By On the occasion of our 20th anniversary
By Gustavo Arellano
By R. Scott Moxley
By Alfonso Delgado
By Courtney Hamilton
By Joel Beers
By Peter Maguire
By Charles Lam
Steve and Vicky Carrico watch their 5-month-old twin daughters, Ashley and Dalen, as they wiggle on their tummies in the living room of their Capistrano Beach home. Dressed in matching "I [heart] Mom" onesies, the wide-eyed girls coo softly while lifting their heads to gaze at their surroundings.
"I can't describe it," says Steve, a realtor. "I never knew there was such a hole in my life until they got here. I would do anything in the world for them."
Like all new parents, they want nothing more than to protect their children. And for the Carricos, this mandate includes fiercely guarding what gets injected into their bodies. When the babies were born, doctors said they would need the Hepatitis B vaccine, given to all newborns in the United States, before being discharged from the hospital. The Carricos refused.
"They don't need to be vaccinated for a sexually transmitted disease," Steve says with a tone of disdain. "Come on, they're babies! They're barely out of the womb, and it's like, 'Let's dope them up and stick them with needles!'"
Vicky, a stay-at-home mom, adds softly, "They're so little. Their immune systems aren't strong."
Since then, the couple has decided to skip or delay various vaccines recommended by government health agencies, believing the injections could have harmful side effects. "The human body was put together pretty darn good," says Steve, who has always believed in medication as a last resort. "God did a great job in giving us all the tools we need to heal ourselves."
* * *
The Carricos are part of a growing group of moms and dads that questions the vaccine schedule set forth by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP), a standard pediatricians have long seen as sacrosanct. It's a group with which doctors don't know what to do. In the parenting sphere, few issues are as polarizing as childhood vaccinations. Those who forgo some or all of the recommended children's shots do so for a spectrum of reasons, from concerns about toxicity to fears about autism to religious beliefs to a faith in "natural immunity" to a general distrust of the government agencies that approve vaccines and the manufacturers that profit from them.
Those who do vaccinate their children, along with a majority of medical experts and public-health officials, contend that most fears about vaccine safety are based on unproven science and that skipping vaccinations is fundamentally irresponsible—low vaccination rates can threaten the immunity of entire communities. In his book The Panic Virus, which delves into the vaccine wars in the U.S. and England, author Seth Mnookin writes, "If only there were a shot for irrational fears."
For years, the issue seemed to be black and white—moms and dads either gave kids all their shots or were ostracized by doctors and their communities. But now concerned parents are discovering what they see as refreshing middle ground. They're turning to Dr. Robert Sears, a Capistrano Beach pediatrician and author of The Vaccine Book, described as an "authoritative, impartial, fact-based guide to childhood vaccinations." In his turquoise, 335-page manual, which has sold more than 180,000 copies in the five years since it debuted, Sears pinpoints the vaccines he deems most crucial and presents his own alternatives to the CDC-recommended schedules. He backs up his claims with countless findings from medical papers, translating medical information into layman-friendly language. "This infection can be a real pain in the . . . diaper area," he explains of the rotavirus disease. Across the world, parents walk into their doctor's offices armed with his book, highlighted and dog-eared.
"It's a lot of common sense," says Steve, whose daughters are patients of Sears. "I'll take my chances with diseases that haven't been seen in America in 50 years. Sometimes, you gotta put your faith in somebody."
But whether Sears is the man to follow has been a focus of intense debate. A quick Google search on the Orange County doctor results in headlines such as "Cashing In On Fear: The Danger of Dr. Sears" and "Bob Sears: Bald-faced liar, devious dissembler, or both?" The book has been called "the bane of pediatricians everywhere" and Sears himself a "prophet of doom." Steven Novella, a writer for the medical website Science-Based Medicine, compares Sears' alternative stance to "trying to compromise between mutually exclusive positions, like young-earth creationism and evolution," adding, "it doesn't work." Sears' opponents criticize his downplaying of vaccine-preventable diseases, with some even blaming him indirectly for the 2008 measles outbreak in San Diego, which infected 11 people. The child who had brought back the disease from a trip to Europe was once Sears' patient.
Where does Sears stand on vaccines? He makes his proclamation in the opening line of The Vaccine Book: "I am a pro-vaccine doctor." He then follows this statement with "I am also a pro-information doctor, and today's parents are asking many more questions about vaccines than parents in decades past."
His open approach is what brings flocks of parents to his offices at Sears Family Pediatrics, a red-tile-roofed, Spanish-style building he shares with his dad, Dr. William Sears, author of the ubiquitous parenting guide The Baby Book and the father of attachment parenting. (The elder Sears catapulted to mainstream prominence earlier this year when he was profiled in a Time magazine piece that featured a woman breastfeeding an almost 4-year-old on the cover.) Taped onto the front desk is a newspaper article with a declarative headline: "Nursing a 3-year-old is normal, child experts say." Brochures stacked on wooden shelves offer statistics on autism and lists of resources. (One in 88 children—and 1 in 54 boys—is diagnosed with the disorder, according to the CDC.)
Sears, who goes by "Dr. Bob" to avoid confusion, sits in an exam room after sending home a little patient with a high-five and a sticker of her choice. The bespectacled 43-year-old wears a polo shirt, khakis and a stethoscope around his neck and looks as though he could be your high-school science teacher.
"Anyone who thinks I'm a radical hasn't read my book or hasn't met me," he says with a gentle smile. "I'm just a regular, small-town doctor."
The families that come to him, he says, are often fed up with the condescension they've experienced at other doctors' offices. Some have a baby who once had a bad reaction to a vaccine, yet the doctor wouldn't alter the vaccine schedule. Others have been barred from practices that won't accept patients who aren't immunized. Roughly 25 percent of his patients do not vaccinate, and another 25 percent partially vaccinate. Sears takes them all. "Vaccines are probably the only area of medicine that we're not allowed to question," Sears says. "Doctors are very happy to answer questions all day, but as soon as someone asks about vaccines, some sort of alarm goes off and it's suddenly, 'Oh, no, you're one of those parents.' I don't know why that is."
So Sears sees his role as a bridge between the medical community and those skeptical of it, declaring that vaccinations don't have to be an all-or-nothing decision. "More and more parents are wanting to do vaccines differently, and if we keep kicking them out of our offices, we're going to have fewer vaccinated kids," he says. "I see using alternative vaccination approaches as a way of keeping vaccination rates higher and preserving our nation's immunity."
And it may just be effective. He's finding that some parents who once rejected vaccines altogether are easing into them with his modifications tailored for their individual needs.
"A doctor is finally listening to them," he says.
* * *
Vaccines protect us in two ways. On an individual level, they expose the body to a weakened, usually harmless form of a disease, allowing the immune system to strengthen its defenses in order to fight that disease if it encounters it again. On a societal scale, when a certain threshold of a population is vaccinated, it creates what's known as "herd immunity." Diseases need hosts in order to survive, so if the vast majority of people in a given area is protected, a disease has nowhere to go and disappears. For decades, vaccines all but wiped out many diseases in the U.S. that once killed millions, including smallpox, polio, measles, diphtheria and bacterial meningitis. The only children who went unimmunized were those who had medical issues or whose parents couldn't afford the shots, a problem now remedied through federal funds.
In 1998, the public's confidence was shaken when British medical journal The Lancet published a study linking the common MMR (measles, mumps and rubella) vaccine to the onset of autism. The author, Andrew Wakefield, had found traces of the measles virus, presumably from the shot, in a dozen autistic children, eight of whom developed regressive symptoms soon after receiving the vaccination. But the paper was later discredited by scientists. In 2010, after an in-depth investigation concluded that Wakefield was guilty of dishonesty and misconduct, the journal retracted the study, with editors noting, "It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false."
Meanwhile, when her son Evan was diagnosed with autism, actress and former Playboy pinup Jenny McCarthy became one of the world's most prominent advocates for autism, writing several best-selling books in which she claimed the MMR vaccine had probably contributed to her child's disorder. Medical professionals blasted McCarthy for spreading what they saw as dangerous misinformation. Parents with autistic children, many who were diagnosed not long after they were vaccinated, hailed the actress as the "voice" of the medical mystery. The fiery debate intensified when the self-proclaimed "mother warrior" went on Oprah in 2007 and proudly told the audience, "The University of Google is where I got my degree."
Years before the wave of panic had been set off, Sears, a graduate of San Clemente High School and Biola University, began his own road of questioning as a first-year medical student at Georgetown University. He and his wife, Cheryl, had a new baby, and the young family was living with a friend during the transition to the new city. The friend happened to be an early vaccine-rejector and had Sears read Harris Coulter and Barbara Loe Fisher's 1985 book, A Shot In the Dark. It had sparked the first modern popular concern about the risk of neurological damage from vaccines, in this case the DTP vaccine, which doctors no longer use.
"When the book came out, a lot of people didn't believe it," Sears says. "I didn't believe it either. I'd always been taught that vaccines don't cause any bad side effects and that there were no worries whatsoever."
But the book cited numerous scientific articles, and Sears was intrigued. So outside of class, he'd spend his days in the medical library reading every paper he could find on childhood vaccines. A soon-to-be pediatrician, the information was relevant to his career, but he also wanted to know if he had done the right thing by giving his infant son, Andrew, all the standard shots. "I didn't want to just listen to all the mainstream messages that were being taught to me without reading the research myself," he says. "I wanted to investigate."
After graduating and moving back to Orange County, Sears' interest in vaccines escalated. He started dissecting every ingredient in every vaccine pamphlet, highlighting each one and studying its side effects. Ethyl mercury in the preservative thimerosal, which some parents associated with autism, had already been removed from common childhood vaccines starting in 1999, but Sears discovered others that weren't exactly organic. "Some of the chemicals are very toxic and can cause cancer and reproductive problems," he says. "There are chemicals such as formaldehyde. MSG is in some vaccines. There are chemicals that are very similar to antifreeze. Some flu shots actually have a spermicide used as a preservative. But they're all in tiny amounts, and I believe they're probably safe because they're in such tiny quantities."
One chemical did stand out to him—aluminum. It's found in about half of vaccines, and Sears dedicates about 15 pages in his book to the potential dangers of it. (According to a paper published by the AAP, aluminum can cause neurological harm, but the quantity at which it's a threat has not been determined.)
In his practice, Sears would host monthly lectures about his findings. He'd ask parents why they were declining vaccines, and the most common answer was they didn't like the "overload." Back in the 1980s, doctors gave children a total of 12 vaccines throughout their childhood, with no more than three on the same visit. Now, Sears says, doctors give children 54 doses of 12 vaccines, sometimes with seven vaccines on the same day. Parents also expressed they only wanted to give their kids vaccines against diseases that posed a real threat, not long-shot illnesses. Sears listened.
"Most doctors aren't even willing to discuss vaccine options," he says. "They will say every single vaccine is absolutely important and just as important as any other vaccine. Those statements are very closed-minded. If you have disease such as meningitis that does occur in babies and kills babies, and then you have a disease such as Hepatitis B that doesn't occur in babies, how can you say the Hepatitis B vaccine is just as important? When parents hear those types of statements from doctors, they automatically tune them out. Because parents are smarter than that."
He also had an issue with the way vaccines are approved by the government. When a medical manufacturer makes a vaccine, a panel of doctors at the Food and Drug Administration must decide whether to approve it. Doctors on that panel might own stock in the vaccine manufacturers or even work for the vaccine manufacturers. "It's a huge conflict of interest," Sears says. "We're asking doctors to approve these vaccines when their whole life and professional world is being funded by the people that make that vaccine."
With all his material, Sears decided to write an easy-to-digest vaccine guide that presented information for each of the 12 standard vaccines and answered questions about every disease: Is it common? Is it serious? Is it treatable? When is the vaccine given? How is the vaccine made? What ingredients are in the final solution? Should you give this vaccine to your baby? For every vaccine, he included a section called "The Way I See It," in which he simply shared what makes the most sense to him. (Polio: get the shot. Hepatitis A: wait until the child is at least 2. And so on.) He designed two alternative vaccination schedules—one for parents who only wanted the most crucial shots for their children, and the other for parents who wanted to minimize the number of shots per visit to no more than two. Both spaced out the vaccines under the theory that tiny bodies could better process fewer shots at a time. With the alternative schedules, he says, he rarely sees the severe side effects he hears about from patients coming from other doctors' offices.
The Vaccine Book became a parent's bookshelf staple. Vanessa Showalter, a 39-year-old mom in Mission Viejo, started reading it while pregnant with her second child, Justin, now 2. She says she wanted to do things differently from the first time around after learning more about possible links to autism. "As a first-time parent, you really just go along with what the doctors tell you," says Showalter, whose first-born, Jacob, had all the standard vaccines. "Your baby is 2 days old, and the doctor wants to give him a shot, and you don't know any better, so you say yes." With Justin, Showalter went through Sears' book, making notes in the margins and picking out what she felt were "common diseases." She eventually came up with her own vaccination timetable, calling the process "empowering."
Rebecca Estepp, an activist with Talk About Curing Autism, a national organization that offers support and information to families, believes Sears' approach "makes far more sense than the CDC schedule." Her 14-year-old son, Eric, was diagnosed with autism at age 3, and she believes a Hepatitis B vaccine was the cause. "[Sears] spent a lot of time thinking about how to prevent infectious diseases while not creating chronic ones at the same time," says Estepp, who moved from Aliso Viejo to San Diego. "Vaccines should be a risk-benefit analysis." (Sears contends that there is no scientific proof that vaccines trigger autism, but he is pushing for more large-scale research to be done.)
Dr. David Nunez, family-health medical director of the Orange County Health Care Agency, emphasizes that low vaccination rates put the community at risk for outbreaks of vaccine-preventable diseases. According to the California Department of Public Health, more than 9,000 cases of pertussis, also known as whooping cough, were reported in California in 2010. (See "Host Bodies" for more information about OC parents in a cluster of South County schools who are choosing to not vaccinate their kids.)
"Providers should not be advocating for delayed vaccines as a matter of practice," Nunez says. "The research shows us that vaccines are safe and that there's no evidence the number or the schedule of vaccines overwhelms the immune system. Many of the vaccine-preventable diseases have the potential to cause severe illness or death for infants."
Sears doesn't see a problem. At least not immediately. "Right now, enough people are vaccinating that the herd immunity of our nation is not being compromised yet," he says.
He continues to be an advocate for parents who want choices, and at the moment, that includes fighting against Assembly Bill 2109, which would require parents to obtain a doctor's signature before they can enroll ther child in public school if they wish to skip one or more vaccines. Authored by Dr. Richard Pan (D-Sacramento) and supported by the California Medical Association, the bill was passed by the state House in a majority vote and is currently being discussed by the Senate Health Committee. "We're giving doctors too much power," Sears says. In the next five or 10 years, what else are parents going to need their doctor's permission for? This sets a dangerous precedent." As of press time, the bill is in the Senate.
Sears does emphasize that from a public-health standpoint, vaccinating is "clearly in everyone's best interest." He offers a quote from Star Trek to further the point: "The needs of the many outweigh the needs of the few . . . or the one."
But most parents aren't Spock. Most parents simply want to be protectors.
"You can argue with these parents that the decision they're making to not vaccinate is bad for public health, but most parents are trying to make a medical decision that's best for their baby," Sears says. "I think we're all selfish when making any decision for our own children. I can't fault parents for thinking that way."
This article appeared in print as "The Needle Doctor: OC's Dr. Robert Sears, author of The Vaccine Book, finds the middle ground in America's war on vaccinations."