Causation and Credibility
The story told in part one—the story of the early search for the cause of AIDS, the initial consolidation of the HIV hypothesis, and the challenges subsequently posed to that hypothesis—has important implications for the study of scientific fact-making in politicized environments. The construction of belief about the causes of AIDS, and the dynamics of controversy, cannot be understood through an analysis of the "scientific field" as traditionally understood
as a self-contained arena in which credentialed researchers are the only important actors. Rather, a highly public and somewhat "open" field has been the site of incessant struggle, negotiation, cooperation, and interaction among a variety of individuals, institutions, and organizations. What are the tactics by which credibility is advanced or attacked in this field? What are the distinctive characteristics of the attempts to resolve controversy in this case?
In an analysis of scientific controversy, Collins and Pinch have suggested that it can be useful to distinguish between struggles waged in what they call the "constitutive forum" and those that are enacted in the "contingent forum." The constitutive forum is the world in which scientific knowledge-production is traditionally believed to unfold—the world of "scientific theorising and experiment and corresponding publication and criticism in the learned journals." The contingent forum, by contrast, includes everything that is supposedly "external" to real science: "popular and semi-popular journals, discussion and gossip, fund raising and publicity seeking, the setting up and joining of professional organisations, the corralling of student followers," and so forth. Collins and Pinch's point is emphatically not that one domain is "scientific" while the other is "extra-scientific." Rather, they seek to show how scientific debates are advanced through recourse to different types of arguments, some of which seek to create the appearance of being "based on universalisable non-contingent premises," while others do not.
Clearly, the AIDS causation controversy has heavily depended on both modes of argumentation. Working within the constitutive forum, AIDS dissenters such as Duesberg have highlighted inconsistencies in the orthodox position, enumerated predictions that have not been fulfilled, pointed to violations of "classical methods" such as Koch's postulates, and made use of medical analogies that compare the conventional wisdom about AIDS to that of other diseases "mistakenly" thought to be caused by microbes. In response, the proponents of the orthodox position have spelled out specific lines of rebuttal, defended the mainstream position through "clarifications" and auxiliary hypotheses, and invoked their own medical analogies that compared AIDS to other conditions where Koch's postulates have not been satisfied. In Susan Leigh Star's terms, both sides have manipulated "hierarchies
of credibility" through "claims that one procedure or approach is more scientifically viable, or technically astute, than another."
At the same time, scientists and medical doctors, not to mention lay participants in the controversy, have been quick to employ the contingent forum to assail the credibility of their opponents. Their mechanisms for doing so have been surprisingly familiar, as revealed by a comparison with the controversy in the 1970s and 1980s over fluoridating public water supplies. In that controversy, as Brian Martin's analysis makes clear, the mainstream position has enjoyed a near-monopoly of scientific credibility, but dissenters have found ways to undercut the credibility of their opponents.
Certainly the most obvious tactic available to the dominant group in such controversies is to try to ignore their opponents—as scientists successfully did with Sonnabend but had more trouble doing with Duesberg. When this tactic fails, the dominant group is typically confronted with the question of whether or not to engage in public debate. Defenders of fluoridation expressed the same sorts of concerns that Fauci and others did about debating Duesberg. One fluoridation enthusiast wrote in the American Journal of Public Health: "A debate simply serves to give more credibility to fluoridation opponents." As Martin has observed, experts who refuse to debate risk being perceived as arrogant, yet simply by engaging in debate they risk undercutting their own expert status by being viewed as partisans. Scientists supporting the dominant position walk a tightrope in trying to retain both their scientific credibility and their moral authority.
In the AIDS causation controversy, as in that over fluoridation, actors on all sides have sought to undermine claims by venting ad hominem attacks against their opponents. In doing so, they have attempted to tarnish their opponents' credibility by challenging either their expert status or their motivations or both. As Martin has noted, supporters of the mainstream position tend to work especially hard to attack the credibility of those opponents who have the most legitimate credentials; and the intensity and range of criticism directed at Duesberg—that he's just a chemist, that he's never worked on human diseases, that it's all a "game" with him and "he has to know he's wrong" —would seem to bear out the general point. Although "more than one can play the game of attacking the credentials, motivations, and honesty of those with opposite views," Martin has said in reference to fluoridation, the majority position tends to win this "battle over reputation in an overwhelming fashion because they have
the preponderance of professional support and especially the backing of professional societies."
In the case of AIDS, defenders of the HIV hypothesis could point not only to all the prominent national and international organizations that agreed that HIV causes AIDS (as Gallo, for example, was apt to do), but could even invoke the general consensus among grassroots activists, who were themselves typically critical of established authority. As ACT UP member Michael Botkin wrote in his column in the Bay Area Reporter , what "bugged" him about the fans of Duesberg was "the way they completely ignore the opinion of the AIDS movement." Noted Botkin: "ACT UP is no dupe of either the federal government or the medical mainstream. Everyone loves a good conspiracy theory, and certainly it's easy to believe that the government is blind, incompetent and corrupt. But if Duesberg's theory has some substance to it, why hasn't it garnered some interest, if not support, in the savvy, skeptical AIDS movement?" This move on Botkin's part might be described as the "monopolization of oppositional credibility."
Some of the most powerful weapons available to the defenders of the dominant position in scientific controversies are the sanctions they can exercise against dissenters. Through control over professional organizations, funding institutions, and journals, they can suppress heretical views and even those who dare voice them. Martin has recorded a variety of examples in the case of fluoridation. When a Minnesota dentist spoke out against fluoridation, his local dental society suspended him for one year without giving him a chance to speak in his own defense. In 1964, when a U.S. sociology student conducted a survey of a group of doctors and discovered that only half the respondents favored fluoridation, the student reportedly was chewed out by an assistant dean "for abusing the good name of her school." An Australian chemistry professor claimed in 1973 that "his staff and equipment had been taken away because of his public opposition to fluoridation." When an article critical of fluoridation was submitted to an Australian journal, it was rejected over the telephone by an editor who claimed "it might encourage the antifluoridationists."
Arguably, these examples are reminiscent of the experiences of Duesberg. The Berkeley scientist has indeed had increasing difficulty getting his views represented in prominent scientific journals, while some of the comments by reviewers and editors have suggested that political considerations (such as protecting the journal's reputation)
have been one factor in the process. He has seen his funding terminated in circumstances that invited suspicion. And he has reported being ostracized by his colleagues and former friends. At the same time, as Martin has pointed out, dissenters in scientific controversies can use such experiences of "unjustifiable" scientific behavior as "a resource in their struggle": "Opponents of fluoridation frequently raise these cases of 'suppression' as showing the political rather than the scientific basis for the promotion of fluoridation."
Criticizing instances of suppression and gatekeeping is one example of a more general tactic that both sides in the causation controversy have employed—what Martin has described as "highligting discrepancies between the stated norms of scientific behavior and the actual behavior of certain scientists." Duesberg has made frequent reference to the charges of fraud that have been brought against Gallo, while opponents of Duesberg have argued that, by speaking to a lay audience, he has sacrificed his scientific integrity. And each side has accused the other of a dogmatism that is antithetical to the true spirit of scientific inquiry: their predictions have been falsified, their arguments have holes in them, yet they refuse to forswear their beliefs. "A powerful hypothesis has to explain and predict," dissenter Harvey Bialy has told Spin: "I ask you, what kind of scientist continues to support a hypothesis that fails to explain and fails to predict?" Writing in the San Francisco Chronicle , Martin Delaney has turned the argument back against Duesberg: "Duesberg is well aware of [contrary] evidence, having been briefed regularly by his faculty peers. Yet he clings to his views, in spite of any and all data, while presenting no original AIDS-related data of his own, a puzzling pattern for someone who claims devotion to science."
Mainstream and Alternative Media
The extensive participation of the media has had important consequences for how credibility struggles have been waged in the AIDS causation controversy. Of course, the media are not monolithic, and different sorts of media have played different kinds of roles. The gay press has been far more receptive to giving space to nonmainstream positions and to citing the noncredentialed as legitimate experts. Alternative news vehicles like Spin , the New York Native , and the Meditel television programs have themselves become important actors in the controversy, intent on advancing certain
positions and demoting others. But as a general rule, the media, by their very presence, have transformed the collective assessment of credibility.
According to Anthony Fauci, "the media are great equalizers in science, which is most disturbing to us scientists"; "any scientist quoted in the media becomes an 'expert.'" Because Duesberg was presented by the media as credible, many people became concerned that the HIV hypothesis is a hoax, Fauci explained, adding that his own sister had called him repeatedly to ask: "Are you sure he's wrong?" Journalistic norms of "balance" impelled reporters to present the controversy as having "two sides"; media consumers, unable to judge for themselves the relative solidity of consensus among AIDS researchers, assumed controversy was rampant.
Martin Delaney, along with other defenders of the established position, has emphasized the penchant for sensationalism and sympathy for anti-establishment views found among at least some journalists and publishers. Yet to dissenters like Duesberg and Jad Adams, the problem is precisely the opposite: the media are the obedient lapdogs of government science. As Duesberg put it: "The press has been functioning like this [taps tape recorder] for the AIDS establishment. They have been Sonys.… Fauci calls the press and there it goes in the New York Times and the Los Angeles Times . Front page. No Fumento balancing it, no second guy writing what you have said. [They] speak directly to the American public. Immediately. That's the difference." Duesberg's critics complain vehemently about the amount of ink that the media have devoted to him, but Duesberg's perspective is completely the reverse: "I mean, measure it against the … 1,000 [articles] on the virus hypothesis that the New York Times alone publishes a year.… You will have a factor of like 1,000 … to one … in their favor. And that's how it works in the propaganda business. That's why Goebbels and others were so successful." In Britain, Duesberg has acknowledged, the media have been more critical, as have been some alternative reporters in the United States like Farber and Lauritsen. But in general the United States "is actually extremely conformist in many ways," Duesberg has complained.
Various analysts have claimed that reporters covering science and medicine—who often fail to have a thorough grasp of the scientific principles at stake—can become especially dependent on their contacts. "Such symbiosis between journalist and source is common in the American media," according to an analysis by Rae Goodell, "but
especially intense in science reporting." One study of U.S. media coverage of the potential swine flue epidemic found that "in spite of the many hundreds of experts who might have been contacted for comment, the same group of medical spokespeople from government authorities was quoted to the virtual exclusion of anyone else." Duesberg has claimed that the same phenomenon is at work in AIDS reporting. Because journalists are so dependent on their official sources, they decline to cover nonmajority views out of fear of being "frozen out": "They won't get further information on the subject from the mainstream.… And then they're out." After all, he has said, "without AIDS, you can't be a science reporter these days."
"My regard for science reporters is very, very low," Duesberg has concluded; and that's one thing that he, Gallo, and Fauci would all seem to agree on. Yet everyone in the AIDS causation controversy also recognizes the singular importance of playing to the media. In explaining why most people accept the orthodox position, Duesberg told California Monthly : "Science is really now a popularity contest, made by newspapers. You hype something in the press, and people take it from there." Duesberg was being critical, but of course, he has played the same game; and he had little choice but to do so if he wanted to advance his claims in the controversy.
Democracy as Rhetoric and Reality
Perhaps the most important factor altering the grounds for credibility in the AIDS causation controversy is the deeply embeded concern with "democracy"—understood in various ways. The most obvious examples of this preoccupation relate to questions of "academic freedom" or "freedom of thought." Duesberg's supporters routinely insisted upon his "right to speak the truth"; a San Francisco Examiner editorial blasting Duesberg nonetheless acknowledged his "right to air his view even in the face of nearly unanimous scientific disapproval." A more profound democratizing claim, also pushed by some of the HIV dissenters, is that the scientific marketplace must be opened up to all those who seek to compete within it. "The 'AIDS establishment' is under the impression that it has a right to govern all discourse on AIDS," complained Celia Farber in Spin . "It feels no one has any business disrupting its conclusions and treatment strategies. But don't all those AIDS posters remind us, 'AIDS is everybody's disease'? Doesn't that include the people who question those who made the posters? Isn't it everyone's debate, too?"
This is a very different kind of claim, one which proposes that science ought to be opened up to anyone who seeks to present knowledge as credible or evaluate the credibility of others. Ironically, even Duesberg has had his doubts about such a project and would reserve science for the scientists. "I'm not excluding anybody else," Duesberg has hastened to add. "It would be great if others would participate too, but they're too easily misled or bought. I mean, [scientists] give them a slide … and it shows something with T-cells … and people say, 'Oh my god, these guys must know everything.' And so you can easily impact a gay activist or counteractivist by this type of information without telling them anything.…" There may indeed be limits to the extent that lay activits can contribute to answering questions such as what causes AIDS. At the same time, there is no avoiding the astonishingly public and contested nature of biomedical science in the late twentieth century, particularly in the AIDS epidemic. Like many of his mainstream critics, Duesberg would have us return to a mythical golden age when researchers did their work in peace, protected from the play of "politics." Yet his own interventions have helped to open the gates to the citadel—and the ordinary people who have gotten the chance to step inside are not likely to surrender that prerogative.
From Causation to Treatment
The democratizing claims of laypeople, while surfacing regularly in the causation controversies, have been even more pronounced in the evolution of debates about treatments for AIDS. These debates, the topic of part two, have been enacted concurrently with the causation controversies, and they involve some of the same protagonists; indeed, references in past chapters to topics such as AZT, which feature prominently in part two, suggest a certain overlap. More profoundly, the intervention of laypeople, particularly within gay communities, in debates about the nature and causation of AIDS from 1981 onward helped construct "knowledge-empowered" communities that could then participate in even more radical ways in debates about treatments.
Yet in certain respects, research into treatment is different from the sort of research involved in determining the cause of AIDS. Since drugs cannot be tested without patients willing to participate in clinical trials, laypeople occupy a central position in the very process of knowledge-making. And since the approval of drugs is often a highly
politicized process involving government agencis, pharmaceutical companies, and other players, debates about the safety and efficacy of treatments travel with particular ease between the pages of scientific publications, the mass media, and—in the case of AIDS—activists publications and the gay and lesbian press. The chapters that follow track the history of research into antiviral AIDS drugs and explore the crucial role of AIDS activists in transforming themselves into experts who could speak credibly about treatments. The interventions of the AIDS movement have had profound implications.for the social construction of belief—for what we come to think is true about the safety and efficacy of antiviral drugs.