Video edition is now available!
Hi, I'm Nicholas, the author of A Chemical Mind on Substack. This is the first of what I hope will be an ongoing series of special podcast interviews with great scientists and science communicators. To start us off, I had the absolute privilege to interview the great and prolific Dr Paul Offit (Substack:Beyond the Noise).
He's a professor of vaccinology and pediatrics at the University of Pennsylvania and a member of the FDA vaccines Committee, founding member of Autism Science Foundation, formerly on the CDC Immunization Committee.
He's also the co-inventor of a vaccine against rotavirus. He's a prolific author of books on science, medicine, and a great debunker of misinformation. His latest book is Tell Me When It's Over, all about Covid-19 topics.
I've edited out some of my waffling moments. I'm clearly lacking in practice, and he's a personal hero of mine, so I was supremely nervous.
I've cut out some of the time lag of being on the other side of the world from each other. I've also asked him questions sent in by subscribers on the Substack chat thread, so stick around for those as well as a few shout outs.
If you enjoyed this, please make sure to like, subscribe and share it around.
Without further ado, let's get on with the show.
You know you want more great interviews. Subscribe today!
Let us begin!
Nicholas:I'm here with Dr. Paul Offit. It is an absolute pleasure and honor to be able to talk with you. Thank you so much for doing this with us.
Dr. Paul Offit:That's my pleasure. Look forward to it.
Nicholas:You've done a lot of things. You're the professor of vaccinology and pediatrics at the Perelman School of Medicine and University of Pennsylvania. You've also been on the FDA and the CDC, you're a founding member of the Autism Science Foundation, and you've done so many papers and books and even created a vaccine.
What inspired you to take on misinformation, especially health misinformation and vaccine misinformation?
Dr. Paul Offit:I think the first thing was I was on the Advisory Committee for Immunization Practices to the CDC. I came on in 1998 and was on for five years or so, and that was a rough time for vaccines. There were sort of like the big one-two-three hit. One is in 1998, Andrew Wakefield published a paper in The Lancet claiming that the combination measles, mumps, rubella (MMR) vaccine caused autism, which wasn't a study, it was just a case series of eight children. You might as well have published a study showing each of them developed signs and symptoms of autism within a month of eating a peanut butter and jelly sandwich. It didn't make biological sense, nor did it offer logical sense. And nonetheless, it was published in arguably one of the oldest and best respected medical journals in the world, The Lancet.
And it set off a firestorm. There were many people in the United Kingdom that chose not to vaccinate their children. There were a lot of children who were hospitalized. There were four children who died from measles, really because of that paper. Then it spread across the Atlantic Ocean to the United States.
Thousands and thousands of parents chose not to give that vaccine in order to avoid autism, which made no sense. At the ACIP, we were asked to vote on whether or not that vaccine should be divided into its three component parts, because that's what Andrew Wakefield said. He said that because you're giving it in one vaccine, that's overwhelming the immune system.
If you divided it up, you could avoid autism. There was a congressman named Dave Weldon from Florida who was on the Appropriations Committee. CDC, like all government agencies, gets money from the Appropriations Committee. And he was a friend of Andrew Wakefield. He asked us to actually vote on this ridiculous notion, which basically means they win because then the paper says the CDC was suggesting this like it was in any sense debatable.
So that was number one. Then RotaShield was a simian-human rotavirus vaccine. It was on the market for about ten months before it was withdrawn because of safety issues, which was really the first time a vaccine had been withdrawn for safety since the Cutter incident in the mid-50s when a polio vaccine was made badly.
And so that scared people because it had been routinely recommended to be given to all children at less than six months of age. And then you had thimerosal, this ethyl mercury-containing preservative in vaccines. Basically, the Public Health Service put a gun to the head of the pharmaceutical industry and said, "You've got to take this out," even though all the evidence to that point was that at the level contained in vaccines, it wasn't harmful. Which is what they said, by the way, in the American Academy of Pediatrics missive - that all the evidence is that thimerosal at the level contained in vaccines is safe. To make vaccines "even safer," we're going to have to take it out.
Well, if it was safe, then taking it out doesn't make it safer. What struck me was that although the pediatricians were good - they got out there and said vaccines are good, vaccine-preventable diseases are bad, we vaccinate our own children - I didn't see any scientists standing up and saying this doesn't make a whit of biological sense in terms of thimerosal, the MMR story.
And so that's why we created the Vaccine Education Center at Children's Hospital. That's why I wrote the book "Autism's False Prophets," and then later "Deadly Choices" and "Bad Advice," and a variety of books that I think take on this notion of how we perceive science.
Nicholas:Your points about separating out the measles, mumps and rubella vaccines - Andrew Wakefield actually patented his own measles vaccine. He did this two years before his paper came out. He was essentially setting up a whole scheme to cause pressure to be placed on governments to separate the vaccine into its three parts by saying this ingredient is dangerous and, "Oh, here's a vaccine I've prepared earlier that's safer. You should buy it from me."
Dr. Paul Offit:Right. And in addition, of the eight children who he described in that paper, five of them were in the midst of suing pharmaceutical companies. And he got money, roughly the equivalent of 800,000 USD, to basically launder legal claims through a medical journal, which is also a conflict. Eventually those conflicts became clear. He also frankly misrepresented biological data and clinical data. By 2010, that paper was retracted.
You really got to work hard to get your paper retracted. There's a lot of bad science published out there every day. You have to really not only be wrong, but frankly fraudulent and wrong, which is what he was.
Nobelitis
Nicholas:And it's amazing how long it took for that paper to be retracted. It took quite some time for an entire investigation to go through. By 2010, the writing was really on the wall. It was a surprise just how much effort it required before that thing was formally retracted.
I myself have autism spectrum disorder. Both my kids have autism spectrum disorder as well. I still hear to this day continuing claims stating, "Oh, but the vaccines probably did it." It's remarkable that even when the science is demonstrated to be so clearly fraudulent, these things still seem to come up.
What is it going to take for honest science and science-based medicine to continue to push back against these claims? And how do we help people to know who to trust as well?
Dr. Paul Offit:That's really the seminal question. That's the hardest question to address. Andrew Wakefield was an accomplished researcher. He was smart. He did interesting work on the basis of Crohn's disease and intestinal disease, showing that it was in part a vasculitis. That was breakthrough work. He was a smart guy, well-spoken, published previously on Crohn's disease.
And so he was an expert in many ways. When he says something, that means something. And that's really interesting because we're fighting that in this country now. You have people like Congresswoman Marjorie Taylor Greene who believes that Jewish people created space lasers that cause California wildfires each year, that the shootings in Sandy Hook and Las Vegas were just staged.
So she's a little bit of a nut, and she's not really trustworthy. You could feel the same way about Robert F. Kennedy Jr. - some lawyer who's basically a conspiracy theorist. But it's the people like Robert Malone who's a brilliant guy, did important work on mRNA back in the late 1980s. He arguably could have been in line for the Nobel Prize for the work he did on mRNA.
And yet there he is in front of Congress saying that these COVID vaccines could cause cancer, without any evidence. So these are the people I worry about - the ones who are credentialed and accomplished. Peter McCullough is another one. He's a cardiologist, I think he was chief of cardiology at a midwestern hospital.
And he gets up there and says the COVID vaccine spike protein is dangerous. And by the way, just to your point, he also sells COVID rescue kits which include ivermectin and hydroxychloroquine.
Nicholas:Yes of course he does (all you can do is laugh)And this seems to be a really fascinating phenomenon. You mentioned it in one of your books as well - Pandora's Lab - "Nobelitis," where sometimes you get a legitimate Nobel Prize winner who decides that because they've had such a history of being right, because they've had a lot of success in their career, that they're infallible. And once they come up with a pet theory that turns out to be wrong, they can't accept that. There have been quite a few examples of this, haven't there?
Dr. Paul Offit:Sure. There are four Nobel Prize winners who believe that blacks were genetically inferior to whites, including James Watson of Watson and Crick, who figured out the structure of DNA. Or Shockley, one of the inventors of the transistor. And they never backed down, no matter how much evidence showed that wasn't true.
They never backed down because - why, I don't know. It may be narcissism or omnipotence or omniscience or whatever. It's hard to win a Nobel Prize. You have to work hard to get there. And when you're there, it's hard. And so you think you're just always right.
Linus Pauling believed vitamin C not only could prevent or cure colds, but could prevent or cure cancer. And when study after study showed he was wrong, he never backed off. I mean, when you discover the alpha-helical structure of proteins like Linus Pauling did, and when people are saying "Well, that doesn't make sense that it would look like this kind of spiral staircase or corkscrew," and you prove you're right through these X-ray diffraction studies, you believe you're just right about everything.
And I think because we're often taken in by these people - you have AIDS denialists who really believe that HIV was created by the CIA. I mean, Nobel Prize winners like Wangari Maathai or Kary Mullis. Kary Mullis invented PCR.
Knowing whom to trust
Nicholas:And this is the thing as well. One of the things that I've done a little bit of writing about is that sometimes really smart people can come up with ideas and theories, or can back and support ideas and theories, that are just outside of biological reality or physical reality. And it's especially hard to combat that because it means that you can't just sort of trust, on faith, any authority figure just because they have a Nobel Prize.
You can take what they say seriously, but you can't take it on face value. And especially for laypeople - I mean, I myself am a layperson, but I read a lot of Wikipedia. Being a layperson, it is hard to really nail down whether what I'm reading is really sensible. Andrew Wakefield's paper, if I had read that before it was retracted, when it first came out, I could very easily have been taken in for sure.
Dr. Paul Offit:I think that's asking a lot of laypeople. You want to trust experts. And the question is, how do you know who to trust? People who really are experts - take for example somebody like Joseph Ladapo, who's the Florida State Surgeon General. He's MD, PhD from Harvard.
Now, that's a good school. It's not Penn, but it's a good school ;)
And here he is sending a letter to every healthcare worker in Florida saying that the mRNA vaccines are contaminated with fragments of DNA that are going to insert themselves into your DNA and cause cancer and autoimmune diseases and a variety of other diseases, when that patently is just false. First of all, we're exposed to foreign DNA all the time.
If you live on this planet and eat anything made from animals or vegetables, you are going to ingest foreign DNA, some of which will end up in your circulation. You have mechanisms in the cytoplasm to recognize and destroy foreign DNA. That DNA doesn't have a nuclear access signal, so it's never going to get into the nucleus.
Even if it got into the nucleus, it doesn't have an integrase to be able to insert itself into your DNA. So it's just nonsense. Utter nonsense. And frankly, any vaccine that's made using cells as starting material - because viruses grow in cells and that's how you make your vaccine - measles vaccine, mumps vaccine, rubella vaccine, rotavirus vaccine - any of these vaccines are going to have fragments of DNA at levels in the picograms level, which is not in any sense harmful.
But you know, it sounds bad, right? Foreign DNA, that can't be good, right? Although it's always interesting - these people never think it makes you smarter or gives you superpowers.
Nicholas:That's right. It's like it's never got the positive attributes. And there's a lot of that emotive language, isn't there? A lot of questions came out when it was announced that there was an mRNA vaccine. "Oh, mRNA - that's genetic code!" You know, it's kind of like that old prank, dihydrogen monoxide.
“Dihydrogen monoxide is a dangerous chemical, because if you breathe it in, you'll die!”
But it's water; of course if you breathe it in, you'll die.
When you change the language, you can create a narrative, positive or negative. When people were talking about 5G spreading COVID, my wife and I would often joke with each other after we got the vaccine, "Oh, my 5G reception is really good right now. Really glad that Bill Gates was able to give us better 5G right now."
Dr. Paul Offit:Penn and Teller, comedians in the United States, did a thing on this where they went to a California State Fair and they had a petition. They never lied - they said they were looking to ban dihydrogen monoxide from the face of the Earth. They said, "You know, it's in the water we drink, as a result it's in our urine, it's in our tears."
And you know, we just have to get it out of there. And so they got 300 people basically to sign a petition to ban water from the face of the earth by using its chemical name.
Nicholas:And that just will never cease to blow my mind.
Choices between risks
Nicholas:You talk about choices between risks, and I think this makes a lot of sense especially in the context of vaccines, because nothing - not even water - has absolutely zero risk. But there's a choice: you can either drink water and continue to live, or you can choose not to drink water, ban it from the face of the earth, and you will probably die in about 3 or 4 days. Those are very different risks. If you're only ever hearing about the risks of, say, inhaling water and things like that, it can be easy to fall into the trap of thinking, "Oh well, there's so much negative around that choice."
Dr. Paul Offit:I think that's right. But I think we rate those risks differently at some level, that we rate the risk of something that we do that ends up in harm as being different than the risk that comes with not doing something. I mean, I just don't think we see it the same way. A choice not to get a vaccine, for example, is a choice, and it's not a risk-free choice.
For example, if you get a vaccine, you get an mRNA vaccine and you develop myocarditis, which happened at a rate for males between 16 and 29 at a rate of roughly one per 6,600 - so not that rare. Generally myocarditis of the heart muscle was short-lived and temporary and self-resolving. But nonetheless, you basically have an inflammatory reaction against your heart.
But if you choose not to get a vaccine and you get COVID, the incidence of myocarditis is much higher. It could be as high as 50% for people who have so-called MIS-C, multisystem inflammatory disease - much more serious disease. But I think it's the sin of omission versus the sin of commission.
The sin of commission is seen as greater than the sin of omission, which is ridiculous because they're both bad. It's just a matter of relative risk is what it should be. But it's not perceived that way. If I give my child a vaccine and they have a negative consequence, that's seen as different than not doing anything and having them get sick - that's just seen as bad luck, right?
Nicholas:You're right, because it's seen as like I'm making an active choice, as if my personal agency is the only thing that influences the world or my circumstances. Sometimes things just happen to us, but there are choices we can make to make those things that happen to us less likely to happen.
One really interesting case as well is just how throughout history, there's always been a tendency to look back at incidents where there were bad outcomes, like for example some of the polio complications in an initial batch way early on in the polio vaccination campaigns, or when a particular batch of smallpox vaccination goes bad. In the early days of inoculation, sometimes it would develop into full-blown smallpox.
So people look at those cases and say, "Well, here I can show that something bad has actually happened when I've gone and made that choice." The difference between the active choice and then an event you can point to, versus an active choice and an event you can't really point to - something that could have been chance or coincidence.
Dr. Paul Offit:I lived through this. I was fortunate to be part of a team at Children's Hospital Philadelphia that invented the rotavirus vaccine. But there was a vaccine that preceded ours that came onto the market in 1998 called RotaShield. And it was found to be a rare cause of intussusception, which is intestinal blockage where the intestine sort of falls in on itself, gets stuck, and then there's a decreased blood supply.
And so there can be bleeding which can be fatal. And then there's often an entrance of bacteria into the bloodstream causing sepsis, which also can be fatal. It was rare - it was about 1 in 30,000 babies who got that vaccine had intussusception. And there was at least one death associated with that.
So it was taken off the market. When I was on the Advisory Committee on Immunization Practices, I got up in front of that group and tried to make a case for it, because you were still, even in the United States, 5 to 10 times more likely to die of rotavirus than to die from a rotavirus vaccine.
So on balance, the benefits outweigh the risks. But there was a risk and it was a serious risk. What ended up happening is that vaccine came off the market here. The virus in the United States kills about 60 children a year before that. But in the world, it would kill 2,000 children a day. I mean, it would be 500,000 deaths a year from that virus.
And so the World Health Organization, to their credit, tried to save that vaccine. I actually went to this meeting in Geneva in February of 2000, and country after country stood up and said, "Look, if it's not safe for America's children, it's not safe for our children."
Even though the risk-benefit ratio was dramatically different in those countries where rotavirus would routinely kill. And so therefore, there wasn't another rotavirus vaccine for seven years because of that. Do the math - seven years of 2,000 children dying a day, because those countries believed that if our notion of safety should be exactly the same as theirs when the benefit-risk ratios were even worse.
But I would even argue that even in our country, the benefits outweighed the risks. But that was just not - nobody wanted to hear that because it had a serious side effect. That was the end of it.
Nicholas:So my uncle-in-law was Dr. Frank Fenner. He led the last eradication program of smallpox and was the one who got up in front of the WHO in the 1970s and announced to the world that we had finally eradicated smallpox.
Smallpox vaccination continued for a little while after that. But eventually, once we were confident that it was finally gone from the Earth, vaccination was able to stop because, of course, there are risks to smallpox vaccination.
They're very small, but those risks do exist.
But then smallpox - people don't remember what a scourge to humanity smallpox was. It would still be killing millions and millions of people if it weren't gone from the earth because of vaccines. We all too often forget these diseases that used to absolutely terrorize us, and used to kill so many people. Now that they're kind of in the background or out of the picture, or they're a problem for developing countries, first world countries don't really care.
Dr. Paul Offit:I was on the Advisory Committee on Immunization Practices in 2001. The George W. Bush administration wanted us to give smallpox vaccine to all frontline responders because the fear was that it would be used as a weapon of bioterror by agents in the Middle East, because we were about to enter into a war with Iraq.
I voted against that. I was the only person that voted against immunizing frontline responders because there hadn't been a case of smallpox in the world for decades. Why were we giving this vaccine, which did have side effects like myocarditis - inflammation of heart muscle - or pericarditis - inflammation of the membrane around the heart?
I argued against it because you can also give that vaccine post-exposure. Post-exposure prophylaxis works because it's a long incubation period disease. And so I said, why don't we just wait till we see one case somewhere on the face of the earth before we do this? Because this is a vaccine that has side effects.
It was a short-lived program. We vaccinated maybe about 40,000 people in the United States, but it wasn't the right thing to do because it's always a matter of risk-benefit. And if the benefit's not clear, the risks become more marked.
Questions from Subscribers
Nicholas:I could talk with you forever, but I better get to the questions from the subscribers. Otherwise, they will all be upset with me. (true story)
I will start with this obscure little event you might have heard happened in the United States recently - I think it was called the US presidential election?
Dr. Paul Offit:I think I read about it ;)
Nicholas:Jack Cooper, who's the host of the History vs. Hollywood podcast - really good podcast - he asks:
is it too soon to ask what you think of RFK Jr. having a role in the next administration?
Dr. Paul Offit:Well, it sounds like he will play a role. Donald Trump has said that he will have a role. To quote Donald Trump: "I'm going to go crazy on public health." These are not phrases you usually see in the same sentence - public health and crazy. But that's what he said.
RFK Jr. has stepped forward and said he will have a role. It's not clear exactly what that role will be, but it is a frightening thought. Here's a man who's a science denialist, a conspiracy theorist, an anti-vaccine activist who will have some kind of role supervising public health agencies like the Food and Drug Administration or the National Institutes of Health or the CDC. It's a frightening thought.
Do you really want a science denialist in any sense involved with science-based agencies? No. He worries me when he talks about taking fluoride out of the water, which is one of our best public health achievements. He talks about wanting to eliminate whole sections in the Food and Drug Administration, which he feels were unduly influenced by industry.
He's an agent of chaos. And I think that's what will happen. So it's not too soon, but he hasn't really declared exactly what he's going to do or how he's going to do it. We'll find out after January.
Nicholas:Yeah, he really is an agent of chaos. And it worries me too, even being in Australia. You know, the term they say about the stock market - when the US sneezes, the world catches a cold. Well, it might be much more literal in this case.
So I've got another question. Thig (my number 1 fan) asks:
How do we combat misinformation and pseudoscience, the kind of things that RFK would bring in at a federal level? How do we make science appeal to people who think magic crystals are a thing?
Dr. Paul Offit:It's hard. I think the misinformation and disinformation business is far more lucrative than the information business, but all you can do is the best you can do. Try and make it clear that damage is being done. Try and make science fun and exciting and interesting and understandable and palatable.
Tell a story and just keep putting it out there, doing the kind of thing that you're doing (hell yeah, he gave me props!)
The number of groups in the United States - Science Based Medicine, Skeptical Raptor, Voices for Vaccines, I think our Vaccine Education Center - just keep pounding out good information. For the most part, the media is generally responsible in that they at least - mainstream media - they go to real experts for advice often, but they also often like conflict because that's what sells.
And so that's what you're always up against.
I've been asked now three times to debate RFK Jr. And I don't do it because I think all it does is elevate him. Five minutes into the discussion, people remember the fight far more than the facts. They don't know who the expert is. I might as well debate whether or not birds are real.
Nicholas:You know, there is a Reddit community that's all about how birds aren't real. Thankfully, it is a joke - at least most of them, I'm pretty sure, know it's a joke. There's another one that's all about how New Zealand is not a real place. I quite like that one. As an Australian I don't believe New Zealand is a real place. (Big-Kiwi Conspiracy)
Thomas asks - okay, so he's got a very long question. I'll try to summarize it:
When there are tools and methods for deciding truth, things like Carl Sagan's baloney detection kit, when those things fall short, especially with adults who lack some scientific literacy - is there a productive way to communicate critically with them about things like vaccines?
Dr. Paul Offit:I think in the end - I will try to find a nice way to say this - in the end, you do have to trust the real experts. I'll give you an example. When the chickenpox vaccine first came into use in the United States in 1995, I had a number of people who called me who said, "You know, I've done my research and I don't want to get this vaccine."
But what they meant by research is they looked at people's opinions on the internet. That's what they meant by research. If you really want to do your research on the chickenpox vaccine at that time, you should have read the roughly 300 articles that were published on the vaccine, which would have meant you would have had to have had expertise in immunology, virology, epidemiology, statistics, which very few people have.
And frankly, few doctors have that expertise. So what you do is you look to expert bodies like the FDA Vaccine Advisory Committee or the CDC Vaccine Advisory Committee, which collectively have that expertise and have read those papers and have generally given us good advice. But that is not a message that sells in the 21st century.
“Trust us, we're experts.”
They're now “experts” because they have internet access - that's what you're up against. I'm on the FDA vaccine advisory committee.
In December of 2020, we got about 400 pages to read on the Pfizer vaccine before we recommended authorization on December 10th, and another 400 pages on December 17th for the Moderna vaccine. It was 800 pages we read in that few-week period, and I read every word - we all did, because you want to make sure you got it right.
I think I was an informed consumer. When that vaccine was offered to me about a month later, I couldn't wait to get it. I was an informed consumer because I'd read the 800 pages. Most people didn't even know you could read them. I mean, it was all online, but that's what you're up against.
Nicholas:It was also open access as well, which was amazing actually. I was excited to get it as well because I thought, this is cool, this mRNA technology. I thought it was the coolest thing. I remember there were two lines - there was a line for AstraZeneca, which I think was the adenovirus vector, and then there was the line for the mRNA version. This was just after some news reports had come out about AstraZeneca having a connection with heart inflammation and all that kind of stuff.
And nobody was in the AstraZeneca line. Everyone was in the mRNA line. But I was there merely because I'd always been planning to be there. And I was excited just to get this. See if I could get superpowers from the mRNA vaccine - I didn't get any superpowers :(
But information, whether or not it's true, can really swing people in a massive way.
Dr. Paul Offit:The AstraZeneca vaccine did have a rare side effect of clotting, including clotting in the brain. It was very rare - any clotting was like 1 in 100,000. But it ultimately drove the vaccine off the market in the United States because the mRNA vaccine was safer. Yet there were systems in place to pick that up because the Vaccine Safety Datalink or the VAERS system can pick that up fairly quickly. Pre-licensure studies are never going to be able to pick up very, very rare adverse events.
You have to have those systems in place. And they were in place. But you have to know that medical innovations are always at some level associated with a human price for knowledge. That's always true.
Nicholas:The last question for you is from Rafael Olivé Leite, and he's from Brazil. He is wondering whether being an anti-vaxxer is a luxury, first-world kind of opinion to hold - whether it's kind of a privileged opinion to hold. For him being in Brazil, he sees a lot of viruses and infections and things that aren't very common anymore in my country and in yours.
So he's wondering, do you see that as kind of a privileged, first-world-ish kind of belief?
Dr. Paul Offit:Yes, it is. And also, you get to hide in the herd. Most people are vaccinated, most children are vaccinated. And so incidence of measles is certainly way down from where it was in the early 60s. Same thing with German measles - actually gone. You hide in the herd. It's completely selfish. It's unfair.
And if enough people make that decision, as is starting to happen with measles and with pertussis, well, you're starting to see those sort of come roaring back. So that's the problem.
Nicholas:Absolutely. I could go on with you forever, but I think I will let you have your time back. Thank you again so much for coming on and having a chat with me. I hope we can do this again at some point in the future. Next time you have a book, let me know. I've been reading through your entire back catalog, and it's fantastic. So thank you again so much, Dr. Offit.
And I hope you have a wonderful rest of your day and week and hopefully, a good next four years! (As long as you move to Australia, that is)
Dr. Paul Offit:It was my pleasure. Let's do this again.
A final massive thank you to Dr Offit, who has his own Substack and a ton of subscribers, but was kind enough to come visit our little corner of the internet here on A Chemical Mind. You should also look up his latest book, Tell Me When It’s Over, sold at all good book stores.
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