Book review: Deadly Choices by Paul Offit

Deadly Choices book cover

Deadly Choices explores the history of the introduction of new vaccines and the anti-vaccine movements that tend to follow. Offit is a prominent virologist and he doesn’t hide his scorn for some in the anti-vaccine movement. His book is unlikely to change the mind of anyone who is firmly within that movement, but I’m not sure what would. The book is a must read for anyone interested in a detailed, well-written, and thoroughly sourced discussion of the scientific basis of vaccines, the real and imagined risks of vaccination, and the consequences of the choices we make about vaccines.

Given that we wrote about the vaccine/autism debate in The Invisible Gorilla in our chapter on the Illusion of Cause (people tend to draw causal inferences from anecdotes, narrative, and temporal associations), I requested and received a review copy of Offit’s new book from the publisher.

Not surprisingly, the book thoroughly documents some of the unfounded claims that the anti-vaccine movement has made and explains the biological reasons why some of the perceived risks of vaccines either are not a risk or physiologically CAN’T be a risk. For example, many of the “green our vaccines” campaigns are based on the concern that there are nasty chemicals in vaccines, which is true. As Offit notes, though, it’s not the substance that’s the problem, it’s the dose. Even water is toxic when taken in a large enough dose (on occasion, college students die during frat hazings when required to drink too much water at once). Most of the substances that scare people away from vaccines (e.g., aluminum and formaldehyde) are in our bodies and blood stream all the time. Our foods contain them, and the quantities in vaccines are relatively negligible. Similarly, babies are exposed to countless bacteria and viruses, so the fact that children get a seemingly large number of vaccines does not mean that those vaccines tax the immune system at all (Offit also notes that it’s not the number of vaccines, but the number of elements within those vaccines that require an immune response).

The book is not one-sided. The first chapters discuss all of the well-documented cases of actual vaccine injury and the real side effects of vaccines (e.g., the live polio vaccine could cause polio, although most vaccines don’t use live viruses). The book uses these tragic cases to document how the CDC and regulatory agencies now catch really rare side effects that didn’t show up in the large-scale testing necessary for approval (side effects that are 1 in a million sometimes don’t show up in testing with 50,000 people). Vaccines undergo more rigorous testing than other drugs, and the mechanisms in place to detect rare side effects work far more effectively than they do for other drugs. In order to introduce a new vaccine into the recommended schedule, testing must show that it doesn’t interact in any way with the remainder of the schedule.

Offit also discusses some of the things that vaccine safety advocates could do (but haven’t done) to help make vaccines safer. For example, people who have egg allergies cannot get vaccines that are made using chicken eggs (e.g., flu vaccine). There might well be alternative ways to make such vaccines, but the pharmaceutical industry has no financial or government-initiated incentives to develop those alternatives. Vaccine safety advocates could push them to do so.

Offit makes the case that anti-vaccine movements raise fears of vaccines that are inconsistent with the science. In so doing, he draws parallels between current anti-vaccine claims and those made over a century ago after the introduction of the smallpox vaccine. Many of the fears of that vaccine are laughable by today’s standards (e.g., that children would develop cow-like facial features because the vaccine was initially taken from cows infected by cowpox). But Offit argues, fairly convincingly, that the logic and nature of current anti-vaccine scares are largely the same as those raised over a century ago and in each subsequent anti-vaccine movement. He also shows that most of the anti-vaccine proponents as well as self-identified vaccine safety advocates (including Dr. Bob) lack any relevant background in virology, epidemiology, or statistics, and that they typically lack the training to evaluate the actual risks of vaccines.

The most compelling chapter is the last one, in which Offit describes what happens when someone who could not be vaccinated (because they were too young) comes into contact with an infected child whose parents decided not to vaccinate. The choice not to vaccinate affects people other than your own child–it puts young infants and others whose bodies lack a typical immune response can’t be vaccinated at risk. The chapter is reminiscent of the PBS Frontline’s unforgettable documentary The Vaccine War, which depicted the impact of vaccine-preventable diseases like pertussis (full show embedded below).

At times, the book can be a bit heavy handed in its tone–Offit’s perspective is clear throughout, and he doesn’t hold his punches. Sometimes his parallels between historical anti-vaccine movements and current ones are a little forced, and in a few cases, the book is perhaps a bit more dismissive than is necessary. For example, in passing Offit implies that all chiropractors reject the germ theory of disease. Although a rejection of the germ theory might have motivated chiropractors at the start, I’d hazard a guess that most present-day chiropractors accept the germ theory of disease. Overall, though, the book presents the scientific evidence in a compelling, comprehensive, thoroughly documented, and engaging way.

For prospective parents whose prior information about vaccines comes from friends, the internet, or even their pediatrician, this book is a must read by one of the top scientific experts in the field. It provides the background and evidence you need to evaluate claims about the dangers and benefits of vaccines and to make the best choice for your children AND your community.

My review is based on a pre-release version of Deadly Choices. I requested and received a review copy from the publisher. I have corresponded with Offit on several occasions since the publication of our own book, mostly to discuss media coverage of vaccine science and the anti-vaccine movement. A slightly different version of this review was posted on

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