Book review.


Steven Epstein, 'Impure Science; AIDS, activism, and the politics of knowledge' University of California Press USA 1996, 466 pages, ISBN 0-520-20233-3.


This book on AIDS treatment activism is based on the author's sociology thesis at the University of California. A striking difference from most AIDS activism books is that the author followed a methodology of analyzing both mainstream and dissenting views in the same way; this differs from the usual approach which tends to accept a mainstream world view as true, and then tries to "explain" other opinions as various kinds of errors. (Many books on treatment activism pick the authors' favorite heroes -- and often villains as well -- typically chosen arbitrarily depending on whom the author happened to talk to; the need to maintain these arbitrary white-hat/black-hat assignments gets in the way of telling what people said and did, and why it was important.) The strength of Impure Science is in telling what happened; its weakness (for the general reader) is that it tends not to come to conclusions, leaving no easy bottom line to take away.

Part I of the book, "The Politics of Causation," looks at the questioning by Dr. Peter Duesberg and others about whether HIV causes AIDS. One looks in vain for Epstein's opinions about Duesberg and his views -- but does get a useful 135- page annotated chronology of the controversy.

The longer and more important part II, "The Politics of Treatment," looks at many issues in AIDS treatment activism, for example in drug regulation, and in the design and methodology of clinical trials. Epstein sees CREDIBILITY STRUGGLES as central to the dynamic of science -- and is most interested in what it means, for good and/or for ill, when lay persons and groups develop their own expertise and enter into specialized policy realms previously left to certified experts.

By making contemporary history accessible in an unbiased way, Impure Science will have lasting value for scholars, writers, policy experts, AIDS professionals and activists, and others with a deep interest in the subject. But it is probably too specialized to have much effect on the sound-bite world of general public discourse.

For treatment activists, the practical bottom line that this reader has taken (or, perhaps, constructed) from the book is support for the view that the key factor influencing technical issues of AIDS research/development/treatment policy is the professional consensus (primarily of scientists and physicians, in academic, government, corporate, private, and other roles, but also including some other AIDS professionals, and lay experts to some extent). When treatment activists have an important concern, the best place to take it for action (if action is possible) is usually this professional consensus -- although of course there are also times to address other centers of influence, such as Congress, or the White House, or the FDA, or the public and the media.

Review by: John S. James
Source: AIDS Treatment News Dec. 1996