I didn’t post anything yesterday because, for whatever reason, I was beat on Monday night. So I missed discussing a study released on Monday that made the news. However, better late than never, right? In any event, a very frequent topic on this blog in 2015 was SB 277, the law passed in California that eliminates nonmedical so-called “personal belief exemptions” (PBEs) to school vaccine mandates. After SB 277, nonmedical exemptions were no longer allowed in California. The law was basically fallout from the Disneyland measles outbreak. The outbreak began over the Christmas holidays of 2014 and continued for several months into 2015, ultimately spanning eight states and two additional countries (Canada and Mexico). Because of where it happened and how many states it encompassed, the Disneyland measles outbreak made it politically possible for California legislators to do something that would definitely not have been possible before the outbreak: Pass a law outlawing PBEs. Prior to the outbreak, only two states (Mississippi and West Virginia) allowed only medical exemptions, while the other 48 states allowed some combination of religious or personal belief exemptions (PBEs, or, as I like to call them, “I don’t wanna” exemptions), As I’ve said many times before, California was the last state I would have every predicted to pass law to become like Mississippi or West Virginia, and I was happy to be mistaken about this. Co-sponsored by Senators Richard Pan and Ben Allen, SB 277 was approved by the California legislature in June 2015 and signed into law by Governor Jerry Brown on June 30, 2015, taking full effect at the beginning of the 2016-2017 school year.
The intent of SB 277 was to decrease the nonmedical exemption rate and thereby increase vaccine uptake. This was a goal that had been perceived as critical in the years leading up to the passage of SB 277 because there were pockets of low uptake that were leading to outbreaks, an observation that led me to predict in 2009 and 2014 that when the next big outbreaks happen they’d happen in California. Unfortunately, the Disneyland measles outbreak proved me, if not right, at least definitely not wrong either. (Thanks to SB 277, my more recent prediction is that when the next big outbreaks occur they’ll happen in Texas, and California doesn’t even show up in a recent study looking at pockets of low uptake that would be most likely to lead to new outbreaks.) We also know from early data that SB 277 works. It almost immediately began to decrease nonmedical exemptions, as shown in figures from 2017, before the first year of its implementation had even ended. We also know, unfortunately, that the rate of medical exemptions was starting to tick upward at the time of the that study. Part, but not all, of that was probably due antivaccine pediatricians, family practitioners, and other doctors following a trail blazed by Dr. Bob Sears by selling medical exemptions based on non-evidence-based
What can we say now that California is into the third school year under SB 277? So how is SB 277 doing, two years later? In a study by Salini Mohanty et al, we find out. Basically, what Mohanty et al did was to describe the experiences of health officers and immunization staff in California in addressing medical exemption requests. They did this through 34 interviews with 40 health officers and immunization staff representing 35 of the 61 local health jurisdictions in California.
First, the authors note that in California:
Medical exemptions submitted to the school by a parent or guardian must meet certain criteria to be legally acceptable under California law, including the following: (1) a written statement signed by a licensed physician (MD or DO), (2) a statement that the child’s physical condition and/or medical circumstance is such that immunization is not considered safe, (3) an indication of which vaccines are being exempted, and (4) an indication of whether the exemption is permanent or temporary (with an expiration date if temporary). In Mississippi and West Virginia, a central or state-level review is required for all medical exemptions submitted by physicians. In contrast, California requires parents or guardians to submit medical exemptions directly to the schools.
This is, of course, the single biggest flau in SB 277. It doesn’t require any sort of review by a state health officer and allows the acceptance of a letter from any licensed physician. As a result, a cottage industry selling medical exemptions in California has sprung up, following a trail blazed by Dr. Bob Sears, who started giving paid seminars to parents on how to get around the requirements of SB 277 almost as soon as the bill was signed into law by Governor Jerry Brown. As a result, medical exemptions have increased. Some of that was probably due to parents whose children had been eligible for medical exemptions but just got PBEs because it’s easier to sign a form than to get a doctor to write them a letter, as noted by the authors:
In the 2 school years after the implementation of SB277, the proportion of kindergarten students reported to have received all required vaccines increased from 92.8% in 2015–2016 to 95.1% in 2017–2018, and the rates of personal belief exemptions (PBEs) have steadily declined since the 2013–2014 school year. However, the rates of medical exemptions in California after the passage of SB277 increased 250% (from 0.2% in 2015–2016 to 0.7% in 2017–2018).7 Counties that had high PBE rates before SB277 also had the largest increases in medical exemptions during the first year of SB277 implementation, leaving portions of California susceptible to vaccine-preventable outbreaks.8,9 Potential explanations for this steep increase include underuse of medical exemptions before SB277 (when PBEs could still be obtained) and the willingness of some physicians to write medical exemptions for parents who are vaccine hesitant whose children may lack scientifically justified medical contraindications as defined by the Advisory Committee on Immunization Practices. Previous studies have revealed that states that have more lenient immunization laws (permitting PBEs; easy to obtain exemptions) generally have higher nonmedical exemption and disease rates compared with states with stricter exemption laws. Moreover, there is considerable variability in the implementation and enforcement of exemption requirements among states.15 Importantly, easier processes for granting exemptions at the school-level is associated with the increased likelihood of a child having an exemption.
As I’ve documented, these bogus “medical exemptions” generally run parents between $100-$300 a pop, depending on the physician. A reader even sent me an example of just such a letter from Dr. Bob Sears that was obtained through an online application without the child even being seen.
The authors noted four main themes in their structured interviews: (1) the role of stakeholders, (2) reviewing medical exemptions received by schools, (3) medical exemptions that were perceived as problematic, and (4) frustrations and concerns over medical exemptions. As far as the role of the stakeholders, the physicians’ role was described as writing medical exemptions and having the authority and discretion to decide the reason for the medical exemption. The exemption is then submitted directly to the school, and the school staff reviews it on the basis of criteria in SB 277. If a discrepancy is noted, namely missing elements of the medical exemption, different methods were employed to address the discrepancy. These methods include reaching out to the local health department for guidance, reaching out to the parent, or occasionally contacting the physician. Unfortunately, the local health department has no authority to question the scientific validity of the medical exemption under California law. As a result, many of the participants want the California Medical Board to take a much more active role in disciplining physicians writing “problematic” medical exemptions. (Indeed, the Board did just that with Dr. Bob Sears.)
Basically, any licensed doctor can list any reason he or she wishes to in a medical exemption letter, and there’s nothing in SB 277 that lets health authorities deny it, an issue I’ve discussed before. Antivax groups maintain lists of “vaccine-friendly” doctors willing to write dubious medical exemptions, many of whom advertise on various antivaccine sites their willingness to write medical exemptions. Basically, as the study notes, all local jurisdictions can do is to verify whether the doctor is a DO or MD using a state database, reach out to the physician and/or parent, or, in extreme cases, report the doctor to the Medical Board of California.
As the authors note:
The most commonly reported conditions that participants described as suspicious were family history of allergies and family history of autoimmune disorders because these are not medical contraindications to immunization according to the Advisory Committee on Immunization Practices.10 However, participants did acknowledge that although they might not agree that these are scientifically valid contraindication to immunization, the regulatory language of SB277 does state that it is legally acceptable for a family medical history to be taken into consideration.4 Of greater concern were reports of physicians who advertised medical exemptions online for a fee. Examples that participants had encountered included a physician who charged a fee for watching a video on vaccines in exchange for a medical exemption and a physician who required and charged for medical tests of the child and family members to establish a family medical history. Participants also described receiving medical exemptions signed by physicians who do not typically treat children (cardiologists, dermatologists, surgeons, and physicians at medical marijuana dispensaries) and by unauthorized nonphysician providers, including nurse practitioners.
Basically, the law has nothing to say about these abuses and gives local school officials and jurisdictions no authority to do anything about them other than report physicians to the Medical Board of California, which, understandably, few local school health officials want to do.
Tracking medical exemptions is also problematic. Only five jurisdictions tracked all medical exemptions, and this was the result:
One of the 5 jurisdictions that tracked medical exemptions was mentioned in a federal civil lawsuit against SB277 that was filed by a group of parents and nonprofit organizations. The lawsuit, which mentioned the Department of Public Health, the Department of Education, the local health jurisdiction, and health officials from the local jurisdiction, created some concern among other jurisdictions that they could be targeted next. This lawsuit was ultimately withdrawn, but this case was frequently cited as a reason for not tracking medical exemptions among other participants. The participant from the jurisdiction that was mentioned in the lawsuit described receiving “hate mail and death threats across all social media” as a result of the decision to track medical exemptions; however, this jurisdiction continued to track medical exemptions during the first year of SB277 implementation. Other reasons that jurisdictions did not track exemptions included the following: not being required by law to do so, not having the perceived legal authority to track, not having the staffing or resources, wanting to see how the law worked before deciding to track, having low rates of medical exemptions and PBEs before SB277, and trusting doctors’ judgements about the reasons for medical exemptions.
This is the second biggest flaw of SB 277: It does not require the tracking of medical exemptions or provide resources to local jurisdictions to do so. California has no organized method to systematically determine for what conditions medical exemptions are being issues, which means it can’t tell how many are questionable and how many are justifiable by science.
As a result of all these issues, the interviewees noted feelings of frustration and concern over these issues: (1) frustration over the lack of authority for local health departments, (2) concern over the burden on school staff to review medical exemptions, (3) frustration with physicians who are writing problematic medical exemptions, and (4) concern about an increase in medical exemptions under SB277. Here are some sample quotes:
- “My frustration is dealing with these doctors that would write what is thought to be maybe not completely valid medical exemptions for the students whose parents just don’t want them to get any. That’s my personal frustration, and that is shared by a lot of school nurses.” Immunization coordinator, urban jurisdiction, low PBE rate, medium household income.
- “Some of them go into great detail. In fact, almost a startling level of detail considering what they’re actually alleging as contraindications…like I say, I’ve got very little sympathy…the physicians know better. And this is where I start to get a little bit annoyed with my own profession.” Health officer, urban jurisdiction, low PBE rate, medium household income.
- “I don’t get to approve or disapprove the medical exemptions. The law didn’t give the health officer any role, and I’ll tell you how ridiculous this is. In comparison with the fact that I have to review dog rabies vaccine exemption requests and I get to see medical records of dogs and I have the authority to disapprove requests for exemptions for rabies vaccines…and for people, we don’t have that authority.” Health officer, urban jurisdiction, medium PBE rate, high household income.
That last one really nails the level of ridiculousness of the worst shortcoming of SB 277. Don’t get me wrong. It is far better to have SB 277 than not. However, it should be viewed only as a first step. Like many new laws, it needs tweaking and fixing. As Richard Pan and Dorit Rubinstein Reiss note in a commentary:
Unfortunately, currently, only 6 states require the involvement of public health departments in reviewing MEs. Thus, most health officers and licensing boards do not have direct access to data on MEs. To protect public health, this situation needs to change. States can collect and maintain searchable records of MEs, which could be included as part of state immunization registries. This information would both benefit patients with valid MEs by alerting clinicians of patient MEs and provide important data for public health. Laws should also require parents to submit MEs to public health departments as well as schools. These data allow for public health officers to assess public health risks from a congregation of unvaccinated children and limit the risk of outbreaks.
SB 277 is good, but it has two glaring holes in it. These are defects that should be addressed by the California legislature as soon as feasible. Unfortunately, given the vociferousness of the negative reaction to SB 277 and the difficulty getting it passed in the first place, coupled with the backlash of antivaccine activism it provoked, I fear that the will to do this might not be there. After all, no other state since California has passed an SB 277-like law, and it’s not for lack of trying. Meanwhile, in numerous states like Texas, antivaxers are becoming more politically powerful by co-opting small government, anti-regulation conservative philosophy to represent school vaccine mandates as an un-American assault on freedom and aligning with conservative groups to punish legislators who try to eliminate nonmedical exemptions, or at least make them more difficult to obtain. I hope I’m wrong.
40 replies on “The problem with SB 277, the law that eliminated personal belief exemptions (PBEs) in California”
Here’s an idea, and feel free to tell me if you think it’s [email protected]:
1) If a given practitioner writes medical exemption letters for more than X percent of their patients, they become subject to official scrutiny in a manner analogous to that for practitioners who write unusually large quantities of prescriptions for narcotic analgesics.
2) If a given geographic area (however defined e.g. by zip code, county, etc.) shows a rate of medical exemptions higher than X percent of the school children in that area, the area itself becomes subject to some kind of additional scrutiny, also similar to what occurs in areas that are hotbeds of high rates of prescriptions for narcotic analgesics.
3) One of the “higher level of scrutiny” measures could be to enable local or state public health officials to question particular medical exemption letters, such as by requiring the issuing physicians to add sworn statements attesting to the relevant medical conditions of the patients in question, or alternatively to rescind their original exemption letters. The physicians in question would not be allowed to charge their patients additional fees for meeting this requirement. (The point of “sworn statement” is that if they lie, they’re committing something equivalent to perjury.)
4) Take all of the above measures and attach them to a bill that would claim to create uniform or at least consistent standards of reporting and scrutiny for certain public health issues, mentioning narcotics specifically and in the title of the bill. For example “Uniform Narcotics and Public Health Issues Reporting Act.” This would be more likely to get passed as a matter of pure routine, and fly under the antivaxers’ radar (plus or minus that they occasionally spy on this column (go away, arseholes!), so some of them might cite it as evidence they’re being conspired against (you betcha’!).
The point being to get it done in a practical and efficient way, without giving the antis a chance to stir up a stink about it. Is this any good?
Whatever steps are taken, we might want to consider the makeup of the CA legislature and who’s in the Governor’s office after next week’s election, before we seek to do anything about fixing SB 277. The reason being, if the climate is more favorable, great, full steam ahead, but if not, then sit tight until the next opportunity presents itself. If the climate turns unfavorable, we don’t want to risk the possibility that trying to tighten up the law could present an opening for antis to instead try to loosen or repeal it.
Between now and then: fellow Californians here, be sure to vote next Tuesday, and make sure all your friends & family members & coworkers do likewise. Everybody in: that’s how we win!
IANAL, so I don’t know how well your ideas would hold up in court, but it sounds mostly reasonable. I would make sure that geographic areas are defined to be always large enough that small number statistics don’t come into play: a region with 10 kids of which one has a medical exemption has the same ME rate as one with 10000 kids of which 1000 have an ME, but the former could just be random chance while the latter implies the existence of one or more physicians granting unjustified MEs. I don’t know how big a typical practice is in California, but that will also be location-dependent, so you have to be careful not to snag small-town physicians who have a high ME rate due to random chance.
Excellent point. I’m going to be lazy and ask you (rather than looking it up;-) What’s the minimum N and what’s the preferred N, to obtain a significant result for this? As you said, 1 PBE in a cohort of 10 = not significant, may be random; 1,000 PBEs in a cohort of 10,000 = it’s time to go quack hunting. We need decent guidelines for this, backed by solid science. Including the issue of how many PBEs in a given geographic area add up to a contagion path for spread of measles (since the R number for measles is 17, substantially higher than for other vaccine-preventable transmissible diseases: if herd immunity is sufficient to stop measles it should stop others as well).
The folks who created SB277 were MDs, so I’m inclined to think they would be able to come up with numbers for this as well; ideal case, yours and others, and theirs, are reasonably convergent so we know we’re on the right track.
In Australia there are no religious or personal belief exemptions; and any medical exemptions have to be picked from a list of medical conditions compiled by experts in the field. To me, that seems a much simpler way to do this. Also child care payments and any form of child assistance programs are dependent on the child being fully up-to-date with their vaccinations (unless, of course, they have at least one of those listed medical conditions).
The problem is figuring out that a practitioner writes exemptions to more than that X percent. It would require accumulating and tracking exemptions, and that’s been a challenge.
Just to be clear, district have legal authority to do that, as far as I know.
Yes, but only a minority have the resources.
BillyJoe: In Australia you also have this thing called civilisation, that appears to be on the decline in here the States (hopefully only temporarily). That said, your description of the law in AU is something we should aspire to here, and probably use as a template for further legislation.
Practical question: to what extent do anti-vax physicians find a way to weasel something from the approved list of conditions? We’re going to have to deal with that issue here, as Dr. Bob Sears has made clear by running an exemption mill to duck SB277 here in California.
Where can I find an official text of the law in AU and the list of approved conditions?
Yes, it was easily predictable that unethical doctors would build a cottage industry in medical exemptions. If only their own professional body would deal with this before people ask the state to act.
Of course Dr Bob didn’t need to build up a cottage industry. He just needed to buy some new pens.
Here’s another look at this from yesterday’s Los Angeles Times:
“Anti-vaccine stupidity returns, as measles cases rise and California parents evade the law”
Every year I visit vaccine phobic areas of California: Marin-Sonoma-Mendocino counties. I worry about these people. I learned about the epicenter of this region through Lord Draconis: it’s called Sebastopol- the West County’s hub.
Unfortunately, it’s also hip, fashionable, naturally beautiful and friendly to visitors. Most of the visitors, however, seem to be adults- couples, gay and straight, all ages, so probably already immune to most VPDs
I can imagine outbreaks in Waldorf schools and enabling doctors.
Even though it is a net gain for the proportion vaccinated, it is essential to close these loopholes and start coming down on these doctors who play fast and loose with vaccine exemptions. Frankly it speaks to their quality of care and ethics in other facets of their practices as well.
O true. If a Dixie is willing to bend or break science to issue a medical exemption, it makes me wonder where else he’s willing to cut corners.
Somewhat OT, but the radio show “Maine Calling” had nice episode recently with two epidemiologists talking about the flu season. I don’t think the call screener let Ginger Taylor through.
I may be optimistic, but I kind of hope that we won’t need new legislation. As it is, rates overall have risen – and I think overtime, the medical exemption issue will grow less, espeically if some further action is taken against abusive doctors. I agree with much of your comments, but laws can affect norms, and I do hope over time school immunization mandates here will become obvious to the 99% of people that are not extreme anti-vaccine activists.
The only way this i see this happening is if the Medical Board of California cracks down.
There’s the rub. There has been no action against these physicians (save one, sort of) and as long as overall vaccine rates rise, will it be easy to turn a blind eye to the sale of bogus medical exemptions? Unfortunately, there has to be an epic or tragic event on a population scale to shift perceptions and incentivise politicians and/or public health officials to take meaningful action.
My understanding is that the board is actually working on a number of cases, but its investigations take a long time (remember Sears was sanctioned in, if I recall, 2017 for a 2014 case).
Ah, I should have known how intentional your use of “further action” was. Hopefully the CA Medical Board won’t cave to any pressure and roll over.
Compared to the other 47 states, California, Mississippi and West Virginia have a much better vaccination situation. Still, it would be nice if California could find a way to crack down on quack physicians writing bogus medical exemptions.
Oh, don’t we know it!
According to AoA, their cohorts in WV are pushing back ( Fight the Power!) by renting billboards, playing upon the name of a recent movie.
One wonders if these sleazy doctors who so easily write bogus exemptions to placate their customers (and I use that word intentionally since some of the anti-vaxxers they service are not even their patients) also have the same laxness when it comes to placating patients who demand narcotics.
I know youse guys are now rolling your eyes because exemptions and narcotics are worlds apart but I think the anti-vax docs have given a glimpse into their morality, or lack thereof.
In the same vein…
Are medical exemptions considered similar or the same as a prescription or are they just a formal statement of opinion by the MD and nothing more?
If they aren’t considered prescriptions could they be made to be prescriptions with all the ensuing medical/legal ramifications?
No, I think you might be on to something. I think there are difference forces driving a doc to write bogus exemptions (at least somewhat true believer) versus being a pill mill (money money money). But I bet that a doc who writes bogus exemptions probably also writes prescriptions for antibiotics at the drop of a hat.
I don’t think exemptions are regulated nearly as much as narcotic prescriptions because, yeah, America and addiction. (I shan’t go into my opinions here.)
[…] The problem with SB 277, the law that eliminated personal belief exemptions (PBEs) in California October 31, 2018 […]
Every time you write about SB277 you complain about the “bogus” medical exemptions, you mention that “someone” even sent you an example exemption letter, you discuss supposed groups where these medical doctors who give “bogus” exemptions for a fee are listed, you share a link about another blog you wrote where you complain about “bogus” medical exemptions, and then you pretend that you just “documented” that the medical exemptions being issued are “bogus”.
To be honest you operate a lot like Fox News.
But you haven’t “documented” anything.
I have yet to see any hard evidence from you about any of this. Did I miss something? Please feel free to cite any actual evidence. But please do not simply include links to your other blogs which lack corroborating evidence. The way you characterize it, one would think there would be evidence about this supposed cottage exemption industry everywhere.
And by the way, what is the current rate of exemptions in California? From the media hysteria one would think California was a cesspool of diseases, what with the increasing rate of medical exemptions. What exactly did the experts think would happen if they took away all other options? Parents with concerns about vaccine safety have only one option (and do not start with that pretense that homeschooling is an actual option…this is the CA economy we are talking about).
So yes, if you take away religious and personal beliefs exemptions parents will try to use the only option available to them. After AB2109 exemption rates dropped significantly, and then after SB277 of course they dropped even more. Vaccination rates in CA are over 95%. And if memory serves the rate of medical exemptions is somewhere close to 2%, you may need to refresh my memory a bit but I’m pretty sure that’s close.
You can strike your typical authoritarian pose all you like, but you and your readers need to remember that SB277 would have NEVER passed if it had included significant limitations on the medical doctors’ right to exercise their own judgement when it comes to granting medical exemptions. I watched every bit of the hearings so I remember distinctly the long debates about this, the lawmakers made it very clear that they felt that doctors should be able to grant exemptions without interference from health agency overlords. So you can fantasize about this all you like, but it will never happen. Dr. Pan was emphatic about this, honestly I think he would have said just about anything to get this to pass. And then he later tried to suggest that health agencies have oversight of this process, a betrayal of everything he lied so eloquently about during the hearings. But guess what, it aint gonna happen. SB277’s days are already numbered…you are just too dogmatic to see it.
Let me correct myself. That figure of about 2% I mentioned is actually for all exemptions prior to SB277, not medical exemptions. So what is the rate of medical exemptions in California? It is 0.7%. Yes, it has increased from 0.2% which is significant, but not surprising.
But it is amazing to see all you snowflakes whining about a 0.7% exemption rate and pretend that we are all doomed, and that any outbreak is specifically caused by this….even while the vaccination rate is over 95%. Wait…isn’t that the magic number for herd immunity??
Actually, in order to truly correct yourself you need to delete your postings.
“Please feel free to cite any actual evidence.”
Which we have asked you for years! Where are those PubMed indexed studies by reputable qualified researchers that any vaccine on the present American pediatric schedule causes more harm than the diseases? When you are asked that you just give lame excuses.
Also, you also are ignoring actual research into the real causes of autism, that includes actual accommodations and treatments: https://sparkforautism.org/portal/page/autism-research
Stop with the lame excuses, come up with some evidence, not weak complaints and lame excuses. Otherwise, just deal with the fact you have figure out how to homeschool your kids. Because that was your choice because you ignored actual science.
I suggest you actually contact the group that is doing the SPARKS study and ask them whether or not they believe they have discovered what causes autism. I have, and they readily admit they have not.
Try reading the link, or joining the study. Or if that is too difficult, watch this video that explains what they are doing:
Wow! Mr. Foster, you don’t even understand autism is not just one type of developmental delay, it is several dozen. It is like you have never once clicked this link that I have given you several times: https://sparkforautism.org/discover/
You sure did not click on the one I included in the comment you responded to… the one that if you actually read it has a link further explanation: https://sparkforautism.org/portal/page/genetic-analysis-faq/
The first sentence of that goes to a pdf of several identified gene sequences that cause autism spectrum symptoms. You never once clicked on that link to read these words: “There are 11 CNVs and 78 single genes, which are selected by a medical genetics committee that meets bi-annually to review candidate autism genes and make updates to the SPARK gene list.”
Are you so afraid of actual science that you won’t even try to read the links, nor even learn about the research? The inside of your welded shuck skull must be a dark scary place where no new information is allowed. Try cracking it open.
I suspect it’s closer to a soft-boiled egg, so a spoon should do.
No, that is just the stuff inside the rock solid skull.
Oops forgot one important bit: “PubMed indexed studies by reputable qualified researchers… not on the Dwoskin payroll“
“SB277’s days are already numbered…” T.M.Philips has been touting that line since the bill was first announced. If his attempts are anything to go by… well, good luck with that.
Yep. Antivaxers have been making this claim ever since SB 277 passed.
Foster has a habit of saying that we don’t know the science, but he refuses to provide what I request. Instead he posts something from VaccinePapers or the actual paper that Orac has just torn apart in that particular blog post.
He flat out dismisses the large scale genetic studies funded by the Simons Foundation. Which has so far discovered the genetic sequences of over half the cases along the autism spectrum.
Aside from the suggestion to bugger the fuck off if you don’t think you’re getting your money’s worth here? It’s not as though there’s a shortage of whiny, pompous, rambling gasbags in this neck of the woods.
[…] The problem with SB 277, the law that eliminated personal belief exemptions (PBEs) in California October 31, 2018 […]
[…] nonmedical exemptions than going to the trouble of claiming a medical exemption, but also due to bogus medical exemptions on sale from a cottage industry of antivaccine quacks like Dr. Bob Sears, who blazed the […]