Impure Science: AIDS, Activism, and the Politics of Knowledge

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University of California Press, Dec 9, 1996 - Medical - 480 pages
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In the short, turbulent history of AIDS research and treatment, the boundaries between scientist insiders and lay outsiders have been crisscrossed 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, activists, policy makers, and others to discover how knowledge about AIDS emerges out of what he calls "credibility struggles."

Epstein shows the extent to which AIDS research has been a social and political phenomenon and how the AIDS movement has transformed biomedical research practices through its capacity to garner credibility by novel strategies. Epstein finds that nonscientist AIDS activists have gained enough of a voice in the scientific world to shape NIH–sponsored research to a remarkable extent. 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. He 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, Epstein 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, physicians, and scientists.
 

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Contents

CONTROVERSY CREDIBILITY AND THE PUBLIC CHARACTER OF AIDS RESEARCH
1
The Crisis of Credibility and the Rise of the AIDS Movement
5
Analyzing AIDS Controversies
14
The Plan of the Book
26
Some Intellectual Debts
38
THE POLITICS OF CAUSATION
43
THE NATURE OF A NEW THREAT
45
Lifestyle vs Virus 19821983
55
POINTS OF DEPARTURE
181
Clinical Trials Take Center Stage 19861987
194
DRUGS INTO BODIES
208
A KnowledgeEmpowered Movement A LAB OF ONES OWN
216
THE CRITIQUE OF PURE SCIENCE
235
Activism and the Manufacture of Knowledge 19891991
246
DILEMMAS AND DIVISIONS IN SCIENCE AND POLITICS
265
Inside and Outside the System
280

The Triumph of Retrovirology 19821984
66
HIV AND THE CONSOLIDATION OF CERTAINTY
79
HIV as Obligatory Passage Point
90
REOPENING THE CAUSATION CONTROVERSY
105
RED FLAGS AT THE ACADEMY
127
THE DEBATE THAT WOULDNT DIE
143
Whither the Controversy? 19921993
163
Causation and Credibility
170
THE POLITICS OF TREATMENT
179
CLINICAL TRIALS AND TRIBULATIONS
295
MORE PIECES OF THE ELEPHANT
310
CREDIBLE KNOWLEDGE HIERARCHIES OF EXPERTISE AND THE POLITICS OF PARTICIPATION IN BIOMEDICINE
330
The Transformation of AIDS Research
337
The Legacy of AIDS Activism
346
METHODOLOGICAL APPENDIX
355
NOTES
361
INDEX
445
Copyright

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About the author (1996)

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.

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