BOOK REVIEW (CONTINUUM)
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
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
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
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
- 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
- the falsity of the officially sanctioned dogma, "AIDS
is invariably fatal", for which there was never any
- 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.