Steven Epstein, 'Impure Science; AIDS, activism, and the politics of knowledge' University of California Press USA 1996, ISBN 0-520-20233-3.

In the short, turbulent history of AIDS research and treatment, the boundaries between scientist "insiders"and lay "outsiders" have been criss-crossed to a degree never before seen in medical history. Steven Epstein's astute and readable investigation focuses on the critical question of "how certainty is constructed or deconstructed," leading us through the views of medical researchers, activist, policy makers, and others to show how knowledge about AIDS emerges out of what he calls credibility struggles.

Epstein finds, among other things, that "non-scientist" AIDS activists have gained enough of a voice in the scientific world to shape NIH-sponsored research to a remarkable extent. Some, however, have been sufficiently converted to what at first seemed like archconservative research methods to wonder whether their initial "success" has been helpful in the long run. Have these activists become educated about science - or simply co-opted? Have these scientists been made to understand the human consequences of their methods - or simply forced to knuckle under? How unique are these activist-scientist relationships to the AIDS movement, and can they be expected in other medical contexts?

Epstein shows with great clarity the extent to which AIDS has been a social and political phenomenon and the manner in which the AIDS movement has transformed biomedical research practices through its capacity to garner credibility by novel strategies. Because of the blurring of roles and responsibilities, the production of biomedical knowledge about AIDS does not, he says, follow the pathways common to science; indeed, AIDS research can only be understood as a field that is unusually broad, public, and contested.

Epstein concludes by analyzing recent moves to democratize biomedicine, arguing that although AIDS activists have set the stage for new challenges to scientific authority, all social movements that seek to democratize expertise face unusual difficulties. Avoiding polemics and accusations, he provides a benchmark account of the AIDS epidemic to date, one that will be as useful to activists, policy makers, and general readers as to sociologists and scientists.

Steven Epstein is Assistant Professor of Sociology at the University of California, San Diego. The work on which this book is based won the American Sociological Association's award for best dissertation of the year.

• A book review by John Lauritsen.
• Another book review from the NEJM.
• The book review from AIDS Treatment News.
• A book review from the BMJ.
• And a book review from the San Francisco Chronicle.