Textbooks are often a core element of curricula and delivery of classroom instruction and have long been a source of controversy. The textbook adoption process has become less about content and more about political/cultural pressure. Special-interest groups from the right and left exert enormous influence on textbook content through bias and "sensitivity" guidelines and "review" processes. Textbooks are now often judged not by their style, content, or effectiveness, but by the way they live up to such guidelines. Texas is the second largest textbook market in the country, behind only California. This paper examines the controversies behind, and the lessons to be learned from, the textbook adoption process in Texas. Recent history has demonstrated that health textbook content decisions are often not based in science or pedagogical best practices. Health educators must be proactive in recognizing this trend and work at the state and local levels to ensure that students have access to scientifically accurate, age-appropriate information that can help prepare them for life in the twenty-first century. (Contains 1 table.)