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.