In my last post, I called for the licenses of anti-vaccination doctors. In response to my request, I received an e-mail from Dr. Bob Sears. I was asked to post it only in its entirety. However, in the long-standing internet tradition of “fisking” I will comment on it extensively. It begins: “I didn't read the story, but I can certainly speak to the question posed in the title. Although I am a pro-vaccine doctor, I don't think anti-vaccine doctors should lose their licenses.”
Whether or not Dr. Bob is “anti-vaccine” could be said to be a matter of opinion, but an examination of the facts based on his statements and writing leads me to conclude otherwise. I suppose it depends on what you choose to define as “anti-vaccine.” For my purposes, an anti-vaccine doctor is one who consistently recommends against following the science-based guidelines on vaccination for people who should otherwise follow it. In my opinion, Dr. Sears is most certainly anti-vaccine: “There are very few anti-vaccine doctors anyway. However, in America, as in most free countries, everyone is entitled to their own opinions, and doctors can choose to practice the type of medicine they wish.”
This is a non-sequitur. It doesn't matter so much how many doctors are anti-vaccine, but what effect these doctors have. A radiologist who is anti-vaccine is much less relevant than a well-known pediatrician. And certainly anyone is entitled to their own opinions, but not their own standard of practice. If I decided that amputation was the cure for all toe-nail fungus, I would and should lose my license, not because of an opinion but because of a dangerous and incorrect practice: “For example, most doctors of Chinese medicine don't offer vaccines. Neither do chiropractors, homeopaths, naturopathic physicians, and many other integrative and complementary practitioners. To say that such practitioners shouldn't be allowed to practice the form of medicine they wish to is prejudice against forms of medicine that are widely accepted in many parts of the world. Of course, we should also “do no harm,” and there are policies and practices put into place which prevent practitioners from providing harmful treatments.”
This is, in my opinion, either willful ignorance or stupidity, and I doubt Dr. Sears is stupid. I don't give a cricket's cloaca what various sorts of “alternative healers” do. It's not a matter of “prejudice” but “postjudice.” None of these “alternative” healing arts has anything to do with the scientific practice of medicine that keeps us alive and well. I'm sure a homeopath doesn't prescribe beta-blockers for heart failure either, but that doesn't make it right. We're not talking about chiropractors or auto mechanics here. If someone is a licensed physician and cannot follow basic standards of care, they need a new job: “But, in my opinion, failing to provide vaccines in a practice is not the same as “do no harm.” It's simply a more narrow scope of practice. I practice what is called allopathic medicine, which is the standard type of medicine that American doctors are trained to practice. I provide vaccines in my office every day. But I'm not so arrogant as to claim that my way is the only way, and I certainly acknowledge that these other forms of medicine are valid and have their place in our country and around the world, as does the American Academy of Pediatrics (which has a section on Complementary and Alternative Medicine).”
Hey, I'm a so-called “allopathic” doctor, too. I treat heart disease every day. My patients with heart disease take aspirin because it's the standard of care. I can't simply say, “Yeah, I treat heart disease but aspirin is outside my scope of practice.” That would be something else, like malpractice, say. It is most certainly not OK to hang out a shingle as a “homeopath” and claim to prevent influenza with vitamins and tinctures, but not offer flu vaccines. This argument is idiotic. I'm also curious what percentage of Sears' patients receive all their recommended vaccinations on time: “
Now, I would add that if your article is speaking more to those American-trained doctors who receive standard medical training, but then decide to be anti-vaccine (there are very few such doctors), I would still hold that they should not lose their license, and that they have the right to practice a scope of medicine that does not include vaccines.
—Dr. Bob Sears”
Dr. Sears and I obviously disagree as to what a doctor is. I certainly need to be free to choose treatments based on my patients' individual circumstances within the standard of care. If my patient has had a bad reaction to flu vaccines, I would advise against it. If they simply decline a flu shot, so be it. But if I were to advise them that flu shots “aren't for everyone” and are “often harmful” and then spout some unscientific nonsense as many do, I'd be a lousy doctor.
No doctor should ever be forced to offer services which they do not feel comfortable with. I don't do surgery, which is a very good thing. But if I have a patient who needs an operation, such as a gall bladder removal or an abortion, I refer them to someone who can help them. If an anti-vaccine doctor were to say (somewhat ridiculously) that vaccination is outside his scope of practice but he knows a guy who will take care of you, that seems relatively ethical, if somewhat bizarre.
If Dr. Sears and those like him really believe what they say about vaccination, where's the data? Why aren't they working on testing their hypotheses? In my opinion, it's because you cannot reason someone out of a position they never reasoned themselves into in the first place.
Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog at Forbes. His blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.