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Pediatric Bioethics

August, 2018

Dr. Sears on Probation

 

Author: Susan H. Wootton, MD | University of Texas Health Sciences Center, Houston, Texas | Graduate of Children’s Mercy Bioethics Center Pediatric Bioethics Certificate Program

Column editor: John D. Lantos, MD | Director of Pediatric Bioethics | Professor of Pediatrics, UMKC School of Medicine

In 2016, the Medical Board of California (CA) accused Robert W. Sears, otherwise known as “Dr. Bob” of gross negligence, repeated negligent acts and failure to maintain adequate and accurate records. Specifically, Dr. Sears wrote a letter excusing a patient (2-year-old boy) from “all future vaccinations” without obtaining the information necessary to make such a decision or retaining a copy of the letter in the boy’s chart. He then failed to include neurological testing when he evaluated the boy for headaches following a blow to the head with a hammer. Two years later (June 27, 2018), the CA Medical Board revoked Dr. Sears’ 22-year license (issued September 1996) and placed him on probation for 35 months. He is required to take at least 40 hours per year of continuing education courses “aimed at correcting any areas of deficient practice or knowledge,” plus an additional ethics course, and have his practice monitored by a physician approved by the board. According to Dr. Sears’ Facebook page (followed by 72,746 people), the board is investigating four more of his cases.

Considering Dr. Sears’ cult following within the U.S., the lack of national attention to this news is surprising and concerning. Dr. Sears is best known for his recommendations to space out vaccine administration (“alternative schedules”). He has written extensively on this issue, including books (“Vaccine and Autism: What can Parents Do During This Controversy,” “The Vaccine Book: Making the Right Decisions for Your Child”) and newspaper interviews (The New York Times, The Huffington Post), as well as appeared on TV shows (All In with Chris Hayes). Additionally, he has actively opposed pro-vaccine bills, such as California’s Senate Bill 277 eliminating non-medical vaccine exemptions. The impact of Dr. Sears’ quack views is far from minimal. The index patient of one of the largest measles outbreaks in San Diego (2008) was his. Since 2009, the number of vaccine nonmedical exemptions has risen in 12 of 18 states that currently allow this policy.1  Such rates threaten herd immunity, creating hotspots for already identified and future outbreaks. 

The path forward is complicated. States faced with growing vaccine exemption rates are caught between wanting to promote pro-vaccine policy, but not wanting to mobilize an extremely sophisticated anti-vaccine base. Currently, little data is available that shows one state policy move is better than another.1 Additionally, organizations, such as the AAP, are struggling with guidelines that represent providers on the frontlines, yet promote evidence-based guidelines.3    To date, for unclear reasons, very few medical boards, academic departments, physician organizations, specialty licensing boards or even hospital credentialing committees have dipped their toes into this chaos with consequences such as revoking membership or certification. Caplan called for “the license of any doctor who opposes vaccination” to be revoked, as they were in violation of the American Medical Association’s Code of Ethics.4
     
Variability in usual care is common, primarily because of lack of evidence for one therapy versus another. On the other hand, as stated by Dr. Stanley Plotkin, “… the impact of vaccination on the health of the world’s people is hard to exaggerate. With the exception of safe water, no other modality has had such a major effect on mortality reduction and population growth.”5   Certifying boards are critical in defining the boundaries of usual care. Not recommending vaccines is not usual and should have clear consequences. As of now, Dr. Sears remains a fellow within the American Academy of Pediatrics and continues to see patients.

References:

  1. The State of the Anti-vaccine Movement in the United States: A Focused Examination of Nonmedical Exemptions in States and Counties. Olive, JK et al. PLoS Med 15(6):e1002578.

  2. Protecting the Community Through Child Vaccination. Anderson, EJ and el. Clin Infect Dis 2018;67(3):464-71.

  3. Countering Vaccine Hesitancy. Edwards, KM et al. Pediatrics 2016;138(3):e2016246.

  4. Revoke the License of Any Doctor Who Opposes Vaccination. Caplan A. The Washington Post, February 6, 2015. https://www.washingtonpost.com/opinions/revoke-the-license-of-any-doctor-who-opposes-vaccination/2015/02/06/11a05e50-ad7f-11e4-9c91-e9d2f9fde644_story.html?noredirect=on&utm_term=.4f8ee628d14a (Accessed 3 August 2018)

  5. A Short History of Vaccinations. Plotkin SL, Plotkin SA (2004). In S.A. Plotkin, W.A. Orenstein (Eds), Vaccines (p 1). Philadelphia, PA: Saunders