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
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.