It should come as no surprise to anyone here that I consider Bill Maher to be an antivaccine and pro-alternative medicine wingnut. Indeed, early on in my blogging "career" (such as it is), I used to blog about him fairly regularly, mainly because he served up deliciously stupid antivaccine red meat to a blogger like me on a depressingly regular basis. As hard as it is to believe, my first acknowledgment of Bill Maher's antivaccine proclivities was nearly ten years ago, when Maher promoted the myth that Louis Pasteur had "recanted" on his deathbed, adding to that a statement that "I don't believe in vaccination, either" because it's a "theory that I think is flawed." Indeed, he's been promoting the lie that vaccines don't work and that the influenza vaccine causes Alzheimer's disease since before I started blogging (although it's been nine years since I first noticed it) and proclaiming his lack of belief in "Western medicine" to the point of telling David Letterman after his heart surgery that maybe he could come off his medications.

A few years ago, though, Maher seemed to have made a strategic decision not to spout off so much about vaccines and his belief that, if you just eat the right foods and keep the body "pure," you will be magically immune to the flu. Maybe it was because his pseudoscientific invocation of "will" was so ridiculous that Bob Costas mocked him for it on his very own show, dismissing his claim that he wouldn't catch the flu on an airplane sarcastically by saying, "Oh, come on, Superman!" Or maybe it was the flak so justifiably aimed at the Atheist Alliance International for giving him the Richard Dawkins Award in 2009, which inspired me to liken giving Maher such an award to giving Jenny McCarthy a public health award. Back then, when he tried to defend himself, he just dug himself in deeper and deeper, to the point where Chris Matthews even compared him to a celebrity Scientologist like Tom Cruise denouncing psychiatry. Or perhaps it was Maher's foolishly ignorant attempt to refute Michael Shermer's open letter to him urging him to reconsider his antivaccine and anti-"Western" medicine views. Or maybe it was his endorsement of cancer quackery.

Whatever the reason, for the most part, Bill Maher has been relatively quiet about vaccines and medicine of late. Sure, I saw him or heard of him reverting back to form briefly on various occasions, letting loose with a sarcastic joke or two about big pharma or the like, but quite infrequently. He seemed to be sticking to politics and pop culture and laying off of medicine for the most part. Actually, I was grateful. It made Real Time With Bill Maher actually watchable for me, as in general I could compartmentalize and appreciate Maher's other humor, as long as I wasn't having his quack-friendly tendencies shoved in my face every episode. Too bad it couldn't last. Or maybe it did, but Maher just can't resist every so often letting people know he's still antivaccine. Whatever the case, on Friday, Maher couldn't resist reverting to form at the tail end of an interview with Dr. Atul Gawande. In fact, Maher couldn't resist introducing his last question with, "I got a lot of shit a few years ago because I said that flu vaccines are bullshit."

I bet you can tell where this was going.

Yes, Maher asked (with glee) about the news reports last week in which the CDC reported that the flu vaccine is 23% effective this year, you know, the stories and study that I discussed in depth on Friday. Maher continued by saying:

It's a big scam to make money, but flu vaccines are bullshit. I was right, wasn't I, Doc?

No, Bill. You're the one who's full of bovine excrement, not the flu vaccine. I suppose, however, that the story about this year's flu vaccine not being well below its usual average in efficacy this year was just too big a temptation, rather like a huge piece of catnip to a cat or a big fat joint to, well, Bill Maher.

Dr. Gawande did his best to school the ever-ignorant Bill Maher, putting up with Maher interjecting periodically after parts of his explanation, "That's why they're bullshit." For instance, Gawande explained patiently, in a manner that I envy greatly given that, were I being interviewed by Maher I'd have to resist with every fiber of my being the overwhelming urge to call Maher an idiot, that flu vaccines depend on an educated guess made in February about what strains will be circulating in the fall, and that's why their effectiveness can vary so much from year to year. Of course, I don't discount the possibility that Dr. Gawande was also resisting with every fiber of his being an overwhelming urge to call Bill Maher an idiot but was simply much better and hiding the inner struggle than I could ever be. Almost certainly he was, but his self-control is far greater than mine. That's probably part of the reason why he's on TV all the time, and I'm not. (That, and because he's written some bestsellers, which reminds me: I really need to write a bestseller.)

Be that as it may, if you've read my two posts on why this year's flu vaccine is not as good as we had hoped it would be, nothing that Gawande told Maher will come as a surprise to you. He basically explained to Maher, once again, the science. This led Maher to mock his explanation:

MAHER: What else would we use this method with? Let me just guess what would work? GAWANDE (leaning forward): Meaning...? MAHER: Meaning if you're guessing what would work and you don't know and you're going to inject that into your body, that's a good plan?

Gawande again tried to explain the rationale, namely that we do know what components will work if we can predict what strains will be circulating with sufficient accuracy. It was, not surprisingly, in vain. While he was trying to explain what you and I know about the flu vaccine, Maher looked at him with his smarmy, smug look, interjecting mocking little "yeahs" and a "twenty-three, Doc."

The interview ended with Bill Maher blithely dismissing Gawande with an airy, "We'll just agree to disagree here" and a joke about how he's not the Pope and therefore won't punch Gawande.

I left the whole thing annoyed. (Of course.) However, I was not surprised. Certainly I was under no illusion that Maher had changed his antivaccine views, his tendency to conspiracy theories about big pharma, or his proclivity to support quackery. He had just been spanked down a few years ago and decided to take this opportunity to let his antivaccine freak flag fly again.

Same as it ever was.