PUBLIC KNOWLEDGE, PUBLIC TRUST:
PUBLIC KNOWLEDGE, PUBLIC TRUST:
Toward Democratic Epistemic Practices
Abstract and Keywords
Taking its point of departure from the suppression of research findings by a Canadian drug company with a vested interest in keeping them from the public eye, this chapter reads the ambiguous gendered implications of the positioning of Dr. Nancy Olivieri, a scientist and physician, as the principal player in the story. Issues of credibility, answerability, academic freedom, and the role of trust in knowledge figure centrally in the analysis. It shows how ecological thinking allows for the development of a productive reading of responsibility, rooted neither in individualism nor in an implausible voluntarism; and attentive to the climatic conditions in which much scientific research in the 21st century takes place. It extends the discussion of collective responsibility that begins in chapter six to raise questions about ecologically sound research practices, justice, and citizenship.
To know what took place, summary is enough. To learn what happened requires multiple points of address and analysis.
—Toni Morrison, Race‐ing Justice, En‐Gendering Power
Captioned “Whistle Blower,” the cover photograph of the 16 November 1998 issue of Maclean's: Canada's Weekly Newsmagazine features Dr. Nancy Olivieri, a hematologist at the University of Toronto and Toronto's Hospital for Sick Children (fig. 1). It names her principled breaking of a confidentiality agreement with a pharmaceutical company whose product she had been testing as the catalyst for “a debate over money and morality … raging through the medi-cal world.” The Olivieri case, which I read through diverse lenses in this chapter, exposes tangled issues peculiar to late‐twentieth‐ and early‐twenty‐first‐century politics of knowledge, which indeed require—and invite—multiple points of address and analysis. These issues figure among those I adumbrate in the introduction, about the preservation of public trust and the creation of responsible epistemic citizenship—concerns notably absent from putatively universal, a priori theories of knowledge and action. They show how knowledge claims advanced and substantiated even by the most authoritative of knowers—an (p.238)
Although “the sex of the knower” has received scant mention in the press coverage about Olivieri, a salient aspect of my purpose in reading the case ecologically is to examine the epistemological significance of its location not just within a corporate climate, but also within a sex‐gender system, embedded in the culture of white western scientific research and practice and in the larger society.2 Curiously in this instance, it is difficult, without endorsing a knee‐jerk ideology bent on exposing blatant sexism in any equivocal or negative depiction of a woman's plight, to frame or even name the gender issue as operative within reports that maintain so audible a silence on the matter. Yet my proposal is that the hegemonic imaginary within which laboratory science (p.240) is practiced in the affluent western world colors this case “pink‐for‐girls,” intentionally or otherwise producing a gender‐inflected framing. Reading some of the imagery through a feminist lens and against the verbal silences that cloak the ambient sexual politics uncovers a set of gendered modalities that, in white western societies, routinely play into the politics of knowledge, responsibility, science, and expertise. With the silencing they condone and the forms of oppression they thus sustain, these issues, too, function as situational obstacles to the creation of habitable epistemic community. Their seeming effectiveness in shaping public perceptions of this case suggests productive analogies with other modalities of the politics of epistemic location and authority.
The Maclean's cover photo is striking in the way it positions its subject so as to glamorize, to sexualize her, positing a marked incongruity between her overt, professional self‐presentation as a lab‐coated doctor (albeit with stethoscope rakishly worn) and the tropes it mobilizes of the vamp, the defiant troublemaker, the woman who, as a whistle‐blower, steps out of line to become as much a part of the problem as of its solution. Because such incongruities permeate the early press coverage, my reading of the case looks through a feminist lens at how the imagery installs gender as an analytic category3 among the issues that invite address and analysis. One of my strategies, therefore, in attempting to understand what happened is to map samples of that coverage for how their positioning of events and protagonists highlights gender as an operative, if often silent, factor in the politics framing the case. These samples, I will suggest, expose a subtext to the Maclean's photograph and other visual and verbal representations, beneath the surface of the explicitly deployed rhetorical imagery. Both visually and verbally, the reports convey unspoken but legibly/audibly gendered messages that work, sometimes tacitly but also more overtly, to divert attention from and even to impugn Olivieri's scientific and medical credibility. Photographs are a peculiarly rich resource for thinking about gender for, by contrast with print, they cannot avoid displaying the players as embodied, thus sexed‐gendered, beings; they cannot keep gender out of the picture. Thus the Olivieri photographs, like images more generally, work as much to generate meaning as to transmit it, nor does an image carry its meaning, preformed, from one venue to another. Its meaning depends as much on deployment and uptake as on its source: there is no uncontested (p.241) “given” in the presentation. Hence, as I will show, the Olivieri photographs lend themselves to multiple and often contradictory readings.
The Olivieri Affair
The broad outlines of the Olivieri affair4 are as follows. In the New England Journal of Medicine (NEJM) in 1994, Dr. Nancy Olivieri (then) of the Division of Haematology/Oncology at Toronto's Hospital for Sick Children (HSC) and professor of medicine at the University of Toronto, published a team‐authored article, “Survival in Medically Treated Patients with Homozygous B‐Thalassemia,” reporting on “transfusion and iron‐chelation therapy” (administered in a drug called deferiprone‐L1) for the treatment of patients (mainly children) with thalassemia major, a genetically transmitted condition of the blood, prevalent around the Mediterranean, in the Middle East and Southeast Asia, and in Canada among children of Chinese, Greek, and Italian parents. Characterized by abnormalities in red blood cell production, thalassemia major (also called Mediterranean anemia) results in oxygen depletion in the body and, if untreated, can cause death within a few years. Growth failure, bone deformities, enlarged liver and spleen, which begin to appear within the first year of life, are some of its indications. Before deferiprone was available, patients had required monthly blood transfusions, administered by connecting them for as much as twelve hours a day to a drug infusion pump, a treatment whose effects include a dangerous iron build‐up. Because the procedure for clearing the iron is so onerous, many patients opted out of treatment in their teenaged years, and many died in their twenties. Thus 1993 press reports herald deferiprone as a “revolutionary new treatment,” promising “an entire new way to treat these diseases” (= thalassemia and sickle‐cell anemia),5 citing testimony from parents relieved at the prospect of taking their children off the intravenous pump, and children pleased with their newfound freedom.
Nonetheless, just a year after the first article appeared, Olivieri published concerns about deferiprone's long‐term effects, in response to emerging evidence that, for some patients, it, too, could produce iron overload serious enough to cause heart, liver, and endocrine damage. In a 1995 letter to the New England Journal of Medicine she cautions: “When new therapies are (p.242) introduced, it is important to confirm promising initial findings … so that false hope and expectation on the part of patients with chronic disease can be avoided.”6 And in 1998, a second team‐authored article concludes:
Deferiprone is not an effective means of iron‐chelation therapy in patients with thalassemia major and may be associated with worsening of hepatic fibrosis, even in patients whose hepatic iron concentrations have stabilized or decreased. After a mean of 4.6 years of deferiprone therapy, body iron burden was at concentrations associated with a greatly increased risk of cardiac disease and early death … in 7 of 18 patients (39%).7
For western scientists, philosophers of science, and an informed public alike, these events fit easily into received images of “normal science,” following a standard trajectory from positive initial findings through cautionary warnings to (partial) refutation of a hypothesis in light of new evidence, with modifications of (putative) knowledge and treatment and/or withdrawal of the drug as its outcome. Yet in this instance the trajectory was blocked: what could and should have been a set of uncontroversial epistemic and ethical decisions devolved into a contest of wills and interests, generating the “debate over money and morality” announced in Maclean's cover story.
Deferiprone research had been generously financed by Apotex Inc, “one of Canada's most high‐powered pharmaceutical firms”;8 in 1993 and again in 1995, Olivieri had signed confidentiality agreements prohibiting disclosure of information about the drug's trials without written permission from the company;9 and Apotex was negotiating a large donation to the University of Toronto. Thus, making new evidence public, exposing the fallibility/corrigibility of the initial findings, cautioning parents and patients, withdrawing the drug from circulation, were not as straightforward as allegedly value‐neutral empiricist epistemologies contend, according to which error suspected or exposed forces a reevaluation of knowledge claims, if it does not simply negate them. When, despite a warning from the Research Ethics Board (REB) at HSC, Olivieri insisted on modifying consent forms to warn patients of the dangers, Apotex (p.243) threatened legal action, and both the hospital and the university refused to support her decision. Nonetheless, Olivieri publicly “defied the confidentiality clause and the company's threats to sue, arranged for her own legal counsel, informed her patients and the [hospital's] REB, informed the federal government's Health Protection Branch, reported her research at a medical conference”10 and published the 1998 NEJM article. In consequence, she was dismissed from her position as head of the hospital's hemoglobinopathy program. Although subsequent collegial and public pressure forced a review of the case, and a settlement brokered by the Canadian Association of University Teachers (CAUT), with two of the world's other leading experts in blood disease testifying to Olivieri's scientific integrity and worldwide eminence, was instrumental in bringing about her early‐1999 reinstatement, the story does not end there. Even a putative ending that Olivieri reports in October 2001 scarcely counts as a “resolution.”11 Nor is there any clear indication of justice having been done either for Olivieri and her supporters or in addressing the wider issues of “money and morality,” academic freedom, corporate sponsorship, and public trust that permeate the case and its aftermath, with ongoing ripples spreading through western medical and scientific institutions. Indeed, taking the Olivieri case as their central example, David Nathan and David Weatherall observe in an October 2002 NEJM article that such things are still happening, although “they generally take milder and less public forms.”12
Despite her 1999 reinstatement, the university was slow to restore Olivieri's research space, laboratory access, and lab assistants; for months she and her supporters were subjected to vicious email attacks and anonymous letters calling her supporters “pigs” and “unethical” and making damaging allegations about Olivieri's professional conduct. In a bizarre twist to the story, in January 2000 Dr. Gideon Koren, a colleague at the HSC, himself an eminent authority on blood disorders in children and highly respected for having established Motherrisk—a service that gathers evidence and dispenses advice to practitioners and lay people on risks to fetuses and children from drugs, chemicals, toxins ingested by their mothers—cosigner of the 1993 contract and a coauthor of the 1994 NEJM article, was exposed as the sender of the hate mail. The exposure surprised “a lot of people both inside and outside the hospital because of his stature and reputation (p.244) as a top scientist and caring doctor.”13 Meanwhile, in 2001, Apotex was still promoting Koren's “scientific opinions regarding its controversial drug”14 and persevering in attempts to license the drug in the United Kingdom and Europe without the expertise—indeed over the protests—of Olivieri and of Dr. Gary Brittenham, who resigned his cochairmanship of the research team in Italy, following actions by Apotex, which left “less experienced and less principled investigators … [to] continue … a year‐long study, not designed in the first place to examine efficacy,”15 as Olivieri describes it. In 2004, Miriam Shuchman reports, doctors in the United Kingdom, Italy, India, and Taiwan were regarding L1 as a reasonable option for patients unwilling or unable to take the alternative, Desferal. According to Shuchman, L1 “owes its staying power to science.”16 But the question remains: does it?
The Scientific Imaginary
The claim that science—and thus medical science and technology—figures in the present‐day western epistemic imaginary as the most objective, certain, and sophisticated knowledge humankind has achieved requires no argument to support it. Nor does the claim that expert scientific practitioners occupy positions of acknowledged epistemic authority, commonly stretching well beyond the boundaries of their specific domains of professional expertise. Merely prefacing a newspaper or television report with the words science has proved generates a public presumption in favor of taking the report seriously, accords it a credibility that frequently exceeds its evidential warrant, works to mask such agendas and vested interests as might underlie its presentation to the public eye. This same epistemic imaginary, with its adherence to an autonomy‐of‐knowledge credo, promotes a belief that scientific knowledge production takes place, appropriately, in enclosed, segregated laboratory settings—locations allegedly removed from the structures of power and privilege constitutive of all human institutions, practices, and societies—and in science itself as one such institution. Although self‐critical work by scientists, and by philosophers and others in critical science studies, reveals this imaginary to be neither (p.245) seamless nor impervious to critique, its tenacity in the public eye has not diminished to keep pace with these interventions. It sustains an imaginary of science (often cursorily essentialized) as self‐contained and politically neutral—an imaginary within which members of an informed public judge and debate reported scientific “facts” and advance their own, derivative, claims to know.
As I have explained, a social imaginary is about often‐implicit but nonetheless highly effective systems of meanings, metaphors, and interlocking explanations‐expectations within which people, in specific time periods and geographical‐cultural climates, enact their knowledge and subjectivities and articulate their self‐understandings as knowers—as producers, perusers, critics, beneficiaries, and/or consumers of expert and everyday knowledge. An imaginary is as productive in generating and sustaining images, metaphors, and operative idea(l)s that underwrite patterns of epistemic legitimacy and credibility as it is in situating and evaluating practices of scientific inquiry. Imaginaries, I have also noted, are self‐reinforcing rather as self‐fulfilling prophesies are: although ongoing successes consolidate their sense of rightness, it takes more than a few counterexamples to unsettle them. Thus understood, a social imaginary carries within it the normative meanings, customs, expectations, assumptions, values, prohibitions, and permissions—the habitus and ethos—into which members of a society are nurtured from childhood, which they internalize, affirm, or contest and refuse, as they make sense of their place, options, possibilities and prohibitions, risks and responsibilities in a social and physical world, conceptions of whose “nature” and meaning are also instituted in these imaginary significations.
As I indicate in chapter one, this imaginary is social in the broadest sense: not only is it about principles of conduct, both epistemic and ethical, but it is about how such principles claim and maintain salience. It is about the scope and limits of human knowledge and its place in the social‐political‐material world; about the appropriate hierarchical ordering of institutions of knowledge production; about intellectual and moral subjectivity and agency; about social‐political structures and the distribution of goods, privileges, power, and authority. In this complex sense, the social imaginary of mastery and instrumentality, animated, as we have seen, by an inflated individualism and born of the Industrial Revolution and late capitalism, extends across the ethos and habitus of an affluent western world where there seem to be no limits to human capacities for prediction, manipulation, and control—to possibilities of mastering this world's resources, be they animal (both human and nonhuman), vegetable, or mineral. Nor, apparently, is there any reason either to contest the rightness of “man's” claims to dominion over (p.246) all the earth or to challenge the exclusionary scope of the putatively generic term man.
The operative public image of laboratory science in this imaginary—however incongruous it may be with “the facts”—is of an esoteric, authoritative inquiry, practiced by privileged, mainly white men in enclosed communities, sealed off from open public discourse by a language in which even the well‐educated, literate, and privileged members of a nonscientific public cannot readily find their place. It effectively masks the human—thus fallible—provenance of scientific discoveries behind impersonal, passive locutions such as “it has been shown” or claims such as “the data show” or “science has proved,” which erase the specificities, and thence the responsibilities, of human agency. The esoteric aura this discourse engenders creates a protected insularity for laboratory life, separating quests for knowledge itself from the social‐political‐ethical effects of its circulation and enactment, often dismissively labeled its “uses” that, in this rhetorical frame, are extraneous to science and epistemology proper. It underwrites a mystique of official secrecy in which a confidentiality agreement such as Nancy Olivieri signed would pass merely as a matter of course. Such rhetorical tropes may partially account for the efforts of Olivieri's detractors to contain her story by labeling it “a scientific controversy,” situating it within procedures and rules that pose as self‐justifying and thus impersonally apolitical (Olivieri observes: “Having created this fiction, they were able to express the desirability of ‘not taking sides’ ”).17 The strategy echoes what Evelyn Fox Keller calls an “unspoken agreement that privilege[s] questions of truth over questions of consequences … [and] demarcat[es] the internal dynamics of science from its social and political influences”18—a strategy adept, even in these days of the “science wars,” at protecting a laboratory “club culture”19 from the public accountability regularly demanded of more secular forms of knowing. That such external factors would be operative in knowledge production is neither a surprise nor a sin; but in shielding them from view, an institution of knowledge production defies expectations of the transparency integral to public trust, thereby compromising its responsibly authoritative status.
The metaphor of the hortus conclusus in medieval painting—the walled garden, complete in itself, isolated from the outside world and protected from (p.247) unwanted (unwonted?) intruders by the stone wall surrounding it20—conveys the flavor of how the laboratory figures in this imaginary. Michèle Le Dœuff, to whom (with Castoriadis) I am indebted in my thinking about epistemic and social imaginaries, invokes a related image in her conception of philosophy's islanded consciousness, elaborated from Kant's reference to the “territory of pure understanding” as “an island, enclosed by nature itself within unalterable limits.”21 Kant's first Critique endeavors to “prevent the understanding, which has at last applied itself to its proper, empirical employment, from wandering off elsewhere,” leaving its rightful, island domain, Le Dœuff contends.22 These rhetorical images prefigure the “enclosed communities” of present‐day laboratory science, where whistle‐blowers are bound to be vilified, pilloried, excommunicated from the ranks of those whose domain they threaten to unsettle. Residues of a chemistry‐set imagery of the laboratory and of a tabula rasa theory of mind, yielding a picture of white‐coated (thus pure white, politically innocent) practitioners engaged in solitary, value‐, and theory‐neutral quests for truth, still tacitly shape secular visions of scientific inquiry. They sustain an imaginary of scientific methodology and discovery as autonomous, internally justifying, and hence immune to the ethico‐political critiques enunciated by feminists and other Others.
The Olivieri case challenges these aspects of scientific self‐presentation head on. It exposes some of the strategies that institutional authorities employ to shore up cherished beliefs in scientific purity and isolation, as laboratory science has no choice but to emerge into public discourse to address matters of confidentiality in conflict with principles of informed consent. Moreover, as I will elaborate with regard to its implication with “the gender question,” the case shows something of why medical science's social‐ecological location as a specifically populated institution of knowledge production cannot be ignored.
No unequivocal conclusion about what took place is immediately forthcoming from the press coverage I have cited. Nor, despite Olivieri's having enlisted the authority of the CAUT in her defense, is it easy for members of a thoughtful public who have not been privy to its unreported aspects to judge wisely about what happened in this case, even after engaging “multiple points of address and analysis.” For example, in a highly skeptical article in MD (p.248) Canada, editor David Dehaas disputes the credibility both of Olivieri's expressed concerns about deferiprone and of her allegations of dismissal, harassment, and other grievances; and he contests the plausibility of casting academic freedom as a central issue in the case.23 Emphasizing expressions of incredulity vis‐à‐vis Olivieri's stance on the part of European researchers who remain convinced of the drug's safety and effectiveness, and casting the disagreements between Olivieri and Koren in a quite different light from the CAUT report and the NEJM articles, Dehaas reads the case as an overblown scientific controversy whose fervor is out of proportion to the facts of the case. His piece complicates evaluating the case itself and the larger questions it poses about credibility and public trust it: it cannot, for example, be concluded that the pro‐Olivieri side is right simply because it has generated more public support, on a quasiconsensus reading of truth. And the Dehaas article's tone of mockery, together with its flippant dismissal, compounds the difficulty of evaluating “the facts” it reports, especially for a lay public trying to think well both about the case and its larger ramifications.24 Complicating the issues still further, Shuchman's detailed documentation of the multiply contestable details of “the scandal,” from 1998 to 2005, confirms that there is more to be told—that the jury is still out on the drug, its defenders, and its detractors. These ongoing analyses attest at once, to the vital part that public disagreement plays in keeping debate alive and open and to the complexity of the politics of knowledge in a world where not even privileged and educated members of the nonscientific public can easily acquire a level of scientific literacy adequate to the task of enabling responsible readings of what people need to know in order to pursue, and advocate for, conditions of viable epistemic cohabitability.
In the affluent twenty‐first‐century western world, public willingness to trust what “science has proved” and, derivatively, to entrust people's lives and well‐being to medical science rests, if cautiously, on beliefs woven into the very fabric of an instituted, entrenched scientific‐epistemic imaginary. Its rhetorical apparatus, in which the “science has proved” locution plays an emblematic part, is structured around tacit assumptions that accredited practitioners will (p.249) adhere to received research standards and submit their results to established procedures of critical review. Professional codes of conduct are designed to safeguard such confidence; and the value of testimony as a source of knowledge is routinely affirmed with reference to the credentials of the testifier. With knowledge remote from lay experience, accessible at first hand only to the initiated, giving or withholding trust rests on beliefs, widely nurtured in open democratic societies where free inquiry is said to flourish, that practitioners have conformed to the norms of “normal science” and the participation of patrons, sponsors, and institutional guarantors of projects carried out under their auspices fulfills the requirements of professional epistemic and moral responsibility. Public outrage in the media, the academy, and the wider world when violations of such assumptions are exposed shows how tightly they are wound into this web of social expectations.
Prior to the exposure of Apotex's role, the public credibility index of the deferiprone project was high, owing in part to the credentials of the research team, listed with their degrees—in effect, to confirm their conformity to these very norms—and reinforced by the articles’ publication in the New England Journal of Medicine with its (erstwhile) proud policy of refusing to publish materials by authors whose research is sponsored by pharmaceutical companies or who are known to have other vested interests in its outcome. These are typical ingredients in maintaining public trust in research and in the responsible use of its products. Indeed, Olivieri's public credibility remained high, on the whole, throughout the unfolding of the case, because of her refusal to abide by the confidentiality clause, her commitment to her patients and to a cautious but careful reading of the evidence, her perseverance in making developments public despite high personal costs, her resistance to allowing “the profit motive [to take] precedence over scientific rigour” or to “lose [her] objectivity.”25 But she did not become the hero she might have been; and the dispute has been long and damaging. Even after the 2001 release of the CAUT's 540‐page document, The Olivieri Report,26 which (in her words) “vindicates” her and “set[s] the record straight” about the egregious attacks she and her supporters experienced, Olivieri remains pessimistic about prospects for resolving the larger issues of public responsibility and trust.27
Clearly, the mere fact of a high‐profile female doctor as the main protagonist—and in some reports the victim—is not sufficient to cast the events in the Olivieri affair, unequivocally, as effects of gender politics. Despite, or more likely because of, their often having been instrumental in forcing public inquiry into conflict of interest and other unethical practices in medicine, science more generally, and other public practices, whistle‐blowers of any gender, race, class, religion, ethnicity put themselves seriously at risk.28 Yet since so much coverage of this case focuses on Olivieri herself, rather than on the knowledge and/or its misuses under investigation, it stands as a persuasive example of how even the most authoritative practitioners’ allegations of research misconduct are vulnerable to critique that enlists aspects of their social‐ecological location. Thus in my view, examining how Olivieri's female presence figures in and shapes public understandings of what happened in this exposure of the research laboratory and its inhabitants to scrutiny adds a vital dimension to projects of determining why the events unfolded as they did, accompanied as they were by a media chorus in which gender functioned as a recurrent, if secondary, Leitmotiv. In a society where hierarchies of gendered power and privilege remain firmly in place even after almost three decades of feminist research in epistemology, this case raises crucial issues about the politics of representation, especially when the press as a source of public knowledge is so active a participant in the unfolding, positioning, and judging of what happened.
To a feminist eye, some early media reports point—if obliquely—to gendered assumptions at the core of the attacks directed at Olivieri: First, in the months leading up to her dismissal, the HSC publicly debunked—mocked—Olivieri's claims that the administration was threatening to dismiss her; second, a CBC television documentary characterized by one of her strong supporters as full of “grave factual errors and innuendo,” claimed that Olivieri was “not only an incompetent scientist but carries responsibility for the suffering and death of thousands of patients worldwide.”29 Third, a Toronto newspaper (p.251) carried the heading “Firm axes outspoken scientist's research: Woman went public with concerns about drug's safety.”30 Fourth, a caller to Maclean's magazine from inside the hospital “accused her of stealing money from her research grant, treating her patients unethically, and sleeping with some of the scientists who looked favorably on her research findings,” while another, with links to Apotex, “stubbornly referred to the trained medical specialist as ‘Miss Oliveria.’ ”31 And fifth, the pediatrician‐in‐chief at the HSC maintained that patient care would be unaffected by Olivieri's removal from the research program: she would “actually have more time to care for her patients.”32 Regardless of how the case is ultimately evaluated, these remarks expose a gendered subtext beneath the dominant readings. Discrediting a woman's take on events is a familiar ploy; just as, in the politics of discourse, “outspoken” is rarely a gender‐neutral term;33 nor is labeling her a “woman” who went public—not a doctor or scientist—a gender‐neutral action. Attributing a woman's professional success to her having slept her way to the top is a common strategy in the politics of gender, as is casually “forgetting” her name and professional title; and announcing that her time would be better spent with her patients trivializes Olivieri's scientific stature, relegating her to a caring position where she will, assuredly, “be better off.” In gendered divisions of labels and labor, these are familiar scripts for designating a woman's place in a man‐made world and cautioning her should she fail to know that place.
Even these items are not enough to establish a pivotal role for gender in the politics of knowledge and ethics of inquiry operative here, for explicitly gendered comments are sufficiently rare in the early press coverage that skeptics can easily discount them as mere slips of the pen. But there are exceptions, so telling as to make the larger silences resoundingly audible: A reference to “the dysfunctional patriarchy in which she works—The Hospital for Sick Children” describes it as “a place where senior scientists are scolded like schoolgirls and their concerns ignored”;34 a feminist columnist quotes a male colleague and supporter of Olivieri at the University of Toronto saying: “If she were a six foot two male football player, her concerns for her patients’ well‐being would not have been treated this way.”35 (p.252) And the HSC's CEO Michael Strofolino refers to her as “this poor little innocent researcher,”36 a comment unlikely to be made of a man.
Striking as they are, these examples combine neither to support a focus on gender nor to single it out as an explanatory‐causal factor, for male scientists face comparable sanctions from pharmaceutical sponsors and/or universities devoted to protecting their financial assets. To cite just three well‐known examples, Dr. Arpad Pusztai of the University of Aberdeen found his contract terminated after he spoke out about the risks of genetically modified foods;37 Dr. David Healy's offer of an appointment as clinical director of the University of Toronto's Centre for Addiction and Mental Health was revoked when he published concerns about increased suicide risks among patients taking antidepressants;38 and Olivieri compares her experiences with threats directed at Dr. David Kern, formerly of Brown University, in response to concerns he expressed about interstitial lung disease in workers at the industrial plant Microfibers.39 Nor are gender issues explicitly named in reports of the professional harassment directed at Dr. Ann Clark of the Plant Agriculture Department at the University of Guelph, following her opposition to the development and use of genetically modified seeds (although reading her situation through a feminist lens could yield quite a different interpretation).40 Yet (partial) media silence notwithstanding, there is every reason to evaluate gender as an analytic category in analyzing this case, given a scientific‐research climate where a sexualized politics of knowledge sustains hierarchies of credibility, epistemic authority and trust in ways detrimental to open, democratic epistemic negotiation.
Although the fact of a high‐profile female doctor as protagonist—and sometime victim—cannot by itself catch the gendered tenor of events in the Olivieri affair, some photographs of the main players offer a way of rereading the silences around gender.41 Their messages are as insistent, in the hegemonic scientific (p.253) imaginary, as the whistle‐blower montage with which I open this chapter. Constrained by the very nature of the medium to represent these players as embodied, thus as gendered beings, photographs display gender at work in ways that the verbal imagery of the print medium cannot so explicitly achieve. Differently, but with effects continuous with those of the oblique verbal rhetoric I have cited, these photographs subtly shape, and work to complicate, public assessments of Olivieri's professional stature and the value of her testimony, in a society better equipped to read the more common, stock representations of disembodied, neutral expertise and authority kept in circulation by photographs that deemphasize the bodily specificities of (usually male) doctors and CEOs. Reading through the silences to how the early press coverage highlights Olivieri's gender while rarely naming it allows the gender question to surface in a different register, as the focus shifts to how Nancy Olivieri's public credibility—hence her trustworthiness—is unsettled, how it evolves into a contentious issue, in the politics and ethics of representation.
Figure 2 presents a typically feminine image of Olivieri's professional demeanor, showing her with a child, in a female‐caring posture. In the larger montage from which this image is taken, the photo is placed together with head‐and‐shoulders images of four men in suits—two of them her detractors and two her champions (captioned “The men in the middle”)—and a full‐length photo of the (also suited) president of the HSC.42 Contrasting sharply with the Olivieri photograph, the men stand against neutral backdrops that could be anywhere or nowhere. They are the dispassionate, neutral leading actors in the drama, exemplary autonomous men: men of reason, whose gendered positioning is itself neutralized, unmarked. She bends forward in a strikingly subordinate position, leaning toward her patient and the camera. The provocatively defiant image of the bad girl—captioned “Courage under Fire” (fig. 3)—recalls another set of stock of images, among which the taming of the shrew is a clear contender. Like the images in figures 4 and 5,43 it provides an intriguing contrast with a press photograph of Dr. Gideon Koren in which, looking straight at the photographer, frankly, in a normal professional posture, he appears as the very image of the avuncular doctor, the man everyone can trust, a kindly, if misunderstood, physician who must be forgiven for his blunder because it was “the only way to express himself” against this out‐of‐control woman.44 His (p.254)
(p.258) In ways such as these, ecological inquiry searches for, sleuths out, discerns factors specific to the place and the governing imaginary where knowledge is being negotiated, that contribute—however subtly and silently—to establishing or interrogating/destabilizing presumptions of trustworthiness, causally, temporally, and spatially distant though they may be from the matter at hand. (Compare Rachel Carson, who looked far afield for explanations, some as distant as the oriental home of the Japanese beetle, to determine what had happened where she was.) Images that focus attention on Olivieri's gender by sexualizing her public persona contribute, if at a subterranean level, to obscuring what, in the discourse of “normal science” should count as the main concern. They cast in doubt her scientific and medical expertise, in a research climate increasingly governed by practices that cannot help but skew expectations of scientific integrity when they place the pharmaceutical industry's gifts to the university, and its profits, above a quest for the reliable knowledge that has been science's long‐imagined goal.
The Elm Street photos of Olivieri (figs. 3–5), like the Maclean's cover photo (fig. 1) admit of multiple “points of address and analysis”: they can be read as self‐consciously defiant, transgressing the scripts and expectations of docile, compliant white femininity, countering the negative social effects of the “blonde syndrome,” to present a woman who has no need to downplay her femaleness in order to achieve professional distinction, who can be classy, good looking, assertive, and a rigorous research scientist. Olivieri is not without agency in their production: she authors herself, participates in crafting images of herself, acquiesces in the modes of address expected by Elm Street's readers at that period in its publication history. She may have adopted such poses for just such purposes, by way of resisting those of the demure woman or the faceless professional. Indeed, Dehaas charges that Olivieri, together with a communications consultant, orchestrated this “highly successful ‘media blitz’ … that put [her] … on the cover of Elm Street and Maclean's magazines and made hers a household name synonymous with ‘academic freedom.’ ”46 Whether such effects figured in the planning process or are merely natural products of the hegemonic social imaginary, in both photos, the stance, the lip gloss, the earrings exploit an imagery overdetermined in spite of itself to take its point of reference from the entrenched disciplinary apparatus of gender politics—an imagery that requires Olivieri to navigate across a narrow range of options. She has to defy, evade, refuse, ignore, exploit, or reconfirm stereotypes, either of acquiescent or of out‐of‐control femininity.
(p.259) Even the lab‐coat image (fig. 4) is glamorized, flouted, trivialized, as is the fetching pose in figure 5, where Olivieri presents herself—or is represented—in the visual idiom of a fashion model or movie star, in her mock‐assertive, come hither stance, posing as defiant, yet still unable to step outside the larger imaginary where such emphasis on her body works as readily to interrogate or mock her defiance as to celebrate it. Nor, despite the lab coat in figure 4, does she look, first and foremost, like a scientist or a doctor: she is a woman, and then—incidentally—a doctor.
Feminists of the second wave have asked whether science would be different if there were more women scientists, whether women would import “styles of reasoning”47 or modes of inquiry capable of reconfiguring scientific practice in its process and products. In the first heady aftermath of Carol Gilligan's In a Different Voice, the essentialist imagery it generated, despite Gilligan's disclaimers, might have found in the Olivieri case an affirmative answer to the question, modeled on the exchange Gilligan constructs between Amy and Jake.48 For a man (Jake), the Apotex contract would carry absolute, principled force, overriding all situational particularities. By contrast, Olivieri (as Amy) would respect the contract; yet her responsibilities to protect her patients, even from effects she had sworn not to disclose, would override its absolutism. Only by adhering to moral‐epistemic principles respectful of circumstantial specificities could she ensure her ability to provide the adequately informed consent she required to prescribe the treatment. The press reports that highlight Olivieri's concern for her patients over her scientific authority are tacitly complicit in such a reading. But only a simplified, essentialized application of Gilligan's thesis could attribute overtly gendered styles of reasoning to the Olivieri story: an outcome that confirms the limits of this conceptual frame that was so plausible in the 1980s. Feminist ethico‐political theory and epistemology have shifted from analyzing dislocated, dyadic relationships founded in stereotyped masculine and feminine styles toward addressing the intricacies of multiply situated knowledges and principles.
Yet it is instructive to read these displaced stereotypes and the photographs I have shown together with Londa Schiebinger's discussion of women scientists’ efforts to achieve a credible professional image, both serious enough to present an authoritative demeanor and frank enough to avoid the dissembling that was one of the few options available to early women in western science. (p.260) Schiebinger's approach in her book Has Feminism Changed Science?49 is at once more cautious and more wide‐ranging than some previous feminist science writings (such as Keller's Reflections on Gender and Science),50 assuming neither a hard‐edged, dichotomous imagery of masculinity and femininity nor fixed, unified gendered scientific styles. Schiebinger examines structural‐situational factors in the culture of science together with the substance of diverse scientific practices, to arrive at complex responses to her title question.
Analyzing an opposition between western images and ideals of science and femininity, Schiebinger traces its origins to the “privatization of the family and … professionalization of science” in the seventeenth and eighteenth centuries, when “the private, caring woman emerged as a foil to the public, rational man,” and science “came to be seen as decidedly masculine” (hence Olivieri, by contrast, would be “better off caring for her patients”). As more and more women entered professional science, in the early twentieth century, the persistent effects of this opposition turned “shedding the trappings of ‘femininity’ ” into one of the prices a woman had to pay to be taken seriously as a scientist.51 At the beginning of the twenty‐first century, Schiebinger suggests, both scientists and nonscientists still tend to see precise alignments between science and masculinity and to imagine science as naturally, appropriately populated by men.
So entrenched are residues of this history in the dominant social imaginary that it is scarcely surprising to find the Olivieri photographs delivering equivocal messages: they work both toward defying intransigent gender norms, undermining sedimented stereotypical imaginings, and against a measured representation of her as a scientist worthy of respect. It is a notorious double bind in patriarchal societies: women who flout the norms of femininity are rarely commended; women who conform to them are rarely taken seriously. Schiebinger recalls Martha Minow's “difference dilemma” according to which “calling attention to gender stereotypes can reinforce them and create friction where before there seemed to be none, but … ignoring gender differences can leave invisible power hierarchies in place.”52 Either way, the images insert a (p.261) gendered dimension into the early stages of this controversy as it plays into an overactive rumor mill exploiting gossip about Olivieri's personal life and character (“she's known to have a flaming temper”)53 and representing her as a scapegoat just as often as she appears as an exemplary practitioner. They divert attention toward her person, thus away from her research as the appropriate locus of inquiry, and from larger, pressingly urgent ecological issues of institutional accountability and corporate complicity in circulating or suppressing putative truths that need to be open to deliberative evaluation. Thus they expose the irony of an official rhetoric that would construct the case as a “scientific controversy” in which the sex/gender, or any other personal attribute, of the scientist/knower would be insignificant.
Regardless of how the case is ultimately resolved, the images confirm that a high‐profile “outspoken” woman scientist remains an anomaly in the dominant western scientific imaginary of the late twentieth and early twenty‐first century, where everyday epistemic‐moral discourse has no comfortable place for her. Nor could the standard conceptual frames have permitted gender to function analytically in the case's unfolding, unless by naming it simplistically to enlist the mere fact of one woman's extraordinary success, by entrenched criteria of “ordinariness,” as evidence that the gender question has been resolved, ceased to be an issue, because women have “made it” even to the upper echelons of science. So long as they refrain from explicitly addressing the question in its multiple entanglements with power and privilege, explanatory‐analytic accounts will remain too slender, the choices too stark. They reduce to two: either the affair generates a scientific controversy in which gender by definition is irrelevant; thus a new postfeminist era must be heralded, and one successful woman suffices to establish the point; or Nancy Olivieri is just being difficult, a “troublemaker,”54 living proof, after all, that women cannot do science‐by‐the‐rules; so it is easy to situate and contain her within a female/feminine domain, to downplay her expertise and blur the clarity of her professional profile. In other words, in this “imagined community”55 forged around tacit understandings of what must and must not be said or shown in print—this community that coalesces around a set of common expectations and outrages to submit or admit Olivieri to a trial by media—it is nothing less (p.262)
Had it been challenged, then, media neglect of the gender question might have been excused with an argument that the very category is obsolescent, beside the point, precisely because Olivieri—and others—have broken through outmoded obstacles by doing what a woman must do to succeed in a world shaped by male power: become twice as good as most men, and on male territory. Thus, it would be ideologically excessive to raise the issue. But such a response would show only that the entrenched social‐conceptual imaginary is not sensitively enough crafted to engage with gender's ongoing effects as an (p.263)
Expertise, Credibility, and Trust
The questions about public credibility and epistemic responsibility generated by the Apotex sponsorship and complicated by the verbal and visual images I have recorded are entwined with larger questions about trust in knowledge and ethics. While it is not essentially—though it may be quintessentially—feminist to name public openness, answerability, and trust as central to an ethico‐political analysis of inquiry or to social‐material‐ecological analyses of institutions of knowledge production, it is feminists who have moved the question “whose knowledge are we talking about?” to center stage in epistemology, where it occupies a conceptual space close to Schiebinger's question “has feminism changed science?” The epistemological question acquires a sharper edge when—as in the Olivieri case—it must open out to ask about the provenance and putative ownership of knowledge, prompted by the Apotex sponsorship and similar arrangements in an increasingly privatized research climate. It must investigate the sources of knowledge in practices more complex than direct, controlled observation and less available to straightforward verification‐falsification, while examining genealogical, power/knowledge intrications to discern their effects. It must direct its attention to public access (p.265) to knowledge, to determine how a lay population—patients, parents, relatives, and other caregivers—can “have” good enough knowledge to give adequately informed consent, when knowledge becomes a commodity whose purchasers and beneficiaries guard it zealously against unwanted challenges.
Images are integral to a society's ways of thinking about such questions; and the imagery of the hortus conclusus, the closed—therefore inaccessible—scientific community, is clearly still effective in these debates. Yet within that closely guarded space, the old chemistry‐set/tabula rasa image of (male) scientists engaged in solitary, value‐, and theory‐neutral quests for truth has lost its plausibility, despite its tenacity in the public imagination.
In the new corporate research climate, public trust and epistemic responsibility, both individual and collective, are integral to and pressing within evaluations of scientific and other knowledge practices. This thought is not so new, even though questions about trust and trustworthiness were expunged from the epistemic imaginary when logical positivism heroically appeared on the scientific scene with a method heralded as capable of supplanting an allegedly unreliable, potentially subjective reliance on trust that, historically (according to Steven Shapin), had characterized both scientific and secular communities of inquiry, and not inevitably to their detriment.58 As Apotex's policies and practices indicate, the emergence of new forms of patronage in present‐day institutions of knowledge production confers a particular urgency upon issues of responsibility and trust. Yet they cannot adequately be addressed by condemning patronage unequivocally, either in scientific research or in other realms of inquiry and creativity: it has a long, often venerable history, even though neither its political innocence nor disinterested commitment to pure inquiry can be presumed before the fact. Contrary to the positivistic imaginary of scientific insulation from the circumstances of its making, in the early twenty‐first century, the structures and effects of institutions and forms of patronage that underwrite and enable laboratory research and the circulation/application of scientific knowledge again—as in Shapin's reading of seventeenth‐century England—count among conditions that make knowledge possible. Such conditions shape research findings, block or promote lines of inquiry, and regulate patterns of circulation and application. It would overstate the case to represent them, uniformly, as determining scientific knowledge as process or product, but understate it to gloss over their constitutive effects. Hence they demand investigation as integral to epistemological analysis and to the ecology and politics of (p.266) knowledge, for the structures of science as a public institution have undergone such radical transformations since the Industrial Revolution and especially during the twentieth century as to reconfigure—reimagine—patterns of accountability and to redistribute epistemic, moral, and political responsibilities in ways that theorists of knowledge have still to think through. The persistence of intransigent gender, racial, class‐, and ethnicity‐based stereotypes, among others embedded in the everyday visual and verbal imagery of science and expertise, is just one reminder of how much remains to be done.
Prompted by these thoughts, I am adapting an insight of Cheshire Calhoun's to propose that, within the instituted social‐epistemic imaginary, events like the Olivieri affair generate abnormal contexts. These, for Calhoun, “arise at the frontiers of moral knowledge … when a subgroup of society … makes advances in moral knowledge faster than they can be disseminated to and assimilated by the general public and subgroups at special moral risk.”59 Calling the events abnormal casts them neither as singular nor isolated: it shows how they disrupt the complacency of the presumed “normal,” stretch the boundaries of fixed images and conceptual frames, multiply points of analysis. Olivieri's refusal to remain silent is by no means abnormal in the everyday discourse of knowledge and morality: in normal contexts it would be an obvious, straightforward choice. Its abnormality is more epistemic than moral, for the resilience of the hegemonic imaginary in sustaining a picture of normal science as a project of pure inquiry (all evidence to the contrary notwithstanding) deters the general public from assimilating exposures of scientific thralldom to the interests of its investors. It is difficult for a public, committed to imagining a direct correspondence between scientific‐observational knowledge and independent “reality,” to acknowledge the darker underside of scientific practice that the Olivieri case displays; it is not easy to assimilate the complexity of negotiations and often ruthless conflicts of interest integral to the production, validation, circulation, and now ownership of knowledge. My borrowing, then, extends Calhoun's insight into debates about the social‐political location—temporal and spatial, demographic—of scientific knowledge, generated by thinking through these complexities. In my reading, these issues are the counterparts of Calhoun's “frontiers.”
Questions about responsibility and trust arise at these frontiers. A renewed focus, in both feminist and nonfeminist writing, on “the role of trust in knowledge”60 attests to their salience while reconfirming the ineluctable (p.267) situatedness, in Haraway's sense, of all inquiry. Situated knowers cannot perform the abdications of responsibility that orthodox positivism's value‐neutral “god‐trick” would allow, cannot, however persistently they may try, remove themselves from view as distinctively embodied, located epistemic agents. Nor is it possible, before the fact, to pronounce particularities of their embodiment or location irrelevant to their scientific practice. Abnormal moral contexts are, by definition, specifically inhabited and situated even though the knowledge production they foster will usually be more than locally valid.
In medicine throughout the affluent western world, trust, both epistemic and moral, is constitutive of practices of giving and seeking informed consent: trust in the knowledge underpinning such transactions (especially for the physician) having been responsibly sought, produced, and evaluated according to established criteria of scientific trustworthiness; trust that the information conveyed neither conceals nor mystifies that knowledge; trust in a commitment to establishing a reasonable openness and respect as a goal of physician‐patient interactions. Physicians have also, judiciously, to know when to trust testimony conveyed in the professional literature and in collaborative practice. Because no practitioner can investigate everything, reconstruct every experiment for her/himself, responsible medical practice requires a just, reliable, and trust‐presumptive, division of intellectual labor. Hence, speaking of Apotex's and others corporate efforts to suppress research findings, Dr. Miriam Kaufman comments, “if drug companies can control research … we're sunk as clinicians.”61 Nancy Olivieri could not seek appropriately informed consent from her patients or their parents as long as she observed the confidentiality agreement; thus it was impossible for her to invite their trust.
Perhaps paradoxically, feminists—and I among them—have argued that the “whose knowledge?” question confers a new salience upon appeals to ad hominem—in this case ad feminam—evidence.62 So when “two of the world's other leading experts” testify to Olivieri's scientific eminence and professional integrity, their testimony enhances professional and public readiness to affirm her trustworthiness. Their (masculine) gender may enhance it still further. My defense of the plausibility of her cautionary findings would carry none of the presumptive knowledgeability imputed to the testimony of experts, whose credentials are cited to establish the credibility of their beliefs. Indeed, public presumptions in favor of believing in the truth or even the plausibility of knowledge claims are commonly generated, enhanced, or discredited by appeals to the credentials and (p.268) character of the claimants, and reasonably so. Such appeals are strengthened or weakened by ad hominem/ad feminam images, both verbal and visual, that display modalities of conduct, character, and demeanor favorably or otherwise.
But such arguments lend themselves as readily to trust‐destroying as to trust‐enhancing purposes, as when media representations enter the ad feminam repertoire to deploy verbal and visual images whose effects are ambiguous as to whether they enhance or unsettle Olivieri's credibility. The contrast with Koren is again instructive: his depiction as a “top scientist and a caring doctor,” is invoked to excuse his misconduct, thus to reestablish a credibility he might on some accounts be thought to have forfeited. Olivieri's Elm Street and Maclean's photos, by contrast, carry the potential to shift attention from her work's scientific merits to her unruliness. Such contrasts in imagery open out into other ways of asking the gender question even when the answer is equivocal; they approach it by circumnavigating standard propositional analysis and orthodox confirmation and/or falsification procedures to reveal the extent to which public credibility and trust emerge as artifacts of rhetoric and imagery.
Toward Democratic Epistemic Practices?
To continue our present course is to risk losing the one commodity which, for physicians, universities and hospitals, should be viewed as beyond price: the public trust.
—Nancy Olivieri, Doctors for Research Integrity panel, Toronto, September 2003
Questions posed by how corporate interests are served in pharmaceutical and other private research funding are about epistemic responsibility preserved, threatened, enhanced, compromised, even destroyed in reliance on commercial sponsorship at all levels, from the traditional contexts of discovery and justification, to circulation and practical deployment. They call urgently for democratic debate and collective rethinking of the very idea of trustworthy epistemic, scientific, and communicative practices.63 Yet in the twentieth and early twenty‐first centuries, as I have observed, trust has not ranked (p.269) unequivocally as an epistemic virtue or value. Nor, for epistemologists and philosophers of science who carry positivism's legacy forward, is its low epistemic status surprising. Autonomous, impartial knowledge seems to risk being destabilized beyond tenability when trust figures among necessary and sufficient conditions for knowledge in general. Hence, Shapin persuasively maintains, epistemologists have defined “legitimate knowledge” by “its rejection of trust”: indeed, “trust and authority stand against the very idea of science”64 as the putatively most reliable form of human knowledge. He exposes a curious paradox: “Knowledge is supposed to be the product of a sovereign individual confronting the world; reliance upon the views of others produces error. The very distrust which social theorists have identified as the most potent way of dissolving social order is said to be the most potent means of constructing our knowledge.”65 Knowledge production, on this account, is strangely anomalous among human practices: it is paradigmatically asocial, kept apart and isolated from the networks of social interdependence constitutive of viable human lives. According to Lynette Hunter: “Absolute objectivity, a fixed truth, value‐free and neutral rationality … [comprise] a game that can be played by scientists and philosophers [only] so long as they remain isolated from society.”66 Introducing trust‐related questions into rhetorical spaces thus delineated, thereby explicitly socializing epistemological inquiry, could scarcely fail to threaten disruption. Shapin contends, by contrast, that concerns with trust and trustworthiness were manifested, in early modern England, in the cooperation of “gentlemanly society” with the new “practice of empirical science” (“gentlewomen” were not judged equivalently trustworthy, nor were nonwhite, nonaffluent, nonheterosexual, non‐Christian men). He sees the combination of a scientific method founded on individual epistemic self‐reliance with an ethic for which the reliability of its gentleman practitioners could be taken on trust as providing a “local resolution of a pervasive problem about the grounds and adequacy of knowledge.”67 It took a sharp separation of the contexts of discovery and justification, instituted by the positivism of the Vienna Circle, to banish trust once more from the epistemic terrain.
(p.270) As I propose in chapter two, in post‐1969 naturalistic and social epistemology and at points where they intersect, a space opens for reintroducing responsibility and trust into epistemic discourse, even though, in isolating the laboratory from the rest of society to study it as a self‐contained, self‐justifying unit, Quinean naturalism also distances itself from these issues. Ecological naturalism, by contrast, and often making common cause with social epistemology, examines knowledge‐making practices to expose the material, social‐political forces that conspire to foster or constrain inquiry.68 Because of their situational derivation, these analyses bring regulative epistemic principles into closer ethological alignment with the diverse capacities and practices of real knowers than Quine‐line naturalism does, thereby beginning to close a gap between theory and practice whose effects, I have observed, are often to keep an instituted epistemic imaginary at a distance from the very knowledge epistemology purports to evaluate.
Recall John Hardwig's now‐classic illustration of epistemic interdependence in laboratory science, announced on the title page of a report of a physics experiment where ninety‐nine “authors” are listed. He observes: “No one person could have done the experiment … and many of the authors of an article like this will not even know how a given number in the article was arrived at.”69 Analogously, with the division of intellectual labor in the Olivieri affair, it would be impossible for every author listed for the 1998 NEJM article to repeat the experiment for her/himself. They have to take on trust a commitment of their coauthors to responsible epistemic practice, in order to contribute knowledgeably to the enterprise; and the case shows how fragile such trust can be. If knowing “is a privileged state at all,” Hardwig comments, “it is a privileged social state.”70 Hence, I am affirming the epistemological significance of the structures—the situations, places, societies—that position some people as knowers and others not; I am presenting the Olivieri affair as exemplary for developing an analysis at once politically fraught and illustrative of the complexity of establishing the public epistemic status and trustworthiness of knowers, and of scientific truths, in the real world of empirical science, vested interest, power, and patronage.
Locating my discussion in a space where trust and epistemic responsibility are addressed and debated more publicly than in scholarly/professional (p.271) journals, I have enlisted newspaper reports and media imagery as sources, reading them as a midlevel locus/site of the making‐public of knowledge, as a place in mass societies where a deliberative democratic public forum is often conducted.71 They are commonly partisan, thus neither perfectly, objectively reliable; but neither are they always irresponsibly sensationalist, ideological. Public knowledge—albeit frequently contestable, merely putative knowledge—commonly derives from such sources and their analogues, where trust accumulates or diminishes, at least in part, according to judgments about the credibility of the testimonial claims of one or several report(s), and thus even of a particular reporter. As Hardwig's essay shows, it cannot be reserved for “knowledge‐by‐acquaintance,” which, for classical empiricism, was the only knowledge in the world “so certain that no reasonable man could doubt it.”72
In the Olivieri affair, responsibilities devolve across the epistemic and moral planes, as lines of confidentiality and trust become tangled in this head‐on collision of “truths” and financial interest. Apotex's public responsibilities are both epistemic and moral: epistemic in the requirement to take new evidence seriously into account, following precepts assumed by a tacit “normative realism”; moral in the requirement to evaluate the impact for ordinary and professional human lives and for knowledge (hence not just for financial gain) of failing to do so. When such failures of responsibility are exposed, the fabric of epistemic reliance is torn. It is always more difficult to repair a fractured trust than to establish it initially.
In the individualistic language of Epistemic Responsibility, I advocate honesty and humility: “Honesty not to pretend to know what one does not know (and knows one does not) or to ignore its relevance; humility not to yield to temptations to suppress facts damning to one's theory.”73 These injunctions (p.272) translate, with modifications and refinements, into the socially‐ecologically framed discourse of the present discussion. An informed public placing its trust in public knowledge tends, in western affluent societies, to expect such intellectual virtues to count, ex officio—so to speak—among the credentials of practicing scientists and other knowledge makers and for their patrons and sponsors, thus offsetting risks of epistemic imperialism and the oppressive effects of such putative knowings beyond the confines of the laboratory or other institution. Hence epistemic responsibility requirements are peculiarly stringent when it is mooted that the profit motive might take “precedence over scientific rigour” or “the researchers themselves [may] lose their objectivity,”74 in consequence of these conflicts.
Apparently, Nancy Olivieri did not “lose her objectivity.” Her cautionary 1995 letter to the editor of the New England Journal of Medicine, with its language of confirming findings, ensuring against false hope and expectation, tells in favor of maintaining public trust in her scientific responsibility, and many of the media assessments tend in this direction. Yet Dehaas's reading contests the very confirmations she has declared; and there is no easy resolution. Olivieri's responsibilities are analogous to those of Apotex, but they differ in her relationship to a wider scientific and secular public wondering how far to trust her knowledge as she reports on it publicly. They differ also in relation to the patients from whom she must, in good faith, ask informed consent, confident in her capacity to provide knowledge sufficiently sound and complete to inform that consent.
This discussion redirects the question “whose knowledge are we talking about?” toward larger matters of democratic epistemic‐scientific practice: democratic in the sense of facilitating informed public participation in deliberating science and knowledge policies, fostering open debate, building bridges between accredited expertise and people reliant upon it across a range of specialized and everyday practices. It focuses on cultivating public sensitivity to the specificity of diverse social circumstances and positionings, in diverse habitats, and with acknowledged differences in habitus and ethos. My interest is in developing strategies and policies to address the ecological implications and effects of socializing and naturalizing epistemology in these ways, thus to locate inquiry in a community that bears—or shares—the burdens of epistemic responsibility. I think it is from similar interests that Ursula Franklin deplores the loss of moral literacy in an age of increasing technological literacy, and the rarity of public discussion about “the merits or problems of adopting a (p.273) particular technology.” Advocating public inquiry, open debate, she contends that “what the real world of technology needs more than anything else are citizens with a sense of humility,”75 echoing Rachel Carson's plea for intellectual‐moral humility in scientific inquiry and scientifically informed practice. Such democratic, participatory inquiry would engage critically and subversively with social arrangements that position citizens unequally in relation to sources of public knowledge, posing obstacles to democratic participation, and with patterns of informed consent and confidentiality as they inflect these larger issues.
It would be naive to imagine the mere act of locating epistemic practices within a social, communal frame as a straightforward solution, capable of redistributing burdens of justification or proof, enabling ready agreement and smooth epistemic negotiations. Situating knowledge socially and ecologically could not produce instant consensus within a community—nor is even the highest degree of consensus truth‐ or justice‐guaranteeing. It could, as readily, close down interrogation and dissent: Apotex's silencing efforts are one pertinent example. Neither can the multiplicity of scientific micropractices be contained within a single communal vision—which could not, in any case, permit a sufficiently reflexive, self‐critical relation to its own practices. Hence for Joseph Rouse, scientific practices have to become intelligible “within enacted narratives that constitute a developing field of knowledge, and they [= the practices] are important to the extent that they develop or transform those narratives.”76 In constructing such narratives, practices like those Haraway advocates in Modest_Witness suggest a productive model for democratic deliberation. As I note in chapter five, she writes of a Danish practice of “establishing panels of ordinary citizens, selected from pools of people who indicate an interest, but not professional expertise or a commercial or other organized stake, in an area of technology. … [They] hear testimony, cross‐examine experts, read briefings, deliberate among themselves, and issue reports to a national press conference.”77 The debates generated in the Canadian press by the Olivieri case bear some informal resemblance to this process, as, more (p.274) formally, does Doctors for Research Integrity, “an independent, non‐profit group that seeks to promote research integrity and academic freedom,” established by Olivieri and her colleagues after the Olivieri vs. Apotex affair.78 In societies where scientific‐technological discourse remains largely inaccessible to a public comprised of people who have to make wise decisions about how, when, and why to confer or withhold trust, such debate could advance projects to establish properly deliberative democracy, whose citizens—when they can—have to assume some responsibility for interrogating the taken‐for‐granted status of institutions of knowledge production, even if only in gadfly questioning, in micropractices that demand accountability. Thus Calhoun observes, in a related context, “It is … the actions of engaged social critics and political actors—‘moral gadflies,’ who take potentially severe personal risks—that enable moral progress in a society.”79
Enacting such responsibilities cannot be represented as a universal requirement, given the uneven social distribution of practical and structural access to sources of knowledge making and the contested relationship to patronage that twenty‐first‐century research scientists have often to maintain. But the present‐day variation on the gentlemanly scientific culture Shapin details, which is as exclusive and exclusionary in its membership and esotericism as Shapin's society of gentlemen, has to be opened to social‐political critique. In such cultures trust and credibility tend to attach less to putative truths than to their makers and promulgators; ordinary lay access to scientific facts is rarely unmediated, and practices of mediation, as with Apotex, are kept closed to scrutiny. When public knowledge can be crudely controlled by mechanisms such as Apotex's confidentiality clause, epistemic negotiations move uneasily across the power differentials whose structuring effects reinforce Rouse's doubts about the very possibility of community bearing the justificatory weight that some social epistemologists urge. Here, principled, informed critique has a vitally important part to play.
The issues are not simple. Patronage, which literally makes so much research and thus knowledge possible has long been in place, if not in the forms it takes in this era of multinational corporations and multimillion dollar funding. Shapin's gentlemen, like western laboratory scientists now, comprise a distinct, predominately male segment of civil society, privileged by class, race, and gender, even when such specificities go unmarked in the imagined naturalness of the social order and the presumed autonomy of scientific inquiry. (p.275) When patronage makes truth subservient to profit or ideology, the very possibility of evaluating knowledge and public trust collides head on with a power that simultaneously thwarts inquiry and, in a complex doubling back upon itself, immobilizes investigations of the very conditions of inquiry it is bent on examining.
The task, then, for philosophers and other citizens is to work through questions about collective responsibility and opportunities for critical intervention, in relation both to publicly and to privately funded institutions of knowledge production. Despite the notoriety of its conduct, Apotex is not solely answerable for the Olivieri affair: it is a symptom, not the disease. The social practices and institutions that make its funding style possible demand ongoing social‐political intervention, committed to democratic, ecologically attuned epistemic‐scientific process whose purposes include honoring the responsibilities capable of contributing to viable, habitable community. Analogously, although seeking informed consent was not possible so long as Nancy Olivieri observed the confidentiality—the nondisclosure—agreement (hence its centrality in prompting her to act), confidentiality requirements and their analogues are not the only obstacles to informed consent. The power‐knowledge‐privilege differential between doctor and patient is an equivalently complicating structural factor. Feminists have developed cogent analyses of the systemic politics of knowledge at work here, consequent upon women's and other Others’ frequent silencing, mystification, and induced ignorance in their dealings with the medical profession. Susan Sherwin, for example, writes of some physicians’ persistent allegiance to a paternalist model that, despite feminist and other activist pressures, requires only “minimal standards of informed consent.”80 Lucy Candib remarks on the legalistic tenor of informed consent language, observing that it is rarely intelligible to the point of giving patients “a clear idea of risks, benefits, side effects, and alternatives to tests or treatment”; often its purpose reduces to relieving “the hospital or doctor of the charge of battery … it does not constitute informed consent.”81 Thus conceived, it scarcely attests to a physician's wish for good relationships with her/his patients.
Feminist philosophers have been among the most persistent interrogators of beliefs that consent can count as informed before the fact, that patients can know well enough what they are to consenting to; nor is it easy for a physician to ascertain how much/how well a patient knows, given that one effect of the power‐privilege differential is to produce wariness, for patients, of the (p.276) humiliation that can follow seeming not to know. This issue, in a different register, is also about money and morality. With respect to money, it is about public health policy reluctance to allow for the (billable) time it takes to insure well‐informed consent; with respect to morality, it is about the mutual responsibilities of doctor and patient to work together to the point where consent is as informed as it can be. Here again, advocacy is instrumental in making knowledge possible—concerted advocacy to funding agencies about the time that “good enough” explanations take, where the threshold of “enough” must not be set too low. It is equally about education. Virginia Warren, for example, urges patients and physicians to work together—democratically—to develop an educational model that could facilitate properly, responsibly informed consent.82 Her recommendation extends beyond the borders of the medical world to represent many of the issues I have addressed in this book as educational issues. Such a model would, at minimum, have to take situational specificities and circumstances seriously, as integral to, not extraneous details to, medical and other epistemic practices. It would work toward developing safeguards against universal, impartial one‐size‐fits‐all formulas, thereby endeavoring to set right an irresponsible epistemic neglect, so irresponsible and at the same time so culturally entrenched as to be beyond simple reform within the received social imaginary.83 As I have urged throughout this book, it would require nothing less than a Copernican revolution in knowledge.
In medical knowledge, as in other modes of knowing I have examined, I am suggesting that the conceptual apparatuses of mainstream epistemology, of natural and social epistemology, and of epistemic responsibility, need to be reconfigured, often collaboratively, reciprocally. Detractors might contend that an old‐style empiricism could have addressed the Olivieri situation perfectly well. But my argument has been that the goal of disentangling knowledge production from the effects of its social‐institutional situation, to submit it to unmediated justification or falsification procedures, is so remote from the habitus and ethos of actual epistemic practices and institutions of knowledge production as no longer to merit respect. Evaluative projects have to be situated close to and engage sensitively with the particularities of real, natural‐social knowledge; and public assessments of responsibility have to be conducted on a deliberative‐democratic model constructed out of a commitment to eschew imperialistic pronouncements from on high, while cultivating sensitivity to the requirements that emerge from acknowledged human diversity. Negotiation is (p.277) integral to such deliberations, in knowledge‐making practices and policies engaged by numerous participants, incorporating multiple points of view, diverse locations and situations, resisting too‐early closure, aware that there can be few once‐and‐for‐all, or once‐and‐for‐everyone/everywhere solutions, yet that often people have to proceed with the best available explanation, have simply to act.
My readings of the Olivieri affair in this chapter have, admittedly, posed more questions than they answer. Answering them, I have suggested, requires negotiations more cognizant of the detail of human lives and locations than the stripped‐down examples that orthodox epistemology serves up as paradigmatic. Institutions of inquiry are not populated by the faceless, disembodied knowers who figure in the positivist imaginary, but by diversely gendered, classed, raced, abled, aged practitioners whose embodied specificities and material‐cultural situatedness cannot be disregarded. Although issues such as these rarely figure in academic epistemology, feminists and other Others are in the business of crafting conceptual tools to enable theorists and practitioners to see their pertinence to the politics of knowledge. Recall my chapter three discussion of Haraway's brief for a vision not found but made, for a seeing that requires learning to see what is ordinarily invisible, to see from below, from the margins, and—self‐critically—from the center.
In such inquiry, evaluations and justificatory practices will be more nuanced, less certain, more multifaceted than philosophers of science and epistemologists have hoped; but directing attention to metaphors, images, styles of reasoning for which the instituted scientific‐epistemic imaginary has no place makes for a more ambiguous but richer, more ecologically informed and informative analysis than truncated summary accounts can provide. Ecologically grounded, gender‐sensitive analyses enlarge the scope of inquiry while media imagery adds layers of complexity to gender itself as an analytic category, refining and expanding its explanatory scope. The result may not be a never‐ending story, but premature closure—a too‐easy dismissal of the part gender and other Otherings play in the politics of knowledge—risks truncating explanatory approaches capable of making all the difference. (p.278)
(1.) See Olivieri, “When Money and Truth Collide.” Parts of this chapter draw on my “Images of Expertise.”
(2.) I first posed this question in my essay “Is the Sex of the Knower Epistemologically Significant?” Chapter 1 of my What Can She Know? bears the same title, although the chapter does not replicate the original essay.
(3.) The concept of gender as an “analytic category” is due to Scott's Gender and the Politics of History, chap. 2, “Gender: A Useful Category of Historical Analysis.” I follow Scott's definition of gender as both “a constitutive element of social relationships based on perceived differences between the sexes, and … a primary way of signifying relationships of power” (42).
(4.) Press reports tend to call it “the Olivieri case.” Nancy Olivieri herself, in a public lecture (September 2003), referred to “the Olivieri affair.”
(5.) Quotations from Priest, “Sick Kids Doctor Finds Anemia Drug.”
(6.) Olivieri, letter to the editor, New England Journal of Medicine 333.9 (1995): 1287–88.
(7.) Olivieri et al., “Long‐Term Safety,” 420–21.
(8.) Papp, “Firm Axes Outspoken Scientist's Research.”
(9.) The 1993 contract with Apotex Inc., which Dr. Olivieri signed (with Dr. Gideon Koren), contained a “one‐year, post‐termination confidentiality clause”; the June 1995 contract that Dr. Olivieri signed “had a three‐year, post‐termination confidentiality clause” (Thompson, Baird, and Downie, Olivieri Report, 24–25).
(10.) Valpy, “Salvage Group Tackles Sick Kids’ Image Disaster,” A9.
(11.) Olivieri, “Scientific Inquiry.”
(12.) Nathan and Weatherall, “Academic Freedom in Clinical Research,” 1370. See also Horton, “Dawn of McScience” (a review of Krimsky's Science in the Private Interest). The Olivieri case is discussed in both the article and the Krimsky text.
(13.) Foss, “Sick Kids Doctor Breaks His Silence.” Thanks to Dr. Sandy Macdonald for information about Dr. Koren.
(14.) Olivieri, “Scientific Inquiry.”
(15.) Olivieri, “When Money and Truth Collide,” 54.
(16.) Shuchman, Drug Trial, 363.
(17.) Olivieri, “When Money and Truth Collide,” 53, 59.
(18.) Keller, Secrets of Life, 84.
(19.) I owe these references to the “club culture” and “enclosed communities” of laboratory science to Hunter's Critiques of Knowing, 30, 104.
(20.) Clark mentions the hortus conclusus in Landscape into Art, 24, 29.
(21.) Le Dœuff, Philosophical Imaginary, 8. The quotation is from Kant, Critique of Pure Reason, 257. See also Le Dœuff, Sex of Knowing, xvi: “I believe there is no intellectual activity that is not grounded in an imaginary.”
(22.) Le Dœuff, Philosophical Imaginary, 10, 11.
(23.) Dehaas, “Much Ado about Nothing.” Thanks to Dr. Sandy Macdonald for bringing this article to my attention.
(24.) Dehaas writes, for example, “The public perception, gleaned from cursory news reports and some perhaps overly enthusiastic advocacy on the part of Dr. Olivieri's wider group of supporters, is that she was restrained, reprimanded and ultimately fired by the hospital for publishing her findings. But that's simply not so” (ibid., 29).
(25.) The phrases are from Foss and Taylor, “Volatile Mix,” A1, A4.
(26.) Thompson, Baird, and Downie, Olivieri Report.
(27.) Olivieri, “Scientific Inquiry.”
(28.) See in this regard Faunce, “Healthcare Whistle‐Blowing.” Shuchman cites a 1998 U.S. Office of Research Integrity analysis that concludes “that scientists who blow the whistle on scientific misconduct are primarily males and nearly half hold senior appointments at their institutions” (Drug Trial, 215).
(29.) Shafer, “Science Wars.” That program, according to Dehaas, “was one of the few media outlets to examine the other side of the dispute,” contrasting “the hugely positive press Dr. Olivieri had generated … with patients who had benefited from the drug” (“Much Ado about Nothing,” 30).
(30.) Papp, “Firm Axes Outspoken Scientist's Research.”
(31.) O'Hara, “Whistle‐Blower,” 66.
(32.) Foss and Taylor, “Sick Kids Demotes Controversial MD,” A12.
(33.) A subsequent article refers to scientists (apparently both female and male) who “have been outspoken in their support for Dr. Olivieri” (Foss and Mitrovica, “Sick Kids Battle Turns Bizarre”), but my point holds.
(34.) Valpy, “Science Friction,” 28.
(35.) Landsberg, “U of T Should Back Demoted Doctor,” A2.
(36.) O'Hara, “Whistle‐Blower,” 66.
(37.) See, e.g., Flynn and Gillard, “GM Food Scandal Puts Labour on Spot.”
(38.) See Horton, “Dawn of McScience,” 7; and Healy, “Conflicting Interests.”
(39.) Olivieri, “When Money and Truth Collide,” 58.
(40.) See Clark, “Academia in the Service of Industry.”
(41.) In rereading the silences, I follow Davis, who remarked that no matter how she read the evidence, she could not discern clearly gendered implications. When a graduate student recalled her earlier insistence that gender is always an issue, if only for its invisibility, she reexamined the silences. See her Gift in Sixteenth‐Century France, esp. 75–79.
(42.) See Toronto Globe and Mail, 2 November 1998, A9.
(43.) The Elm Street article, where these frankly female‐feminine poses appear, praises Olivieri's for her courage under fire. It is one of only a few pieces to refer to her consistently as a scientist.
(44.) See Toronto Globe and Mail, 7 January 2000, A2.
(45.) Thompson, Baird, and Downie, Olivieri Report, 396.
(46.) Dehaas, “Much Ado about Nothing,” 24.
(47.) The phrase is Hacking's in “Language, Truth, and Reason.”
(48.) See Gilligan, In a Different Voice, 25–37.
(49.) Schiebinger, Has Feminism Changed Science? See also Creager, Lunbeck, and Schiebinger, Feminism in Twentieth‐Century Science.
(50.) Keller, Reflections on Gender and Science.
(51.) Schiebinger, Has Feminism Changed Science? 69–70, 76. Schiebinger pursues her project of “understanding gender and other social aspects of science” in an investigation of “Europeans’ efforts to globalize their understanding of nature” in her essay “Feminist History of Colonial Science,” 234–35, which I read as ecological both in subject matter and in method.
(52.) Schiebinger, Has Feminism Changed Science? 68.
(53.) O'Hara, “Whistle‐Blower,” 66, spoken by a male caller who had not met Olivieri and offered no examples.
(54.) See Olivieri, “When Money and Truth Collide,” 53. Shuchman quotes Janet Bickel, a U.S. expert on women in medicine, who “says that few academic women over forty escape being described as ‘difficult’ by their peers” (Drug Trial, 81).
(55.) I owe the phrase to Anderson, Imagined Communities.
(56.) Potter, Gender and Boyle's Law of Gases, 4.
(57.) Ibid., 16.
(58.) See Shapin, Social History of Truth, esp. chap. 1. See Shapiro, Culture of Fact, for a provocative reading of the history of factuality that contests many of Shapin's conclusions.
(59.) Calhoun, “Responsibility and Reproach,” 250.
(60.) See, e.g., Hardwig, “Role of Trust in Knowledge”; Barber, “Trust in Science”; and Scheman, “Epistemology Resuscitated.”
(61.) O'Hara, “Whistle‐Blower,” 67.
(62.) See my Rhetorical Spaces, 70–71.
(63.) Horton observes that societies need “a model of independent critical rationality for the proper conduct of democratic debate, judicial inquiry, and consumer protection” (“Dawn of McScience,” 9).
(64.) Shapin, Social History of Truth, 16.
(65.) Ibid., 17 (emphasis added).
(66.) Hunter, Critiques of Knowing, 145.
(67.) Shapin, Social History of Truth, 42. Shapiro concurs on the centrality of trust, yet she argues for a different model, drawn from the legal arena: “The mere status of gentleman could hardly be decisive in the courtroom where one gentleman might well be contending against another and where witnesses of several classes might appear on both sides. I suggest that the scientific community adopted important elements of legal witnessing as constituent elements in the construction of the ideal scientific observer and reporter rather than relying on the courtier‐aristocratic model” (Culture of Fact, 118).
(69.) Hardwig, “Epistemic Dependence,” 347. See also Latour and Woolgar's Laboratory Life for a study of the ineluctably social character of knowledge making in a laboratory.
(70.) Hardwig, “Role of Trust in Knowledge,” 697 (emphasis added). See also Barber, “Trust in Science.”
(71.) My intention is not to contrast the press with scholarly/professional journals, implying that the journals are incontestably objective whereas media reports are not. Horton, for example, draws attention to sponsorship's role in determining which findings will be reported and how, charging medical journals with having become “an important but underrecognized obstacle to scientific truth‐telling … information‐laundering operations for the pharmaceutical industry” (“Dawn of McScience,” 9). According to Miriam Shuchman the Nancy Olivieri case has had significant international repercussions. She notes, “In September of 2001, the editors of some of the world’s leading medical journals (including the Lancet, the New England Journal of Medicine, JAMA, and the British Medical Journal) established a policy that they would not review or publish work by scientists whose sponsors prevented them from analyzing their data independently or publishing their work freely.” Drug Trial, 359.
(72.) The phrase is from Russell, Problems of Philosophy, 1.
(73.) Code, Epistemic Responsibility, 137, where I cite Nozick's claim that “intellectual honesty demands that, occasionally at least, we go out of our way to confront strong arguments opposed to our view” (Anarchy, State, and Utopia, x).
(74.) Foss and Taylor, “Volatile Mix.”
(75.) Franklin, Real World of Technology, 69, 91.
(76.) Rouse, Reconstructing Philosophy of Science, 168–70.
(77.) Haraway, Modest_Witness, 95–97. Note that Haraway sees no automatic utopian promise in such panels. As Eckersley, for example, cautions in a different context, “simply ceding political and economic control (including environmental management powers) to existing local communities does not in itself provide any guarantees that those communities will exercise their powers in an ecologically responsible manner” (“Politics,” 323). But their promise is nonetheless apparent.
(79.) Calhoun, Setting the Moral Compass, 17.
(80.) Sherwin, No Longer Patient, 139.
(81.) Candib, Medicine and the Family, 136.
(82.) Warren, “Feminist Directions in Medical Ethics,” 38–40.
(83.) Thanks to Peta Bowden for suggesting this way of formulating the matter.