Bill Maher, the moronic Food Babe, and the NYT discusses what to call climate change denialists

Bill Maher did it again last night, doubling down on his anti-vax nonsense claiming the real problem is we haven’t done a controlled population-based trial on vaccination vs non-vaccination. Sadly, I don’t have a clip, but I have to say this time at least I was gratified that his panel wasn’t composed of complete morons and they actually challenged him on some of his nonsense. This is actually a classic impossible expectations denialist argument, he essentially proposes an experiment that would be wildly expensive, impossible to perform, and highly unethical. Worse, it still is internally inconsistent. He claims, as he did last week that vaccines are somehow preventing us to experience the benefit of fighting our own individual battles with infectious disease, and that in some Nietzschean fashion, this makes us weaker. But this makes no sense, as vaccines, after all, are antigen exposure. Second, there is no evidence that shows that exposure to infectious disease of one kind somehow makes you stronger, or more able to fight off other infections. It is a point unworthy of debate, not-surprisingly, as Bill Maher tends to make lots of such points. Vaccines have made our populations healthier, live longer, and all but eradicated several devastating diseases in plagues in modern times.
The second interesting article is Justin Gillis at NYT’s What to call a doubter of climate change? You all probably have an idea where we stand, and we have previously discussed the problematic nature of the use of denier as it gives them easy ammo to dismiss critique of denialist tactics as ad hominem. Unfortunately Gillis fails to actually define the problem adequately, in that he fails to describe the behavior and tactics of denialism. As a result his comment section, already at about 400 at the time of writing, mostly consists of Galileo gambits and comparisons of modern denialists to Einstein or Marshall and Warren. This is a newer modification of the Galileo Gambit which hijacks the work of Thomas Kuhn to suggest the denialists aren’t hacks, but revolutionaries!
Of course, the problem is the scientific revolutions that Kuhn described weren’t accomplished using the tactics of denialism. It’s also very important to understand such revolutions don’t invalidate previous data, which are still true. Einstein didn’t invalidate Newtonian physics, he expanded upon them in areas where they don’t work, such as at high speeds or small scales. Climate change denialists aren’t advancing a radical new theory, or compiling an alternative data set, they’re nitpicking existing science and promoting conspiracy theories about fraud that routinely get pants on fire level ratings. It’s a clever tactic, but totally bogus. When Jim Inhofe says that climate change can’t be dangerous because God is in control, that’s not a scientific revolutionary speaking. That’s a crank.
So Gillis makes a critical error, I believe, in the presentation of this problem because he fails to adequately describe the tactics of denialism being criticized, because the tactics are indefensible, and documented from one side of the internet to the other. It’s psuedoskepticism, and psuedoscience, and the key from distinguishing it from actual science that has the capacity to generate a revolution is to point out that no actual science is being done by these jokers, just cherry-picking, conspiratorial fear-mongering and rhetorical tricks. I think he describes the problem well but has opened himself to undue criticism by not making the issue the tactics rather than the specific belief. (of note Gillis spoke to me in prep for this article about some of the history of the debate)
Finally, the Food Babe. She truly presents an abundance of stupidity to debunk, and Orac does it well. Her newest, shockingly-stupid statement is just mind-blowing. She has apparently said, “There is just no acceptable level of any chemical to ingest, ever.”
Her history of doing this is pretty significant and she follows a pattern – she says things that show that she is so mind-bogglingly ignorant that she proves she has no business representing herself as a source of valid information or expertise on any topic. Then she realizes she’s crossed the line of unbelievable ignorance, and tries to hide it from the internet. Notable examples include her now difficult-to-find claim that pilots flood airplanes with toxic nitrogen gas rather than healthy oxygen during flights. Or her claim that brewers use toxic chemicals to fine beer, ignoring, of course, the toxicity of ethanol or that her sub-high school level of chemistry has not prepared her to understand even very basic concepts in organic chemistry.
Let us be very clear. This isn’t even denialism (although she does make those arguments too). This is just abject stupidity. This is such a low level of knowledge and understanding of the physical world it actually falls more into the Not even wrong category of argument. I don’t even need to debunk such a stupid statement, I trust my audience to be smart enough to see the glaring flaws, and there are a few contained in that special little nugget.
But this ties back into Bill Maher in an important way. As we discussed last week, Bill Maher essentially buys into this same ignorant medical belief that toxins are somehow to blame for a significant portion of human illness. On its surface its an appealing piece of woo, because it accomplishes one of the most important tasks of a really attractive piece of nonsense, that is, it offers adherents a false sense of control over their health. If I just avoid “toxins” I can avoid heart disease! And Cancer! and liver forever! Clearly, there are some toxins that humans frequently ingest that can cause disease, like alcohol (she doesn’t pick up on the toxicity of alcohol amazingly), tobacco, and various chemical exposures that at high levels can cause liver disease, heart failure, cancer. It’s entirely possible for toxins to cause disease, this is true. But it’s not in the way that the toxin fanatics think, in which anything natural is falsely seen as “non-toxic” and anything man-made or processed is “toxic”, and it also fails to understand the most important principle in understanding (most) toxic exposures, that is the general association between dosage and toxicity. For the moment we’ll put aside idiopathic toxic reactions, but generally, dosage is important. A chemical like water, the essential molecule of life, can be toxic to humans at high levels, but essential in the range that our body needs to keep all of its complex chemical reactions in equilibrium.
Further, natural foods, plants, etc., contain toxins as a part of their basic make-up. Consider the tomato. A member of the nightshade family Solanaceae, it contains toxins including solanine (as do many other fruits and veggies). Luckily, humans have an organ called a liver, and for most levels of this toxin contained in your all-natural, GMO-free potatoes, tomatoes, blueberries and apples, you’re going to be just fine (unless you eat like 100 potatoes in a sitting).
Toxins are everywhere, they’re in our food, our natural, wholesome, tasty healthy food. We’re just able to process most of them, at the levels that our bodies have adapted to over the millions of years we’ve been evolving on this planet. When morons like the Food Babe, and Maher vaguely refer to “toxins” and then in the next breath talk about eating veggie, avoiding meat (very low in toxins compared to say a nice plant like belladona – or cherries), they just show they have no clue what contributes to health and human disease.
Disease can be avoided, but the only things we really have good evidence for is that we should eat less, exercise more, and avoid true toxins like tobacco and ethanol (although moderation on booze is probably ok – thank your liver). Most of the rest is out of our control and is a combination of genes and luck. There are no superfoods. There are no panaceas, no magic vitamin supplement which has been shown to substantially effect our mortality (read the link, most supplementation is at best useless, at worse, harmful). It would be wonderful if there were, but there simply isn’t good evidence for this nonsense. When someone shows me some real data that we can fool our body into not aging with some specific diet, supplement or food, I’ll happily eat it, but they just don’t have it (and I’ve read the Mediterranean diet data which is pathetic.)
The best advice I can give after studying this stuff for years is that no one knows the ideal diet. It’s important to avoid obesity. Malnutrition is rare with most typical, varied diets so supplementation is likely unneeded outside of specific illnesses or life changes like pregnancy. Eat more high fiber foods like fruits and vegetables, and avoid junk food, avoid calorie-dense foods like sugary sodas, highly-processed food and fast food. Exercise. Sleep. Until we know better, we can’t say much more. And the certainty with which natural-food pronouncements claim foods are “miracles” or “super” is a sure sign of fraud.

John Oliver, right on drug rep influence

It is amazing how powerful a free lunch is. And the data are real, that people tend to favor those who do nice things for them. That is why, despite new rules about the amount drug companies can give to doctors, or all the rules on disclosure, the pharma reps are always going to push the boundary to try to gain any advantage because it results in real world financial benefits to pharmaceutical companies.
Leave it to John Oliver to nail this. Reps are pervasive. They are influential. Their influence comes not necessarily from the right impulses of science and data, but from attractiveness and free food.

Since I’m a surgical resident, I am mostly immune to this kind of temptation. Not because I’m some kind of special human. Its because I only prescribe a tiny set of medications. In fact only really prescribe one type of drug – pain killers – because I’m a surgeon. I have no business screwing with people’s other meds. At the same time I get invitations to free dinners hosted by these companies designed to tempt even lowly residents like me into changing our prescribing practices. Oliver is right, these things happen.
My joy in this is, if I ever take up one of these offers, all I get is information about drugs I’ll never prescribe and an opportunity to antagonize drug reps, which I usually find entertaining. I have gone to them, gleefully, as I literally prescribe only 1-2 drugs ever, and they can tell me about whatever they want, it is totally irrelevant to me, and hey I get free food! Suckers. As a resident you search out free meals, it’s a matter of survival. If you bring a resident within arm’s reach of a shrimp platter it will be destroyed because we’re hungry and we feel the world owes us for all the other crap we have to endure.
So yes, this is a real. And while the idea there is a quid pro quo relationship is a wild exaggeration, we know, psychologically and because drug companies spend money on this that these tactics work. Money spent on advertising is effective. Money spent on wooing doctors to one prescription vs another will tempt enough to be profitable. I will show up and listen to a drug rep talk about their drug for a candy bar. The difference is, I prescribe almost no medications, so, at least in my case, it’s a losing investment for the reps. For most doctors who have to deal with these influences all the time, I’m sympathetic, it’s easier to listen to an attractive person bearing a free lunch than it is to independently investigate every new drug that is dropped on the market. And to be fair, this isn’t always a bad thing. We need to know about which products are out there and which are most effective for our patients. But a situation in which the drug company with the best reps, or the best market share, or saturation of the market, or whatever, wins, is not necessarily what is best for the patient.
There is a simple solution. Ban the practice of using drug reps and food. It’s not like pharmaceutical companies are selling placebos like herbal supplements. They aren’t devastated by the loss of advertisement. Usually what they’re doing is trying to push equivalent (but usually more expensive) medications, or gain market share for some slight advantage, or advertise some niche they think their drug should enjoy, or some off-label use that some physician should think a lot harder about before they decide it’s appropriate. We’ll still have access to the same meds, but the decisions will be based on things like journal articles, data and research. Instead of diverting money into advertising and drug reps bearing food (I am so jealous I’m not the type of doctor that gets all this free food), maybe they’ll spend the money on the research that bears results that should influence physicians in a legitimate fashion. If the only influence they have to bear is copies of peer-reviewed journal articles you will be sure docs are making these decisions based on the right information.
So let’s ban drug company practices which seek to influence physicians based on meals and perks rather than data. Let’s ban direct to consumer advertising too, because you know who is even easier to influence? The lay public who have little to no access or knowledge to interpret and understand the literature on appropriate treatments for illnesses. The United States is the only country that allows this, because basically every other country figured out long ago it is a terrible idea. Let’s stop all drug advertising period. If a drug company wants doctors to prescribe a drug, they should use the scientific literature to justify its use. Not free food, or stupid advertisements with animated bees, or smiling happy people pushing their kids on swings. Drug reps, if anything, should show up with papers, not sandwiches.
This is a gimme. While people shouldn’t overblow the effect here – most physicians have a great deal of skepticism to claims from reps and are very reluctant to change practice unless they provide good data – there is clearly some influence, and it’s not based on legitimate enticements, which are data, and the interests of our patients.

Are we giving Jon Stewart a pass for his contribution to the measles outbreak?

I’m glad to see clips like this from the daily show appropriately mocking the deluded, and supposedly “educated” types that don’t vaccinate.

But have we forgotten this episode from 2005 when he allowed RFK Jr to basically spout his nonsense about vaccines without challenge?

It’s good and fine for Stewart to mock these people now. But he seems to forget he helped contribute to this problem. Is anyone aware of an apology from Stewart for allowing this crackpot to use his megaphone? Isn’t it precisely members of the media like him that are to blame for failing to vet the claims made by guests such as these?
Sorry for the autoplay. How do you stop this nonsense with code? Everything I have found doesn’t work.
**Update** Carl Zimmer points out that Jon obliquely references the RFK Jr. bit around minute 8:05. I missed it. I’m sorry, I failed there. But I think I still would have posted this and I still ask, are we giving him a pass on this? Is that brief, “I had a guy on 10 years ago” reference enough of a correction to the record? I still think he can do better. It’s not like we’ve learned so much new from 10 years ago. This was bogus 10 years ago as it is today and that is part of our frustration that it had to take an outbreak to change peoples’ minds.
**Update2** The more I think about, the more I’m still mad. Stewart really needs to do more than hand-wave away his role in this.

In other news, herbal supplements are truly placebos

My favorite news story of the week, herbal supplements don’t contain anything at all apparently. Why should we be surprised that big placebo is selling placebos?

The authorities said they had conducted tests on top-selling store brands of herbal supplements at four national retailers — GNC, Target, Walgreens and Walmart — and found that four out of five of the products did not contain any of the herbs on their labels. The tests showed that pills labeled medicinal herbs often contained little more than cheap fillers like powdered rice, asparagus and houseplants, and in some cases substances that could be dangerous to those with allergies.

Industry representatives have argued that any problems are caused by a handful of companies on the fringe of the industry. But New York’s investigation specifically targeted store brands at the nation’s drugstore and retail giants, which suggests that the problems are widespread.

Heartwarming.

Bill Maher is an astonishingly anti-science anti-vax crank

This week’s Realtime with Bill Maher was just about the most perfect example I’ve seen yet that maybe reality doesn’t have a liberal bias. Due to the measles outbreak becoming a hot-button issue, and the realization that his smoldering anti-vaccine denialism would not go over well, our weekly debate host decided to instead unleash all of his other incredibly stupid, unscientific beliefs about medicine.

This was astonishing. And because his panel, as usual, is composed largely of political writers and journalists, there was no one to provide a sound scientific counterpoint to the craziness. The sole non-crazy person (on this topic) was the conservative guy!
What a turn around for liberalism. It turns out, the problem hasn’t been that conservatives hold the key to anti-science crazy, we just haven’t had a good issue to expose the anti-science of the left wing for a while. Maher goes into a list of things he decides are examples of failures of “Western” medicine (because Eastern medicine has figured out cancer or something).
1. Bill Maher repeats the trope that the vaccine schedule is too much too fast – straight out of the anti-vax denial playbook! Human beings of course can handle thousands upon thousands of antigenic exposures daily. It’s called living on a planet where everything on it is trying to kill everything else all the time. It’s why we have an immune system.
2. Then in a feat of mental gymnastics only an unthinking crank can manage, he jumps into the hygiene hypothesis! He says he’s “not so sure that people who get a lot of them [vaccines] have as “robust” an immune system.” He then goes on to say we’re seeing more allergies and autoimmune disease, maybe vaccines or “environmental factors” are to blame. Now our children suddenly aren’t getting enough antigenic exposures! Our immune systems need to be challenged in order to grow and become strong. This is a fascinating feat of mental gymnastics. The antigen exposure of vaccines is “bad”, but somehow the antigen exposure from, say, measles is “good”. Granted those who have had actual infections develop stronger responses to those infections, there is no evidence that getting these childhood illnesses is protective from other illnesses, or against autoimmune disease. There is no reason to think that exposure to specific viral disease antigens would be protective for autoimmunity, not to mention since the vaccine is viral antigen exposure why wouldn’t it then serve the same purpose? The immune system just doesn’t work that way, and the hygiene hypothesis is about routine exposure to common antigens.
3. He complains none of his doctors have ever asked about his diet, because in his mind, what you eat is the most important thing ever. I can understand this for a couple of reasons. For one, Maher is thin. Generally if patients are thin, seemingly taking care of their bodies, a physician won’t typically interrogate them on their diet. If you then get a screening cholesterol panel that shows a high LDL and low HDL or triglycerides, the physician may start asking questions about diet, recommending exercise, more vegetables, less meat etc. Doctors aren’t here to micromanage your life, we are here to address problems, caution against the more harmful behaviors, and provide general recommendations for which there is good evidence. But in Maher’s mind, which seems to be the mind of the toxin fanatic, the only path to good health is through diet, so a doctor that doesn’t buy into this particular nonsense is a bad doctor. The reality is, there is not great data on which diet is best. There is no evidence that some foods are “super”, or carry some life-extending property. None of the claims made by the promoters of these foods has evidence of the caliber Maher is demanding from vaccines, and most of them have no evidence at all.
A good rule of thumb is, if a website uses the word “super” as a prefix, they’re full of it. Worse, the toxin hypothesis is nonsense. Toxins are not a significant source of human disease (at least not in Hollywood). Humans are extraordinarily good at detoxifying foods, and just because you’re eating plant material – the diet he promotes – doesn’t mean you’re not eating toxins. Plants are full of toxins they’ve developed over the years to prevent pests from consuming them and their fruit. It just happens that when a human eats a tomato, or chocolate, or one of the many plants we’ve genetically-modified through breeding and selection to suit our diets or learned to process since the birth of agriculture, we have an effective means of detoxifying them. Worse they make claims that non-toxic chemicals are actually toxic. Like glucose! The fuel your own body naturally makes to feed your brain is routinely castigated on the natural foody websites as a killer. This is the chemical your own body turns all these super-foods into! The inability to understand basic physiology is just wonderful.
You want non-toxic? Eat meat. It’s just protein, water and fat, just like us (although even a complete non-toxin like water can of course be toxic at high enough exposure). If you’re feeling sadistic and want to see the toxic effect of a superfood, feed these human foods to a non-omnivorous animal like a cat. They’ll get sick. Many of our “super foods” which the morons on these websites sell as “detoxifying” or laud their anti-oxidant properties (another bogus and unfounded diet hypothesis), are actually full of various plant toxins which we have no problem with because we have awesome livers. So thank your liver, and don’t buy into this toxin nonsense.
Finally other reasons he feels like he’s never heard a doctor ask about his diet (because we do) is he’s either not listening, or maybe he just sees a crappy doctor? So whoever is this magical “Western” doctor that Maher sees, please just ask this silly crank about his diet during the next visit so we don’t have to hear this tired nonsense anymore that doctors don’t care about diet. We do, we just don’t buy into the silly unfounded nonsense of the toxin hypothesis which is likely his real complaint.
4. He says “we overdid antibiotics” – This could be a fair point, however, the doom and gloom about antibiotics not working anymore and our whole medical system collapsing is a bit overblown. After all, most of the antibiotics we have developed over the years were discovered, not invented. We have been taking chemicals developed in the environment by various organisms and using them to suit our purposes. However, the targets of those chemicals have been engaged in this evolutionary war for millennia before we ever even got into it. Bacterial resistance is not “new”, or something created just by humans. We have to see this problem as an eternal struggle that’s been going on between micro-organisms for eons, and if we’re going to participate in it, we have to continue to innovate, just as life has, since the beginning. There is no “winning” here. There will never be a time when we can say we have solved bacterial resistance or have a perfect antibiotic, because we’re learning more and more we have to live with our bacteria in our biome, we can’t kill them all. We just have to keep working, keep innovating, and keep learning so we learn to develop antibiotics that are more specific, more targeted, and yes, more cautiously applied so we can continue to benefit from the ability to control these ubiquitous organisms that help us, are part of our normal physiology and function, but also occasionally overgrow and kill us.
5. He points out “not one country in the world does nearly as much surgery we do” – I recuse myself as I have conflict of interest.
6. He complains “I’ve heard on the news endlessly 2 drinks a day is good for you, I think no drinks a day is good for you.” And again Maher would be wrong. For one, no real medical authority has come out and said, “drink 2 drinks a day.” I’m sorry that the news misled you. I have no doubt there’s a bunch of crummy journalism out there that could be interpreted this way, but it’s not the medical establishment’s fault that science and medicine reporting is so full of bogus nonsense. This is still a controversial medical issue. The data from sources like NHANES show that there may be a protective effect for alcohol consumption with 1-2 drinks a day. This has been seen in multiple other studies, and in other countries. The effect is more profound in men. It might disappear if you eliminate co-morbidities (in other words some people may not be drinking because of health issues making the teetotaler data look worse). Ultimately doctors can’t really recommend you drink, but we typically won’t castigate you for drinking 1-2 drinks a day because the health effects are likely small, and for 1-2 drinks a day, their might be a slight cardiovascular protective effect. Prospective trials suggest 2 maybe even too many. So I would rate this as a major straw man argument. As a doctor I would say, 1-2 drinks a day is probably not harmful, but no one should be drinking saying “this is for my health”.
7. He wails we are Ok with aspartame, and GMOs! / and “One word, Monsanto” – and here we have it, Bill Maher’s clearest example of total crankery, his complete hysteria over GMO. There is a moment then when the conservative John McCormack butts in and points out there is no evidence that GMOs are harmful, and Maher and his panel of ignoramuses are shocked into silence, and one panelist gives this weighty sigh and covers her face in horror and Maher simply sighs. No, Bill Maher, it is we that should be asking you to justify your foolishness here, McCormack, the conservative who should supposedly be the one without the liberal bias of reality asked the right question. Where is your data? Where is the proof? There is no evidence, and worse, no even plausible mechanism by which he can describe the current GMO foods on the market to be harmful to humans. Despite consumption of billions by billions, you can’t point out one sickness or death. Instead they can only resort to the classic denialist correlation trope, which is exactly what the anti-vaxers have done for decades. And if someone wants to talk about the Seralini rat study, please don’t bother. Another retracted paper being the sole source of proof for a bunch of denialists, where have we heard this before?
Finally Maher complains, “we can’t ask any questions.” The classic cry of the persecuted crank! The same whiny response you see from the 9/11 truther, the climate science denialist, or any other individual who has found their ludicrous ideas has bought them some much needed societal shame. No on is telling them they can’t ask questions, but when you repeat the same question, that has been answered, and answered, again and again, and you don’t listen, eventually we are going to lose our patience and say enough! The debate is over! Vaccines do not cause autism. Enough with your crankery. Enough with the harm that has come from this bogus skepticism. We have an outbreak now. We are tired of hearing this question which has been answered and the accompanying obstinance has caused real-world harm.
Maher in this episode performs an astonishing Gish-gallop proving, once again, he deserves to be called out for denialism and being an infectious disease advocate. Can we drop the notion that liberalism is somehow protective against anti-science? Do we remember when he tried to blame cell phones for colony collapse disorder? (I couldn’t resist going to the old blog for that) Maher is resentful that his anti-vax nonsense is compared to global warming denialism. This is exactly like global warming denialism because all denialism ultimately comes down to the same tactics. I think we’ve a good example here of conspiracy (in one word! monsanto!), moving goalposts, cherry-picking, and a whole host of logical fallacies in his little Gish gallop (that’s four of five of the classic tactics). Let us dismiss him as a spokesman for science. He’s too easily impeachable as an anti-science crank.

Hand washing? Really Libertarians?

The latest entry in the “OMG really?” wars is brought to us by the libertarians, who, using the example of the brutal oppression of hand washing regulations, make total fools of themselves.

Speaking during a question-and-answer session at the Bipartisan Policy Center on Monday, Tillis related a story from his tenure in the North Carolina legislature to help explain his overarching philosophy on the finer points of hand-washing.
“I was having this discussion with someone, and we were at a Starbucks in my district, and we were talking about certain regulations where I felt like maybe you should allow businesses to opt out,” Tillis said, in remarks first reported by the District Sentinel. “Let an industry or business opt out as long as they indicate through proper disclosure, through advertising, through employment, literature, whatever else. There’s this level of regulations that maybe they’re on the books, but maybe you can make a market-based decision as to whether or not they should apply to you.”
When Tillis’ interlocutor noticed a Starbucks employee coming out of the restroom and inquired whether Tillis would apply his anti-regulation stance to employee hygiene, Tillis affirmed that he would.
“I don’t have any problem with Starbucks if they choose to opt out of this policy as long as they post a sign that says, ‘We don’t require our employees to wash their hands after they use the restroom,’” he said. “The market will take care of that.”

That’s right folks, now pillars of basic public health and sensible regulation to prevent things like typhoid fever or hepatitis A represents an undue burden on businesses serving the public. I guess we should all have to be our own public health department, and upon entry of any business should have to sign a EULA in tiny print freeing them of responsibility if they have filthy food prep areas, warm refrigerators, and potato salad left at room temperature for days on end. Just imagine this brave new world where every decision you make as a consumer you get to individually vet for basic things like, “will this product poison and sicken me?” or “am I about to die if I consume this?” Because we all have time for such nonsense, or the knowledge, or access to information, and I’m sure we can rely on businesses to always be forthright with consumers about risks of their products.
And we thought anti-vax was bad. At least they’re not denying germ theory, just the last 100 years or so of public health and sanitation measures that have drastically-reduced food-borne illness. I guess freedom means the ability to sell poison and tainted meat, albeit with a disclaimer and the wonderful reassurance that if I die from a tainted taco my family can sue for damages (unsuccessfully if the business has a good lawyer).
Can we please not live in such a world?