This post is from Dr. Bob Sears' Facebook page.
DR. BOB'S DAILY:
ONCE MORE INTO THE BREACH
I'm tired of flying up to Sacramento. And why Sacramento anyway? Who puts the state capitol that far away from the majority of the population? Anyway, I'll see you all on Wednesday, again. Sigh.
Here's a letter I wrote to a couple of Senators. Feel free to send it to all of them, or at least to your own Senators.
Hello. My name is Dr. Bob Sears. I am a pediatrician in Orange County, CA. I have lived and worked there for 20 years. My reason for contacting you is to open up a dialogue for you to get an opinion outside of your normal circles of influence in the medical arena regarding SB277. I oppose this bill and would welcome the opportunity to speak with you.
I imagine you've spoken at length with other physicians. What makes me unique is that I am among only a couple handfuls of doctors in southern California who approach vaccines in a different manner than most by giving them more gradually, spread out over a longer period of time instead of grouping so many together during young infancy. But give them I do. I give vaccines every single day in my office. I am pro-vaccine and understand that vaccines work and have reduced and eliminated many serious diseases. And that's not just spouting a party line - I firmly believe that, and that's why I give them in my office.
I would like to introduce you to the single primary reason that I'm reaching out (because I know there are dozens of different issues we could discuss). It is this: I want to consider the practical implications of how life will be for Californian families if SB277 moves forward and eventually passes.
I feel that I am in a unique position to understand this better than most physicians because this is the primary focus of my practice. Virtually all pediatricians, including our colleague Dr. Pan, fully vaccinate all of their patients. And they, fortunately, only see a few severe vaccine reactions since they are somewhat rare, and they accept those reactions when they happen as an unfortunate and unavoidable effect of the vaccination process. I can be thankful that very severe reactions are uncommon enough that they don't feel like a significant risk. Those infants and children who suffer an extremely severe, life-threatening reaction obviously would become exempt from further vaccines because we can all agree that such risk would be much greater for that individual child than the benefit provided by further vaccinations.
But, allow me to introduce to you two serious additional aspects to this equation that most doctors don't consider:
1. When a severe, life-threatening reaction occurs after a vaccine, both parties agree that that particular vaccine shouldn't be repeated, and a medical exemption would be granted. BUT, most doctors would want all the other vaccines to continue. If several vaccines were given together, most doctors would attribute the bad reaction to one of the most suspect vaccines (such as DTaP and MMR, two which seem to cause more reactions), and want to continue all the other vaccines that were given that same day.
So here is the first crux of the problem: Many parents in this scenario would want to stop all vaccines, but most doctors wouldn't agree and would want to limit a medical exemption to one vaccine. If the primary doctor who handled the case doesn't agree to exemption, the parent has to find another doctor to review the case, and I know for a fact it is almost impossible for parents to find an uninvolved doctor to then provide such as exemption.
Doctors like myself can certainly consult with such families, yet there are only a few like me. State-wide, families across CA don't have such access.
2. But there's another side to this, a side which is even MORE significant. It is those children who suffer a moderately severe reaction to vaccines (as opposed to the extremely severe ones discussed above), and the parents don't want to proceed, yet the doctor does not believe the reaction was severe enough. These reactions are NOT uncommon. I see them almost every month in my office. Reactions such as brief seizures or tremors, high fever for several days with either lethargy or extreme irritability, poor feeding and extreme sleepiness, sudden onset of severe eczema, sudden symptoms of inflammatory bowel disease, and others. Some parents describe how their infant seems to "shut down" for several days to a week after vaccines. These kids do recover, fortunately, yet the decision then has to be made whether or not to proceed with the next round of shots two months later.
And this is the second crux of what I would ask you to understand. Pediatricians simply won't give medical exemptions for these reactions. That is because the medical community at large believes so firmly that all vaccines are critical and must be given no matter what. And the only exception is a prior severe, life-threatening reaction (or severe immune compromise due to cancer or chemotherapy).
I might grant exemptions on a case by case basis after careful consideration of all the implications, but those doctors like me are only a few. We can't serve the whole state.
I remember one of the Senators making a statement to this end in Wednesday's hearing. He said patients can seek out doctors like me and get an exemption. Well, doctors like me have to be careful with our licenses. And we have to be honest. And since we don't witness the actual reaction when new patients come to us for this second opinion, we have to go simply based on the parent's story. Can I also share that virtually no doctors write down such reactions in their medical records, so we can't even review those to get to the truth.
Dr. Pan stated in the hearing that he would expect doctors to only give appropriate exemptions. In other words, only exempt those kids who had an extremely severe, life-threatening reaction. Those with moderately severe reactions that were not life-threatening would not be exempt.
3. Sorry, just remembered one more crux: Family history of severe auto-immune problems, prior severe vaccine reactions in a parent or in a previous child, and families who have been affected by neuro-developmental disorders. Many of these families don't want vaccines, yet their circumstances do not warrant exemption. So they are coerced into vaccinating against their wishes if they want their children to participate in a school-based childhood. Even parents who watched their first baby suffer a serious, life-threatening reaction, must vaccinate their second if they want to attend school.
As for autism alone, I know there are about 2 million children living with autism in the U.S. How many in CA? I don't know for sure. A 2011 CA Department of Education report stated 1% of children in CA public schools have autism. If we estimate about 6 million public school kids, then there are about 60,000 with autism. Many of these families don't want more vaccines. Yet, without them, they cannot get school-based therapy or Regional Center based therapy in any setting with other kids. They will be left to exist at home and at home only. Parents can't afford that. And these kids don't deserve that. They deserve a life. And since medical science has not shown any link between vaccines and autism according to most mainstream studies, these kids are the last ones for whom a doctor is going to write a medical exemption.
One might think that a solution to this problem is to write guidelines into the bill which specify what constitutes a medical exemption. That is a pandora's box. That would open up an enormous debate about the medicine and science of vaccine reactions that is too complex to try to work into a bill. I appreciate that this aspect of the decision is put into the hands of each patient's physician and is done on a case-by-case basis, not done with a legal checklist. To try to create written guidelines on such would seal the fate of many because such written guidelines would probably only include immediate, life-threatening reactions.
Two items I'm sure you already know:
2000 severe, life-threatening reactions are reported to the CDC each year. That's only the most severe ones which result in prolonged hospitalization, permanent disability, or death.
3 billion dollars have been paid out to victims of vaccine reactions. That's not a small number. These reactions do exist, and I don't think anyone's arguing that they don't exist. I just wanted a reminder.
Dr. Pan's bill (AB2109) from two years ago has already influenced families and reduced personal belief exemptions by 20%. It's working. Now Dr. Pan wants to throw out that bill and make vaccines mandatory for school. Such a drastic action simply isn't necessary.
Life for hundreds of thousands of Californian families will suddenly change if SB277 passes. We know that about 2.54% of families filed a personal belief exemption in CA last year. With 9 million school-age kids in CA, that's about 225,000 children. And for every such instant home-schooler, one parent will have to quit their job to become a teacher. People will have to leave CA because no one can afford to live here on one salary (well, a small percentage can). Schools will lose a huge chunk of their revenue because the number of kids who leave will not be small, and the state will lose tax revenue for every lost job.
How much money will public schools lose? This isn't easy to estimate. There are approximately 6 million public school children in California (out of about 9 million children total). We know the personal belief exemption rate is about 2.5%. This equals about 150,000 public school children. At about $10,000 per child, public schools will instantly lose about $1.5 billion. That's $1,500,000,000. This doesn't even include all the loses private schools will endure. Teachers and other school employees will lose their jobs left and right.
Will parents line up to vaccinate their kids if this passes so they can go to school? A few will. But human nature is such that when someone tries to force a decision on a parent regarding his or her kids, they don't line up. They run the other way. How many families in your district will this affect? I don't know. But it's not a small number.
But worst of all, in my opinion, is that we will create a whole sub-culture of children being raised outside of society, ostracized and alone. Am I being too dramatic? Admittedly, maybe. But with this bill also comes prejudice. You heard the testimony at Wednesday's hearing from those who support this bill that they don't wont their children to be around "those unvaccinated children." Those people. Those unclean people whose beliefs they don't agree with. Sorry, dramatic again. But I think there is some truth to this worry of creating a whole new reason for people to feel prejudicial against a new class of society. In every neighborhood, parents won't let their kids play with "those homeschoolers" because homeschooling will come to mean unvaccinated, different, contagious. Yes, we won't have measles in schools. But is this worth it?
Senator, know you can probably feel my passion. I know this bill had some initial good intentions for trying to reduce measles. As you have learned more and more about this issue, have you come to a point where you are questioning some of the aspects of this? Is there a chance that you are open to recognizing some of the challenges this bill creates? I would love to speak more. Again, I am at your disposal over the days and weeks to come.
With all respect for you, your office, and the government of California,
Dr. Bob Sears
Graduate of the Georgetown University School of Medicine
and the Children's Hospital of Los Angeles.
Catchup schedule for unvaccinated five-year-old children who want to enter Kindergarden:
First round: DTaP, Polio, Hep B, MMR, Chickenpox, Hib
One month later: MMR, Chickenpox, Hep B
One month after that: DTaP, Polio
Two months after that: DTaP, Polio
Two months after that: Hep B
Four months after that: DTaP
Additional vaccines that could be insisted upon should the public health department add them to the bill requirements:
Hep A: two doses
Flu vaccine: two doses first year
Pneumococcal vaccine: one dose
This equals 15 required vaccines all in one year, and 5 more that could be added. This is unprecedented in medicine. No child ever receives this many vaccines at this age in the normal course of medicine. So this will create a whole new experiment on how older kids handle the sudden introduction of so many vaccines.