A Matter of Episteme

Last week I wrote about a series of articles claiming that folks who question vaccine safety and efficacy have constructed an alternate, and by the authors’ accounts, incorrect episteme. The length of the article prohibited a full discussion of the concept of episteme and epistemic ‘truths’. I would like to dig into that a bit more here.

Episteme is a Greek philosophical term that refers to the rules by which knowledge is determined and accepted. It refers to a system of understanding that is, in many regards, codified culturally by the acceptance of others. Those who study epistemology are interested in understanding the conditions for, and structures of, knowledge as it applies to systems of thought like those employed in science, politics, or culture. In general, epistemology asks questions about how ‘truth’ is defined, who is allowed to speak about truth, and how these truths are disseminated. The how and the who of epistemic knowledge are important considerations when evaluating systems of thought as they are often deeply entangled in webs of influence that may or may not be clear to those operating within that system.

When we look at systems of thought, there is always a dominant one that defines what truths are acceptable and who is allowed to speak them as well as countervailing, non-dominant epistemes, with equally defined roles and expectations, but different beginning points, and thus, different endpoints. In this case, the dominant episteme holds that vaccines are completely safe, always effective, and thus, necessary, even if by compulsion, to achieve public health. It is a zero-sum framework, an all or none conceptualization of medical or pharmaceutical capability that accepts no gray area whatsoever. The alternate episteme suggests that maybe these chemicals are neither as safe, nor as effective as proposed by their manufacturers and perhaps we ought not make vaccines mandatory. Which one is correct? Is vaccine safety and efficacy a settled science such that a zero-sum approach is reasonable? Or, as the advocates of the alternate episteme argue, are there safety, efficacy, and ethical issues that we are not considering in our application of what has become an almost completely compulsory program of vaccination?

The answer, it seems, depends upon what questions one deems reasonable to ask. That is, how one constructs the questions, informs what ‘truths’ one might find. If the science is settled, then safety and efficacy are foregone conclusions. This means that not only does one not need to ask about safety and efficacy, to do so implies a heresy of sorts, one that invites almost necessary ridicule. As a foregone conclusion, there is no need to investigate and all research to contrary is automatically false. The only questions that can be asked within this episteme then, become how best to compel higher rates of vaccination. There are no other valid questions. Since safety and efficacy questions cannot be asked, then again, and necessarily, those folks who ask them operate in an alternate, and by definition an incorrect and heretical episteme. It is a very circular line of reasoning to be sure, but in one fell swoop, the pro-vaccine framework of total safety successfully forecloses any admonitions to the contrary.

Of course, this aligns beautifully with the economic interests of the manufacturers, the political and economic interests of folks who benefit from happy manufacturers (lobby, advertising, medical societies, journals and schools, doctors, and everyone along the food chain). And if we are honest, it aligns perfectly with our innate desire to ward off illness, without effort and without thought. Just get a shot and all will be well. It also aligns with what I think may be the overriding episteme of the late 20^th and early 21^st century – that of man’s technological invisibility, his infallible rightness of reason. In the vaccine industry and somewhat less brazenly, though no less dominantly, across all of the chemical industries, pharmaceutical, food additives, environmental, industrial included, the prevailing episteme is marked by two mutually reinforcing themes: man’s technological (and intellectual) invincibility and a concept of toxicological safety I call ‘not quite fatal’. The first theme implies that no matter what problems arise, technology, in this case, synthetic chemistry, is the answer. While the second holds that so long as something does not kill us or kill us immediately, it is safe and if it is safe, it is beneficial. What follows from the ‘not quite fatal’ perspective, is that if the individual does succumb quickly to a chemical toxicant within a dose deemed safe, then the fault lies with the individual, not the chemical; never the chemical. As is the case with most things, particularly in Western countries, these two themes align perfectly with economic and political interests.

Returning to vaccines, if man is invincible via his technology and if safety is defined only as the absence of immediate death, then, of course, vaccines are always the answer to any question. They are always safe and when mortality or morbidity occurs, as they do so often, the blame can be placed on some inherent weakness of the individual. The entirety of the Western vaccine apparatus, from the initial premises mentioned above, through the legal, economic, and political institutions that have been developed around these notions and that absolve the chemical companies of responsibility, enforce these truths. Thus, in the vaccine debate, there can be no debate. It is a zero-sum, with us or against us proposition. Vaccine science, safety, and efficacy are settled and only those who are unquestioningly pro-vaccine are allowed to speak and disseminate knowledge (aided and enforced in no small part by the billions of dollars spent on marketing, trolling, ghostwriting, journal sponsorship, medical society sponsorship, institutional grants, CDC, FDA, grants and fees, sponsored research, opposition research, political bribes and the like).

According to the authors of previously critiqued ‘vaccine denialism’ papers and by this definition of episteme, because vaccine safety is unassailable, those who question vaccine safety must operate in or by a different episteme than those who do not question said safety. Ignoring for a moment the fact that vaccine safety is neither settled nor unassailable, and thus, the entire argument becomes moot, this construction of episteme fails to recognize the play of power in defining the boundaries of knowledge. For that, we have to look at the work of the late French philosopher, Michel Foucault. He argued that the rules of knowledge, the episteme, have to include the influence of power.

…truth isn’t outside power, or lacking in power: contrary to a myth whose history and functions would repay further study, truth isn’t the reward of free spirits, the child of protracted solitude, nor the privilege of those who have succeeded in liberating themselves. Truth is a thing of this world: it is produced only by virtue of multiple forms of constraint. And it induces regular effects of power. Each society has its regime of truth, its “general politics” of truth: that is, the types of discourse which it accepts and makes function as true; the mechanisms and instances which enable one to distinguish true and false statements, the means by which each is sanctioned; the techniques and procedures accorded value in the acquisition of truth; the status of those who are charged with saying what counts as true.

Epistemic knowledge from Foucault’s perspective is the very expression of power. The recognition of truth, and by association falsehood, conveys that power. The dynamic tension between the two is both necessary, but also, violent. We see that violence in vaccine debates, and indeed, in all debates where questions regarding the safety and efficacy of pharmaceutical, environmental, and industrial chemicals threaten to overturn the dominant epistemic embrace of man’s technological invincibility. This is a carefully constructed reality that bolsters economic interests by sowing the seeds of doubt but only of the science that points to risks. Of the science regarding the safety and efficacy of a product, there can never be doubt, mainly because it is paid for by the industry itself. It is a brilliant, if not maniacal method for achieving dominance, perfected in large part by the tobacco industry.

Faced with mounting scientific evidence and general agreement amongst credible researchers, those whose interests were threatened needed a strategy to win that didn’t rely on scientific evidence. The tobacco industry led the way by hiring “a public relations firm to challenge the scientific evidence that smoking could kill you,” (p. 15) and to ensure that “scientific doubts must remain.” (p. 16) ‘Doubt is our product,’ ran the infamous memo written by one tobacco industry executive in 1969, ‘since it is the best means of competing with the ‘body of fact’ that exists in the minds of the general public.’ (p. 34)

With the tobacco industry, however, it was a small group of individuals who beat the ‘body of facts’ down by simply contesting otherwise. Here now, we have a fully and financially entrenched marketing apparatus whose purpose is to sell products liability-free. To that end, they have been successful, perhaps more successful than any other industry ever, for they have defined and managed the modern medical episteme for decades.

…one has to reckon with its strokes of genius, and among these is precisely the fact of its managing to construct machines of power allowing circuits of profit, which in turn re-enforced and modified the power apparatuses in a mobile and circular manner.

The question becomes, what shall we do about it?

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Image by Sarah Richter from Pixabay.