Dr. Bob Sears is a Capistrano Beach pediatrician who is famous for opposing mandatory vaccinations and the current CDC vaccine schedule. He has promoted his alternate vaccine schedule, which spreads out the vaccines much greater than the standard schedule. This has made him a darling of the anti-vaccine movement, an expert who supports part of their narrative (specifically, “Too many too soon” and parental choice).

Recently the Medical Board of California filed a complaint against Sears for “gross negligence.” There are three counts, the first for recommending a 2 year old patient not receive any further vaccines because of apparent reactions to previous vaccines. The complaint alleges:

Respondent was grossly negligent and departed from the standard of care in that he did not obtain the basic information necessary for decision making prior to determining to exclude the possibility of future vaccines, leaving both patient J.G, the patient’s mother, and his future contacts at risk for preventable and communicable diseases.

The complaint also alleges that Sears failed to adequately assess the patient after a head injury with complaint of headache, and also that he failed to keep adequate records by not filing the letter excusing the patient from vaccines in the chart.

The Standard of Care

Given the facts laid out, I completely support the medical board’s decision to file a complaint against Sears. In the US it is the job of each individual state to license, monitor, and discipline health care professionals. Part of that duty is to maintain what is called the standard of care.

No one expects states to micromanage the practice of medicine, and they do not determine what the standard of care is. The medical community as a whole determines the standard and polices its members. The state only gets involved when a practitioner displays gross negligence and practices substantially and repeatedly below the standard of care.

This is meant to be a minimal safety net for patients. It is part of the contract that professionals have with society – they are granted certain exclusive privileges, like a license to practice medicine, in exchange for maintaining professional, quality control, and ethical standards. Seems like a fair exchange.

If anything, in my experience, states are generally too reluctant to take action against physicians for practicing below the standard of care. They tend to give physicians a wide benefit of the doubt and allow for physicians to have opinions that are in the minority.

In most cases physicians sincerely want to practice within the standard of care, and lapses can be dealt with through education. Disciplinary action is not always, or even often, required.

However, some physicians blatantly fly in the face of the standard of care.  This can be due to simple incompetence (they really shouldn’t be practicing medicine), to prioritizing profit over patient care, simple hubris, to having an alternate philosophy of health and disease, or some combination of these factors.

Sears’ Anti-Vaccine History

Bob Sears, in my opinion, is one such example. He vocally opposes the standard of care, writing and lecturing against the standard vaccine schedule. Orac, who has written about Sears extensively over the years, gives this summary:

Given Dr. Bob’s history of opposing SB 277, the new California law that eliminated nonmedical exemptions to school vaccine mandates and his willingness to give paid seminars teaching parents to avoid the requirements of SB 277 and even outright selling nonmedical exemptions, I consider him a menace to public health, particularly that of children.

Essentially Sears thought he could substitute his own gut feelings for the carefully researched standard of care as outlined by the CDC vaccine schedule. In general, if you are going to deviate substantially from the standard of care, especially one that is published in detail, you better have a darn good reason and be willing to defend yourself before a disciplinary board.

To be clear, the standard of care is not just what most physicians are doing. It is the consensus opinion of relevant experts based on existing evidence and careful review. Often panels of experts review all the evidence and publish practice standards. Every physician needs to know the practice standards in their field.

Where the evidence is unclear, physicians can rely on their experience and personal expertise, and are generally given a lot of elbow room to do so.

I previously reviewed the evidence for the current vaccine schedule. Various studies show that delaying or spreading out vaccines has no medical benefit. It does not reduce the incidence of any adverse outcome. What it does do is increase the risk of vaccine preventable diseases.

That’s the evidence. Delaying vaccines does not help, but it does hurt. Because vaccines are a public health measure, the negative outcomes spread beyond the individual patients of a doctor who delays or does not give vaccines, making them a “public health menace.”

Conclusion

Often (but not nearly often enough) states bring disciplinary complaints against doctors who are practicing according to their personal philosophy or claims and against the standard of care. This is always good to see, but too often the complaints are dismissed or result in only a slap on the wrist.

The burden of proof on the state is high. In many states laws have been passed, so called “health care freedom laws” which make it impossible for health boards to discipline physicians for practicing “alternative” medicine. This is essentially a get-out-of-jail free card to physicians practicing below the standard of care.

I am glad that California is cracking down on Sears, basically for his opposition to the standard of care when it comes to the vaccine schedule. I suspect that not much will come of it, however. I could be wrong, though. The political mood has definitely shifted against the anti-vaccine movement following the Disneyland measles outbreak.

As many of my colleagues and I predicted, this shift would only take place when vaccine-preventable illnesses start to return, and parents again fear these childhood diseases more than the vaccines that prevent them.