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An AIDS activist is arrested outside the National Institutes of Health in 1990. Photograph by Richard Tomkins/UPI/Corbis Bettman

Steven Epstein's book on aids research and treatment, Impure Science, announces straightaway a contentious contrast between pure and impure research: AIDS science, he asserts, is impure. The claim has an easy plausibility: driven by the urgency of an epidemic and the consuming tragedy of deaths too soon and far too young, AIDS research is science-in-haste, necessarily impure. As one AIDS activist wrote in 1986:

We should point out that ten thousand people are expected to die of AIDS in the next year. And with deaths doubling every year, a little math shows that a two-year delay...means that three quarters of the deaths which ever occur from the epidemic will have been preventable....[T]o rely solely on official institutions for our information is a form of group suicide.

Epstein, an assistant professor of sociology at the University of California, San Diego, means by impure science more than just research driven by exigency. Impure science is an in-your-face challenge to some other kind of science Epstein doesn't much love. He believes that the story of AIDS research is a fine and imitable example of the democratization of science; he means that AIDS research has been guided to particular outcomes by forces that are essentially political--by a movement "broad based and diverse, ranging from grassroots

activists and advocacy organizations to health educators, journalists, writers, and service providers...gays and lesbians, people with hemophilia, injection drug users, and members of many hard-hit African-American and Latino communities."

Epstein's claim about AIDS science is not just descriptive, but normative--research should be impure, democratic, and politically driven, he thinks. The book, begun as a doctoral dissertation, was forcefully shaped by a current controversy about the very nature of science, a debate that has been heavily influenced by the work of French theorists--Michel Foucault, Pierre Bourdieu, and Bruno Latour. The main question addressed by the new sociologists of science--or "social constructivists"--is whether the cognitive content of science is determined by nature out there, or is merely the temporary construction of social entities and processes. The social constructivists, of course, advocate the latter view and come across as vividly anti-realist and relativistic (to philosophers) and anti-Mertonian (to older sociologists). In opposing Robert Merton's celebrated views about the autonomy of science, the constructivists believe that they are opposing a political conservatism that defends at least one dominant elite--scientists. Not surprisingly, they would like the social construction of science to be more democratic, although it is not clear what that will mean. Controversy invoked by these new sociologists of science has turned out, rather surprisingly, to be the major preoccupation of fin de siècle metascience.

Certainly The Flight from Science and Reason, generated by a 1995 conference sponsored by the New York Academy of Sciences (NYAS), is premised on a perceived crisis of confidence in science's autonomy. The "flight," or science-skepticism, of its title is the sort of attitude recently parodied by physicist Alan Sokal in his celebrated tongue-in-cheek article in Social Text: "Transgressing the Boundaries--Toward a Transformative Hermeneutics of Quantum Gravity." Among the postmodernist targets of the Sokal hoax were sociologists who view quantum mechanics as a social construction.

"...[R]ejection of reason," writes editor Paul Gross, "is now a pattern to be found in most branches of scholarship and in all the learned professions." The NYAS collection is an attempt to let "scholars of competence and integrity, representing a broad range of disciplines," create "a forum in which to measure the phenomenon." Harvard-affiliated contributors include Baird professor of science Dudley Herschbach, Geyser University Professor emeritus Henry Rosovsky, and Mallinckrodt professor of physics and of the history of science emeritus Gerald Holton.

Herschbach's essay is a model of civility and real engagement (in contrast to editor Gross's hyperventilating prose). He guides us into the murk of contemporary antiscience by way of his own startling encounter on a PBS science program when a fellow contributor stated: "The happy delusion that there are such things as facts, and that they do not deceive us, underlies the whole progress of science and chemistry down to the present day." This fairly radical skepticism left Herschbach politely astonished. As we press further in the Academy's 593-page tome, we find a quotation from a social constructivist who claims that the "natural world has a small or non-existent role in the construction of scientific knowledge." Happy delusion, indeed. Variants on the theme are reported in the volume: scientific fact is a result of social transactions among scientists, or the product of economic interests, or the dual outcome of power and interest. Thus, as Stephen Cole reports in his essay "Voodoo Sociology: Recent Developments in the Sociology of Science," one prominent sociologist has "argued that Boyle's law was influenced by his conservative political beliefs and his desire to maintain the status quo in order to protect his vast Irish land holdings." Hold it there, we want to say. These constructivists are clearly weaseling back and forth between "influence" and "cause." Would the inverse proportionality of a gas's pressure and volume be different if Boyle had not been a landholder? Would Boyle not have articulated the law had he not been conservative? Would someone else have done so? What then?

The social constructivists are quite hard to pin down: either they are saying that science is influenced by social forces (ho-hum) or that scientific knowledge is only the product of social forces, and therefore "relative" (wait a minute). As the volume's philosophers of science point out, no acceptable defense of the relativist implications of social constructivism has, so far, been made. Why? As Cole quite brilliantly reminds us, sociologists are just plain used to social facts--that's what they study--and may be constitutionally unable to distinguish the other kind:

That social science is completely or almost completely socially constructed helps explain how the social constructivist view of science could have become so powerful in the absence of any good supporting evidence and in the face of such devastating empirical critiques as those found in books like...How Experiments End [by Peter Galison, Mallinckrodt professor of the history of science and of physics].

All this helps explain why Epstein, writing about AIDS research, has a hard time with the social constructivist line, although he adopts its rhetoric. Epstein does allow, for example, that Luc Montagnier and Robert Gallo did actually identify the AIDS virus. That Montagnier and Gallo eventually engaged in a publicly dispiriting priority dispute suggests less that science is impure--for whoever claimed that it was ever above personal ambition?--but rather that they believed they were making true claims about nature, and that somebody got to nature first. (Remember how Newton and Leibniz each found the calculus, more or less independently.) This point is philosophically crude, but worth noting. Priority disputes are a problem for anti-realists.

Epstein has not flown so far from pure science as to be a clear anti-realist or radical social constructivist. Rather, he believes that science (whatever it is about) ought to be more buffeted by social forces. Despite that belief, he has a rather embarrassingly linear tale to tell about the search for the cause of AIDS. His main example of disruptive impurity in the first half of the book is the work of Peter Duesberg, a well-established biochemist on the faculty at Berkeley. Just as AIDS researchers had pretty much agreed on HIV as the viral cause of AIDS in the mid 1980s, Duesberg lobbed up an array of annoying criticisms: that the number of people estimated to be HIV infected and the number with AIDS were wildly disparate; that a retrovirus (like HIV) was not likely to cause illness years after infection; and that the "simian model" for the causal claim failed to show an AIDS-like condition in apes. Moreover, he claimed that HIV, like the Epstein-Barr virus and herpes, was no more than an opportunistic viral infection sustained by people with AIDS or at risk for AIDS.

Although Duesberg was initially ignored, his jabs were taken up in the early 1990s by some AIDS advocacy groups, which began demanding answers for the questions he had raised. Beyond the inevitable frustration over the pace of AIDS research, however, it is, frankly, hard to understand why Duesberg's criticisms were supported so strenuously. Epstein doesn't help us here. It begins to look as if democratizing science can be bad--costly, time-consuming, and a plain nuisance. Anthony Fauci, who as head of AIDS research at the NIH was responsible both for AIDS science and its public defense, fretted that he might "be answering Peter Duesberg for the rest of my life."

Duesberg's critique was gradually chopped away by Fauci and others. His hypothesis seems to have fostered no new experimental lines of inquiry, nor for that matter any challenging counterhypotheses. His later ideas about AIDS causality--that it was the result of "addiction to psychoactive drugs"--has not led to new work and has failed to explain, for example, the prevalence of AIDS in Africa. Thus, Epstein's reliance on l'affair Duesberg to show the benefits of democratic forces on science turns out to be a bust. And strangely enough, sociologist Epstein has nothing to say about the economics of AIDS research--the sharp rise in dollars earmarked for AIDS--certainly the clearest example of a democratizing influence on science brought about by the newfound political power of mostly middle-class gay men.

The story of AIDS treatment, epstein's focus in the second half of the book, may have a very different take-home lesson. The treatment of AIDS, as distinguished from the search for its viral cause, has taken an improved course because of the work of lay activists, doctors, and the ever-expanding circles of friends, family members, and partners of people with AIDS. (Epstein's story, in fact, brings to mind the March of Dimes' democratizing support for testing the Salk vaccine.) From these groups came questions, a clear insistence on participation, and, perhaps most riveting, challenges to the standard protocols for clinical trials for AIDS drugs.

Why, activists demanded, would one ever design a protocol that relegated some participants to placebos (in effect, no treatment at all), when the inevitable outcome of no treatment was death? Epstein guides us from that question to a later stage when activists "maintained that the point was not so much placebos versus no placebos, but whether a trial asked a meaningful, real-world question that the patient community wanted answered." "Clinical trials are experiments," Epstein goes on, "but they are real-world experiments with real-world implications."

The very success of trials depends on "patient compliance" by the people upon whom the experiment is conducted, and this, Epstein reports, improves when the very notion of compliance is blown up and replaced with participation. The book has many wonderful examples of the small ways in which treatment, and the relationship between doctors and patients, was altered. Among them:

At a 1988 conference on AIDS held in London, an anthropologist held up two books side by side to illustrate the gap in perceptions: one was called AIDS: A Guide for Survival, the other, The Management of AIDS Patients. (Only two years later...AIDS Treatment News would publish an article for patients..., "Managing Your Doctor.")

Or:

"You'd tell some young guy you were going to put a drip in his chest and he'd answer: 'No, Doc, I don't want a perfusion inserted in my subclavian artery,' which is the correct term for what you proposed doing."

Sadly, Epstein's poignant forays into the possible good of democratizing knowledge are marred by the doughy, theoretical hugger-mugger accompanying his claims. The fog is densest in his introductory essay. He writes of "praxis," "reification," "cultural discourses," and "frames," as in:

As frames of knowledge and belief about AIDS have become fixed in place, a range of social actors have engaged in credibility struggles to defend, refine, subvert, overturn, or reconstruct those frames.

Epstein turns every which way for theoretical guidance and finds no consistent framework. His language is, of course, strategic--it tells current sociologists that he's in the right place, more or less. But it is very off-putting and theoretically muddled, turning his study into a landscape littered with half-digested, often highly politicized claims that, flatly, detract. Even in summing up his own rich and thoughtful work, Epstein chooses tiresome leftish hortatory prose to be absolutely sure that we know where he stands: "[I]t is unlikely that knowledge-making practices can be substantially democratized, except when efforts to do so are carried out in conjunction with other social struggles that challenge other, entrenched systems of domination."

This particular political positioning comes down to what Henry Rosovsky would call (in his essay in the NYAS volume) an active dislike, or at least a misunderstanding, of Enlightenment ideals. Let's put it this way, although Rosovsky does not: there are fairly good historical reasons to link the birth of modern democratic theory and the growth of modern science. Karl Popper, among others, made the connection perspicuous, recalling his argument in The Open Society and Its Enemies that "one of the best senses of 'reason' and 'reasonableness' [is] openness to criticism," a mark of both science and democracy. Thus, when Epstein argues for the democratization of science, he is, in effect, arguing for better science, for improved and more open criticism.

The "better" part is critical, an injunction against bad science, trivial science, banal science, nuisance science--and possibly the object lesson of the Duesberg fiasco. Here Rosovsky (arguing for the place of expertise--and even narrow specialization!) and Holton (making the much-needed public case for science literacy) have something to say to Epstein: Yes, let's have lots of criticism, but let's do everything we can to see that it is informed. Otherwise we waste time, and people are dying. As another NYAS contributor, Robin Fox, stresses, "the very ideals of science itself are the only real antidote to its misuse." Just as democracy is (ideally) self-correcting, so (ideally) is science. The ideals matter. They are regulative. Neither expertise nor science is inherently antidemocratic; instead, as it turns out, they are bound up in the very idea of a working democracy. This is one reason why science education matters so much.

Should we worry then, along with the authors of the NYAS volume, about the "flight from reason and science"? You bet, and largely because--in high schools, colleges, and universities--we have almost failed to give non-science students a basic, flexible, and confident understanding of science. As Holton writes, "[A]ll but the most elementary rudiments of science, mathematics, and engineering have been squeezed out of the curriculum for the majority of college students." We can't democratize science with ignorance.

The real virtue of Epstein's book is as a case study: to get us thinking about how science might be different, and under what circumstances difference would mean improvement. After all, it might even turn out that we are still trying to figure out how to do science, that science isn't some immutable set of hegemonic (as Epstein would say) methods and practices, that we have actually become better at doing it, and that we stand to improve it as time goes on. In this sense, Epstein is right to enjoin a democratizing science, to allude (although he is unaware of it) to Popper's old ideas about the connections between democratic political ideals and the growth of knowledge.

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