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This book is a classic example of pseudoscience, and thus this review will concentrate on demonstrating that, and pointing out how it could be used as a case study for folks interested in understanding how pseudoscientists manipulate facts to fit their false narrative. What are some of the hallmarks of pseudoscience, and what aspects of this book are good examples? In no particular order; these are: 1) A search for a simple answer: Science is intellectually demanding, and understanding the data and its relationship with a conclusion is something that even veteran scientists find to be hard work. In this case the simple answer, sadly aimed at folks seeking answers about the cause for a complex disease like autism, is that vaccines are bad. Wanting a simple explanation for a complex disease, which actually is dependent on many genetic, developmental, and environmental factors, is a valid human urge. Unfortunately, simple answers are rare. Books like this promote simple answers, and although that might be comforting, in the end it can also cause great damage. 2) Lies of omission: This is the best tool in the toolbox of pseudoscience, because most folks don't have the deep background to know what is being omitted, and most folks really won't check the references cited. Such errors in scientific articles are usually discovered during peer-review, but books like this are not peer-reviewed, and pseudoscientists rarely if ever publish in peer-reviewed journals. Because this is such an important tool of pseudoscience, I’ll give three examples. I suspect that a close read of the many citations in this book would reveal many more. A) In the chapter on diphtheria, the authors quote from a 1996 article about an outbreak of that disease in St. Petersburg: “If a wide diphtheria epidemic affects and industrialized country, it would probably not any more be the big killer that it was in Europe and in the United States in the 1950s and 1960s.” They imply that the conclusion of the study’s authors is that medical advances other than vaccination stemmed this outbreak, and that vaccines had no effect, because immunity from the vaccine is “short-lived”. However, the sentences IMMEDIATELY PRECEDING that quoted sentence read: “In a subgroup of 1,045 patients the protective efficacy of vaccination could be evaluated. A 2.2 fold protection was found, but the study may underestimate the efficacy.” In other words the authors of that study believe that vaccination is a critical part of stemming that outbreak, that it provides substantial protection from the disease, and that it would be critical in future outbreaks. Selective quotation of a single sentence allows them to argue exactly the opposite of the authors’ conclusions. B) In the chapter on smallpox, the authors spend a lot of time discussing the Leicester Method, where early anti-vaxxers rebelled and refused to get their children vaccinated in that English city. This history is used to suggest that quarantine and sanitation measures alone eliminated smallpox, and that vaccination is useless and even dangerous. Left out of the discussion is the reality that Leicester hospital and medical staff were vaccinated. Many vaccinated people remained in the population. Furthermore, contacts of patients were urged to get vaccinated. So it is a bit more complex than the authors would like us to believe, and the notion that it was ONLY better sanitation and medical treatment does not stand up to scrutiny. This is a classic lie of omission. C) The authors cite a study by Stephen J. Walker, implying that it documents a link between vaccine-derived measles virus and autism. But this study is not as advertised. It is actually not even found in a peer-reviewed article, it is a preliminary report given at a conference. Furthermore Walker himself disagrees with the implication that his results imply a link between measles, vaccines, and pathology. Via his university press office, this misrepresentation is called out. "Walker says the new research does not support the connection, and he notes that the results have not even been published in a peer-reviewed journal. ‘Even if we showed association (between measles virus and bowel disease) and we published it in a peer-reviewed journal, the conclusion will be simply that there is measles virus in the gut of a large number of children who have regressive autism and bowel disease. End of story.’" 3) Allegations of massive problems with current science, documented by massive citation lists: In creationism circles (creationism is another good example of pseudoscience) this is known as the Gish Gallop, after Duane Gish, who often moved so quickly from one bogus argument to the next that his opponents had no time to counter the first one. One example should suffice. Among the many irrelevant graphs and images in this book, there is a photo of a mosquito dying from DDT. Even if there was a lot of evidence that DDT was a problem in the polio epidemic (there isn’t), this image really doesn't add much to the vaccine argument. This makes the book longer and perhaps makes it appear more "sciencey" to a lay audience, but serves no useful scientific purpose. If confined to the simplest and most concise arguments needed to make their case, the authors might have produced a book less than 10% the length of this one. 4) Correlation conflated with causation: There are dozens of examples in the book, including the aforementioned correlation of DDT and polio cases, most of the graphs, etc. Simple graphs of disease mortality vs. time are appealing to non-scientists, but the reality is that these unsophisticated bivariate analyses of events with many confounding variables are neither helpful nor explanatory. 5) Setting up a false dichotomy: The authors strenuously argue, in many chapters, that sanitation, not vaccination, can explain decreases in incidence and mortality of many diseases. There is no consideration that both sanitation AND vaccination might be important, and that both are effective. They state, correctly, that medical doctors could have prevented lots of deaths by washing their hands. That is certainly true, but so what? Has someone claimed that there is only one medically valid way to save lives? Or is it possible that sanitation is just one of many useful advances? Ditto with the arguments about nutrition. As noted above, the simple answer is always preferred; complicated answers, which recognize a complicated reality, will be discarded by pseudoscientists and thus will never occur to their readers. 6) Personal subjective anecdotes and testimony are emphasized over objective evidence from many subjects and many studies: This is not as obvious with this book as it often is, but nonetheless both authors write, in the author's introduction section, about personal experiences that drove them on this quest. That's fine. But we all know that anecdotes ain't data. 7) Misrepresenting the facts: Besides the harder-to-detect lies of omission, careful research will always find some outright whoppers in the arguments of pseudoscientists. In the chapter about polio vaccines, some early versions of which were contaminated by a monkey virus known as SV40, the authors claim that "SV40 is known ... to induce tumors when injected into volunteers". In support of this assertion, they cite an article from 1964 (ref. 468). However, that article does NOT report the production of tumors after viral injection, contrary to the statement made by the authors of this book. The article does describe the formation of nodules after injection of various amounts of transformed human cells (NOT live virus) into terminal cancer patients; these nodules do not progress to become tumors, but instead regress and disappear. In the one case where a patient is injected with virus, as a control, no nodules or even a reaction occurs. Nobody reading that article could legitimately claim that it showed that injection of live SV40 produces tumors in human beings. Yet that is the claim made in this book. 8) Pointing out problems without mentioning that these problems were DISCOVERED by scientists who want to solve them: Vaccines, like all medicines, are imperfect, particularly in their first versions. These imperfections were discovered by other scientists (not by pseudoscientists like the authors of this book) and, in fact, other scientists have taken steps to use that information to make vaccines better. Case in point - Adenylate Cyclase Toxin from B. pertussis is known to be a major immunogen in patients who are naturally infected, and is now being engineered to be a component of next generation vaccines. The authors make a big point that this lack of a major immunogen in current vaccines is a problem, but fail to acknowledge that actual working scientists found the problem and are actively striving to correct it. Science solve problems; pseudoscience merely points them out and pretends that science stopped there. 9) Conspiracy theories based on "big science" or "big pharma" or other nebulous groups who are somehow covering up the truth: Again, one example (out of many) should suffice. The authors mention the article by Andrew Wakefield that started this whole recent anti-vaccine industry, and assert that it was retracted "without explanation", in a "bizarre move". No, it was retracted after an investigation by the British General Medical Council found that Wakefield had "acted dishonestly, irresponsibly, unethically, and callously in connection with the research project and its subsequent publication". He had a disqualifying conflict of interest that was not disclosed. Later, it was shown that he had falsified some of the data. Additionally, despite many subsequent efforts to detect a link between vaccines and autism, none have been found. That's how science works; conflicts of interest, outright fraud, and lack of reproducibility are signs that the conclusions of the paper are incorrect. It can only be considered "bizarre" if you subscribe to pseudoscience rather than science, and believe in conspiracy theories. The notion that there is a global conspiracy to hide the truth is laughable to anyone who is a scientist, and who understands how competitive science actually is. If a scientist figured out a way to overturn a paradigm, or, even better, advance human health, he/she would immediately do so, and the notion that some vague international cabal could keep them from that is not only dubious, it is insulting to every real scientist on the planet. 10) Invoking irrelevant bogeymen: Pseudoscientists know their audience, and understand that the mere mention of particular words or names will make that audience associate the evil person or concept with the evil that they are decrying. So these authors trot out Charles Darwin and evolution, as well as Margaret Sanger and Planned Parenthood, and Hitler and Nazism, secure in the knowledge that their audience hates those people and those words, and will therefore automatically be suspicious of any concept, no matter how irrelevant, that they can link, no matter how tenuously, to those bogeymen. Darwin, Sanger and Hitler had nothing to do with vaccines or vaccination, but that is not the impression that the authors would like you to retain. In closing, it is good to quote the epigram for chapter 16, from Daniel Boorstin "The greatest obstacle to discovery is not ignorance - it is the illusion of knowledge." Truer words were never spoken; this entire book is the illusion of knowledge, and it is an obstacle to discovery. The simple easy answers sought by many are not found in this book, and accepting its arguments without deeper investigation will only set up more obstacles to understanding and discovery. A good antidote to this ignorance would be to read Seth Mnookin’s “The Panic Virus”, in order to actually gain the knowledge needed to dissolve the illusions created by the half-truths in this book.