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.


Impure Science is a fascinating history and analysis of the complex interactions among government agencies, pharmaceutical companies, scientists, medical people, and "treatment activists". AIDS dissidents feature prominently in the history, as do the many-hatted defenders of AIDS orthodoxies.

The book, which evolved from Epstein's dissertation in Sociology, is informed by the currently fashionable ideas and language of "science studies", "social construction" theory, etc, as espoused by Michel Foucault et al. These vaguely leftist approaches tend to foster an excessive relativism which, by denigrating objective standards of evidence and logic, can lead into the mists of obscurantism and irrationalism. However, here the approach proves useful. Epstein claims that his analysis "shows how knowledge emerges out of credibility struggles" [emphasis in original]

One of Epstein's guiding principles in "reconstructing" scientific controversies is the "principle of symmetry", according to which the same types of conceptual tools ought to be used to explain both "true" and "false" beliefs. Conceding that "a symmetric analysis is not necessarily a 'neutral' analysis", he nevertheless maintains that it is the fairest, and "one that requires the investigator to bend over backwards to consider the arguments of scientific 'underdogs'." This determined impartiality is, paradoxically, both the strength and the weakness of the book.

Impure Science is divided into two parts. The first, "THE POLITICS OF CAUSATION", covers early etiological hypothesizing about the illnesses that began appearing in gay men in 1980, the hardening of the 1984 "AIDS virus" hypothesis into unchallenged fact (in Epstein's phrase, the "consolidation of certainty"), and the challenges raised by critics of that hypothesis. It is curious that Epstein, despite his social-constructionist affinities, does not accept that "AIDS" itself exists only as a construct.

The second, much longer part of the book deals with "THE POLITICS OF TREATMENT" -- a black tragi-comedy in which pharmaceutical companies, the Food and Drug Administration (FDA), intellectually and ethically deficient physicians, rogue scientists, biotechnology hustlers, and "AIDS activists" and "treatment activists" of many stripes, succeeded in destroying the last pretense of rational drug regulation in the United States. Their activities led directly to the mass poisoning of gay men and others with toxic and worthless drugs, which were put on the market through invalid or non-existent research.

The ActUp slogan, "Drugs Into Bodies", the title of the sixth chapter, perfectly captures the pharmacomania of "treatment activism". Any drug at all, no matter how toxic, no matter how theoretically inappropriate, no matter how lacking in benefits, is better than "doing nothing". The "treatment activists" extended to the point of mass insanity the implicit tenet of Modern Medicine since World War II: recovery from illness is only possible through a pharmaceutical intervention. A Los Angeles doctor with a large AIDS practice summed it up: "You don't get better by yourself." Martin Delaney, founder of Project Inform, said publicly, "We don't know how these drugs will work, but it makes more sense than the next best thing, which is dying without trying anything."

When in 1985 the National Cancer Institute announced a small study of an experimental cancer drug, "two thousand people telephoned within two days to find out how to get into the trial." The totally unfounded belief system developed that people with "AIDS" diagnoses not only "needed" drugs, but would die without them. The phrase, "death by placebo", found its way into ActUp rhetoric, and patients assigned to the placebo groups of drug trials were referred to as "sacrificial lambs". ActUp staged "die-ins" with signs saying, "FDA, YOU'RE KILLING ME" -- by withholding drugs.

This kind of activism led to the death of the traditional double-blind, placebo-controlled trial, which had been considered the gold standard of drug testing. It led to the abandonment of all evidentiary standards for drug approval. Toxic drugs, with no known benefits, were put on the market.

As scientific standards for drug testing went out the window, so did meaningful standards of knowledge and training. Some of the "treatment activists", who became leading "experts" in recommending what drugs should be prescribed, for what conditions, and in what doses, had no scientific or medical training of any kind. Martin Delaney was a former business consultant and seminary student. John James, founder of AIDS Treatment News, was a former computer programmer. (We learn from Impure Science that in 1986 James characterized AZT as "an effective, inexpensive, and probably safe treatment for AIDS" -- months before large-scale tests of AZT had even begun.) Mark Harrington, of the Treatment Action Group, could only say that his father had subscribed to Scientific American.

In trying to make sense of all this madness, one should never forget, as Epstein tends to, the logic of profit. Some of the "treatment activists" may have been sincere individuals. Others, however, were undoubtedly paid tools of the pharmaceutical companies, the only real beneficiaries of "treatment activism". Looking back on ActUp, whose meetings I attended for several years, my strongest impression is of phoniness: phoney ideals, phoney anger, phoney styles. I remember thoroughly middle class men and women, mostly in their 30s or 40s, wearing the costumes of "street people" or ghetto youth: torn jeans, truculent T-shirts, baseball caps worn backwards, etc. One moment they would be acting like spoiled children throwing a tantrum; the next, they would be hard as nails, demanding that the FDA give immediate approval to ddI on the basis of non-existent research.

Epstein does not tell the story of the IXth International Conference on AIDS (1993), at which the "treatment activists" showed their true colors. ActUp members from America and Europe travelled to Berlin, staying in luxurious hotels with swimming pools, with all expenses paid by Wellcome Pharmaceuticals, the manufacturer of AZT. London ActUp had taken 50,000 pounds from Wellcome, for travel expenses alone. However, at this particular conference, there were also genuine AIDS dissidents in front of the conference center, holding up such signs as "HIV is harmless" and "AZT is poison." On the next to last day of the conference, two of the dissidents were violently attacked by several dozen members of Act Up, who destroyed signs, burned leaflets, and attempted to destroy camera equipment. Conference officials who witnessed this criminal assault did nothing. Media people who witnessed it reported nothing.

And this omission of Epstein's illustrates the weakness of the "principle of symmetry" approach. The truth does not always lie between two extremes. Sometimes one side is entirely (and monstrously) wrong, as is AIDS orthodoxy. The only way to achieve symmetry, then, is to balance things by attenuating or concealing arguments from the side that is right. Among Epstein's omissions are:

  • the official rebuke of the leading AIDS expert, Robert Gallo, for "scientific misconduct"
  • criminal indictments and/or convictions of three of Gallo's closest associates
  • the ActUp boycott of the New York Native for criticizing the HIV-AIDS hypothesis and AZT
  • my fully documented expos‚ of the blatant cheating that took place, and was condoned and covered up by the FDA, in the Phase II AZT trials
  • the full toxicological profile of AZT, including its carcinogenicity
  • the falsity of the officially sanctioned dogma, "AIDS is invariably fatal", for which there was never any evidence
  • the devastating criticisms made of the "viral load" tests by Peter Duesberg, Harvey Bialy, Kary Mullis, Mark Craddock, and many others
  • the influential Meditel documentaries, seen by millions of television viewers, "The AIDS Catch", "AZT: Cause For Concern" and "AIDS & Africa".

Throughout his book, Epstein maintains a dichotomy between "scientists" and "laypeople". However, in the context of AIDS, who are the scientists? Within the current paradigm, "AIDS scientists" comprise medical people, virologists, some biotechnologists, and perhaps also "epidemiologists". I maintain that this particular mix of experts is entirely a function of the crazy hypothesis that "AIDS" is caused by a retrovirus. If the AIDS phenomenon were seen for what it is -- different people sick in different ways and for different reasons -- there would be an entirely different set of experts, and the word "AIDS" would no longer be used. If reality were to break through, then the experts would include toxicologists, psychologists, social scientists, and probably also lawyers (to handle law suits and prosecutions of the AIDS criminals).

I don't want to be too hard on this book. It is well written, and represents substantial scholarship. With the reservations indicated above, I recommend it.

Review by: John Lauritsen
Source: Continuum June/July 1997