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Tuesday, February 24, 2015

Measles vaccination: a response from Dr. Bob Sears

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.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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