr. Jay seems unwilling to stretch things too far beyond what is medically justifiable, at least comparatively speaking.

Among the tidbits of information Dr. Bob dropped on his audience were:

A description of an effort to amend the law to allow chiropractors and naturopaths to issue medical exemptions. I know antivaccinationists tried to get that slipped into SB 277 and failed. One can only hope the legislature doesn't fall for that one. If you think Dr. Bob will give an exemption to virtually anyone who wants one, just let chiropractors and naturopaths write exemptions based on "aggregate toxicity" or something like that.

A suggestion that parents seek out a DO because, or so Dr. Bob thinks, they tend to be more "open minded" than MDs. Personally, this hasn't been my experience, at least not in the US, but I don't know many DO pediatricians or primary care docs. One of the best surgical intensivists I ever knew was a DO, as is one of the premier phase I cancer clinical trialists in the country.

Another suggestion that parents seek out physicians in solo or small private practices rather than larger groups. The reason for this one to me is obvious. Larger groups tend to have more explicitly codified practice guidelines.

Aligning himself with his audience, Dr. Bob stated "We have to work on the way we have been perceived—we have been maligned." The "we," of course, are parents who attend sessions given by antivaccine doctors on how to comply with SB 277 and still refuse to vaccinate; i.e., antivaccinationists.

Here's where Dr. Bob got into the nitty-gritty of telling parents just how they can do that. Remember that the law doesn't take effect until the 2016-2017 school year. So, according to Dr. Bob, here are the ways to get around the law other than home schooling. The first method is to et an Individualized Education Program (IEP) that specifies regular classroom time. For those who have no experience with them, let me briefly explain. IEPs are mandated by the Individuals with Disabilities Education Act (IDEA) for children with special needs. If a child receives special educations services, he must have an IEP that includes a description of how the child is doing, the child's specific annual education goals, specific special education supports and services that the school will provide to help the child reach those goals, modifications and accommodations the school will provide to help the child make progress, and other information. To comply with federal law, SB 277 specifically stipulates that the law "does not prohibit a pupil who qualifies for an individualized education program, pursuant to federal law and Section 56026 of the Education Code, from accessing any special education and related services required by his or her individualized education program." So you can see where Dr. Bob was dishonestly going. In fact, he was quite explicit. He recommended that parents seek an IEP, even for "minimal speech delay or learning issue" when the child is 2 or 3 years old so that they have it later and will be "protected" from SB 277 for the entire child's school career. This is gaming the system at its most blatant.

Naturally, the other option is a medical exemption. Dr. Bob, as did Dr. Jay before him, characterized whether or not a medical exemption is granted as being "completely up to the opinion of the doctor," which unfortunately is basically true. This led him to recommend "seeking out open-minded doctors," doctors who, apparently, agree with his non-evidence-based reasons for not vaccinating, including:

Prior vaccine reaction in child, sibling, parent, or more distant relative (protected by mention of "family history" in SB277)

Family history of autoimmune disease. He added: "And everyone has autoimmune disease in their family." (Nudge, nudge, wink, wink, know what I mean, say no more!) The audience laughed appreciatively. He went on: "So an openminded doctor could use a family history of vitiligo, celiac disease, autoimmune thyroid disease, or other disease on to support a medical exemption."

Autism, learning disorders, and ADHD

Allergies, esp if more severe

Other chronic conditions

Of course, none of these are evidence-based reasons except for a personal prior severe reaction to a previous vaccine or a severe allergy to a vaccine component (which would only be valid as a reason not to use that vaccine). Such reactions or allergies in family members don't count, although unfortunately "family history" was placed into the law as a potential reason to grant a medical exemption. Given that Dr. Bob appears poised and ready to start passing out medical exemptions like candy, it's not surprising that he mentioned the state medical board; it's also one part of his message that's not in his Facebook post on the subject. In brief, he told the audience that he had spoken to someone at the California Board of Medicine and been told that to date "they have not investigated any doctor for writing medical exemptions." He stated they could, but to get involved they would need someone to file a complaint about a specific case. Yes, clearly Dr. Bob has thought about this issue and made preparations to cover his posterior, to the point where he apparently believes that if the board investigates, "nobody would get into trouble, they would just void the exemption." Personally, I wouldn't be so sure of that, but apparently Dr. Bob is sure enough to be telling parents this, even adding, "There might be people out to get me, but not the Medical Board."

Not yet, perhaps. Here's hoping that can be changed.

Next up, Dr. Bob talked strategy, asking that audience members not try to get a medical exemption if they have other options. Indeed, he even asked them to "save those for the people who are not grandfathered in; wait until your 3rd grader is about to be a 7th grader before seeking an exemption." What he meant by this is as follows. Under SB 277, exemptions are good until certain "checkpoint" years, which typically occur when a child first enrolls in a new school (no matter what age), when a child reaches kindergarten, and when a child reaches 7th grade. Any child who already has an exemption (medical or PBE) at the beginning of the 2016-2017 school year will be able to keep that exemption until the next "checkpoint" year. So if a parent gets a PBE for her child entering kindergarten in 2016, that exemption would be good until the child reaches seventh grade or moves to another school. He also discussed taking advantage of "conditional entry" in order to spread vaccines out over years. "Conditional entry" means that a child who hasn't met all the vaccine requirements can still be enrolled as long as there is a plan to eventually complete required vaccinations, which usually requires a note from a doctor outlining the plan. Dr. Bob actually advised dragging this process our over months or even years, only getting vaccines when the school absolutely insists on it, and hoping the school is too busy to call, saying, "You might not get by with this in a regular public school, so try charters and small private schools—seek those schools out." To be honest, I'm not sure about that; I'd guess it might be easier to get lost in the shuffle of bureaucracy in a large public school and thus drag things out.

After Dr. Bob's talk people lined up to ask him questions, may of which were a about whether condition X would allow him to grant a medical exemption. My reader reported that he said yes to several, including conditions like celiac disease in a relative, vague "neurodevelopmental issue" in a sibling, having a "grandfather who got diabetes after the pneumonia shot" (my jaw dropped when I read this one in the account), a mother with vitiligo (ditto), and other equally ridiculous reasons. He only hesitated once, when a parent who described his daughter getting "recurrent mouth ulcers" after a vaccine. For this one he said he'd have to discuss it in further detail at an office visit.

Of course he would.

After the main meeting broke up, there was a smaller group of parents still asking Dr. Bob questions, his answers to some of which were overheard. For instance, he was asked how much an office visit costs (his answer: $180) and whether he took insurance (his answer: no, other than TriCare). At one point, a woman approached and told Dr. Bob that her pediatrician whom she otherwise liked would not issue an exemption, asking if he would see her for a one-time visit. His response? "I would be happy to provide that service." He also confirmed that a one-time medical exemption visit is $180 and that he'd be willing to issue such an exemption and send the child back to his primary pediatrician. When asked whether that was a conflict of interest, Dr. Bob was taken aback, reacting with genuine surprise and answering, "Do you expect me to see them for free?" According to my reader, Dr. Bob seemed genuinely not to understand the point of the question. At another time, he seemed to try to defend himself by pointing out how infectious diseases are bad, that he wrote about how bad they are in his book as well as how vaccines prevent them. When asked why he did not mention any of this to the audience, he responded, "This is about politics, I do talk about that to other audiences."

Sure. I'll bet he does.

Three weeks ago, I asked the question, Will SB 277 enrich antivaccine doctors? The answer is clearly yes, particularly for Dr. Bob Sears. From my perspective, he's basically offering to sell medical exemptions to parents for $180 a pop, and he couldn't be more blatant about what he's doing if he tried. Indeed, I'm surprised just how closely my reader's report aligns tightly with Dr. Bob's advice posted on his Facebook page. The only differences were his more jocular manner and his demonstration that he's thought about how to issue exemptions for sale without having the California Board of Medicine come after him. As far as I'm concerned, he's become just like doctors who run prescription mills or sell prescriptions for medical marijuana. He has no honor.