If You Like Your Doctor’s Advice, You Can Keep Your Doctor’s Advice: A New State Challenge to “Medical Judgment” (Tim Kowal, New Reform Club)

In 2014, Dr. Bob Sears wrote an exemption for a two-year-old who suffered adverse reactions to prior immunizations. Sears is an outspoken supporter of both vaccines and vaccine choice. He is respected by opponents of SB277 for his even-handedness on the fraught subject. The California Medical Board is now accusing Sears of “gross negligence” related to the 2014 exemption. The Board alleges Sears failed to get written medical history concerning the child’s prior adverse reactions.* “If the board finds Sears negligent,” the Orange County Register reports, “he could face discipline ranging from a public reprimand to revocation of his medical license.”

On the one hand, you have to have a rearguard against circumventing the law. This strikes me as analogous to cracking down on Dr Feelgoods more recently physicians who make bank with medicinal marijuana cards. This one, though, is (a) more tied into the public health since we’re dealing with contagious stuff, and (b) the subject of a much greater ideological battle (as opposed to simple profit, as is the case with the drug docs).

That second one kind of cuts both ways, though…

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6 Responses to This Is A Tough One

  1. Road Scholar says:

    The problem with the “patient choice” standard is that, in this case, it isn’t the actual patient making the choice, but rather the parents. This can also amount to making the “choice” for unrelated individuals such as folks who have genuine medical issues such as severe allergic reactions or compromised immune systems.

    It’s unclear to me how having a choice forced onto you by the state is intrinsically worse than having the opposite choice forced upon you by your neighbors.

    • trumwill says:

      The contagious factor does weigh somewhat heavily. The parent vs patient thing less so.

      But with required immunizations comes the need of somebody to make the call on whether there is a medical exemption. I am wary of a situation where doctors might be putting their licensure on the line for granting one. That’s not something I want the doctor thinking about with my kid, to say the least.

      Sears himself is a favorite of the anti-vaccination and the anti-mandatory folks. Which itself cuts both ways. There are accusations that his bread is buttered by the anti-vax folks. But it also may be a case of professional retribution for having an unpopular approach to vaccinations (letting parents delay them).

      • Road Scholar says:

        The patient vs parent angle seems roughly equivalent to failing to use an approved child safety seat in a car. Basically negligence IMO, so I guess it depends on how much latitude you feel parents should have in that regard.

  2. I’d add ( c ) to your list above: We’re talking about exempting patients otherwise required to do something whereas with the Dr. Feelgoods we’re talking about preventing patients from doing something (abusing drugs). In each case, the doctor is the agent, but in the first he/she is exempting someone from having to do something while in the second he/she is granting a special privilege to do something. (You touch on that, of course, in the OP and especially in your response to Road Scholar.)

    Compulsory vaccination is one of those mandates where we require people to subject their bodies or their children’s bodies to a procedure in the name of serving the common good. In my opinion, there’s always something at least a little illegitimate about that. But all said–and however uneasy I might feel–I do support making vaccines compulsory.

    • trumwill says:

      For MMR, I support mandatory vaccines with as many outs as can be afforded to maintain herd immunity. If too many people are taking advantage of the exemptions, then you need to crack down. It’s entirely possible that California needed to. On the other hand, Texas has historically generous exemptions and high vaccination rates, so no action is really necessary.

      More broadly, though, there are reasons for concern. Not every vaccination is like MMR with its track record of safety and effectiveness. It makes for some difficult calls.

      And loathe as many people seem to be to admit it, we want people to do it willingly. That’s why I prefer exemptions where we can afford them. Literally forcing them to do it against their objections creates trust issues, which has ramifications.

      I want every politician, health expert, and celebrity out there encouraging people to have their kids vaccination. Among other things, it helps avoid the necessity of laws! But I was disheartened early in the primary when people who talked about competing interests and allowed for parental skepticism of vaccinations were put in the same bucket as those actively fearmongering them.

      To summarize, mandatory-mandatory (as opposed to mandatory-with-exemptions) is a heavy hammer. We need to wave it very judiciously.

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