It feels odd reviewing a book that was published three years ago (and noted in IJME two years ago). Why is it worthwhile reviewing so long after publication a dryly written sociological monograph built around a case study of risk determination processes in early 20th-century clinical trials of polio vaccines? The answer lies in the accelerating industrialisation of clinical research, the elephant in the room that Halpern's book continually skirts around, never quite addressing it directly, yet evidently aware of its presence as demonstrated by her last, almost ideological chapter. But let me start at the beginning.