“Treatment that is accepted by medical experts as a proper treatment for a certain type of disease and that is widely used by healthcare professionals. Also called best practice, standard medical care, and standard therapy.”
NCI Dictionary of Cancer Terms
Just because a few doctors do something a certain way, that doesn’t make it the proper way for it to be done.
And that’s why a doctor making up their own rules for what counts as a vaccine medical exemption, especially when it goes against published guidelines and advice, isn’t standard of care.
Some want very broad guidelines and are confused about how doctors determine who should get a medical exemption.
Does the CDC Determine Medical Exemptions for Vaccines?
Bob Sears even thinks he has a bombshell revelation that clears everything up.
An email from the CDC!
The thing is, no one has ever said that ACIP contraindications and precautions to vaccination are the one and only factor that should determine whether or not a child should get a medical exemption.
“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”
Dear Colleague letter regarding guidelines for use of immunization exemptions
So no one should really be surprised by an email that says the CDC does not determine medical exemptions.
What Qualifies as a Vaccine Medical Exemption?
What are the other big factors, in addition to ACIP contraindications and precautions?
“A medical exemption is allowed when a child has a medical condition that prevents them from receiving a vaccine.”
“Medical exemptions are intended to prevent adverse events in children who are at increased risk of adverse events because of underlying conditions. Many of these underlying conditions also place children at increased risk of complications from infectious diseases. Children with valid medical exemptions need to be protected from exposure to vaccine-preventable diseases by insuring high coverage rates among the rest of the population. Granting medical exemptions for invalid medical contraindications may promote unfounded vaccine safety concerns. Although states may wish to allow parents who make decisions based on poor science or perceptions to withhold vaccines from their children, these exemptions should be distinguished from valid medical exemptions.”
Salmon et al on Keeping the M in Medical Exemptions: Protecting Our Most Vulnerable Children
For example, in addition to kids who may have had a severe allergic reaction to a vaccine, there are often children with immune system problems or who have a moderate or severe illness who can’t get one or more vaccines, at least temporarily.
Medical exemptions for vaccines should not be based on anecdotes or simply because a vaccine-friendly doctor has scared a parent away from vaccinating and protecting their kids.
In general, they should rarely be given, as the AAP states in their policy statement, Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance, “only a very small proportion of children have medical conditions prohibiting specific immunizations…”
That’s why rates of medical exemptions should be low.
“Between the 2009-2010 and 2016-2017 school years, the national median prevalence of medical exemptions has remained constant, between 0.2% to 0.3%, with state-level ranges showing little heterogeneity over time, never exceeding the range of 0.1% to 1.6% over this period.”
Bednarczyk et al on Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes
Why would anyone go visit a new doctor just to get their child a medical exemption for vaccines?
Shouldn’t they just get the medical exemption from their regular pediatrician?
Who Should Write Your Child’s Medical Exemption for Vaccines?
As lawmakers in California debate passage of a new vaccine bill, SB276, which would put help stop doctors from writing fraudulent medical exemptions, we are learning more and more about what are thought to be fake MEs and the doctors who write them.
“The exemption practices of three doctors in the records have already come under investigation by California authorities, and many are on lists of “vaccine-flexible” pediatricians circulated online by anti-vaccine parents. Three exemptions were signed by a doctor in New Jersey, and a fourth by one in Florida.”
California’s vaccine battle: Here are the doctors behind Bay Area students’ medical exemptions
One of these doctors practices at an anti-aging clinic, so it doesn’t seem like they are the regular primary-care physicians for these kids getting exemptions.
“SB277 did not substantially change the granting of medical exemptions by physicians, which expected and anticipated that each child would be evaluated by a physician who regularly cared for that child and receiving the exemption applying the standard of care.
Instead, after passage of SB277, we witnessed physicians who advertised exemptions for cash on social media and the internet. Some parents posted that their child’s physician refused to grant their child a medical exemption, so they bought one from a distant physician.”
Richard Pan SB 276 Assembly Health Committee Testimony
And that’s why a state without non-medical exemptions continues to have schools with fewer than 50% of the kids vaccinated.
Doctors who think that they are “vaccine experts” are granting kids medical exemptions because they think that everything is a vaccine injury. Or that a family history of something that they think is a vaccine injury qualifies a child for a medical exemption.
“I’ll tell you what I do personally is I charge the same amount of money for a patient who I see for a medical exemption as I do for new patients coming in to me for a check up or a consultation. I don’t charge any more. In fact, my medical exemption appointments are actually two appointments. I don’t make any more money from medical exemption appointments as anything else.”
Bob Sears SB 276 Assembly Health Committee Testimony
Most of us don’t make any money from medical exemption appointments…
“And just to follow up – is there some other… back to the idea of a specialist in this. Could there be some other standard in which a specialist could do more of these?”
Chad Mayes SB 276 Assembly Health Committee Testimony
There are certainly situations in which a specialist will be the one writing the medical exemption.
Is your child getting chemotherapy for ALL? Then his oncologist might be the one to write the exemption.
Did your infant get immunoglobulin to treat Kawasaki disease? Then her cardiologist might write a temporary medical exemption for live vaccines.
Does your child have infantile spasms? Then his neurologist might write a temporary medical exemption for DTaP.
Why Are Medical Exemption Visits a Thing?
In most situations though, it would be your pediatrician who would write the exemption.
“When we passed SB 277, again as we mentioned, we didn’t really touch the medical exemption, but what our expectation was is that it’s going to be your child’s regular doctor who knows the child granting them… And what we’re seeing is that actually we have physicians… who are not really the primary care doctor.
I mean I find this idea of having medical exemption visits kind of intriguing because you shouldn’t really have medical exemption visits. Either you’re the doctor or you’re not. If you’re the doctor you should take care of them. You have that relationship and if they have an issue with vaccines, you write them the exemption.
That’s it. That’s what’s supposed to normally happen. People shouldn’t be going out finding other doctors for exemptions. If you happen to see a specialist, and they think you can’t get vaccinated safely, then they either submit the exemption or they tell your primary care doctor, by the way, that child should not get vaccinated, we should get an exemption. That’s how it should normally work.”
Richard Pan SB 276 Assembly Health Committee Testimony
Of course, medical exemptions to get vaccines are not very common though. If your pediatrician refuses to give your child a medical exemption, it is likely because they don’t need one.
Remember, medical exemptions for vaccines should be for kids who can’t be vaccinated, not just because you’re scared or don’t want your child to be vaccinated.
More on Doctors Writing Medical Exemptions for Vaccines
Even with all of the so-called vaccine-induced diseases that anti-vaccine folks come up with, few people likely think that vaccines cause psoriasis.
Some do though…
Do Vaccines Cause Psoriasis?
Bob Sears thinks that these kids shouldn’t be vaccinated because “vaccines can trigger psoriasis or make existing psoriasis worse.”
He even provided a list of studies that he thinks support his case.
“Nevertheless, the likely very low incidence of psoriasis following vaccination emphasizes the safe profile and the relevance of vaccination strategies in psoriasis patients, especially in candidates for immunosuppressive treatments.”
Sbidian et al on National survey of psoriasis flares after 2009 monovalent H1N1/seasonal vaccines.
“The risk of psoriasis was also increased in subjects who reported a history of a recent infectious episode. The analysis by individual diagnosis pointed to acute pharyngitis as the disease with the strongest association and the only one providing statistically significant results…”
Naldi et al on Family history of psoriasis, stressful life events, and recent infectious disease are risk factors for a first episode of acute guttate psoriasis: results of a case-control study
Psoriatic skin lesions induced by BCG vaccination – a case report of a 6-month-old who developed a BCG-induced tuberculid-like eruption accompanied by psoriatic skin changes one month after vaccination. They went away without treatment within 3 months.
So, none of Bob’s studies were in children, they are mostly about flu shots and the BCG vaccine (which isn’t used in the United States), they are mostly case reports (low on the hierarchy of evidence), and a few don’t mention vaccines…
And most aren’t about chronic psoriasis!
Explaining the Correlation of Psoriasis After Vaccines
Is there anything that might explain the case reports that do show an association between vaccines and psoriasis flares?
“Psoriasis can appear in areas of the skin that have been injured or traumatized. This is called the Koebner [KEB-ner] phenomenon. Vaccinations, sunburns and scratches can all trigger a Koebner response. The Koebner phenomenon can be treated if it is caught early enough.”
National Psoriasis Association on Causes and Triggers
Experts also talk about Th1- and Th17-predominant immunologic responses of flu shots and the BCG vaccine’s Th17 activity. It is known that Th17 cells play a role in psoriasis.
Are there any other studies about vaccines and psoriasis that Dr. Bob left out?
Vaccinations in patients with immune-mediated inflammatory diseases – is very clear that the “Clinical evidence indicates that immunization of IMID patients does not increase clinical or laboratory parameters of disease activity. Live vaccines are contraindicated in immunocompromized individuals, but non-live vaccines can safely be given.”
The bottom line is that experts that treat people with psoriasis recommend that they be fully vaccinated.
“Psoriasis is a treatable, chronic dermatosis. The very low absolute risk of new-onset or relapsed psoriasis following influenza vaccination should not change its universal recommendation, particularly for patients with psoriasis on immunosuppressive therapy. We present this case to highlight clinical manifestations of this rare association.”
Shi et al on Widespread psoriasis flare following influenza vaccination
There is even talk of development of a vaccine to treat psoriasis!
It should be clear that neither psoriasis nor a family history of psoriasis should be a reason to get a medical exemption for vaccines.