Deadly Choices: How the Anti-Vaccine Movement Threatens Us All - Paul A. Offit (2010)

Chapter 10. Dr. Bob

He will look attractive and he will be nice and helpful and he will get a job where he influences a great God-fearing nation and he will never do an evil thing. He will just bit-by-little-bit lower standards where they are important.

AARON ALTMAN, BROADCAST NEWS

Robert Sears is the son of William and Martha Sears. Together, William, a Harvard-trained pediatrician, and Martha, a registered nurse and lactation consultant, have authored more than forty books on pregnancy, birthing, attachment, breastfeeding, nutrition, sleeping, and discipline—all part of The Sears Parenting Library. Their advice once dominated parenting magazines and the airwaves, the couple having appeared on 20/20DonahueGood Morning AmericaOprahCBS This Morning, CNN, The Today Show, and Dateline NBC. Three of their eight children are also doctors, including Jim, who co-hosts the television program The Doctors, and Robert, a pediatrician practicing in southern California.

In October 2007, Robert Sears also published a book. He called it The Vaccine Book: Making the Right Decision for Your Child. Sears’s goal was clear. He wanted to provide what he believed was a gentler, safer way to vaccinate children—a middle ground for parents who wanted to protect their children but were frightened by so many shots. Sears has excellent credentials; he received his medical degree from Georgetown University and his pediatric training from the Children’s Hospital of Los Angeles. Like his father, who prefers to be called Dr. Bill, Robert Sears prefers Dr. Bob. At the end of his book, Sears offers a revised schedule he believes is safer than that recommended by the CDC and AAP. He calls it “Dr. Bob’s Alternative Vaccine Schedule.” For parents looking for a way to delay, withhold, separate, or space out vaccines, Dr. Bob’s schedule is the way to go; many parents bring it to their doctor’s office and say, “This is the one I want.” Sears’s book is so popular, so influential, and so widely quoted that it deserves a closer look.

Many parents are concerned that children are getting too many vaccines too early. (Courtesy of David Gould/Getty Images.)

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“[The alternative schedule] gives live-virus vaccines one at a time so that a baby’s immune system can deal with each disease separately,” writes Sears. By implying that an infant’s immune system is easily overwhelmed, Sears appeals to a common fear. When Jenny McCarthy and Jim Carrey led their “Green Our Vaccines” rally in front of the Capitol, parents marched to the rhythmic chant “Too many too soon! Too many too soon!” And it’s understandable. No reasonable parent can watch a child receive as many as five shots at one time and not worry it’s too much. But the fear should be allayed by the science.

Although the number of vaccines given to young children today is more than at any time in history, the immunological challenge from vaccines is lower. A hundred years ago, young children received one vaccine: smallpox. Today, they receive fourteen. But it’s not the number of vaccines that counts; it’s the number of immunological components contained in vaccines. Smallpox, the largest virus that infects mammals, contains two hundred viral proteins, all of which induce an immune response. Today’s fourteen vaccines are made using viral proteins, bacterial proteins, and the complex sugars (polysaccharides) that coat bacteria. Each of these components, like viral proteins in the smallpox vaccine, evokes an immune response. The total number of immunological components in today’s fourteen vaccines is about a hundred and sixty, fewer than the two hundred components in the only vaccine given more than a hundred years ago.

Further, Sears fails to consider that vaccines do not significantly increase the immunological challenge that babies encounter and manage every day. In the womb, the unborn child is in a sterile environment. But while passing through the birth canal, the child immediately confronts millions of bacteria. And that’s not the end of it; the food that babies eat isn’t sterile, nor is the dust they inhale. By the time babies are just a few days old, trillions of bacteria live on the lining of their intestines, nose, throat, and skin. Indeed, people have more bacteria living on the surface of their bodies (a hundred trillion) than they have cells in their bodies (ten trillion). And each bacterium contains between two thousand and six thousand immunological components. Some of these bacteria have the capacity to invade the body and cause harm. To prevent this from happening, every day babies make large quantities of different kinds of antibodies—some of these antibodies pour into the bloodstream (immunoglobulin G), others travel to mucosal surfaces (secretory immunoglobulin A).

Bacteria aren’t the only problem. Babies also encounter a variety of viruses that aren’t prevented by vaccines—for example, rhinoviruses (which cause the common cold), parainfluenza virus, respiratory syncytial virus, adenovirus, norovirus, astrovirus, echovirus, coxsackie virus, human metapneumovirus, parechovirus, parvovirus, and enterovirus. And, unlike vaccine viruses, which reproduce poorly or not at all, these natural viruses reproduce thousands of times, causing an intense immune response. Arguably, a single infection with a common cold virus poses a much greater immunological challenge than all current vaccines combined. And common viruses occur commonly; healthy children experience as many as six to eight viral infections every year during their first few years of life.

When Sears advised giving live viral vaccines separately, he implied that children have a limited capacity to respond to vaccines. So, how many can they respond to? Do the fourteen vaccines young children receive exceed their immunological capacity? The most thoughtful answer to this question comes from two immunologists at the University of California at San Diego: Mel Cohn and Rod Langman, who study the component of the immune system most capable of protecting against infection: antibodies. Antibodies are made by cells in the body called B cells. Each B cell makes antibodies against only one immunological unit called an epitope. Given the number of B cells in the bloodstream, the average number of epitopes contained in a vaccine, and the rapidity with which a sufficient quantity of antibodies could be made, babies could theoretically respond to about a hundred thousand vaccines at one time.

The model isn’t perfect. It assumes that the immune response is static, which it isn’t. Every minute new B cells generated in the bone marrow pour into the bloodstream. So, it would be fair to say that at any single point in time a child could theoretically respond to a hundred thousand vaccines. Given that babies are constantly confronted with trillions of bacteria and that each bacterium contains thousands of epitopes, the notion that children could respond to a hundred thousand different vaccines shouldn’t be surprising. In a sense, babies are doing that every day. The challenge from vaccines is dwarfed by this natural onslaught.

In 2010, in response to the growing fear of so many vaccines given so early, researchers at the University of Louisville performed a study of more than a thousand children. They found that children who were vaccinated completely and on time were not more likely to suffer neurological problems than children whose parents had chosen to delay vaccination.

Sears advises, “It’s probably okay to give the combination MMR booster at age five, when a child’s immune system is more mature.” Because the MMR vaccine is recommended for children between twelve and fifteen months of age, Sears implies that a baby’s immune system isn’t mature enough to respond to vaccines. To the contrary, vaccines given in the first year of life induce an excellent immune response. Probably the most dramatic example is the hepatitis B vaccine. Babies born to mothers with hepatitis B virus are not only at high risk of infection, they’re also at high risk of chronic liver damage (cirrhosis) and liver cancer. The greatest risk comes at the time of delivery. When passing through the bloody birth canal of an infected mother, babies come in contact with an amazing amount of hepatitis B virus; each milliliter (about one-fifth of a teaspoon) of blood contains about a billion infectious viruses—and birth exposes babies to a lot of blood. So it’s no wonder that almost all unimmunized children of infected mothers get infected. But despite the fact that the hepatitis B vaccine is given after exposure, almost all babies are protected. It is rather remarkable that following passage through a birth canal containing literally billions of hepatitis B viruses, a one-day-old baby can mount a protective immune response to a vaccine that contains only twenty micrograms (millionths of a gram) of one highly purified viral protein.

Sears doesn’t discourage parents who want to delay vaccines. Under the heading “Delaying Vaccines Until Six Months of Age,” he writes, “This choice is one that some parents make, usually for the same reasons as those who wait until two years. They just don’t feel as comfortable leaving their child unvaccinated as long. If you’ve chosen to delay shots, whether it’s for six months, one year, or more, you should be aware that your child would not need the entire vaccine series when you do eventually start.” Sears implies that a choice to delay vaccines is reasonable. Unfortunately, he fails to describe the importance of preventing diseases like Hib, pneumococcus, and pertussis, all of which typically appear in the first year of life and all of which can exact a terrible toll. Most mothers have antibodies directed against all three of these bacteria and, while pregnant, pass them to their babies through the placenta. But antibodies from the mother fade, leaving the child vulnerable. Vaccines against Hib, pneumococcus, and pertussis are given at two, four, and six months of age so that when the mother’s antibodies wear off, children will have acquired their own protective immunity. Also, young infants, because they have narrower windpipes, are much more likely to die from pertussis than older infants. By stating that a choice to delay vaccines is acceptable, Sears fails to explain why vaccines are given when they’re given.

Sears claims that the most important reason to space out and separate vaccines is to avoid one ingredient: aluminum. “The alternative schedule suggests only one aluminum-containing vaccine at a time in the infant years,” he writes. “By spreading out the shots, you spread out exposure so infants can process the aluminum without it reaching toxic levels.” Sears explains that “some studies indicate that when too many aluminum-containing vaccines are given at once, toxic effects occur.” In fact, studies show just the opposite.

Various preparations of aluminum salts have been used in vaccines since the late 1930s. So, the safety of aluminum in vaccines has been assessed for more than seventy years. Aluminum salts act as adjuvants, enhancing the immune response. Inclusion of aluminum salts in vaccines that otherwise wouldn’t evoke a good immune response makes it possible to reduce the number of doses and the quantity of immunological components within each dose.

Although Sears claims that avoiding aluminum-containing vaccines is an important way to avoid aluminum, it’s not. Aluminum, the third most abundant element on earth, is everywhere. It’s present in the air we breathe, the food we eat, and the water we drink. The single greatest source of aluminum is food; present naturally in teas, herbs, and spices, aluminum is also added to leavening agents, anti-caking agents, emulsifiers, and coloring agents, and is found in pancake mixes, self-rising flours, baking powder, processed cheese, and cornbread. Adults typically ingest 5-10 milligrams (thousandths of a gram) of aluminum every day. Babies are no different; all are exposed to aluminum in breast milk and infant formula. Infants exclusively breast-fed will have ingested ten milligrams of aluminum by six months of age; those fed regular infant formula, thirty milligrams; and those fed soy formula, one hundred and twenty milligrams. All recommended childhood vaccines combined contain four milligrams of aluminum.

Sears is right in stating that aluminum can be toxic, specifically causing brain dysfunction, weakening of the bones, and anemia. But he’s wrong in claiming that the small quantities of aluminum in vaccines can be harmful. That’s because aluminum has been found to be harmful in only two groups of people: severely premature infants who receive large quantities of aluminum in intravenous fluids, and people on chronic dialysis (for kidney failure) who receive large quantities of aluminum in antacids. In other words, for aluminum to cause harm, a child’s kidneys would have to work poorly or not at all and the child would have to have received large quantities of aluminum from other sources, such as antacids, which contain more than three hundred milligrams of aluminum per teaspoon.

Other studies are reassuring. Because it’s unavoidable, everyone has aluminum circulating in the body, even babies, who have 1-5 nanograms (billionths of a gram) per milliliter of blood. Researchers have studied the quantity of aluminum in blood before and after receipt of aluminum-containing vaccines. No difference. The quantity of aluminum in vaccines is so small and the body eliminates it so quickly (about half of the injected aluminum is completely eliminated in one day) that it is undetectable following vaccination.

To avoid giving more than one aluminum-containing vaccine at a time, Sears advises that children visit their doctors when they are two, three, four, five, six, seven, nine, twelve, fifteen, eighteen, twenty-one, and twenty-four months old (at least twice the number of typical visits). That’s a lot of work to avoid a component in vaccines that has never been found to cause harm and is otherwise unavoidable, assuming that babies ingest breast milk or infant formula.

Like Jenny McCarthy, Sears states that vaccines should be spaced out to avoid a buildup of potentially toxic chemicals. “[The alternative schedule] gives no more than two vaccines at any one time to limit and spread out exposure to the numerous chemicals so a baby’s system can process each more individually,” he writes. “Of course, we don’t know whether this precaution is necessary, but it’s reasonable.” Sears describes the chemicals contained in vaccines. In addition to aluminum he lists mercury, formaldehyde, polysorbate 80, monosodium glutamate (MSG), ethylenediaminetetraacetic acid (EDTA), 2-phenoxyethanol, sodium borate, octoxynol, and sodium deoxycholate (all used to promote cell viability, prevent contamination, or inactivate bacterial toxins or viruses). He explains that each of these chemicals is potentially harmful: formaldehyde can “cause kidney damage and genetic damage”; monosodium glutamate is an “excitotoxin” that “can affect how the brain functions and ... can damage nerve tissue in a pattern similar to Alzheimer’s disease”; 2-phenoxyethanol “may cause reproductive defects and is severely irritating to the eyes and skin”; octoxynol is “used as a spermicide”; and sodium deoxycholate “is harmful if swallowed, inhaled, or absorbed through the skin.” For each of these chemicals Sears concludes that the quantity contained in vaccines is “minuscule,” “negligible,” or “considered harmless.” Then, in an apparent contradiction, he advises parents to separate out vaccines to limit exposure and possible harm.

Unfortunately, Sears fails to educate his reader about the importance of quantity—that is, that it’s the dose that makes the poison—and that spacing out vaccines to avoid exposure to quantities of chemicals so small that they have no chance of causing harm will accomplish nothing. For example, Sears claims that formaldehyde is a “carcinogen” (cancer-causing agent) but omits the fact that formaldehyde is a natural product: an essential intermediate in the synthesis of amino acids (the building blocks of proteins) and of thymidine and purines (the building blocks of DNA). Everyone has about two and one-half micrograms of formaldehyde per milliliter of blood. Therefore, young infants have about ten times more formaldehyde circulating in their bodies than is contained in any vaccine. Further, the quantity of formaldehyde contained in vaccines is at most one six-hundredth of that found to be harmful to animals. It would have been valuable if Sears had informed his readers of these facts rather than scaring them with the notion that formaldehyde in vaccines could cause cancer.

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The “Green Our Vaccines” rally headed by Jenny McCarthy and Jim Carrey expressed the concern that vaccines contained dangerous toxins and chemicals. (Courtesy of Christy Bowe/Corbis.)

In the preface of his book Sears states, “I want to be clear on something right up front. This is not an anti-vaccine book. There are plenty of books out there that overemphasize the potential dangers of vaccines and leave parents even more fearful and confused.” But Robert Sears’s book isn’t what he’d like it to be. Throughout, he implies that vaccines have a high rate of serious side effects, that they aren’t adequately tested for safety, that diseases prevented by vaccines aren’t that bad, and that pharmaceutical companies misrepresent data. And he makes many claims that are refuted by science. That’s exactly what anti-vaccine books do. Indeed, the themes in Sears’s book are the same as those trumpeted in Charles Higgins’s Horrors of Vaccination Exposed and Illustrated, Lora Little’s Crimes of the Cowpox Ring, Barbara Loe Fisher’s A Shot in the Dark, and pamphlets produced by anti-vaccine activists dating back to the mid-1800s.

Sears makes the following arguments:

Vaccines have a high rate of serious side effects. Sears reviews data from the Vaccine Adverse Events Reporting System (VAERS), claiming that between 1991 and 2001 people reported eighteen thousand severe side effects that “resulted in a prolonged hospital stay, a severe life-threatening illness, a permanent disability, or death.” Sears concludes that, given the number of doses of vaccines administered during that ten-year period, children had a one in twenty-six hundred chance of suffering serious harm by age twelve. That’s a remarkably high rate of serious side effects.

VAERS can, at its best, alert public health officials to the possibility of a serious side effect from a vaccine. VAERS, however, cannot determine whether a vaccine caused a side effect. Only controlled studies can do that. The problem with VAERS is that two groups of people never report to it: people who get a vaccine and don’t suffer any side effects and people who suffer the same illness as is reported to VAERS but never got the vaccine. This information is critical to determining whether the risk of a possible side effect is greater in the vaccinated group. Sears also fails to address another problem with VAERS: biased reporting. For example, 80 percent of people who reported to VAERS that vaccines caused autism weren’t doctors or nurses or nurse practitioners or parents; they were personal-injury lawyers.10

The reason that Sears fails to distinguish whether a side effect following a vaccine is actually caused by the vaccine is that, like anti-vaccine activists before him, he simply doesn’t believe in coincidence. He writes, “Sometimes infants and children develop medical problems ... within days or weeks of a vaccination. Although it can be highly suspected that the vaccine was the cause, it can’t be proven. I’m sure the truth of the matter is somewhere in between causality and coincidence.” Sometimes epidemiological studies find that vaccines cause a problem (e.g., measles-containing vaccine causes a short-lived low platelet count in the blood) and sometimes studies find that they don’t (e.g., thimerosal in vaccines doesn’t cause autism). In each of these studies a truth has emerged. Sometimes it takes months or years or decades for a truth to emerge. Sometimes it never emerges. But there is one truth: a vaccine either causes a problem or it doesn’t. Sears’s protests notwithstanding, there’s no middle ground between coincidence and causality.

Vaccines aren’t adequately tested for safety. Sears writes, “A new medication goes through many years of trials in a select group of people to make sure it is safe. Vaccines, on the other hand, don’t receive the same type of in-depth, short-term testing or long-term safety research.” In fact, vaccines are tested in larger numbers of people for longer periods of time than any drug. HPV vaccine was tested in thirty thousand women, the conjugate pneumococcal vaccine in forty thousand children, and the current rotavirus vaccines in one hundred and thirty thousand children before licensure; all were tested for more than twenty years. No drug receives this level of scrutiny. And the post-licensure surveillance system for vaccines, specifically the Vaccine Safety DataLink, is a model to detect rare adverse events after a vaccine is licensed. If Vioxx were a vaccine, the fact that it was a rare cause of heart attacks would have been detected far more quickly.

Vaccine-preventable diseases aren’t that bad. Sears tells the following story: “A six-month-old unvaccinated infant had a pneumococcal ear infection that spread to the skull bones behind the ear, called mastoiditis. She required surgery and IV [intravenous] antibiotics. Afterward, I asked the parents if they regretted their decision not to vaccinate. They said no. They were both well-educated professionals, had done a lot of reading on this issue, and still felt comfortable with their decision.” Sears implies that, because the child survived, pneumococcal infections aren’t really that bad (or that surgery isn’t really that bad). It doesn’t always work out that way. Every year many children suffer pneumococcal pneumonia, bloodstream infections, and meningitis. And those who don’t die from meningitis are often left blind, deaf, or mentally disabled. For example, in 2001 Shannon Peterson of Minnesota decided not to give her two children the pneumococcal vaccine. Both suffered severe pneumococcal infections. Her five-year-old son survived; her six-year-old daughter didn’t. “I can’t tell parents enough the importance of vaccines,” said Peterson. “I hope that no one else has to hold their child when they die.” Sears could have told a story like this one. It certainly happens often enough. But he didn’t. Instead he referred in glowing terms to the parents of a child who needlessly suffered mastoiditis. The truth is these parents had made a terrible decision for their child—one that could have killed her.

Vaccines contain dangerous ingredients. In the mid-1800s, antivaccine activists claimed that vaccines contained the “poison of adders, the blood, entrails, and excretions of bats, toads and suckling whelps.” When, a hundred and fifty years later, Jenny McCarthy said that she wanted the ether and anti-freeze removed from vaccines, she had carried forward the centuries-old tradition of claiming that vaccines contain ingredients that aren’t there. Vaccines of old didn’t contain products derived from adders, bats, toads, or whelps; today’s don’t contain ether or anti-freeze.

Sears, like McCarthy, claims that vaccines contain phantom ingredients. He writes that some vaccines are made using serum obtained from calves before they’re born. That’s true. Then he takes an illogical step, raising the specter of mad-cow disease. “All animal and human tissues are carefully screened for all known infectious diseases,” he writes. “Some vaccine critics are still worried, however, that there may be other viruses or infectious agents called ‘prions’ ... that are much smaller than viruses and that we don’t yet know how to screen for.” Proteinaceous infectious particles (prions) cause mad-cow disease, a progressive dementia that often results in death. Mad-cow disease swept through the British beef industry in the 1980s, killing one hundred and sixty British citizens; with stricter regulations, the disease has been eliminated. It would have been helpful if Sears had mentioned several reassuring facts: prions grow in the nervous system, not in cells used to make viral vaccines; prions have never been found to contaminate serum obtained from calves before they’re born; mad-cow disease isn’t a problem in New Zealand (where calf serum is obtained); and children receiving vaccines during the mad-cow epidemic weren’t at increased risk of mad-cow disease. Although most parents probably never considered mad-cow disease before they read his book, Sears concludes, “If exposure to animal tissues worries you, you may want to choose the brand that doesn’t use cow extract.”

Sears’s fear of phantom vaccine ingredients didn’t end with prions. Regarding the MMR vaccine, he wrote, “The measles and mumps vaccines are nourished for years in a culture of chicken embryo cells [that contain] human albumin, a protein filtered out of human blood units.” Sears is correct in stating that MMR is stabilized using human serum albumin. And he’s right in stating that it’s a blood protein. But the human albumin in MMR isn’t made from human blood; it’s made using recombinant DNA technology. Human blood is never part of the process. Sears’s misstatements are a far cry from claims that vaccines contain the blood of bats and toads—just not far enough.

Pharmaceutical companies misrepresent data. Sears writes, “Twenty years ago a group of doctors from the CDC, several U.S. medical centers, and two pharmaceutical companies—Glaxo-SmithKline and Merck—undertook the task of determining just how common the hep[atitis] B infection was in infants and children. If they found that hep[atitis] B was very common in kids, it would make sense to begin vaccination of all newborns. The consensus of the researchers was that [thousands of] infants and children were being infected with this virus each year.” Sears didn’t believe it. Taking a closer look, he found only “about 360 cases reported in kids from birth through age nine each year.” Sears implied that the CDC, GlaxoSmithKline, and Merck had misled the public.

It’s not hard to appeal to the public’s distrust of government and pharmaceutical companies. Lora Little did it in Crimes of the Cowpox Ring and Barbara Loe Fisher in A Shot in the Dark. But like Fisher’s and Little’s claims, Sears’s aren’t supported by the facts. Before the hepatitis B vaccine was recommended for babies in 1991, every year about sixteen thousand children less than ten years old were infected with the virus. Given that many hepatitis B virus infections occur without symptoms—and are not reported to the CDC—this estimate is probably low.

On January 20, 1961, during his inaugural address, President John F. Kennedy said, “Ask not what your country can do for you. Ask what you can do for your country.” Twenty years later, Ronald Reagan, during a debate with President Jimmy Carter, asked, “Are you better off now than you were four years ago?” Both men understood the prevailing mood. Kennedy had appealed to a sense of community, sending thousands of young people into programs like the Peace Corps and Volunteers in Service to America (VISTA); he asked Americans to see themselves as part of something greater, to take responsibility for something greater. Reagan appealed to the “Me Generation”; now it was time for me to get mine.

A parallel can be drawn with vaccines. On February 2, 2009, a show titled “The Polio Crusade” aired on public television’s American Experience. The program described a polio outbreak in the summer of 1950 that devastated the town of Wytheville, Virginia. And it told the story of America’s efforts to make the first polio vaccine. It’s a remarkable program. Throughout the documentary are heard the voices of Americans sixty years ago, and they reveal a heart-warming sense of community. People saw polio as a shared tragedy, giving millions of dollars to the March of Dimes to make a vaccine. And they gave more than their money; thousands of community organizers volunteered to conduct the largest field trial of a vaccine ever performed—one that included about two million children. When it was over—when a polio vaccine emerged that eliminated the disease from the Western Hemisphere—Americans were proud. They felt that they, more than anyone else, had developed the vaccine. Individuals saw themselves as part of a group—a public that cared about public health. It was this sentiment that John F. Kennedy so deftly touched during his inaugural address.

Sears, like Reagan before him, is appealing to a generation that doesn’t consider a larger cooperative—an immunological commons. Toward the end of his book, under the heading “Is It Your Social Responsibility to Vaccinate Your Kids?” he writes, “This is one of the most controversial aspects of the vaccine debate. Obviously, the more kids who are vaccinated, the better our country is protected and the less likely it is that any child will die from a disease. Some parents, however, aren’t willing to risk the very rare side effects of vaccines, so they choose to skip the shots. Their children benefit from herd immunity—the protection of all the vaccinated kids around them—without risking the vaccines themselves.” Sears then asks the critical question. “Is this selfish? Perhaps. But as parents you have to decide. Are you supposed to make decisions that are good for the country as a whole? Or do you base your decisions on what’s best for your own child as an individual? Can we fault parents for putting their own child’s health ahead of other kids around him?” In another section of the book, Sears doesn’t hide the deceit. Regarding parents who are afraid of the MMR vaccine, he writes, “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.” In other words, hide in the herd, but don’t tell the herd you’re hiding. Otherwise, outbreaks will ensue. Sears’s advice was prescient. Within a year of the publication of his book, the United States suffered a measles epidemic that was larger than anything experienced in more than a decade. (It was an outbreak fueled by the unfounded fear that MMR vaccine caused autism—a fear that Sears fails to allay in his book.)

Now that herd immunity has broken down, Sears’s position that one should think only of oneself no longer works. Unfortunately, his book contains many examples of this philosophy:

• “In truth, tetanus is not an infant disease,” he writes. “Also, diphtheria is virtually non-existent in the United States. So you could create a logical argument that a baby could skip the tetanus and diphtheria shots for a few years and be just fine.” These statements are inaccurate. First: tetanus is a disease of infants. A cursory look at any textbook of infectious diseases provides grim pictures of newborns suffering severe muscle spasms and breathing difficulties from tetanus; that’s why it’s called the “disease of the seventh day.” Second: the casual advice that one can simply wait to get a diphtheria vaccine ignores history. Between 1990 and 1993, when public health programs were disrupted in the Russian Federation (states newly independent from the Soviet Union), a hundred and fifty thousand people suffered diphtheria and five thousand died, mostly children. In the absence of vaccination, such an outbreak could happen in the United States just as easily.

• “[Polio] doesn’t occur in our country,” writes Sears, “so the risk is zero for all age groups.” Although polio has been eliminated from the United States, it hasn’t been eliminated from the world. Four countries—India, Nigeria, Pakistan, and Afghanistan—have never interrupted polio transmission; and children in twenty-three other countries still suffer the disease. Because international travel is common, and because most people who are contagious aren’t sick, it is likely that poliovirus walks into the United States every year. Children whose parents follow Sears’s advice will be particularly vulnerable when an outbreak occurs or when they travel overseas.

• “Hib is a bad bug,” writes Sears. “Fortunately, it’s also a rare bug, so rare that I haven’t seen a single case in ten years. Since the disease is so rare, Hib isn’t the most critical vaccine.” As Sears knows, Hib is rare because of the Hib vaccine. And if we stop using the vaccine, Hib will be back. Which is exactly what has happened. Sears’s book was published in October 2007. The following year, outbreaks of Hib meningitis occurred in Minnesota and Pennsylvania. All these outbreaks centered on children whose parents had chosen not to vaccinate them; four died from their infections.

Robert Sears peers out from the back cover of his book with an open, caring expression, exuding a kind of California calm. No doubt he wants to do the right thing; no doubt he is trying to find some middle ground between parental anxiety about getting vaccines and physician anxiety about not giving them; no doubt he believes he is on the side of his fellow physicians. Describing his “alternative schedule,” Sears writes, “I have put together a vaccine schedule that gets children fully vaccinated, but does so in a way that minimizes the theoretical risks of vaccines. It’s the best of both worlds of disease prevention and safe vaccination.” But Sears’s schedule is ill-founded. And rather than calming parents with science that exonerates vaccines, he caters to their fears by offering a schedule that has no chance of making vaccines safer and will only increase the time during which children are susceptible to infections that can kill them. It’s the worst of both worlds.

Although Sears is probably well meaning, one has to question the hubris of a man who decides to create his own vaccine schedule—someone who claims his schedule is better and safer than that recommended by the CDC and AAP. It’s all the more amazing when one considers that Robert Sears has never published a paper on vaccine science; never reviewed a vaccine license application; never participated in the creation, testing, or monitoring of a vaccine; and never developed an expertise in any field that intersects with vaccines—specifically, virology, immunology, epidemiology, toxicology, microbiology, molecular biology, or statistics. Yet he believes he can sit down at his desk and come up with a better schedule. And parents trust him. Oddly, they trust him because he doesn’t have an expertise in vaccine science—an expertise that would likely have inspired the CDC, AAP, FDA, professional medical organizations, or vaccine makers to seek his advice.

One final irony. For a new vaccine to be added to the schedule, the FDA requires concomitant-use studies. Pharmaceutical companies must show that a new vaccine doesn’t interfere with the immunity or safety of existing vaccines and that existing vaccines don’t interfere with the new vaccine. Only then can a vaccine become part of the schedule. Dr. Bob’s schedule, on the other hand, is completely untested—never reviewed by the FDA, CDC, or AAP to make sure it’s as safe and effective as the existing schedule. It is remarkable how little Sears thinks of the enormous amount of testing that goes into creating the current schedule.

Sears isn’t alone.

On January 12, 2010, Dr. Mehmet Oz, host of the popular The Dr. Oz Show, told interviewer Joy Behar what he thought about the influenza vaccine.

BEHAR: There’s a rumor that your kids did not get flu shots or swine flu shots. Is that right?

OZ: That’s true. They did not.

BEHAR: Do you believe in them for the kids or what?

OZ: No. I would have vaccinated my kids but you know I—I’m in a happy marriage and my wife makes most of the important decisions as most couples have in their lives.

Given their relative training, one would have imagined that Oz, not his wife, would have made the decision. Mehmet Oz graduated from Harvard University in 1982 and obtained a joint MD and MBA degree from the University of Pennsylvania School of Medicine and the Wharton School in 1986. Since then, he’s climbed the ranks to become a professor of cardiac surgery at Columbia University. His wife, Lisa, has no background in science or medicine. Rather, Lisa Oz is guided by the beliefs of Mikao Usui, who, after three weeks of fasting and meditation on Mount Kurama in Japan, claimed he had been given the power to heal through his palms—called reiki. Lisa Oz isn’t just a follower of Usui, she’s a reiki master.

The four Oz children weren’t among the hundreds of thousands hospitalized or the hundreds killed by swine flu in 2009. But they could have been. And the influenza vaccine would have prevented it. No scientific evidence supports palm healing as a method to treat or prevent influenza.

Oz’s disdain for vaccines didn’t end on The Joy Behar Show. In December 2009, Oz and co-author Michael Roizen published YOU: Having a Baby, a book that promotes Dr. Bob’s Alternative Vaccine Schedule. Oz and Roizen wrote, “One of the most highly charged conflicts revolves around an issue that comes up just moments after your baby is born: to vaccinate or not to vaccinate? That, indeed, is one heck of a question.” Like Sears, Oz and Roizen misinformed their readers on several counts:

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Mehmet Oz, host of The Dr. Oz Show, often dispenses anti-vaccine advice. Shown here with wife Lisa at Time magazine’s 100 Most Influential People Gala, May 8, 2008. (Courtesy of Scott McDermott/Corbis.)

• Regarding the polio vaccine, they wrote, “There’s no doubt that polio vaccine ... causes polio in 1 in 1 million to 2 million,” failing to mention that the only polio vaccine available today in the United States is inactivated and, therefore, incapable of causing polio.

• Regarding the influenza vaccine, they wrote, “Pregnant women should avoid getting the influenza vaccine in their first trimester.” Instead of the vaccine, they suggest that “you can boost your immune system during the winter by taking 2,000 IU [International Units] of vitamin D daily.” Pregnant women are much more likely to be hospitalized and killed by influenza than nonpregnant women of the same age. That’s why they’re asked to receive the influenza vaccine if they’re pregnant during influenza season. The vaccine, not vitamin D, induces specific immunity to the virus.

• Regarding the rotavirus vaccine, they wrote, “A prior version of this vaccine was withdrawn from the market in 1999 because it was linked to a severe condition known as intussusception, a blockage or twisting of the intestine. A new vaccine, released in 2006, has been associated with even more cases of intussusception ... than the first version, prompting an FDA notification in 2007. We recommend that you opt out of this one until more data are available.” Oz and Roizen should have read the FDA notification a little more carefully. If they had, they would have seen that the FDA stated that all cases of intussusception following rotavirus vaccine may have occurred by chance alone. Further, one year before YOU: Having a Baby was published, the CDC found the risk of intussusception was the same in children who did or didn’t receive the rotavirus vaccine; parents no longer have to wait for data.

Robert Sears and Mehmet Oz have followed in the footsteps of anti-vaccine activists before them, claiming to inform parents about vaccines while in fact misinforming them. Their popularity has only widened the gap between some parents and their pediatricians.

So how does one solve the problem of the growing rift between parents who are concerned about the safety of vaccines and doctors who are worried about the reemergence of infectious diseases? The solution may not be easy; but it’s there.