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.

Welcome Back to Denialism Blog

Despite rumors to the contrary, I am not dead. Instead I’ve been working hard as a new surgical intern and sadly not finding the time to write for the denialism blog. However, now more than ever, it seems that we need to talk about the problem of denialism.

Two major new issues for denialism have cropped up, and both are major new forms of political denialism. The first, I’ll broadly describe as Obama-denialism. Obama is a muslim, Obama was not born in the US, there is a giant conspiracy involving the Hawaii Secretary of State, the Democratic Party and muslims worldwide to take over the US government with a madrassa-trained presidential double agent etc. These are of course nonsense. FighttheSmears a website created by Obama supporters has most of the more ridiculous rumors debunked, including the absurd birth certificate/birther conspiracy theory. appropriately mocking LA Times blog entry. Whatever. As readers of denialism blog, it should have been clear from the get-go that this is just the usual conspiracist-drivel propagated by people who are upset at having a black president, and, just like the truthers, holocaust deniers, AIDS denialists, or any other group driven by racism, paranoia or just plain stupidity they won’t be satisfied by any evidence that contradicts their illogical conclusions. The format of the arguments is prima-facie absurd. The conspiracies are non-parsimonious, and lead immediately to more questions that just don’t make any sense. Despite this, bigots and crackpots like Fox News and Lou Dobbs “cover the controversy” to keep it stirred up. We must address it for what it is, closet racism and sour grapes over losing an election.

The second major issue, even more distressing to me now that I’m fully immersed in our health-care system, is that of universal health care denialism. Most upsetting to me was pronouncements like that of Sarah Palin that health care reform will lead to “death panels”. This is where the political opponents of progressive governance have crossed the line from the usual political ignorance and lies to truly despicable tactics designed to sink health care reform at any cost. The reality of the language originally in the bill was that it was designed to encourage physicians to have end-of-life discussions with their patients by paying them for such consultations. This is an area in which our health system currently fails miserably to the detriment of our patients. We truly need to have all patients interacting with our health system to have frank discussions about their wishes at the end of their lives, to have living wills, and make their desires for their level of intervention clear before they end up in the ICU, on a ventilator, and having invasive treatments performed ad nauseum that they may or may not approve of if they were able to communicate their wishes. But no, the political opponents of health care reform have instigated a scorched-earth policy, and even something as noncontroversial as asking people what they want their physicians to do when they’re sick has been thrown under the bus by the denialists. Other lies? Universal health care reform will turn us into communist Russia! A belief inconsistent with the fact that every other country in the industrialized world has survived the conversion to universal systems without requiring Stalinist dictatorships to enforce the dastardly public option. These arguments transcend mere denialism and can only be described as ideological insanity.

There is a legitimate debate to be had over health care, but we clearly are not having it. One legitimate question is how do we pay for it? I’m confident that reform will pay for itself and it is more expensive not to have universal access. As we discussed in our health care series, every other country in the world has accomplished this feat, provide equivalent or measurably better care in terms of access, health of populations, and life expectancy. Despite their universal coverage they all spend less than half as much per capita than the US on health coverage. Having people access the system in our ERs, lacking preventative care, and failing to provide the universal inexpensive interventions costs more than just providing care to people. After all, we already pay for the uninsured, hospitals and doctors are ethically obligated to provide care for everyone who walks in the door, insured or not. The costs of covering the uninsured are already built into our excess costs. Worse, having a administrative system designed to deny care is costly and unnecessary. The “privatization” or “subcontracting’ of medicare administration under Bush increased the cost of healthcare administration by 30% in three years despite the number of patients covered increasing by only about 4%. Paying for things in a planned, thoughtful and systematic way is cheaper than allowing problems to stew and boil over. I’ve already had way too many patients showing up in the ER with disastrous and expensive health problems requiring a huge expenditure of resources that if they had been addressed early would have cost next to nothing. And yes, they always tell me they didn’t get it addressed before it was critical because they lacked insurance. This is stupid and not the kind of care I want to be providing. Another legitimate question is will universality damage our technological and research prowess? Again I believe the answer is no. The US has excellent technology and research because we pay for it through government agencies like the NIH. The technology won’t go away because that has more to do with the culture of our healthcare system than the fact that we have oodles of money to pay for it (because we don’t really). It’s also not a fact that our technology necessarily makes our care better. CT scans, and MRIs are not as important to provision of health care as having ready access to services and adequate access to primary care physicians and preventative care. Another good question, is a public option necessary? Again I believe not. While I believe countries that provide a public option like Australia are ones on which we may model our system, other countries such as the Netherlands or Germany have developed excellent healthcare systems through insurers by tightly regulating them and not letting them screw their citizens. Here’s a great question, would anyone under these systems choose the US one? As evinced by the commentary from our health system, the critics of universal healthcare are speaking from ignorance when they claim citizens of other countries are suffering in their systems. The data we presented, and reinforced by commentary from all over the world, was that these systems have problems, but no one in their right mind would trade them for the US system.

Let’s get back to having a public debate that is not overwhelmed by the ideological fanatics and deniers and instead focus on the very real and critical problems that this president was elected to address. The denialists and their scorched earth tactics have done a great deal of harm to our debate on reform. Now more than ever, we need to talk about the difference between denialism and debate.