The premise of Pinheads & Patriots is taken from a segment on O’Reilly’s talk show, “The Factor,” during which he calls out people who do good things (patriots) or bad things (pinheads). In the book, O’Reilly tries to be more precise about these terms. He defines a pinhead as someone who lacks intelligence or common sense. The term applies to individual actions, but O’Reilly warns that “Pinhead status is a slippery slope. Get in with the wrong crowd, get taken by your own success, or get some bad advice, and all of that can lead to residence in Pinheadville.” By way of contrast, “Patriotism is not short, frenzied outbursts of emotion, but the tranquil and steady dedication of a lifetime.”
An arrangement was made so that every copy of the book sold on Bill O'Reilly's website would require the publishing company, Harper-Collins, to send an additional copy of his book to soldiers serving in Operation Enduring Freedom. The program was called "Books for the Troops".