Unlike most doctors, pediatricians don’t talk about treatment with their patients. They talk about treatment with their patients’ parents. For that relationship to work, parents need to trust pediatricians’ judgment while acknowledging their fallibility. And that trust is bound to get strained by a screaming child or simple parental anxiety, which is why some pediatricians put parents’ feelings before medical best practices, guaranteeing rapport at the potential cost of quality care. Pediatricians who do this tend to be popular. And there’s no pediatrician in America more popular that Dr. Bob, who has been placed on probation by the Medical Board of California.
Dr. Robert Sears is a California pediatrician and son of famed pediatrician Dr. William Sears, who goes by Dr. Bill. The elder Dr. Sears is considered responsible for the popularization of the “attachment parenting” technique, which places an emphasis on parental closeness and intensive nurturing in child rearing. He has eight children, three of whom have entered the medical field. Like Dr. Bob, Dr. Jim Sears is a well-known pediatrician — he used to appear regularly on daytime television talk program The Doctors — and Dr. Peter Sears is a family practitioner. Caring for children is the Sears family business. With matriarch and registered nurse Martha Sears, the brothers run the popular parenting site AskDrSears.com, which they bill as “The Trusted Resource for Parents.”
There are also books. The paterfamilias released the bestselling The Baby Book in 1995. It has subsequently been translated into 18 languages and sold over 1.5 million copies. The Sears siblings and their mother also authored The Healthiest Kid in the Neighborhood and The Allergy Book. Dr. Bob wrote both The Autism Book and The Vaccine Book, the latter of which has sold over 200,000 copies and is now frequently cited by members of the anti-vaccination movement.
That last book didn’t make Dr. Bob a hero to the anti-vaccine community because it is explicitly pro-vaccine. It isn’t. The book is vaccine agnostic. In it, Dr. Bob writes that some vaccines can be skipped, that preservatives in vaccines can overload a baby’s immune system and that vaccines are inadequately tested compared to other medicines. He also posits that childhood diseases aren’t really that bad. The book, which came out in 2007, is frequently carted to pediatrician appointments by parents worried about vaccine injury. It fuels their doubt about the CDC immunization schedule.
And there are a lot of doubtful parents. One study conducted by the American Academy of Pediatrics found that 93 percent of pediatricians and family practitioners have been asked by parents to adjust the recommended schedule. A full 74 percent consented to the request often or sometimes despite believing the vaccination schedule was the best practice and that parents were putting their children at undue risk.
Dr. Bob’s stance on vaccines — that they are a personal choice — and his unique vaccination schedule, which puts off injections, suggests some can be skipped and is featured prominently in the back of his book, makes him something of a heretic in medical circles. The medical consensus is that the current CDC schedule is optimal, safe, and effective. But Dr. Bob is not changing his tune. Which is why Dr. Bob is not, for the moment, allowed to practice medicine without a court-ordered monitor in the state of California.
In 2015, California passed SB 277, a law removing the ability of parents to seek vaccine exemptions for personal and religious reasons. If a child wants to attend public school in Santa Monica, any vaccine exemptions are now required to be based on documented medical reasons. Dr. Bob ran into trouble with the Medical Board the next year when the board threatened to pull his license after he gave a medical vaccine exemption to a 2-year old patient whose mother was seeking custody and did not want to continue vaccinations. The mother reported that the child had experienced adverse neurological reactions to a previous vaccination and Dr. Sears took her at her word. He failed to document any underlying medical conditions or provide any notes that he’d followed up on which vaccines had caused the reaction.
Last year, rather than lose his medical license, Dr. Bob entered into 35 months of probation with the Medical Board of California. He continues to practice with monthly oversight from a colleague who reviews 10 percent of his records. He is also being required to take 40 hours per year of board-approved education courses meant to address “any areas of deficient practice and knowledge…” Asked for comment on Dr. Bob situation, a representative of his practice directed me to his February Facebook post about his probation.
“Nothing has changed about the way I practice,” Sears wrote. “I won’t pretend this whole ordeal isn’t stressful. It is. But it has also prompted me to increase my focus and involvement in what really matters to me in this world — giving each and every family I meet complete, objective, and un-doctored informed consent on the topic of vaccination.”
The wording of the statement seems carefully designed to express Dr. Bob’s professed agnosticism. He seems to remain intent on deferring — to some degree at least — medical judgment to the parents of his patients.
Meanwhile, in Washington state, a 62-case measles outbreak has ripped through a heavily anti-vaccine community. Similar outbreaks in Texas and New York have added to the total number of cases — above 120 now — of a disease that was considered eradicated in the United States in 2000. For context, the vaccination rate in the United States sits around 90 percent. This is indicative of the fact that the anti-vaccine movement is highly localized and that its members are highly vocal. Proponents of the faulty science behind the anti-vax movement cherry-pick and misrepresent data. They dissemble and speak of autism as though it were a death sentence. Many if not most likely do this without malice or with genuinely good intentions.
In a sense, Dr. Bob is on probation because he decided to hear these people out and cater to them. Many doctors say that sort of behavior should be penalized and that Dr. Bob’s agnosticism and alternative vaccine schedules represent a dangerous attempt to cater to an audience that, well-meaning or no, is willing to do harm to children.
“I give him credit for the word ‘alternative’ but what it is is a delayed vaccine schedule — you are getting vaccines later than you would normally get them,” explains pediatrician Dr. Paul A. Offit, Director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. “Children get these diseases when they are less than two years of age. Some beginning as early as 6-months of age. To delay the schedule is only to increase the time during which children are susceptible to potentially fatal infections with no benefit. It does not make them healthier.”
Offit adds that the current vaccine schedule approved by the FDA is recommended by two oversight bodies: the American Academy of Pediatrics Committee of Infectious Diseases and the Centers for Disease Controls’ Advisory Committee for Immunization Practices. They not only do studies to determine that the vaccines do not interact with one another, they determine if they are safe to be administered to children at the recommended time.
“When Dr. Bob makes up a schedule, it’s an untested schedule,” Offit says.
And it’s not just the schedule. Starting in 2011, AskDrSears.com began maintaining a database of “vaccine friendly” doctors on their vaccine information page. “Most doctors around here kick patients out of their practice for not vaccinating, or for asking too many questions,” Sears wrote in an introduction to the database. “That’s why I’ve created a database of a list of vaccine-friendly doctors; doctors who want to help with the vaccine decision or support parents who want to delay or decline vaccines.”
As late as July of 2017 the list included some 44 California physicians, naturopaths, and osteopaths. The Sears clinic was at the top of the list, which has since been taken down. Today, the site prominently features a list of vaccine-preventable diseases. At the bottom of the disease list is a link to a page where parents can buy Dr. Bob’s vaccine book, which still features his distinctive schedule.
This doesn’t bother Washington pediatrician Dr. Carol Doroshow, an AAP fellow and expert on pediatric infectious disease. She was once listed in Sears’ vaccine friendly doctor database and has implemented Dr. Bob’s schedule, which she describes as “great.”
“The fact that it’s caused Brouhaha makes me laugh. It’s one of the most conservative schedules. The only difference is he spreads it out,” she says.
Doroshow says that the families she sees often vaccinate off schedule, save for the Haemophilus influenza vaccine which she encourages children to receive on schedule at 2-months to prevent influenza-related encephalitis.
“People make decisions not based on facts, but on emotion,” Doroshow says. “I try to be respectful of that and as logical as possible. Some people are intrinsic vaccine splitters. I don’t try to talk people out of splitting. As long as they’re willing to come in I don’t mind vaccinating every month.”
Doroshow feels that it’s better to be questioned by parents and take time to put patients at ease rather than commit to a strict CDC schedule. In fact, she argues that the schedule does not have to be an all or nothing proposition because the diseases have varying degrees of risk for her patients. Doroshow points to the polio vaccine as an example. Not only is polio eradicated virtually everywhere in the world aside from remote and difficult to get to countries, but exposure also requires a child to come in contact with feces of a polio-infected individual — an unlikely prospect in Seattle.
In a sense, she shares Dr. Bob’s philosophy, which seems to be that an open dialogue with patients regarding vaccines is more valuable than strict adherence to what are considered medical best practices. This is a parent-centric approach.
But Dr. Offit sees vaccine delays as a slippery slope. “The parent is asking you to practice substandard care,” he says. “They are asking you send a child out of a room susceptible to diseases that could kill them.”
In communities where measles is flaring up, the question for physicians is whether or not offering delayed schedules like Dr. Bob’s is a responsible course in line with the Hippocratic oath to do no harm. For pediatricians like Dr. Bob, the answer appears to be that the risk isn’t enough to not offer a choice for most vaccines. But as outbreaks like the one Washington persist, it’s possible that vaccine friendly pediatricians will lose the option to offer choices. Many states are considering removing options for exemptions for religious and personal reasons and the director of the FDA chief has recently said the federal government may need to step in.
Until that time, pediatricians like Dr. Bob will undoubtedly continue to offer gives safe harbor to vaccine-hesitant parents and ant-vaxxers alike. This will likely earn them the loyalty of many parents, who understandably prefer being catered to than dictated to by a more rule-constrained physician. The cost of that popularity with parents is risk. And no one has summed that up better than Dr. Bob himself. In a chapter of The Vaccine Book about herd immunity, he predicted vaccine hesitancy might lead to disaster.
“When dealing with anxious parents,” he writes, “I 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.”