Chiropractic Assoc. at odds with other medical groups in opposing vaccination bill

The California Chiropractic Association opposes SB 277, a bill that would eliminate personal and religious exemptions that parents currently use to opt out of vaccinations for their children, like this one for whooping cough.
The California Chiropractic Association opposes SB 277, a bill that would eliminate personal and religious exemptions that parents currently use to opt out of vaccinations for their children, like this one for whooping cough.
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The California Chiropractic Association has pulled away from the herd of other medical trade groups to oppose a bill that would require all children entering daycare or school to be vaccinated unless they have a medical exemption. 

Almost every major medical group in the state - including the California Medical Association, the American Academy of Pediatrics California, the American Nurses Association California and the California Association of Nurse Practitioners  - is backing SB 277, authored by Sens. Richard Pan (D-Sacramento) and Ben Allen (D-Santa Monica).

SB 277 would eliminate the Personal Belief Exemption, which provides the option of not vaccinating children because of the parents' personal or religious beliefs.

The Chiropractic Association opposes the bill because it would take away parents' ability to choose whether to vaccinate their kids, said the group's president, Brian Stenzler.

"It takes away...informed consent"

"It takes away a very important aspect of [the] doctor patient relationship, and that’s called informed consent," Stenzler asserted. "Every single patient before receiving any type of medical or health care procedure is supposed to sign off on informed consent, basically stating they understand the potential risks of that medical procedure."

The chiropractic group's opposition to the bill should not be considered "anti-vaccine" or "anti-science," maintained Stenzler. He said the organization does not have a position on vaccines and that he is not qualified to weigh in on the science regarding immunization. For him, what’s most important is preserving parents’ right to opt out of vaccinating their kids.

The Chiropractic Association’s position regarding choice is based on the fact that there is a risk  - a small one according to experts in the field - of adverse reactions from vaccines.

"There are potential side effects and there are potential risks, then ultimately there has to be that choice for parents to make," Stenzler maintained. "And for somebody to say that somebody that is not wanting to give a certain vaccine to their child is anti-science, that person themselves is anti-science because it is obvious that some people do have bad reactions to a vaccination."

Adverse reactions to the measles, mumps and rubella (MMR) vaccine can range from a fever (occurring in up to one person in six) to short-term seizures (about one in 3,000), according to the Centers for Disease Control and Prevention, which adds that more severe problems such as coma or brain damage "are so rare that it is hard to tell whether they are caused by the vaccine."

Backers of SB 277 point out that the risk of "severe complications" for people who catch the measles is one in 20, according to the CDC. Pneumonia is the most common of these complications.

Stenzler points to a one-year old law, also authored by Sen. Pan, that requires parents to consult with a doctor before opting out of vaccines. Some believe that bill is at least partly responsible for a decrease in the number of personal belief exemptions; Stenzler said that it should be allowed to continue to work before a newer, more aggressive law is instituted.

At odds with a public health expert

The Chiropractic Association's position puts it at odds with public health experts who back SB 277, such as Dr. Jonathan Fielding, the former director of the Los Angeles County Department of Public Health and now a professor of health policy, management and pediatrics at the UCLA Fielding School of Public Health and the Geffen School of Medicine.

In an interview with KPCC, Fielding declined to discuss why he thinks the chiropractic group is opposing the bill, but he said he disagrees with the argument that the bill is harmful because it puts broader public health goals ahead of individuals' personal choice. 

"In this balance of what’s important for the public, for all the kids, versus one individual child, I think [the bill has struck] the right balance," said Fielding. "If you look at other things we do, we ask people to wear seat belts, we don’t let people drive drunk even though they might want to, because they are going to affect the public, they are going to affect others."

Bill Meeker, President of Palmer Chiropractic College and former director of its Chiropractic Research Center in San Jose, said the Chiropractic Association's position is grounded in the idea that chiropractors put their patients first. 

But as someone who is also a member of the American Public Health Association, Meeker said he understands the conflict over SB 277.

"Perspectives collide"

"There is a distinction between population health and individual clinical care and sometimes these perspectives collide," Meeker said. "If you are a population epidemiologist it’s very easy to say, 'Oh my god, we need to do these sorts of things in order to protect the population at large against this disease or problem.' The individual clinician, however, comes from the perspective [of asking] what is the best thing for this individual who sits staring me in the face at this particular moment?"

Sens. Pan and Allen floated SB 277 after the measles outbreak that began at Disneyland highlighted how many kids in the state are lacking vaccines.

The California Department of Public Health reports that 2.5 percent of California kindergartners were attending school with personal belief exemptions in the fall and 90 percent had all of their required vaccinations. The Department says .2 percent of kindergartners in the fall were on a medical exemption.

If the bill is approved, incoming students who are not vaccinated will not be allowed to attend daycare, preschool, public or private schools. SB 277's authors made an exception for home-schoolers after parents challenged the bill.

A dustup with the California Medical Association

The fight over the bill has led to a dustup between the chiropractic group and the powerful California Medical Association. 

The Medical Association recently accused the Chiropractic Association of encouraging opponents of SB 277 to stalk Medical Association lobbyists and staff. 

Stenzler said the accusations are false and that his comments - in which he said to "follow the money" - were taken out of context.  He outlined his position in a letter to the Medical Association. Since then, Stenzler added, he has received death threats and has deactivated his Twitter account.

The Medical Association declined to discuss the matter for this story.

Stenzler defended the recent decision of Life Chiropractic College West in Hayward to invite discredited  vaccination opponent Andrew Wakefield to speak against SB 277.  In 1998 Wakefield published a study claiming the MMR vaccine might be a cause of autism. The study was retracted and Britian banned Wakefield from practicing medicine.

The college's students have a right to listen to a diverse set of lecturers and make their own decisions, said Stenzler.

The "shouting...will die down" 

The chasm between the Chiropractic Association and other medical groups over SB 277 comes after decades of work by leaders in the field to be considered on a par with other health care professionals. Historically, chiropractors were seen as practicing alternative medicine. In the last three decades the field has become more widely accepted as a mainstream provider of spinal care.

Meeker, who has studied the field’s move to the mainstream, said the debate over SB 277 will have little impact on the industry's reputation.  

"The sound of the shouting right now on this bill in California will die down one way or the other," he said. "It's not going to change significantly the direction of the profession or our ability to become a bigger part of the mainstream health care delivery systems."

He pointed out that chiropractors are in-house staff at many companies and government health care facilities, including Veterans Administration hospitals. 

The Chiropractic Association is not the only medical group that is opposing SB 277, but it is the most well-known.  Two other organizations are working to defeat the bill: the Association of American Physicians and Surgeons, an ultra-conservative group; and California Nurses for Ethical Standards, an anti-abortion nurses association.