‘One of my most cherished possessions,’ wrote Susah Desmond-Hellman, the Chief Executive of the Bill and Melinda Gates Foundation in The Guardian recently, ‘is a handmade cherrywood salad bowl that’s never held a leaf of lettuce….
It is 25 years old and gets more beautiful every year. The bowl was a gift, carved by a widower who was left to raise his daughter alone when his wife died under my care as an oncologist. My patient, who I’ll call Erica, had the most challenging form of breast cancer and I didn’t have the tools to save her life. I’ve always felt undeserving of the gift, despite doing everything I could.
Five years later, I participated in the development of a medicine for Erica’s type of cancer, Herceptin. While regretting that it had not come fast enough for Erica, I am deeply grateful for the scientific advances that mean better care for patients like her today.
Now, at the helm of the Bill & Melinda Gates Foundation, I see how scientific breakthroughs, such as new vaccines and hardier crops, are helping to make the world safer, healthier and more equal. Life is better because of science, and in the next few decades more discoveries will further improve the human condition.
Desmond-Hellman’s article was a condensation of a Rede lecture that she had delivered at Cambridge University in June. Perhaps inevitably, in 2017, her topic for this prestigious lecture was the place of scientific method, and scientific expertise, in an era of ‘post-truth’ and ‘fake news.’
Desmond-Hellman is of course far from alone in alighting on this issue: the now ubiquitous neologism, ‘post-truth,’ identifies a recent anxiety, among policy-makers, journalists, academics, and many of the other ideological architects of late capitalism, that following the election of Donald Trump, as well as the vote in favour of Brexit, those epistemological mainstays of liberal democracy, ‘facts’ and ‘truth,’ now form a diminished currency. But if there has been much hand-wringing about this development, what distinguished Desmond-Hellman’s contribution was that she turned her analysis of ‘post truth’ on a very specific and concrete set of questions, at the intersection of mortality, philanthropy, bioscience, and capital.
In this short focus piece, I want to show how, from the point of view of Science and Technology Studies (STS), or the sociology of science more generally, Desmond-Hellman offers a much more potent analytic opening than the wearying discourse of a certain kind of public intellectual or popular scientist – several of which have recently tried to analyze the same phenomenon, ‘post-truth,’ through its relationship to one or more of ‘postmodernism,’ ‘relativism’ or ‘the left.’
On January 23rd, for example, the distinguished Cambridge historian, Sir Richard Evans, tweeted: ‘Post-truth and alternative facts: today’s leaders in the USA all imbibed postmodernist relativism at university in the late 1980s and 1990s’. And then later, after much (predictable) disagreement with his tweet: ‘If I am wrong, and postmodernist disbelief in truth didn’t lead to our post-truth age, then how do we explain the current disdain for facts?’ Similarly, the science writer and broadcaster Kenan Malik credited Donald Trump’s spokesperson, Kellyanne Conway, with the deployment of a kind of ‘epistemic relativism’ – which marks, says Malik, ‘the belief that the distinction between truth and falsity is rooted not in an objective reality but in differing social conventions, and that there are many radically different, incompatible, yet equally valid ways of knowing the world.’ Malik argues that this form of thinking ‘has gained academic popularity in recent decades, particularly through postmodernism’ which, he says, in the absence of enlightenment universalism, is the idea that ‘“truth” is necessarily local, and specific to particular communities or cultures.’
Insofar as ‘postmodernism’ identifies any meaningful assemblage in the social sciences (which it does not), it is of course not uniquely associated with STS or with the sociology of science. Yet it seems equally clear that, along (and often in alliance) with sociologies of race and gender, STS has for some time been committed to pointing out the hollowness of liberal-universalist commitment to the solidity of many epistemic things, and indeed has been especially interested in setting out the temporal and territorial shakiness of the scientific practices in which that universalism roots itself. STS has thus long been associated (indeed, often by scientists with a public platform) as a central node in the ‘postmodernist’ tendency, an association that was more-or-less the centre ground of the lamentable exchanges that constituted the ‘science wars’ of the 1990s. Indeed, the medic and science writer, Ben Goldacre, made these inheritances explicit in a tweet that linked ‘post truth’ to the Sokal hoax (in which a nonsensical article using parodic STS-ish language, written by the physicist Alan Sokal, was unfortunately published in the journal Social Text): ‘20 years after the Sokal hoax,’ wrote Goldacre, ‘I put it to you that the left created the post truth virus whose apocalypse we inhabit.’
The possibility that an unfortunate linkage would take root did not go unnoticed in STS. In a signed editorial in Social Studies of Science, the field’s most prominent journal, editor Sergio Sismondo tried to put clear water between post-truth and STS: ‘Embracing epistemic democratization [of knowledge],’ Sismondo argued, ‘does not mean a wholesale cheapening of technoscientific knowledge in the process.’ If scientific facts are achievements, it does not follow they are achieved easily, nor does it imply that we should have no care for their retention. Yes, says Sismondo, STS has shown that ‘the fact’ is a distinctively modern object – but this only makes STS analyses more vital in the post-truth era, showing how, why and where facts can be made to matter. ‘We in STS,’ he argues, ‘know that epistemic competition is as much about choosing which truths can be considered salient and important as about which claims can be considered true and false, and these choices have important consequences.’ Or as Shelia Jasanoff and Hilton Simmett put it: ‘The challenge is to rediscover common ground between facts and values to shore up shared visions of the future.
In contrast, the sociologist Steve Fuller (who actually published in the same issue of Social Text as the fake Sokal article) argues that post-truth is indeed a child of STS – and more, that the discipline should find no shame in this situation: ‘STS’, says Fuller, ‘can be fairly credited with having both routinized in its own research practice and set loose on the general public – if not outright invented — at least four common post-truth tropes’ (for example, that what counts as truth is an institutional arrangement, and one that may then be changed at any time; or that judgments about expertise have always been more-or-less political judgements). And this is all to the good. Indeed, for Fuller, it is to STS’s credit that it has rendered unignorable the way in which truth-claims are rooted in power games. And rather than distancing ourselves from this moment, we should learn to work through it: ‘in 2017,’ argues Fuller, ‘we should finally embrace our responsibility for the post-truth world and call forth our vulpine spirit to do something unexpectedly creative with it’ (2016b).
In a separate contribution, Harry Collins, Robert Evans and Martin Weinel accuse Sergio Sismondo of distorting the history of STS: for much of the time, they argue, in fact ‘the views STS was espousing were consistent with post-truth irrespective of their authors’ intentions or their causal impact.’ But characteristic with their wider work on expertise (and quite in distinction to Steve Fuller’s ‘vulpine’ inclinations), Collins and his colleagues re-cast the debate in normative terms: let us not simply plead, they argue, that STS be absolved of responsibility for the style of post-truth argumentation – but rather let us add, to STS’s history of demonstrating the instability of truth-claims, the capacity and willingness to say (and to say scientifically) which claims should be then established. The current situation can then be eased by ‘empirically informed, scientific understandings of expertise and of the organization and values of science’; the production of such information and understanding, of showing when we should attend privilege scientific expertise is, inter alia, the proper work of STS.
There is no doubt much that be said in relation to all of this. But my goal is to diffract this debate in a perhaps more fruitful direction. Rather than replaying debates about what did and didn’t happen in the 1970s – debates that are perhaps less compelling to those who weren’t there than they are to those who were – I want to re-think post-truth in and through a different set of literatures in STS and the sociology of science, viz. those literatures that have been centrally concerned with bioscience, on the one hand, and biopolitics, on the other. Let me return, in this light, to Susan Desmond-Hellman. In her article (and it is the condensed article I discuss here, not the lecture), Desmond-Hellman argues that ‘science is at risk in an era of fake news, anti-expert feeling, and science denialism’ – that there is strikingly little political appeal, now, in ‘evidence, truth and facts.’
The question that Desmond-Hellman gives herself, in response to this situation, is an important one with a long lineage: how are scientists to speak the truth when, not only does the mantle of ‘science’ not have the rhetorical force it once did, but when the capacity for truth itself seems radically in question? Desmond-Hellman’s answer is that scientists must focus on the consequences of their actions, and communicate about these credibly. For example, scientists speaking in public should not be too boastful; scientific results should be open and transparent where possible; scientists should speak confidently, but with humility; and we should all draw on ‘decision science and behavioural psychology’ in order to learn how to ‘get the facts straight’ by helping to inoculate the public against bad information. ‘It is imperative we get out of our bubble,’ Desmond-Hellman concludes: ‘For the world to continue to experience progress, we must value the scientific method as the ultimate way to improve the human condition. As scientists, we owe it to ourselves to fight for the truth. More important, we owe it to people like Erica, and her family, who are counting on us.’
I don’t at all diminish or make light of the stakes of what Desmond-Hellman argues. But it also seems to me that there might be some gain in teasing apart this paean to scientific plain-speaking, openness and humility. I especially think there is some analytic gain in recalling that it comes from the head of that philanthrocapitalist and global-health behemoth, the Bill and Melinda Gates Foundation – an entity that has, as Linsey Mcgoey has shown, not only become, since its foundation, ‘the largest transparently operated philanthropic foundation in the world,’ but an entity that also operates within a wider move re-situating overseas aid and global health in terms of a new state-corporate nexus, in which for example, interventions in health and development get channelled through non-repayable grants to subsidiaries of Western companies.
The Gates Foundation has also, McGoey reports elsewhere, ‘championed the idea that Coca-Cola should be upheld as a key partner in global health policy-making’ while partnering with Monsanto in the introduction of (as McGoey notes: ‘royalty free for an indefinite period’) GM maize crops in sub-Saharan Africa. Equally, there is scope to think in more nuanced ways about the relationship between science, politics, and communication, in relation to an organisation like Genentech – the pharmacogenomic giant, now a subsidiary of Roche, and maker of perhaps the most famous personalized medicine to come to market, Herceptin, which was in turn created during Susan Desmond-Hellman’s time as President of Product Development at that company. As Adam Hedgecoe has pointed out: ‘for the genomics industry, Herceptin has been proof not just of the scientific principle underpinning personalized medicine, but also of the financial principles that have driven investment in the biotechnology sector, and led pharmaceutical companies.’ The point of Herceptin, says Hedgecoe, was to show ‘you can make money from personalized medicine.’
Herceptin, we might also recall on this same topic, was the subject of a significant political controversy in Britain about 10 years ago, when the then Labour health secretary, Patricia Hewitt, personally intervened to ensure that the NHS funded the treatment, over the head of National Institute for Clinical Excellence – a decision that came when coverage was ‘overwhelmingly positive and uncritical towards trastuzumab [the generic name for Herceptin]’ in the UK media, and much of this coverage anchored by a focus on personal cases, even as patients were being approached by a PR firm providing support to Herceptin’s manufacturer.
My point here is not that the presence of commercial interests in either the production of pharmaceutical products, or in the global health sector more widely, are antithetical to good science or truthful speech. Nor am I of the view that having been (or continuing to be) imbricated in these pursuits disqualifies a person from speaking meaningfully about these topics. What I am trying to do, rather, is to use Desmond-Hellman’s article as a vehicle for making some more nuanced diagnosis of the post-truth landscape vis-à-vis the politics of the life sciences. I am asking, if we want to draw ‘post-truth’ into some clearer analytic focus, and do so without, on the one hand, STS anxieties about responsibility, and, on the other, science-bro inanities about ‘postmodernism,’ whether some finer attention to the interlacing of biomedicine, capital and the politics of health, wouldn’t be a good place to start.
Recall, here, the non-coincidental prominence, during the Brexit campaign, of a bus advertisement that made properly funding the National Health Service somehow a function of EU membership. This invocation of the cost of (population) health maybe read as a signal how a post-truth landscape is going to be at least part-brokered by some strikingly biopolitical concerns, not least among these the speculative futures of personalized medicine and the incalculable desires of private health finance. It seems hard to read this bus ad as other than a potent display of the wider health-related desires that undergird the British state’s ongoing and increasingly melancholic attempt to makes sense of itself (here the putative ‘left’ and ‘right’ are more or less indistinguishable) via nativist anxiety about who gets access to medicine, and related concerns. If Desmond-Hellman show us one way to think the present with and through the life sciences, this bus advert, among a range of related objects, is a sharp reminder of how and why a specifically biopolitical mode of attention helps to make sense of the aggressively ignorant racial and postcolonial politics that dominate public debate in post-Brexit UK.
It is in bringing that attention to bear on the present – in making legible the complex roles of biomedicine and biopolitics in how ‘post truth’ is now being mobilized, claimed, and deplored – that STS and the sociology of science can contribute to a diagnosis of our current predicament. I am far from the first to make this observation: in a prescient reflection on new demarcations between the politics of health and the politics of nationhood in the aftermath of the Brexit vote, Ros Williams and Amy Hinterberger have already pointed out that ‘health provision, biomedical research and technology’ are now inseparable from ‘changing post-colonial iterations of what being British means, along with who has the right to belong and benefit from state institutions, such as the NHS’ – and all while ‘biotechnologies are increasingly playing a public role in answering questions of who is part of a polity.’
Williams and Hinterberger remind us that claims to truth and post-truth, including claims about the end of expertise, are taking place in the foreground of a struggle about the right to health and the place of citizenship – and this struggle, in turn, is caught up in wider developments in global health and governance, involving a range of actors, with different motivations, for whom mobile registers of ‘science,’ ‘truth’ and ‘fact’ can be deployed in any one of multiple ways. Scientific truth is undeniably at stake here, yet there is nothing at all ‘postmodern’ about any of these developments – nor, for what it’s worth, do they bear any obvious relationship to anything we might all ‘the left.’
In his well-known 2006 volume, Biocapital, Kaushik Sundar Rajan shows how the tension of biocapital (i.e. the idea that ‘the life sciences represent a new face, and a new phase, of capitalism’) and the forward-looking statements through which commercial investments in the life sciences makes themselves known, mirrors ‘the tension between the “lie” of corporate PR and the “truth” of science. The truth of capitalist venture science, says Rajan, is that the truth is always ‘already under erasure’ – venture science works through a specific mode of struck-through truth, truth which is not a lie, and also not an error, but which exists rather in a zone of incalculability. To understand the truth of personalized genomics, Rajan points out, we need to understand not whether those truths happen to be right or wrong (whether, we might say, they represent ‘truth’ or ‘post-truth’); rather we need to understand the ‘technical and institutional assemblages’ in which those truths are constituted.
It seems to me that this struck-through truth of biocapital, the truth of capitalized bioscience held to be always-already-under erasure, the truth which is not just embedded in a regime of incalculability but is predicated on that regime – that this truth offers us a much more potent avenue for understanding the present than that forlorn object of liberal and journalistic concern, ‘post-truth.’ It reminds us, contra Steve Fuller, that it is not STS (or ‘postmodernism’) that leads the way in the mutability of truth and post-truth – rather, in this zone of generative ambiguity, it is the contemporary life sciences that constitute their own futures, including the landscapes of veridiction in which those futures are made. This is the sense in which, I argue, the politics of post-truth is, always already a biopolitics. It is also the sense in which I insist that the intellectual tools of STS and the sociology of science have to become central to diagnosing the present.
Desmond-Hellman, S. 2017. In a World Ruled by Rumours, it is Vital that Scientists Speak with Humility and Clarity. The Guardian.
McGoey, L. 2016. No Such Thing as a Free Gift: The Gates Foundation and The Price of Philanthropy. London: Verso.
Williams, R. and Hinterberger, A. 2016. Arguing with Justice: Brexit and Biomedicine. Somatosphere.
Fuller, S. 2017. Is STS All Talk and No Walk? EASST Review 36(2).
Des Fitzgerald is Lecturer in Sociology in the School of Social Sciences at Cardiff University.
Image Credit: Jon Worth. CC BY 2.0