Tag: Melissa Floyd

Have Doctors in California Stopped Writing Medical Exemptions?

A new law in California, SB276, is getting closer to being passed, and it will help stop doctors that are writing inappropriate medical exemptions.

So why do some folks think that other doctors have stopped writing medical exemptions, even for those children who really need them?

This is not proof that doctors have stopped writing medical exemptions.

Oh, because the usual suspects are telling them that…

Have Doctors in California Stopped Writing Medical Exemptions?

The proof that Bob Sears is pushing?

Recordings of folks who called doctors, saying they recently moved to California and need a medical exemption because their child is reportedly unvaccinated after an anaphylactic reaction.

So some doctors are writing multiple inappropriate exemptions because others stopped writing true medical exemptions?
So some doctors are writing multiple inappropriate exemptions because others stopped writing true medical exemptions?

As you can imagine, this is hardly proof of anything…

For one thing, with the passage of SB 277, many parents have been searching for “vaccine-flexible” pediatricians to write medical exemptions in California, as that law eliminated non-medical exemptions.

Imagine the luck, a doctor finding medical exemptions that you didn't know that your child had!
Imagine the luck, a doctor finding medical exemptions that you didn’t know that your child had!

That likely has offices on high alert for parents whose kids do not have true medical exemptions.

“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

And although very rare, an anaphylactic reaction would certainly be a reason to get a medical exemption. It would typically only be an exemption to the vaccine that your child had the reaction to though.

“My son hadn’t been vaccinated since 12 months because he had an anaphylactic reaction and we had a personal belief exemption where we used to live.”

But why didn’t they have a medical exemption where they used to live?

And why did they stop vaccinating at 12 months?

Most importantly, if doctors in California stopped writing true medical exemptions for their patients, why is the statewide medical exemption rate at almost 1%?

So no, a video of a gotcha type phone call, even if it really was to 882 doctors in California, isn’t proof of anything, except what you can expect from the modern anti-vaccine movement.

More on Doctors Writing Medical Exemptions in California

Did the AAP Say That Vaccines Cause Severe Brain Injury?

Bob Sears is telling folks that the American Academy of Pediatrics says severe brain injuries are caused by vaccines.

Bob Sears doesn't mention that measles is much more likely to cause severe brain injury and death, or more recent studies that counter his post.
Bob Sears doesn’t mention that measles is much more likely to cause severe brain injury and death, or more recent studies that counter his post.

Did the AAP say that?

“A causal relationship they say.”

Bob Sears

No, they didn’t.

The researchers in Pediatrics didn’t even say that…

Did the AAP Say That Vaccines Cause Severe Brain Injury?

What did they say?

“This clustering suggests that a causal relationship between measles vaccine and encephalopathy may exist as a rare complication of measles immunization.”

Weibel et al on Acute Encephalopathy Followed by Permanent Brain Injury or Death Associated With Further Attenuated Measles Vaccines: A Review of Claims Submitted to the National Vaccine Injury Compensation Program

The study was about reports to VAERS

Over 23 years, the researchers (in 1998) found reports of 48 cases of acute encephalopathy among about 75,000,000 children who were vaccinated, some clustered in the second week after they received a measles containing vaccine.

Does that mean that those measles containing vaccines caused the encephalopathy?

“In the absence of a specific test to determine vaccine causation, these 48 cases may include some nonvaccine cases representing background rates.”

Weibel et al on Acute Encephalopathy Followed by Permanent Brain Injury or Death Associated With Further Attenuated Measles Vaccines: A Review of Claims Submitted to the National Vaccine Injury Compensation Program

No, it doesn’t.

It was a signal that got some attention though.

And as it has been further investigated, there has been no evidence that measles containing vaccines cause encephalitis, at least not above 1 in a million background rates.

What does cause encephalitis?

“About 1 child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability.”

Complications of Measles

Measles.

Measles, a life-threatening vaccine-preventable disease, causes encephalitis.

Are your kids vaccinated and protected with two doses of MMR?

More on Vaccines and Severe Brain Injury

Vaccine Misinformation from Bob Sears is Not Harmless

The latest from Bob Sears helps illustrate exactly why his vaccine misinformation is far from harmless.

Misinformation about febrile seizures from Bob Sears.
Misinformation about febrile seizures from Bob Sears. He neglects to mention that if fewer kids are vaccinated, more will get vaccine-preventable diseases that actually cause febrile seizures!

What’s he talking about?

Vaccine Misinformation from Bob Sears is Not Harmless

He is talking about a study, Childhood seizures and risk of psychiatric disorders in adolescence and early adulthood: a Danish nationwide cohort study, which looked at “the relation between childhood seizures and the risk of psychiatric disorders in adolescence and early adulthood.”

Wait, so this isn’t a study about vaccines?

No, not directly.

“Children with epilepsy and febrile seizures—with and without concomitant epilepsy—are at increased risk of developing a broad range of psychiatric disorders in later life.”

Dreier et al on Childhood seizures and risk of psychiatric disorders in adolescence and early adulthood: a Danish nationwide cohort study

Vaccines come into the discussion because they are one of the causes of febrile seizures.

Kids are more likely to get a febrile seizure after a natural infection though, including many that are vaccine-preventable, such as the flu, measles, mumps, chicken pox, and pneumococcal disease, etc.

In fact, we have seen a protective effect against febrile seizures caused by rotavirus infections since the introduction of the rotavirus vaccine!

Bob Sears doesn’t mention any of that…

And whether or not febrile seizures can rarely be dangerous and cause long-term harm, we know that vaccine-preventable diseases are life-threatening and their complications can definitely cause long-term harm.

“In our study, we have shown that children with febrile seizures do seem to be at slightly higher risk of developing psychiatric disorders as teenagers and young adults, even in the absence of subsequent epilepsy… We noted that the association with mental illness was strongest in individuals with recurrent febrile seizures and with onset of febrile seizures after the age of 3 years.”

Dreier et al on Childhood seizures and risk of psychiatric disorders in adolescence and early adulthood: a Danish nationwide cohort study

Bob Sears also doesn’t mention that the small extra risk was mostly in kids with complex febrile seizures, which aren’t as common as the single, simple febrile seizures that most kids get.

Not surprisingly, Bob Sears also doesn’t mention that vaccines typically cause simple febrile seizures.

Misinformation is Not Harmless

The bottom line is that you should be more worried about anti-vaccine misinformation than febrile seizures…

Instead of being worried about your child getting a febrile seizure after the MMR vaccine, you should be even more concerned about febrile seizures, epilepsy, encephalitis, SSPE, and death after a natural measles infection.

Anti-vaccine misinformation is not harmless.

If you knew that skipping or delaying your child’s vaccines could put them at increased risk to get a vaccine-preventable disease and THAT would increase your child’s risk of febrile seizures and a host of lifelong mental health disorders, would you have wanted your doctor to warn you about that risk?

“This means for the average pediatrician, who may care for 1000 children younger than 5 including 3 to 500 between 6 and 24 months of age annually, one could expect to see at most 1 child who experiences a febrile seizure every 5 to 10 years due to administration of these vaccines together in the first 2 years of life. This would be in addition to the 30 to 75 patients in each birth year cohort in a practice that would experience a febrile seizure from other causes given the background rate of 2% to 5%.”

Sawyer et al on Vaccines and Febrile Seizures: Quantifying the Risk

Learn about the true risks of vaccines and vaccine-preventable diseases, the benefits of vaccines, and the risks of skipping or delaying any vaccines as you make a truly informed choice about vaccinating and protecting your kids.

More on Vaccine Misinformation from Bob Sears is Not Harmless

Does the CDC Determine Medical Exemptions for Vaccines?

California’s new vaccine law has some folks arguing about medical exemptions again.

Yes, the CDC does not determine medical exemptions for vaccines. That's not news.
Yes, the CDC does not determine medical exemptions for vaccines. That’s not news.

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!

You can be sure that the "medical provider's prerogative" does not include any reason they think up, even those that have no evidence to back them up.
You can be sure that the “medical provider’s prerogative” does not include any reason they think up, even those that have no evidence to back them up.

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.”

What is an Exemption and What Does it Mean?

Medical exemptions for vaccines should be based on AAP and ACIP guidelines, current accepted medical practice, and evidence based medicine.

“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.

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.
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.

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.

There are very few family history issues that would make a child have to skip or delay getting a vaccine.
There are very few family history issues that would make a child have to skip or delay getting a vaccine.

They should rarely be done based on family history of reactions or what some people think are vaccine reactions.

This is what a fake medical exemption will get you - a life-threatening disease.
The child’s medical exemption was for “cytotoxic allergies secondary to immunization,” without any evidence that it was necessary. In addition to a fake medical exemption, he got tetanus.

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

And why you shouldn’t have schools with high rates of medical exemptions or doctors writing a lot of medical exemptions.

More on Vaccine Medical Exemption Guidelines