You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation

by Paul A Offit MD

One of America’s top physicians traces the history of risk in medicine—with powerful lessons for today  Every medical decision—whether to have chemotherapy, an X-ray, or surgery—is a risk, no matter which way you choose. In You Bet Your Life, physician Paul A. Offit argues that, from the first blood transfusions four hundred years ago to the hunt for a COVID-19 vaccine, risk has been essential to the discovery of new treatments. More importantly, understanding the risks is crucial to whether, as a society or as individuals, we accept them. Told in Offit’s vigorous and rigorous style, You Bet Your Life is an entertaining history of medicine. But it also lays bare the tortured relationships between intellectual breakthroughs, political realities, and human foibles. Our pandemic year has shown us, with its debates over lockdowns, masks, and vaccines, how easy it is to get everything wrong. You Bet Your Life is an essential read for getting the future a bit more right.

Genres: Nonfiction, Science, History, Medicine, Medical, Health, Audiobook

242 pages, Kindle Edition

Published September 21, 2021

Reviews

[Petra X]

Very good book. Proper review to come. 5 star information and well-written. Reading Notes: Read it on the plane to Miami. With boyfriend now, Miami, now Delray Beach, tomorrow Marathon Key in nice Mustang with the top down, loud music. Will resume reading on the plane home from Miami, hopefully not before. Wish me luck!

The end: All that's screwed. Still it was a nice holiday and I must have some dignity and stop stooping over to pick up crumbs thrown at me.

Very sad.

[Rennie · Rating 4 out of 5]

I'm a bit torn here. I love his books, they're completely page-turning and very informative and easily understandble and readable in a way that's so helpful for non-sciencey types like me.

And I know he's pro-vaccine, obviously, as he retells part of the story here of his work on the rotavirus vaccine. But the overall effect of some real-life horror stories, especially those that happened to kids, is really bad. It's an interesting topic, no doubt - and one that I always kind of wondered about, like how did we learn what worked and what didn't in medicine? But eek, it is just not the time to give any fuel to the fire of vaccine skepticism or hesitancy.

Again, I know that's not what he meant or wanted to do. His point is that we have to decide how much risk is acceptable for us, and despite the worst cases where things went wrong or what choices were the right or wrong ones, the risk of the eventual treatments versus trying your luck with the illness is a no-brainer.

So I don't know. It's preaching to the choir with me because I'm already on his side but I worry about people remembering the impacting, emotional, heartbreaking cases over the breakthroughs and successes they eventually helped bring about. It's a precarious time for this.

[Stefan Mitev · Rating 5 out of 5]

Задължителна книга за всеки лекар.

Концепцията за риск в медицината е трудна за разбиране. Твърде много лекари, особено в условията на пандемия, не осъзнават важността на отношението полза-риск. Д-р Пол Офит разглежда историята на 9 революционни медицински постижения (сърдечна трансплантация, антибиотици, ваксини, химиотерапия, генна терапия и др.), които първоначално са били свързани с неподозирани опасности. Рискът е навсякъде около нас, независимо дали го осъзнаваме. Да започнем ли лечение или да изчакаме, особено в непозната ситуация? Отговорът често е труден, затова трябва да сме подготвени за възможните последици.

Прочетете книгата, за да практикувате медицина, базирана на доказателства, а не на страх и субективни усещания.

[Steve · Rating 5 out of 5]

I loved this book. Dr. Offit is a great writer and this book is almost impossible to put down. The chapters are short and again I fell into the trap of I’ll only read one more, which was never just one more. Dr. Offit provides a great discussion of risk, what it means and when it is worthwhile. He uses analogy to explain that there is a risk to doing something, for example, getting a vaccine and a risk of not doing anything like not getting a vaccine but getting a disease instead. He walks through many areas of medicine and the history of medicine in a conversational tone, explaining all the science as he goes along. The timing of this book is excellent given that, at this time, we are in the COVID-19 pandemic and he addresses this in his book. But the book covers much more than just this and, like all his other books, is well worth reading. Thank you to Netgalley and Perseus Books, Basic Books for the advance reader copy.

[Marks54 · Rating 5 out of 5]

This is a book about the inherent riskiness of medical innovation. Paul Offit is an accomplished medical researcher who was involved in the development efforts around the COVID-19 vaccines. His punchline is that medical innovation is inherently complex and risky, to patients, researchers, regulators, and loved ones. It is easy to get complacent regarding the vaccines for COVID and the political rhetoric and dialectics around the vaxx or novaxx debates. Offit presents a series of cases about modern medical innovations that most people take for granted, such as transplants, blood transfusions, and anesthesia that show the complexity of the science in basic discoveries. He then expands his analysis to cover relations between researchers, patients, and regulators in such areas as biologicals, antibiotics, and vaccines. The final section covers how innovations are frequently shaped by the reactions of participants to mistakes and unanticipated failures.

Offit is not ideological or pat in his treatment of these topics. If anything he is more critical of the innovation establishment although he is strongly supportive of the idea that progress will be made and innovation will progress even in the face of setbacks.

This is a book that requires careful attention and should offer new material even to those who have overdosed on COVID material over the past two years. I was pleasantly surprised by the book and heartily recommend it to anyone who follows these debates.

[Tammy · Rating 4 out of 5]

Good overview of the:

1. History of medical advancements
2. Political impacts on medical research
3. Unfair judgements made on pioneers of medical technologies, both good and bad
4. Risk inherent in new medical treatments and also the risk inherent in avoiding new treatments

Quite pertinent discussion of risk as it relates to vaccines and treatments for covid19.

The epilogue was the best. But the rest of the book is necessary to truly appreciate the epilogue.

[CatReader · Rating 4 out of 5]

I'm a fan of Dr. Offit's books in general. This one is a brief read that underscores how risk and reward go hand in hand in medical innovations from blood transfusions, organ transplantation, X-rays, and vaccination, set in the backdrop of the COVID-19 pandemic. I'd recommend this group to a layperson audience who's generally unfamiliar with the history of these innovations. As someone in the field, most of these stories are ones I've heard many times.

[Jbussen · Rating 5 out of 5]

Sadly, as always. The people who most need to read this book would be unable to decipher it much less willing to even try to read it.

I enjoyed it so much I read it cover to cover. Too bad the Anti Vaxers can't read.

[Stephan Benzkofer · Rating 5 out of 5]

You Bet Your Life is a fascinating examination of medical innovation. Wielding vivid details and a lively pen, Dr. Paul Offit argues that many life-saving advances that we take for granted today, specifically organ transplants, blood transfusions, vaccines, cancer therapies, and x-rays, did not arrive perfected and safe in hospitals but were the result of trial and error — and loss of life. And that some of those lost lives could have been prevented.

In the process, he also examines the complicated issues of risk assessment and health, something that we Americans are struggling mightily with in the midst of the COVID-19 pandemic. Health choices are rarely black or white, and deciding whether to undergo a surgery can be difficult, especially if the procedure or treatment is new. You didn't want to be the first person to get a heart transplant or the 25th or even the 100th. It wasn't until doctors figured out how to suppress the body's immune response that organ transplant became anything close to a safe option. That took years. But those early patients were going to die very soon anyway, so their acceptance of the high risk for the small chance of a few more days of life made some sense. And it also benefited the greater good as doctors learned from each case.

It is harder assessing the risks and benefits when dealing with children or with patients who are stable but whose quality of life is very poor. And the excitement of the new often tramples necessary caution, even with men and women of science. The unfortunate early handling and treatment of x-rays were a crazy, terrible example of this.

This is a wonderful bit of history that provides eye-opening context to current events. I recommend it highly. (The audiobook version is very good.)

[Neven · Rating 5 out of 5]

A clear, enjoyable, and educational survey of risky medical innovations, their pitfalls, and their promise. Offit writes in a style that’s both passionate about a point of view and also gently pedagogical.

He makes a number of great points, one of them being the many ways that a new treatment can fail. The disease could be misunderstood, or the mechanism of the proposed treatment; tests could be insufficient or compromised; production could be flawed, shortcut, or otherwise lacking; distribution and application introduce new failure points, as does management of any issues that arise in patients. There is no one answer to what ensures a medication’s safety. A constantly updated and diligently supervised process is the only thing that works well.

You might raise your eyebrow for a moment at the author’s mention of the rushed development of Covid vaccines. But he’s not necessarily critical of it, just cautious about any rushed process. He wraps up by noting the dangers inherent in doing nothing vs. trying something novel.

[Katarina · Rating 5 out of 5]

*Audiobook via Spotify Premium*

Everything in life has risks. A decision to do something has risks and a decision to not do something has risks. Nothing in life is risk-free, we just need to choose which risks are “worth it” and say yes to things where the potential benefit outweighs any negative consequence.

This goes for medical innovation and this book goes in depth of safety and testing in certain medical advancements that lower the risk to where we don’t even think about it. It was fascinating to learn about risk and oversight in the U.S. and developmental history of vaccines, discovery of x -rays, anti-poisons/antibiotics, etc.

Fun fact: did you know that with today’s anesthesia and medical supervision, “going under” gives a person a 1 in 300,000-something chance of not waking up? Compare that to vaccines causing a death for every 1 in 1.4 MILLION individuals… we should be in more uproar over anesthesia… Just interesting perspective!

[Stacy · Rating 5 out of 5]

I really enjoyed this read. If you're interested in learning about a brief history of some of the most important medical advancements, this book is a very accessible and enjoyable way to do so. Dr. Offit highlights that our society celebrates the medical breakthroughs and successes but never the failures that make those successes possible. The overwhelming theme is that wether you make a decision to pursue some form of medical care or you make a decision to not pursue medical care, you are always taking a gamble. Favorite quote: "The sin of commission will always be viewed as greater than the sin of omission. But doing nothing is doing something."

[Anindita Mullick · Rating 4 out of 5]

I'm a sucker for medical history, and I think it's interesting to read the history of therapies and drugs that failed. I liked the level of backstory given to the researchers and patients, as well as how the process went when describing the specifics of what went wrong before identifying what to do to make things right (one example was folic acid treatment and leukemia, or gene therapy, adenovirus, and cytokines activation).

The book was also an easy read and I think it is approachable to casual readers without strong biology backgrounds. I personally rated it 4 stars and not 5 because I don't see it as a "want to re-read" book, but I am glad I read it.

[Kirsten Bardwell · Rating 4 out of 5]

If you liked Get Well Soon or Radium Girls, you'll like this one. The author takes you on a quick tour of major medical breakthroughs like chemotherapy and anesthesia, sharing the human cost and risks associated with each.

[Jillian Barthelemy · Rating 4 out of 5]

Informative and easy to follow book about major medical advancements and weighing their risks/benefits

[MC · Rating 5 out of 5]

Really interesting read about the risky history of medical innovation! Reading non-fiction usually feels like watching paint dry for me personally, but Paul Offit has a captivating style that kept me engaged.

[Tama · Rating 5 out of 5]

Highly, highly recommended to my fellow medical science nerds. Contains extremely interesting history on the development of the polio vaccine (and others), which seems especially pertinent at the moment.

[Jim · Rating 4 out of 5]

A well written book for the layman / there is no such thing as a medical decision without risk. Risk in getting a vaccination or procedure vs the risk of doing nothing .

Source Libby audiobook
I have purchase this book as a gift to others as well.

[Anna · Rating 3 out of 5]

I really enjoy medical history and this book was interesting too. I had read much of the heart transplant stuff before in another book I just finished but it was still interesting (if all you know about Christaan Barnard is that he was the first to do a successful transplant, there is a lot more to learn!). The blood transfusion chapter was particularly interesting to me and the story about Ryan White is well known but still kind of a gut punch. The idea that doctors can do no harm doesn't gel well with medical advances. The analysis of risk is key to Offit's argument. I didn't know anything about gene therapy so that was interesting. It's a strange sort of cherry-picked book - not in a negative sense but more in a sort of incomplete sense but I still enjoyed it a lot.

[Mary · Rating 3 out of 5]

Interesting overview of what were the perceived risks vs. benefits (at the their inception) for several medical advances (heart transplants, x-rays, etc.).

[Deb · Rating 3 out of 5]

Interesting stuff, not terribly well-written, some editing errors. Trying to imagine it had it been written by Siddharthra Mukherjee, who has real writing chops.

[Lisa · Rating 4 out of 5]

Science is definitely the new religion. You are almost treated as a pariah if you don't have blind faith in 'the science', and medics are regarded as gods who we should trust absolutely. I am not sure how this happened. Reading Paul A Offit's book is a good cure for it, though, if you can stand the harrowing accounts of the misery and deaths caused by medical mistakes, and new medical innovations. I have to be careful about discussing what he writes about the coronavirus vaccines, but he is shocked by the hubris by which they've been treated, and his discussion is thorough. As he writes, 'virtually every medical breakthrough has exacted a human price'. The first vaccines are not often trouble-free, so, even if they appear to be the only answer to Covid-19, the unquestioned glee that greeted them is somewhat puzzling.

Paul A. Offit includes many horrific events in his book, such as the massive contamination of America's blood supply with HIV, the terrible injuries and deaths caused by the first x-rays, and a man-made polio epidemic caused by mistakes made in manufacturing the vaccine. It's thoroughly researched, but it can be hard to read. It's certainly worth reading, though. I can guarantee that you will get a second opinion before any nasty medical procedure after reading this book, and think twice about putting blind trust in 'the science'.

I received this free ebook from NetGalley in return for an honest review.

[Baudelairecestpasmoi · Rating 3 out of 5]

The book is easy to read, though I was hoping for something with a more sophisticated language and style. There's one thing that didn't make sense, though: the dates of different developments in the chemotherapy chapter. According to the book, the attack on the ships in Bari was on the December 2, 1943. Then Lt. Col. Alexander submitted a report and the OSRD offered a contract to 2 Yale University pharmacologists to do research on a phenomenon observed in the wake of the attack. The book then talks about the case of JD, who was the first person to receive treatment with the substance the OSRD and Yale University were studying. However, this occurred on August 27, 1942, a year and a half before the attack in Bari.

So, I think there was some sloppy writing and editing here. The book mentions the publication of an article on the same phenomenon in 1919, indicating that the report had gone unnoticed. But, if the dates given for the 1940s are correct, then somebody must have noticed and begun pursuing it, namely the OSRD and Yale University, and the attack on Bari just added another incident in which this phenomenon was observed.

[Carol Haldy · Rating 4 out of 5]

Second book by this author. I'm not sure it was the author's intent but it certainly would give pause to the vaccine mandate.

[D · Rating 3 out of 5]

Written at the beginning of the Covid pandemic, You Bet Your Life examines the history of medical breakthroughs, including the risks involved and the process of weighing those risks against very real and very necessary health benefits. Written by someone on the forefront of fighting the pandemic including holding committee positions for both accelerating the development of a vaccine and getting that medicine approved by the FDA. Not only is the author an expert on the Coronavirus and the vaccines that have been developed for it, Dr. Offit has a history of vaccine development and is one of the nation’s experts on immunology and viruses. While this book is, by necessity, constructed with the Covid-19 pandemic in the forefront of both the author’s and reader’s minds, it is about so much more than that. By taking a trip through centuries of medical history, You Bet Your Life, examines the risk-reward calculations which have been made by patients and medical professionals every time new medical treatments and technologies have been made available, such as x-rays and chemotherapy.

[Monique · Rating 3 out of 5]

Thank you Netgalley and Publishers for this digital ARC.

This book was interesting even not being a usual nonfiction reader. While I learned somethings I hadn't understood previously about the COVID-19 pandemic, I wasn't expecting it to be a part of this book. The book as a whole explores topics that the general public really only know at a surface. The only con I would see, is like many references before it, this could eventually become slightly outdated especially with the key notes of the recent pandemic having constant new advancements in the field of medicine.

[BOOKLOVER EB · Rating 5 out of 5]

Paul Offit, M. D., is the director of the Vaccine Education Center at the Children's Hospital of Philadelphia, and he teaches vaccinology and pediatrics at the University Pennsylvania. He is also a proficient and entertaining writer, whose latest work of non-fiction is "You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation." The history of medicine has its share of heroes, villains, and martyrs. Certain scientists made great discoveries through hard work and/or happenstance. Others took a chance on unproven procedures that, much to their chagrin, injured or killed their patients.

Using lucid and generally jargon-free language, Offit explores such topics as heart transplants, blood transfusions, anesthesia, antibiotics, vaccines, chemotherapy, and gene therapy. Amazingly, he has distilled reams of material into a succinct, entertaining, timely, and informative work of non-fiction. One of the points that Dr. Offit makes is that, although we are happy to reap the benefits of cutting-edge techniques and pharmaceuticals, modern medicine's advances did not come cheap. Before certain practitioners knew what they were doing, they experimented on men, women, and children, who sometimes paid with their lives.

One particularly compelling chapter deals with radiology's infancy. In the late nineteenth and early twentieth century, X-ray technicians and their patients often became deathly ill and suffered side-effects that left them mutilated and in horrible pain. It was only later that safety protocols—such as more reliable and sophisticated machines, the use of lead aprons, and strict rules to avoid overexposure—were put into place. Moreover, during the first chemotherapy trials, clinicians injected cancer patients with toxic drugs that, rather than curing them, made them even sicker. "You Bet Your Life" is a well-organized, compelling, and intriguing chronicle of how medicine's catastrophes may, ironically, pave the way for its eventual successes. The bottom line? "Science lurches forward in fits and starts, but it inevitably moves forward." That being said, we must never forget that "humility, not hubris, should rule the day."

[E.Scott Menter · Rating 4 out of 5]

In You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation, author Paul A. Offit offers an entertaining and well-researched perspective on the some of the most important advances in medical history. The stories are truly fascinating, and hold lessons for understanding medical science's response to the current plague, as well as the paradoxical and self-destructive reaction of so many in the population.

The stories lead the reader through the most tragic failures and most stunning achievements of humankind. But Offit doesn't always quite manage to connect the history and the truths we should extract from it. The epilogue is entitled "Living with Uncertainty", and that appears to be the sum total of what we're to take away from the book. Indeed, I was left with the impression that the final chapter and its seven enumerated conclusions were added precisely because no specific ideas are otherwise articulated.

Largely for that reason, You Bet Your Life lacks direction. It seems rushed, and I can imagine a publisher eager to push out a book with relevance to the greatest event of the time; but a later release, with a bit more perspective on how the vaccine debate played out, would perhaps have enabled Offit to bring the narrative to a more natural conclusion. (I felt the same way about Michael Lewis' The Premonition: A Pandemic Story.)

Nonetheless, the relevant lessons are there to be found, even if the author hasn't polished them up and presented them to his audience. The narrative itself is engaging: I stayed up late, eagerly turning pages as though I were reading Stephen King or Tom Clancy. In the end, Offit leaves his reader with hope, a sense that despite the inevitable costs—or, more accurately, becauseof them—there is little we cannot overcome.

[Ed Bernard · Rating 4 out of 5]

Well, I didn’t understand what this book was about from the title, but I should’ve been more clear had I just noted the author, a physician who often writes about medical discovery. I think his premise here is that every medical breakthrough is still a gamble, even if it seems better than what came before — for example, taking the COVID vaccine vs not taking it. He tells nine stories where the breakthrough was accompanied by significant risk. The polio vaccine, for example, was basically safe and effective, but a bad batch ended up sickening about 40 children. There are tradeoffs in chemotherapy for cancer treatment, which Offit also discusses in this book. X-Rays were very dangerous until its advocates recommended limiting exposure to the beams. Blood transfusions are another example of a beneficial technology that nonetheless involves risk. The individual stories are rigorously reported and engagingly told, but I question the premise of the book — these are public health measures and, sure, no medical treatment is without risk, and yes, you should evaluate a treatment option vs your own situation and needs, but I don’t really think the issues Offit raises amount to much. And, of course, vaccines are their own issue, where your decisions on your personal preference affects the whole population, as with, say, parents who decline to get their children vaccinated for measles, leaving at risk children who cannot tolerate the vaccine. Smallpox was essentially eliminated in the US, until enough parents decided to not vaccinate their children that the disease re-emerged in the population. You could make a case that the COVID vaccine was rushed to market with insufficient research and long-term knowledge about its benefits, but there’s no question that the low rate of vaccination in the US vs other countries slowed the end of the pandemic. Regardless, the content of the book is mostly fascinating and some of these stories are not well known. I just disagree with the book’s premise, and I also think it’s very poorly titled — you don’t really bet your life, that’s a radical overstatement to sell books, IMO (of course, Offit’s medical degree trumps my opinion and Google searches every time).

Grade: B+

[Marya · Rating 4 out of 5]

Refreshingly honest. Dr. Offit gives the good, the bad, and the ugly of medical inventions. He thinks it right for people to be skeptical of new things and appreciates how no one really wants to be a guinea pig. So if you're facing a death sentence anyway, being the guinea pig might just be the only chance you have.

But

You can't entirely approach the subject with a "what harm can it do?" attitude. That untested treatment might make you deader quicker (or in a worse way, if that makes any sense).

But

Once those inventions have been shown to work, you should absolutely consider using them. In these cases, not taking the invention is a less sensible choice (to Dr. Offit). Enough people have eaten strawberries at this point to recognize it is a good food source. Does that mean there won't be a few people who are allergic? Does that mean there won't be some strawberries that are drenched in toxins? No, but on average, for the average person, it looks like strawberries are a good idea. Dr. Offit does acknowledge this is cold comfort to the one person who is deathly allergic to strawberries, but he emphasizes there is no way to remove all danger for all people since people are not omnicient.

And

That's because not doing anything comes with its own costs. Not making a decision is in fact making a decision. Like most of his professional brethren, Dr. Offit supports making the best decision you can with the best data you have at the time, and to not beat yourself up too much over choices you were powerless to change without the benefit of hindsight.

Confusing enough? Risk assessment, data driven decisions, and opportunity costs are all difficult topics to communicate. The equations never change, but it's hard for many to separate that out from the variables in those equations do. I'm not sure Dr. Offit succeeds here in laying out those decisions. Maybe it's only possible with a shorter text with even simpler examples. But Dr. Offit has offered honesty and nuance. By laying it all out there, Dr. Offit has at least given the reader the respect to believe they can understand and own their choices.