In his review of “Turtles All The Way Down: Vaccine Science and Myth,” Brian Martin, Ph.D., says the book exposes systematic weaknesses in studying the harmful effects of vaccines and challenges the usual claims about the benefits of vaccines for the individual and the community.
In 2010, I began writing about the vaccination debate — the public debate over the benefits, risks, ethics and politics of vaccines. This was long before COVID-19, so nearly all the debate was about childhood vaccines for diseases like polio, measles, diphtheria and tetanus.
Being on the lookout for good sources on the pros and cons of vaccination, I obtained a copy of “Turtles All The Way Down,” published in 2022. The title, at first glance, sounds peculiar. The subtitle, however, is more revealing: “Vaccine Science and Myth.” For convenience, I will refer to the book as “Turtles.”
The book arrived with plenty of advance publicity. It was originally published in 2019, in Israel, in Hebrew, and made a splash. I read that it had received a positive review in an Israeli medical journal, a review written by Ety Elisha and Natti Ronel.
Well, well. I knew them: We were collaborating, along with two others, on a paper about the suppression of critics of official views about COVID-19. It’s a small world.
An unusual aspect of “Turtles” is that its authors are anonymous. They chose not to reveal their identities to avoid ad hominem attacks.
Also, if they worked within the health system, they could be subject to reprisals in their careers. That’s exactly what I had been studying for the past decade concerning vaccination, and even longer for other scientific controversies.
Remaining anonymous makes a lot of sense to me. Indeed, it’s what I recommend for whistleblowers, whenever possible.
The authors call themselves The Turtles Team or TTT.
“Turtles” is a frontal attack on the assumption that the standard childhood vaccination program is both safe and effective. This assumption is at the core of the vaccination paradigm, the framework that guides thinking and research in the area.
To illustrate the contrast between TTT’s analysis and the official position on vaccination, I found a short article that nicely articulates the orthodox view: “Simply put: Vaccination saves lives.”
The article was published in 2017, in the Proceedings of the National Academy of Sciences, a prestigious long-standing U.S. scientific journal. The authors are Dr. Walter Orenstein and Rafi Ahmed, Ph.D., both from Emory University. Orenstein, is also one of the co-editors of the textbook “Vaccines.”
I will refer to Orenstein and Ahmed’s article to highlight assumptions and emphases in the orthodox position on vaccination — the position challenged by The Turtles Team.
Safety: Are clinical trials adequate?
Let’s start with safety. Orenstein and Ahmed do not explicitly discuss adverse events caused by vaccination, but instead, implicitly dismiss them by countering concerns that vaccines cause autism.
Perhaps their assumption is that if the autism claims don’t stand up, less well-known ones won’t either.
A prime claim in “Turtles” is that if the safety of standard vaccines has never been established, indeed the assumptions or claims about safety have no foundation.
How could this be? TTT begins by examining the vaccine approval process and the randomized controlled trials that are required, clearly and carefully explaining what’s involved.
In phase 3 trials, there are two groups of children. One group is given the vaccine, let’s say a vaccine for chickenpox, and the other group is given a placebo — they are injected with a passive or neutral substance.
No one, including the researchers and the children, is supposed to know which children get the vaccine and which get the placebo.
When testing for safety, the number of adverse events — including seizures, breathing difficulties, allergic reactions, paralysis, severe illness and death — in each group are noted.
If the frequency of adverse events in the vaccine group is not significantly higher than the frequency of adverse events in the placebo group then, after other factors are taken into account, the vaccine is assessed to be safe.
The problem, TTT says, is that the placebos in phase 3 trials of childhood vaccines are not inert. The researchers doing the safety studies could have used a saline solution for the placebo, but instead, they use other vaccines.
This would be fine if the other vaccine had been shown to be totally safe but, according to TTT, no vaccines have been tested against inert placebos, and hence the clinical trials don’t actually show how safe the vaccine is.
This is a striking claim, and also a daring one, given that a single counterexample, a single study, might undermine it. A safer claim by TTT would be that despite extensive searching, they have not discovered a phase 3 trial of a vaccine against an inert placebo.
Note that TTT doesn’t make a detailed claim about the rate of adverse events. They just say the clinical trials haven’t shown vaccines to be safe. As they put it, “The true rate of adverse events of routine childhood vaccines is virtually unknown; therefore, there is no scientific basis for claiming they’re safe” (p. 66).
More on safety: What about ‘undone science?’
Clinical trials are only one way to examine the safety of vaccines. Another possibility is to undertake biological and physiological research into adverse events.
TTT examines studies in this area, or rather their absence. They conclude that the generous funders of vaccine research — there is a vast amount of research in the field — seem remarkably averse to adverse-events research into diagnoses, causal mechanisms, individual susceptibilities and therapies.
By not undertaking studies to better understand damage from vaccination programs, it remains possible to say vaccination is safe.
What about the reporting of vaccine adverse events? Anyone following this issue will soon hear about VAERS, the Vaccine Adverse Event Reporting System, where people can report harmful side effects of vaccines.
If there aren’t many reports in VAERS, that should indicate that vaccines are safe.
But according to TTT, there’s a problem — actually, several problems. Although reporting cases of many infectious diseases is mandatory, when it comes to potential adverse events from vaccines, reporting is voluntary and doctors are not compensated for doing so.
Also, many doctors are reluctant to make reports, telling patients their conditions could not be vaccine-related but are just a coincidence. This suggests considerable underreporting. Some estimates are that only 1 in 10, or 1 in 100 adverse events are reported.
So why not improve the rate and quality of reporting to determine how accurate VAERS actually is?
There was a study to show how this could be done. However, the Centers for Disease Control and Prevention (CDC) — the U.S. body charged with vaccination recommendations — stopped engaging with the researchers without explaining why.
TTT argues the CDC has shown no interest in improving VAERS.
TTT’s next target is epidemiological studies showing low rates of adverse events. Imagine collecting data from a large population about the incidence of a particular condition, let’s say high blood pressure. Then collecting data about people’s ages, incomes, diets and anything else you can think of that might be relevant.
By looking for statistical relations between the given health condition and other factors, you might be able to notice, for example, that people’s blood pressure gets higher as they get older, or that it’s higher for people who eat lots of meat, or whatever.
These are correlations, but they don’t prove causation. Maybe people who eat lots of meat get less exercise. It could be that lack of exercise is the main factor responsible for high blood pressure. Or it could be the salt in the meat dishes. You can see this gets quite complicated.
TTT provides a primer on epidemiology, explaining the basic ideas clearly and simply. They then offer a damning indictment of epidemiological studies about vaccine safety, arguing they are designed to show no correlations between vaccines and adverse events. This is serious.
TTT closely examines five major studies. They suggest the studies are biased by design or execution — using defective research methods, relying on unsubstantiated data, omitting essential data, making meaningless calculations, dismissing unwelcome findings and exaggerating the significance of the findings.
Remember that Orenstein and Ahmed in their article “Simply put: Vaccination saves lives” did not explicitly mention adverse events caused by vaccines, but implicitly addressed them by dismissing a study by Dr. Andrew Wakefield and 12 collaborators about the possible connection between the MMR triple vaccine and autism.
One of the epidemiological studies often cited as showing there is no such connection is by Kreesten Meldgaard Madsen, M.D., and colleagues. This is one of the “doctored” studies that TTT analyzes, showing systematic shortcomings.
‘The studies that will never be done’
TTT next examines what it calls “the studies that will never be done.” An obvious way to investigate the overall safety of the entire vaccination schedule is to compare the health of two groups of children that are as similar as possible except in one respect: One group receives all recommended childhood vaccines and the other group receives no vaccines at all. Simple!
Such a study would gather all the benefits and risks of vaccines, the benefits from reduced incidence of infectious disease and the risks from adverse events and anything else, including beneficial or harmful effects not normally considered.
A study like this showing the benefits of vaccination would be a powerful way to encourage parents to have their children vaccinated. But, perhaps surprisingly, such a study has never been undertaken by medical authorities. (There are some small studies by vaccine critics showing unvaccinated children have better health.)
This is the most striking example of undone science in the vaccination arena. Perhaps proponents are afraid the results might not support vaccination? Or not support it as much as they hope?
TTT goes further, suggesting the CDC has the data and that comparative studies may have been quietly done but never published because the results do not support vaccination. This is speculative.
Another explanation derives from the vaccination paradigm: Proponents operate within a framework that assumes vaccines are vital for health.
Given this belief, there is no need for further studies to see whether vaccines are beneficial. In fact, publicity about such studies might generate alarm by making people think there is some reason to doubt the vaccination program.
Within the assumptions of this paradigm, this is a reasonable concern. However, it does mean that critics can continue to point to the absence of definitive studies showing the net benefits of receiving all recommended childhood vaccines are greater than having no vaccines at all.
In guidelines for childhood vaccination, there are targets for particular vaccines at specific ages, known as the vaccination schedule. For example, in the U.S., hepatitis B at birth, 1 month and 6 months.
“Turtles” also targets the vaccine schedule. For example, in the usual schedule, several vaccines are given in a single visit, but some parents prefer to space out the vaccines.
Is there sound evidence for the safety of giving multiple vaccines at the same time? TTT says no.
Given TTT’s sustained critique of assumptions about vaccine safety, does this mean that vaccines are unsafe? This depends on what exactly is meant by unsafe.
Despite statements declaring “vaccines are safe,” careful vaccination advocates always acknowledge adverse events, but say they are extremely rare.
TTT shows the research behind that claim is simply not there. They show that research about adverse events is either flawed or not done at all.
But what if studies were carried out to accurately determine the rate and significance of adverse events?
It is possible that the adverse events would be shockingly frequent, validating the worst fears of vaccine critics. But it is also possible that harmful effects would be modest, perhaps higher than those currently acknowledged, but not high enough to outweigh benefits.
TTT may have shown that the science of vaccine safety lacks foundations, but it hasn’t attempted to show what the science would say if it did have a solid foundation.
By the nature of undone science, no one can know for sure. But we do know who is resisting doing definitive studies.
Does vaccination really save lives?
In the usual slogan of “vaccination saves lives,” the benefits are assumed to outweigh the risks.
There is a sleight of hand here in referring to “vaccination” rather than to individual vaccines. It is quite possible that one group of vaccines reduces the death rate but some specific vaccines cause more harm than benefit.
Orenstein and Ahmed’s opening sentence claims, “Few measures in public health can compare with the impact of vaccines.” The Turtles Team challenges this claim.
It provides figures showing that deaths and illnesses from infectious diseases were in rapid decline before mass vaccination was introduced, and argues that most of the decline was due to other measures that improved public health, including clean water, good diet, better hygiene and a higher material standard of living.
These arguments are not new. They were presented, most prominently, by Thomas McKeown, M.D., Ph.D., D. Phil., and have been cited repeatedly by vaccine critics. Despite this, vaccine proponents seldom mention these arguments. Orenstein and Ahmed certainly do not.
I wish vaccine advocates would provide a cogent rebuttal of the work of McKeown and others who question the scale of the benefits of vaccination. So far as the public debate is concerned, this might be called an “undone refutation.”
You can see that the slogan “vaccination saves lives” is suspect if the benefits have been exaggerated and the harms undercounted.
But TTT is not finished. There is one more important claim to address.
Herd immunity: the best thing since sliced bread — or fake news?
Proponents argue that being vaccinated primes the immune system, reducing the risk of catching the targeted disease. They also argue that when most people have vaccine-induced immunity, others — including people who can’t be vaccinated — are also protected.
For a virus to spread, it needs to encounter susceptible hosts: others who can be infected. If most people are immune to the virus, the disease outbreak will die out.
This process protects the whole population, the “herd,” a collective benefit from sufficiently high levels of immunity in the community.
Vaccine proponents make a big deal about herd immunity. It provides a moral imperative to be vaccinated and to promote vaccination, including through mandates.
Orenstein and Ahmed devote a considerable portion of their short article to herd immunity, complete with a colorful diagram. They write that herd immunity “provides the rationale for interventions to achieve high population immunity” including “mandates for immunization requirements for attending school.”
For years I’ve read the arguments for and against herd immunity. Vaccine proponents almost invariably argue for its importance, sometimes at such length that people gain the false impression that the main benefit of getting vaccinated is not for yourself but for others.
As a result, vaccination is sold, and often perceived, as altruistic — which means those who question vaccination, or are not vaccinated, can be painted as selfish.
It is also possible to find critics of herd immunity, who argue that it doesn’t exist or is irrelevant.
So is herd immunity the most wonderful thing since sliced bread, or fake news? I don’t remember seeing an intermediate view — until reading “Turtles.”
TTT systematically examines the evidence for and against herd immunity for each of 14 vaccines, from tetanus to measles. They conclude that, with sufficient coverage, five of them may confer herd immunity, whereas the others probably will not, or that their protection is not relevant or beneficial to children.
It was refreshing to encounter an analysis that independently follows the evidence and doesn’t end up purely in one of the two warring camps.
Remember that Orenstein and Ahmed provided figures showing the measles vaccine reduced disease morbidity by over 99%. TTT agrees that the vaccine reduced morbidity through herd immunity, though perhaps not by this percentage.
Some vaccine critics may find this assessment unwelcome.
TTT’s analysis shows the value of making careful assessments of different vaccines, each one with specific considerations and complications.
Rather than follow Orenstein and Ahmed in saying, “vaccination saves lives,” the question should be whether specific vaccines save lives, and beyond this, who benefits and who suffers harm?
To question vaccine-induced herd immunity is to question the rationale for coercing vaccination through measures such as vaccine requirements to attend school.
Even for vaccines providing herd immunity, an assessment of the overall benefit needs to take into account harmful side effects.
As TTT put it, “in the absence of solid evidence for a positive net benefit for individual vaccines, as well as the totality of childhood vaccination programs, there is no moral justification for mandating vaccination, or enforcing it in any other way” (p. 367).
What about polio?
Polio has long had a high profile, first as a disease to be feared and then as one of the great triumphs of vaccine research.
In the 1950s, Jonas Salk developed an injectible vaccine. Then Albert Sabin developed an oral vaccine, typically taken with a sugar cube. I vaguely remember having this vaccine when I was in primary school.
The struggle to eradicate polio is one of the longest-running sagas in vaccination lore. As you can imagine, the idea that pesticides are the main cause of polio is not likely to receive a warm welcome from the medical establishment.
“Turtles” provides the clearest exposition of this hypothesis that I’ve encountered. TTT systematically lays out a series of open questions and contradictions in the official story about polio’s cause, presenting the standard view and an alternative explanation based on pesticide exposure.
For example, they ask, “Why did most of the early polio outbreaks occur in sparsely populated rural areas rather than in the large and crowded metropolitan areas?”
The standard view, which assumes the contagious spread of the poliovirus, cannot explain this. The alternative view explains that “Farming communities were the first to be poisoned by the use of toxic pesticides.”
In total, TTT lists 19 mysteries unexplained by the standard view but apparently explained by the alternative view that pesticides are the primary factor in paralytic polio.
Reading this, I thought, “I’d really like to see vaccination proponents offer their views about each of these 19 apparent mysteries.”
What next?
My guess is that vaccination proponents will studiously avoid engaging with the arguments in “Turtles.”
It is certainly possible that they could counter some of TTT’s arguments but, alas, we will probably never know, because proponents are in the ascendant. They have cemented childhood vaccinations as an unquestioned good and stigmatized the slightest reservation or criticism.
This is a sad state of affairs. There are a great many people who would benefit from an open debate, without ad hominem attacks and with respect for contrary views.
Such a debate might lead to fewer vaccine mandates and more tolerance for selective vaccination and even non-vaccination. On the other hand, it might lead to more solid evidence for the benefits of some vaccines.
However, even such deliberation would not be enough, because of undone science. There is too much research that needs to be carried out and too much evidence that needs to be collected before judgments about vaccination can be put on a solid basis.
Conclusion
Of available critiques of vaccination orthodoxy, I think “Turtles” is the best yet. It exposes systematic weaknesses in studying the harmful effects of vaccines and challenges the usual claims about the benefits of vaccines for the individual and the community.
The book has all the features I look for:
- Comprehensive: It covers the central scientific and medical issues in the debate.
- Reasoned: Evidence and arguments are presented in a careful, logical, systematic way.
- Authoritative: The authors, though anonymous, show their knowledge through their grasp of research and through comprehensive citations to medical research.
- Readable: The writing is remarkably clear, and occasionally high-spirited.
I make two predictions. First, vaccination advocates will try to ignore the book. They are unlikely to engage with the book’s contents, though they might complain about the authors’ anonymity.
Second, “Turtles” won’t end the dispute, which is likely to continue for decades.
“Turtles” was written before COVID-19 and does not address COVID-19 vaccines. Yet COVID-19 is an important factor in the vaccination debate, because the mandates and adverse events associated with COVID-19 vaccines disturbed large numbers of people, leading some to protest publicly. Concern about and opposition to COVID-19 vaccines led to greater questioning of other vaccines.
For those who are energized by concerns about COVID-19 vaccines, “Turtles” is the ideal source for learning about the evidence and arguments.
Although arguments seldom resolve scientific controversies, events sometimes make a big difference.
In the debate over nuclear power, the accidents at Three Mile Island, Chernobyl and Fukushima had immense impacts, serving to discredit the technology.
In the vaccination debate, a major vaccine disaster could play a similar role. The full story of the impact of COVID-19 vaccines is yet to play out, but it is reasonable to say that when promoters endorse a vaccine that is widely seen as disastrous, they jeopardize the rest of the vaccination program.
So perhaps my prediction about the continuation of the debate is off the mark. Time will tell!
There’s much more to be said about “Turtles.” But enough from me, for now. You can form your own view, let me know what you think and, after you’ve read the book, contact The Turtles Team at the email address given in their book.