Anti-vaccine folks who are talking about “standard of care” when deciding who gets a medical exemption for vaccines obviously don’t really understand what it means.
Why are these advocating against keeping kids protected against life-threatening vaccine-preventable diseases?
Maybe that’s why they put standard of care in quotes in the above infographic against SB276, a new vaccine bill in California that will eliminate fake vaccine exemptions.
What Is Standard of Care?
When we talk about standard of care in medicine, it is important to understand that it is a legal term, with a legal definition:
“That which a minimally competent physician in the same field would do under similar circumstances”
Moffett et al on The Standard of Care: Legal History and Definitions: the Bad and Good News
“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.
These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.
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.
Why would anyone go visit a new doctor just to get their child a medical exemption for vaccines?
A medical exemption should be for kids who can’t be vaccinated, not just because you don’t want your child to be vaccinated.
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.
It’s amazing that they didn’t know their child needed a medical exemption until they went to see Dr. Stoller…
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
It is well known that there are doctors in California writing fake medical exemptions for kids so that they can avoid getting vaccinated and protected.
Tara Zandvliet isn’t the only one writing a lot of medical exemptions for vaccines.
Just who these doctors are is probabaly a bit of a mystery to a lot of people.
Who Is Kenneth Stoller?
In addition to Tara Zandvliet in San Diego, Kenneth Stoller has been writing a lot of medical exemptions for kids in California.
Did Kenneth Stoller get referrals for medical exemptions through anti-vaccine groups on Facebook?
In fact, he has been writing so many that he got the attention of the City Attorney in San Francisco, who is investigating “whether the San Francisco doctor has been unlawfully providing medical exemptions that allowed parents to avoid vaccinating their children, which would put those children, their playmates, their schoolmates, and the general public at greater risk of contracting a communicable disease.”
In a response to this investigation, which includes a subpoena for his medical records, Ken Stoller admits that he “issues exemptions based on considerations not listed as CDC contraindications and precaution.”
“In conclusion, the invalid interpretation that the determination of the MTFHR variant is an acceptable reason for vaccine exemptionsis not based on the precepts of replication and rigorous clinical testing. It is unfortunate that the loose application of our exploratory report has been misinterpreted and used to inappropriately justify exemption of children from medically indicated vaccines.”
David M Reif, Ph.D. on the Inappropriate Citation of Vaccine Article
Since the CDC list of contraindications and precautions is what most people consider the standard of care for a medical exemption, it is a little hard to understand what his defense will be? It isn’t the continued use of MTHFR testing, is it?
“There is no published information as of yet as to how many of the 10 measles cases in children were the wild measles strain, (i.e., unvaccinated children, versus children who contracted symptoms from the vaccine, like the 38% in the Disneyland outbreak), or how many were vaccinated and contracted wild measles due to primary vaccine failure, which may be 10% or more.”
Complaint/verified Petition to Quash an Administrative Subpoena,for Declaratory and Injunctive relief against the Subpoena and in Support of an Alternative Standard of Vaccine Exemptions Recognized Under California Law
This is not vaccine strain measles, an idea that anti-vaccine folks continue to push to scare parents away from vaccinating and protecting their kids.
Although some vaccine strains were detected in 2015, they were not in people who actually had measles.
“During measles outbreaks, it is important to be able to rapidly distinguish between measles cases and vaccine reactions to avoid unnecessary outbreak response measures such as case isolation and contact investigations.”
Roy et al on Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR
They are people with a febrile rash illness. The rash and fever is a vaccine side effect. It is not vaccine-associated measles.
And primary vaccine failure is not very common at all, which is why most cases are in those who are unvaccinated.
Kenneth Stoller on Vaccines and Autism
What else does Dr. Stoller believe?
“For many children, the enviornmental illness that we have incorrectly been calling autism, is actually an illness that has been exacerbated by too many toxic vaccines. Contrary to popular belief, there are plenty of people in governmental circles who know that certain vaccine ingredients, such as ethyl mercury, found in the perservative thimerosal, will cause neurobehavioral problems and negatively impact the health of vaccinated children.”
While SB 277 did indeed remove all non-medical exemptions to getting vaccinated, some folks found a way around it. Since 2015, when it passed, some doctors are giving kids fake or unnecessary medical exemptions. These extra medical exemptions are likely making up for their previous personal belief vaccine exemptions.
The result?
It isn’t fewer exemptions since 2015.
Explain to me how it is ethical to misrepresent the rates of medical exemptions during a measles outbreak?
In addition to the 0.9% of medical exemptions, another 1.5% of kids, also up as a percentage, are unvaccinated “for other reasons specified under SB 277.”
There are also about 1.7% of kids in kindergarten who enroll as conditional entrants.
Why is that important? Among those conditional entrants are kids with temporary medical exemptions.
And how many kids aren’t vaccinated simply because they are “receiving IEP services?”
So it is not only wrong, it is unethical to try and say that only 0.9% of kids have vaccine exemptions in California this year.
Update on Vaccine Exemption Rates in California’s Clusters
Still, the big story continues to be what’s going on in the clusters of intentionally unvaccinated kids in California and other parts of the United States.
Are they getting vaccinated and protected under SB 277?
Wait, I thought Dr. Bob said that the vaccine exemption rate was just 0.9%. What happened at this Waldorf school? 30% of the kids have medical exemptions!
Some actually are!
The MMR rate at the Waldorf school in San Diego was just 44% back in 2014, as a whopping 56% of kids had a personal belief exemption. As sad as it sounds, even though it is still below herd immunity levels of protection, their current MMR vaccination rate of 68% is a big improvement!
Unfortunately, there are many schools with even lower immunization rates. And of course, that means even more students with “medical exemptions” at those schools.
School
PMEs
Marin Waldorf School
31%
Yuba River Charter
64%
Westside Waldorf School
37%
Sebastopol Independent Charter
45%
Muse Charter
50%
Live Oak Charter
41%
Nevada City School of Arts
31%
Sunridge Charter
47%
Santa Cruz Waldorf School
34%
Cedar Springs Waldorf School
30%
Journey
33%
Waldorf School of Orange County
33%
Coastal Grove Charter
36%
Mariposa School of Global Ed
31%
Waldorf School of the Peninsula
36%
Maple Village Waldorf School
30%
In addition to these permanent medical exemptions (PMEs), some schools also have high rates of temporary medical exemptions.
Medical Exemptions for Vaccines in California are Unusually High
In one recent report, Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year, the median rate of medical exemptions in the U.S. was just 0.2%, with a range of <0.1 to 1.5%.
Also unusual is that in some cases, many of those exemptions are written by just a few doctors. In fact, families often go to these doctors just to get their kids their medical exemptions!
“…the removal of nonmedical exemptions in California was initially effective in increasing vaccination rates, but the substitution between exemption types may render the repeal partially ineffective in improving immunization coverage and preventing VPDs over time.”
Richwine et al on Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-medical Exemptions for School Mandated Vaccines
How do we fix this and get more kids vaccinated and protected?
“Beyond fostering compliance, tightening the requirements around medical waivers will also aid in promoting public policies that protect public health.”
Richwine et al on Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-medical Exemptions for School Mandated Vaccines
In addition to closing the loopholes that allow some doctors to abuse medical exemptions, it will be important to help parents be more skeptical and see through the anti-vaccine propaganda that other doctors use to scare parents away from vaccinating and protecting their kids.
