Dr. Jay Gordon and Bill Maher: Still spreading antivaccine misinformation to the masses

Dr. Jay Gordon (who usually likes to be called “Dr. Jay”) and I go back a long time, ever since I first noticed him spreading antivaccine propaganda that vaccines cause autism in 2005 on the then-embryonic Huffington Post, to his involvement later in the year in the treatment of a child of a famous HIV/AIDS denialist in which he missed the diagnosis of pneumocystis carinii pneumonia, an opportunistic infection in AIDS patients (the mother died from complications due to AIDS a few years later), to a number of other mentions over the years about his promotion of antivaccine misinformation, from the “toxins gambit” to his invoking a 50-year-old episode of The Brady Bunch in which the kids all got measles as an indication that before the vaccine people didn’t think measles was a serious illness given that the sitcom played six kids getting measles and having to stay home from school for laughs. The quote from Dr. Jay that to me best summed up his attitude was something he said in response to a review I wrote of Paul Offit’s book Autism’s False Prophets (scroll down the comments, as there is, alas, no longer any direct link):

I gave a half dozen vaccines today. I gave some reluctantly but respected parents’ wishes to vaccinate.

If you’re not antivaccine, then why on earth would you say that you gave vaccines “reluctantly” because the parents wanted them? (Also, a half a dozen vaccines seems to be a rather small number to give in a day if Dr. Jay’s practice is as busy as he claims.) Unsurprisingly, Dr. Jay’s signature move any time I write about him is to complain with an oh-so-wounded tone that he’s “not antivaccine” and to try his best to convince me that he’s reasonable and actually pro-vaccine. Never mind that he’s long believed (and, if the Maher segment is any indication, still believes) that vaccines can cause autism despite the evidence otherwise because he just “knows” based on his decades of “clinical experience.” I was even sort of starting to believe him, too, given that, on Twitter at least, he seemed to be coming around, admitting that vaccines “probably” don’t cause autism. On the other hand, given his high profile involvement in the fight to block SB 277, the law passed in 2015 that eliminated nonmedical exemptions to school vaccine mandates in California, and later SB 276, the law passed a couple of months ago that cracked down on fake “medical exemptions” written by antivaccine doctors, he did seem to be refashioning himself as a warrior for “vaccine freedom” and “parental rights” while continuing to claim he’s not antivaccine.

If, as he claims, Dr. Jay is “not antivaccine”, though, why did he appear on Real Time With Bill Maher a week ago and spew antivaccine tropes in front of a national audience? Interestingly, even a week later, the Real Time team hasn’t (yet) posted the segment to YouTube; so if you’re not an HBO subscriber you’re out of luck if you want to see it. I did find this partial video of the segment, which ends about two-thirds of the way through:

Here’s an unofficial video, for however long it’s up before the inevitable copyright takedown. When and if an official video is posted, I’ll delete the link to this one and link to it instead. I note that the segment is a big chunk of the show, nearly 13 minutes. That’s long for an interview on a show like this:

And he was also on the Overtime segment, which was posted on Bill Maher’s official YouTube channel:

Let’s unpack all this. There was a time recently when I thought that Dr. Jay might be coming around, in that he was much more mushy in his pronouncements about vaccines, in which he admitted that they work, and in which he admitted that the probably don’t cause autism. I was mistaken. Moreover, let’s also emphasize right here and now that HBO, by airing Maher’s show, is complicit in spreading antivaccine quackery to a worldwide audience.

Dr. Jay and Bill Maher: Two crappy tastes that taste crappy together

The interview started off with Maher introducing Dr. Jay as a “noted author and pediatrician who gives vaccines to children, to adults, and to himself but who has been called an ‘antivaxer.'” Things went rapidly south from there. As always, Maher’s smugness was something to behold. After the standard pleasantries when introducing any guest, Maher opined about how “it’s courageous today just to speak at all about the subject of vaccines,” leading Dr. Jay to interject, “They do take shots at you.” Of course, some “shots” are deserved. When you promote antivaccine misinformation on a national stage, hell yes, Mr. Maher and Dr. Jay, I am very likely going to “take shots” at you because you deserve it. Maher, as usual, went smugly on about how vaccines are one thing in this culture for which there is only “the one true opinion” and how “we don’t play that game here”, which is his usual self-serving arrogant nonsense when he wants to spout nonsense about “Western medicine.” The only reason Dr. Jay and Mr. Maher get so much pushback is because they promote dangerous antivaccine misinformation.

None of this should be a surprise to longtime readers or observers of Maher. When I first learned that Dr. Jay Gordon was going to make an appearance on Bill Maher’s show, I fully expected a congratulatory self-portrayal as a “truth teller” saying the “politically incorrect” things that need to be said about vaccines. It’s his shtick about everything, not just vaccines, but it didn’t make it any less nauseating to behold. In addition, Maher has a long history of “skepticism” about “Western medicine” and vaccines, particularly the influenza vaccine. Maher has said repeatedly over the years that he considers it useless and has even parroted the claim of an antivaccine quack, Hugh Fudenberg, that the vaccine causes Alzheimer’s disease. Ten years ago, he even claimed that he could go on an airplane and not get the flu because he leads the right lifestyle (although, given his well-known love of cannabis I’m not so sure I buy that his lifestyle is that healthy) he’s resistant to the flu, leading an exasperated guest, Bob Costas, to exclaim in a devastatingly spot-on retort, “Oh come on, Superman!” In 2015, Maher interviewed antivaccine activist Robert F. Kennedy, Jr. on his show, and the antivaccine misinformation flowed. It’s not just antivaccine pseudoscience that Maher’s promoted over the years. It’s cancer quackery and HIV/AIDS quackery as well.

The funny thing is that I haven’t had to write about Maher for four years, the last time he went full antivax on his show. He used to do it a lot more often, but these days he seems to do it only every four or five years, although he certainly does slip little antivax and anti-pharma comments in every now and then. What’s wrong with criticizing pharma? Nothing, if it’s done on the evidence. When it’s done to the point of becoming conspiracy theories, as Maher does, it’s not so good.

Maher started out by asking Dr. Jay about his experience being on other shows, saying that often after guests get off the air they’ll express unpopular opinions but add, “you can’t say that on TV,” asking, “Has that ever happened to you?” This led Dr. Jay to relate a story about when he appeared on The Doctors years ago with Dr. Jim Sears (one of hosts of the show and brother to antivaccine pediatrician Dr. Robert “Dr. Bob” Sears, not to mention at least borderline antivaccine himself given that he believed the “CDC whistleblower” conspiracy theory and even appeared in the antivaccine propaganda film VAXXED) and antivax activist J. B. Handley (whom I’ve written about here a few times before). Of course, a certain friend of the blog was all over that episode back then, way back in 2009, noting that the episode contained some accurate information but a whole lot of misinformation presented with false balance, with Drs. Sears and Gordon expressing a fair amount of agreement that vaccines can cause autism in certain “sensitive” children, without actually citing any evidence that they can. As was noted at the time, the episode fell into the same trap that reporters fall into when discussing any form of manufactroversy about dubious science or even rank pseudoscience, be it creationism, antivaccination myths, and “alternative medicine” quackery and was no different than putting Ben Stein onstage next to an evolutionary biologist or putting Jenny McCarthy onstage next to Paul Offit. In fact, The Doctors did just that, putting Dr. Jay Gordon on stage next to a science-based physician, in this case Dr. Harvey Karp.

But back to the interview.

Dr. Jay related how that episode of The Doctors included a segment about a family with seven children, four of whom had autism. As was noted at the time that fact alone should have strongly suggested a genetic component to autism (and there is strong evidence that autism is mainly genetic in origin, although there is a lot of complexity to its pathogenesis), but naturally the parents blamed vaccines, not genetics, for their children’s autism. You’d think that Dr. Jay might understand that when a family has four out of their seven children with a given condition like autism it’s most likely genetic. Not here. In any case, the first four children had autism, and the last three did not, with the mother at the time being pregnant with the couple’s eighth child. Learning that, Dr. Sears said that, if the parents were in his practice he wouldn’t vaccinate the eighth child. (Because if there’s an environmental component to autism, it must be the vaccines, apparently, because to antivaxers it’s always the vaccines, first and foremost.)

Dr. Jay then described how his “very good friend” Dr. Sears asked him if he believed that vaccines can cause autism, to which he responded that he believes there is an “impact” although he “can’t prove it.” Dr. Jay then asked Dr. Sears, “Do you believe that there’s no effect from vaccines on the prevalence of autism,” to which, according to Dr. Jay, Dr. Sears responded, “There might be a small percentage of children who are adversely effected,” concluding, “That’s all I’m trying to say.”

Maher congratulated Dr. Jay and agreed that “that’s all we’re trying to say” and adding, “To call you this crazy person when what you’re saying is just slower, maybe less numbers, and also take into account individuals. People are different. Family history, stuff like that. I don’t think this is crazy.” Dr. Jay responded about how, if four out of seven children have autism you need to consider the “environment”. Maybe, but such a scenario is a far stronger indicator of something to do with genetics. You’d think that Dr. Jay would realize this, but apparently not.

This led Maher to concede that this has “been studied a million times”, which it has. There are many robust, well-designed studies involving a hundreds of thousands, if not millions, of children all over the world carried out using different methodologies that have utterly failed to find even a whiff of a hint of a signal indicating an association between vaccination and autism risk. Characteristically, Maher also couldn’t resist saying that he doesn’t trust US studies, (because pharma), but he at least reluctantly conceded that the scientific evidence isn’t on his side. Did that stop him from speculating? Of course, not! He invoked the anecdotes of parents who say their children showed the first signs of autism after vaccination, saying that it seems “more realistic” to him that it probably happens so rarely, but “you can’t say it happens one in a million times because then someone will think that I could be that millionth one, and, you see, you scare people.” Unfortunately, as has been pointed out to antivaxers many times over the years, a number of vaccines are administered during age range when autism symptoms first manifest themselves; so, given the millions of children vaccinated every year, by random chance alone a number of children will manifest their first symptoms of autism in fairly close temporal proximity to vaccination. There’s a lovely graphic over at The Logic of Science that shows a back-of-the-envelope calculation of how many children we would expect to exhibit symptoms of autism after vaccination by random chance alone, noting:

Also noted:

Additionally, we would actually expect the odds of a parent noticing the symptoms of autism to skyrocket shortly after a vaccine is administered. Many parents are very concerned about a vaccine harming their child, and, as a result, they will tend to watch their children very closely after vaccinating them (even if they don’t consciously realize that they are doing so). Thus, they are far more likely to notice an early sign of autism that they might have missed if they hadn’t been watching their children so closely. To give an analogy, after people buy a new car, they often start seeing that model and paint job everywhere, but that model isn’t actually any more abundant than it was before, it’s just that their brains notice it because they are thinking about it (consciously or subconsciously). Even so, you are far more likely to notice an early sign of autism if you are worried about it. So in actuality, my numbers are likely underestimates rather than overestimates.

Indeed. There is a lot of confirmation bias in these anecdotes as well, in which parents remember information that supports their current belief that vaccines caused their child’s autism and forget disconfirming information, particularly subtler symptoms that they might have noticed (or missed) before vaccination that are apparent on videos taken of the child before vaccination. This is human nature. We all do it unconsciously; the only difference between skeptics and everyone else is that we try to compensate for it. Truth be told, we don’t always succeed, because it takes effort to be aware when we’re falling prey to this particular human cognitive issue. That’s why the correct question is not whether there is an association between vaccination and autism, but rather whether there is an association between vaccination and autism that is greater than could be explained by random chance alone. There isn’t.

That’s why Dr. Jay has to fall back on a favorite antivaccine trope that says there is a genetic component, but an environmental trigger to autism. It’s the same trope that antivaxers have been using to wave away the lack of evidence of even a small association between vaccination and autism in large epidemiological studies ever since I started taking an interest in the antivaccine movement and likely for long before that. It’s a claim that doesn’t have any compelling evidence to back it up, and even Dr. Jay admits there’s “no proof”.

Dr. Jay and Bill Maher: Appeals to ignorance

The next part of the interview consisted of a lot of appeals to ignorance and how “we just don’t know”. It’s a common fallacy. Certainly there’s a lot that we don’t know about autism and what causes it. However, there’s a lot that we do know. One thing that we do know is that autism is caused primarily by genetics. Another thing we know to a high degree of certainty is that vaccines almost certainly don’t cause autism. Sure, there are huge gaps in our knowledge about what causes autism, but that doesn’t mean that Maher and Dr. Jay can just make stuff up. To paraphrase Dara O’Briain, just because science doesn’t know everything doesn’t mean that you can fill in the gaps with whatever fairytale most appeals to you. Come to think of it, it’s always a good time to insert a video of Dara O’Briain, as a cleansing antidote to this whole segment with Dr. Jay:

Back to the discussion. Maher asked, “Have you met doctors who are idiots?” He seems to think that because there are bad doctors, because there are doctors who are idiots, because there are doctors who don’t keep up on the medical literature, then that’s adequate justification to question the scientific consensus that vaccines don’t cause autism without anything resembling evidence compelling enough to justify such a reevaluation—without any evidence at all, actually! I do like the example Maher used to argue he’s not an antivaxer, though. He said that if there were a vaccine against Ebola and he was going to travel to an area where Ebola outbreaks have occurred, he’d get the vaccine, as if that were evidence of his not being antivaccine. Let’s put it this way. Constructing a far-fetched hypothetical example like this of a situation in which you would accept a vaccine is not a good argument that you’re not antivaccine. We’ll soon contrast that to what Maher says about the flu vaccine.

Even so, Maher repeated the appeal to ignorance, pointing out that we’re “just at the beginning” of understanding how the human body works, which we’re not. There might be a lot that we don’t understand, but we also do understand a hell of a lot, and, again, just because there are big holes in our knowledge of how the human body works doesn’t mean that you can just fill them with speculative fairytales without evidence, but that’s just what Maher did, with Dr. Jay chiming in helpfully, fully agreeing. Basically, the argument was that medicines and treatments have side effects, with Dr. Jay mentioning how acetaminophen can damage the liver, how ibuprofen can damage the kidneys, how antibiotics can cause diarrhea, lead to yeast infections, and cause rashes. Well, duh. The implication, of course, was that vaccines can have adverse events, which is something that no one—and I do mean no one— who defends vaccines against nonsense like that spread by Maher and Dr. Jay denies, Maher’s brain dead claims that we do notwithstanding. However, the whole argument was a non sequitur. It does not follow from the observation that effective medical treatments have side effects and can sometimes harm that the idea that vaccines might cause autism is still a possibility. It’s a speculation without evidence.

Another tactic this brain trust used was to move the goalposts to claim that it only happens in one in a million or even one in a billion. Even if that were true it would be almost impossible to detect above the statistical noise of epidemiological studies (which is why we’re still not entirely if the flu vaccine is associated with an excess risk of Guillain-Barré syndrome given how small the risk appears to be) and, even if it were possible to detect, would still likely not adversely affect the risk-benefit ratio of vaccines.

“Medicine has been wrong before”

A prominent part of Maher’s antivaccine tirades was the appeal to the old quack trope of “medicine has been wrong before”. It’s not a good start when his first example was how dentists used mercury-containing fillings to fill cavities in his teeth. (Mercury-containing amalgams are safe, contrary to what antivaxers and quacks claim.) He mentioned Accutane, claiming it was pulled from the market, which leaves out a bit of critical information. Accutane, a form of the retinoid isotretinoin, was used to treat acne, was indeed pulled from the market in 2009 over concerns that it increased the risk of depression and suicide, although other forms of isotretinoin are still on the market. In any event, it is questionable whether such a link exists, as this article explains:

However, a 2012 meta-analysis published in the Journal of Clinical Psychiatry found that, while infrequent, there is a reported link between isotretinoin use and depression—and higher doses of the drug are linked with more psychiatric side effects. The meta-analysis authors noted that isotretinoin studies are limited in their size and conducting a large trial brings up ethical questions when there is “adequate aggregate information supporting a causal role of isotretinoin in the development of depression in some individuals.” Study authors concluded that isotretinoin does not cause depression, but can increase a person’s risk of depression (especially if they’re predisposed to it). So why is there this discrepancy in the various research studies? A meta-analysis published in the World Journal of Psychiatry in 2015 points out that many of the reviewed studies conducted by psychiatrists showed an increased risk of depression, attempted suicide, and suicide completion after a person used isotretinoin. Studies led by dermatologists found that isotretinoin may have an antidepressant impact, since it can improve self-image and make a patient feel better. The differing views of whether there’s a causal link between the drug and depression may be because dermatologists may not have been aware of the occurrence of psychiatric disorders, the review authors said.

Maher was right about one thing, just not in the way he thought: Medicine is complicated. Also, the FDA sometimes acts on incomplete information because it has to make decisions in the real world, where evidence is not always conclusive. That didn’t stop Dr. Jay from once more obsequiously chiming in, “Black box warnings. That’s what they call it. It’s, ‘Read this before your prescribe or take this medication. You could die.” No, Dr. Jay. The existence of black box warnings is not a reason why the medical consensus that vaccines don’t cause autism might be wrong. Nor are the misdiagnoses that Mr. Maher suffered. Nor are the conflicting diet studies about salts, trans fats, and the like a reason to doubt that vaccines are not associated with autism. Naturally, Dr. Jay couldn’t resist going on about corruption in the studies that originally looked at the role of fats in heart disease. Again, that’s not a reason to think that vaccines cause autism. He also repeated the old medical school adage that half of what you learn in medical school will likely be shown to be wrong within ten years after you graduate. I’ve always thought that that’s an exaggeration, but, again, that’s not a reason to think that vaccines cause autism. You have to show evidence, and neither Maher nor Dr. Jay presented any.

So. Many. Non sequiturs. Straw men too.

For example, Maher kept characterizing doctors as asking, “When were we ever wrong?” What planet is he living on? No doctor ever claims that medicine has never been wrong, at least none that I’ve ever encountered. That’s either a strawman or just plain false. Tellingly, somehow Maher never actually named any of these doctors allegedly saying this. Medicine is applied science, and the science is incomplete. Of course, medicine gets it wrong sometimes. But you know how medicine corrects itself? Evidence, not wild speculation and conspiracy mongering of a “politically incorrect” comedian and an antivaccine-adjacent pediatrician.

I’m going to call out Dr. Jay in the harshest terms here for one part of this interview. Maher claimed that he got the flu shot “one time” and that it gave him the flu. Given that the influenza vaccine is a killed virus vaccine, that’s impossible. Maher most likely had mistaken flu-like symptoms that you can sometimes get after vaccination for the actual flu. Yet Dr. Jay just sat there, chuckling briefly, and muttering, “OK, OK”. That was an abdication of professional responsibility! Any physician, confronted on national TV with a comedian parroting the myth that the flu vaccine can give you the flu, has a duty to jump in and correct that misinformation. Dr. Jay did not. I’m calling him out for that.

This led into this exchange:

Maher: I just saying vaccines, like every medicine, has side effects…so let’s not deny that. So let’s not deny that or pretend it doesn’t happen. Which ones? How much? How do we manage this? This is not crazy talk.

Gordon: We don’t do it the way we should do it. We don’t manufacture vaccines as well as we could. The schedule that is invariable for every single child, one size really doesn’t fit all. The same polio vaccine I would get as a 180 lb. man is the same I would give to a 12 lb. baby. We could do it a lot better. I don’t want to bring polio back. I don’t want to bring measles back. Measles is a nasty illness.

Maher: And we had news we heard that’s interesting today that has something called…

Gordon: Amnesia. It causes the immune system to forget a lot of the antibodies.

Maher: It’s actually a much more harmful disease than we thought.

Gordon: It is.

Maher: Great! New information! We’re accepting of new information! Everyone should be.

Maher is apparently completely ignorant of the fact that physicians and scientists do do exactly that with vaccines all the time. There are three large systems designed to track potential adverse events from vaccines, one passive reporting system (VAERS) and two active reporting systems (the Vaccine Safety Datalink and PRISM, run by the CDC and FDA, respectively). The CDC’s Advisory Council on Immunization Practices (ACIP) meets three times a year to discuss new evidence regarding vaccines for efficacy, adverse events, and other issues, all in order to modify the recommended CDC vaccine schedule! Just because these systems and ACIP don’t find what Maher wants them to find or because ACIP doesn’t do what Maher thinks it should do doesn’t mean that “we pretend” that vaccines don’t have side effects. Maher is so wrong on this issue that he’s not even wrong, and I rapidly got tired of his repetitive nonsense claiming that doctors say not to ask questions and ask when they’ve ever been wrong. This scenario only exists in the fantasy world of Maher’s deluded mind.

As for Dr. Jay, seriously? Does Dr. Jay not know the difference in mechanism between a pharmaceutical drug, whose dose needs to be adjusted, compared to a vaccine? Did he really graduate medical school, get through residency, and practice for something like 35 years without understanding the difference? I guess I should be glad that he’s finally actually admitting that measles is a serious disease after downplaying its severity for so long with references to a 50-year-old sitcom episode that played kids getting the measles for laughs, but immune amnesia is not a new concept. We’ve known about it for a long time (I’ve even written about it—twice!—on this very blog), and it makes children more susceptible to other diseases for three years or more after having suffered a case of the measles. We just didn’t know the mechanism before. That’s the new information that this new study provided, a potential mechanism by which the measles virus induces immune amnesia. Guess what? The measles vaccine provides immunity without having to suffer the disease or causing immunosuppression!

To be honest, I started to tune out when Maher then launched into a news story about the “interstitium” as evidence that doctors are so clueless that they didn’t know that this “new organ” existed until recently, saying, “You mean that there’s this whole new organ in the human body that we didn’t know about until a year ago, and yet you’re telling me not to ask questions about this?”

You might remember news stories about the supposed discovery of a new organ that the scientists publishing about it dubbed the “interstitium.” Let’s just say that there was a lot less to that discovery than met the eye, which is perhaps why hawkers of pseudoscience like Deepak Chopra were unduly impressed by the whole thing. It turns out that Neil Theise, the pathologist whose observations sparked the study, is a fan of something called “post-modern biology”, ideas that “suggest that alternate models of the body, other than Cell Doctrine, may be necessary to understand non-Western approaches to the body and health.” He also thinks the interstitium can explain how acupuncture “works.” He even invoked quantum physics. No wonder Maher likes the finding! No wonder Dr. Jay is too clueless to realize that not a single other researcher has confirmed this finding. I predict that no one will.

Towards the very end, Maher made a big deal about how little we know about how general anesthesia works, which is true to some extent but a highly distorted view of the true situation. In actuality, we’re learning a lot about how general anesthetics work. Here’s my response. It’s not true that we “don’t know how general anesthesia works.” In fact, we know a great deal about the physiological effects and the sites of action. What we don’t yet have is a detailed molecular mechanism to explain how general anesthetic works. That doesn’t mean that a claim that anesthesia wouldn’t work is valid. That doesn’t mean that general anesthesia is unsafe, given that we have many decades of empirical experience to tell us what is and isn’t safe. Maher and Dr. Jay were just adding another fallacious appeal to ignorance to the mix.

Finally, I checked out the Overtime segment. Dr. Jay didn’t speak that much because most of the questions were directed to Ronan Farrow and Dennis Prager, but the one question he was asked was about “toxic metals in baby foods”. Not surprisingly, Dr. Jay didn’t understand dose and exposure and was therefore very concerned. That’s not what irritated me so much. What irritated me is how Dr. Jay used the question as a jumping off point to say that he doesn’t like the new vaccine laws (like, I presume, SB 277 and 276 and recently passed laws in other states that clamp down on nonmedical exemptions or ban them altogether). Naturally, he sees it as a horrible affront to parental rights and physician autonomy. He only got very tepid applause after that answer, leading Maher to crack, “And the sheep not applauding”. I couldn’t help but wonder why, if Dr. Jay is “not antivaccine”, he took advantage of a question about baby food to pivot to complain about the new California vaccine laws.

HBO is complicit in spreading antivaccine misinformation

The entire interview with Dr. Jay was a large segment of the show, nearly one quarter of its running time, and it was a segment devoted to spreading antivaccine misinformation, fear mongering, appeals to ignorance, and false equivalencies. It portrayed Dr. Jay’s ignorant appeals to ignorance and elevation of anecdote above rigorous science and Maher’s anti-medicine rants, misunderstanding of science, and paranoid fantasies (“doctors saying, ‘Don’t ask questions’ and ‘When have we ever been wrong?'”) as reasonable and real. It was every bit as bad, if not worse, than Maher’s antivaccine show in 2015 in which he interviewed Robert F. Kennedy, Jr.

What I should have done then but am going to do now is to denounce HBO. By airing a show in which the host is allowed to spout antivaccine pseudoscience, fear mongering, and conspiracy theories, along with clearly refutable outright misinformation about vaccines to a national—no, worldwide—audience in the middle of a huge measles outbreak in the US (and much larger measles outbreaks elsewhere) resulting from vaccine hesitancy, HBO is complicit in facilitating the spread of antivaccine misinformation, just as Facebook, Google, YouTube, Amazon, and Netflix have been. The difference is that Facebook, Google, YouTube, Amazon, and Netflix have been trying, admittedly with differing levels of commitment and with mixed results, to do something to stop the use of their platforms to facilitate antivaccine misinformation. When will HBO join them?