CHD Book Club: Turtles All the Way Down: Vaccine Science and Myth

The May 2023 selection is “Turtles All the Way Down: Vaccine Science and Myth,” edited by Zoey O’Toole and Mary Holland, J.D.

The “vaccine debate” has been raging for at least a decade now, and only intensified during the COVID pandemic. It can be difficult for parents to sift through all the conflicting vaccine information to find the truth, especially now that search engine algorithms have heavily biased the discussion. “Turtles All the Way Down,” originally published in Hebrew in 2019, puts together everything you need to determine once and for all who is right in the vaccine debate — the folks assuring you that “vaccines are safe” or the parents who say serious adverse events are way too common? Relying only on mainstream medical sources that include CDC publications, peer-reviewed science, and textbooks, “Turtles All the Way Down” leads you gently down the scientific path to the definitive conclusion.

Here are some thought-provoking discussion questions to think about as you read “Turtles All the Way Down.” In addition, we invite you to view the Friday Roundtable featuring editors Zoey O’Toole and Mary Holland, as well as their book club-type discussion on Good Morning CHD on Saturday, March 13, 2023.

Questions for Discussion

1. The authors of “Turtles All the Way Down” made a very unusual decision when they wrote the book: They chose to publish anonymously. Their reasons were twofold: to protect themselves and their families, and to keep the focus of attention on the content of the book. (The English version came out in July of 2022, has sold nearly 40,000 copies, and currently has 528 ratings on Amazon with an average of 4.9 stars out of 5—and it just got its first critical review. Well-known vaccine apologist Dorit Rubinstein Reiss wrote a guest blog for Skeptical Raptor that was published on May 7, 2023. Reiss is a law professor at UC Hastings. To her credit, Reiss actually addressed some of the material in the first chapter of the book. Unfortunately, she made so many errors it’s not clear she read the chapter closely, much less the book.) How successful do you think the anonymity strategy has been so far? Do you see any disadvantages to that strategy?
2. The authors made a conscious decision to choose only mainstream sources that are not associated with vaccine critics and thus cannot be dismissed as “anti-vax.” They also chose to make only the arguments that they could prove in that manner. What do you think are the advantages and disadvantages of that approach?
3. The first chapter of the book analyzes the vaccines on the childhood schedule and makes one crucial point: No vaccine that the CDC recommends for children under two has ever been tested in a randomized clinical trial against a true placebo before it was approved. Every product has been tested against one or more other vaccines, or in the case of some new vaccines, the “vaccine sans antigen.” Yet a randomized clinical trial with a true placebo control is the only way to get a true safety profile of a new vaccine. Thus, we don’t have a true estimate of the risks of any one vaccine, much less the schedule as a whole. Do you think the current way of doing vaccine clinical trials is acceptable? If so, why?
4. Dorit Reiss makes the argument that true placebo controls are not necessary; new vaccines are compared to older vaccines and “the book is wrong to suggest that decades of data collected on these vaccines are not good evidence about them, evidence that would make conducting a clinical trial depriving children of these vaccines unethical.” But Reiss’s argument is based on assumption, not data, and it turns out to be very dangerous to make such assumptions. A Danish research team used data from the Bandim Health Project in Guinea-Bissau, Africa, to analyze the effect the introduction of vaccines had on child mortality. They found — to their horror — the counter-intuitive result that children vaccinated with DTP vaccines, especially girls, died at much higher rates than children who did not receive the vaccine. The vaccine, itself, killed more children than diphtheria, pertussis, and tetanus combined. The analysis was performed in myriad ways in subsequent papers, and the results always showed much higher death rates for the vaccinated children. Knowing this, what would you do to fix the vaccine program if you were in charge?
5. The book makes it clear that vaccine adverse event reporting is “deficient by design.” Reporting is passive, meaning adverse events are not solicited, and voluntary, meaning that medical personnel are not required to report adverse events that they witness. This means that chronic underreporting is a serious issue. Do you consider this a problem? Why or why not? And what would you do to fix adverse event reporting if you could?
6. “Turtles” contrasts vaccine adverse event reporting with infectious disease reporting. Many countries, certainly including the United States, have had robust infectious disease reporting for decades. Reports are solicited and mandatory for a number of diseases. For the most part, these counts are assumed to be pretty accurate. Why do you think countries like the United States do a much better job gathering data on infectious disease than they do gathering data on adverse effects of fighting such disease?
7. In 2013 the Institute of Medicine issued a report that confirmed that parents were right, no studies had been published by the CDC or NIH comparing health outcomes in children who were completely unvaccinated with health outcomes in children who were vaccinated according to the CDC schedule. Yet the IOM said such studies should not be done, citing numerous reasons, none of which were valid. Can you think of any other reason for this recommendation from the IOM than a desire to hide high rates of injury and illness? Do you think if vaccines were truly as safe as we are told that the CDC would refrain from performing the one type of study could best demonstrate that?
8. “Turtles All the Way Down” analyzes the history of infectious disease mortality and the studies that have looked at that history in depth. These studies demonstrate unequivocally that the vast majority of the precipitous decline in infectious disease mortality occurred before there were either effective vaccines or modern antibiotics available. Did you find that surprising? If so, why do you think you had a different impression about that? Do you think knowing that fact alone would make people much less eager to vaccinate themselves or their children?
9. Herd immunity is the cited justification for vaccine mandates. The book analyzes the capacity for all the vaccines recommended for infants and toddlers to generate herd immunity, and it turns out that only five vaccines have a relevant capacity to generate herd immunity. Did you find that surprising? Why or why not? How does this change your perception regarding vaccine mandates?
10. As children we’re taught that Jonas Salk single-handedly vanquished the deadly scourge of polio with his miracle vaccine. “Turtles All the Way Down” does a deep historical dive and comes up with 19 “mysteries” that don’t fit that narrative. Did that chapter change your mind about the history of polio? If so, what did you find the most convincing or puzzling fact to be? Do you think that pesticides had something to do with the epidemic waves of paralysis that hit during the summers, particularly in the post-World War II years?
11. It is well known in public health circles that the last few cases of an infectious disease require sharply increased investment to prevent. That has certainly been the case for measles in the United States. There hasn’t been a year with more than 1,274 cases since 1992, yet the CDC has waged two very expensive campaigns in the last decade — in 2015 and 2019 — trying to get that number to zero. A) Do you think it’s possible to get that number to zero and keep it there? Why or why not? B) If you think it is possible, do you think that getting to zero cases of measles is worth the increased cost, reduced medical choice, and increased injury that it would take to get there?