Welcome back to the Daily Dose and MedHum Monday! Today we have an unusual treat. Galileo’s Middle Finger is Alice Dreger’s third book-length work in the history and ethics of medicine; her previous books are Hermaphrodites and the Medical Invention of Sex and One of Us: Conjoined Twins and the Future of Normal. She also works as an activist in the area of patient advocacy and you can watch her 2010 TED talk, Is Anatomy Destiny?, online. Today’s post has been composed by two of the Dose’s brilliant reviewers, Hanna and Anna Clutterbuck-Cook. Galileo’s Middle Finger, they explain, uses Dreger’s own experience, as well as researched case studies in politics of science, to explore the role (historical and scientific) evidence plays — or doesn’t play — in advancing human knowledge and flourishing. But today’s review offers something new:
“As historians with an interest in both medical history and social justice work, we decided to read the book and have a conversation about it. Here is an edited version of that conversation.”
~ Hanna & Anna Clutterbuck-Cook
REVIEW IN CONVERSATION:
Anna: I first became aware of Alice Dreger’s work several years ago, and when I saw Galileo’s Middle Finger coming out, I was excited to see that she was going to tackle the question of science and social justice. I have an overall positive response to the notion of “evidence-based activism,” though having read the book I can’t shake the feeling that Dreger leans really heavily on the scientific method as a solution to social and political conflict — like, if only people would pay attention to the evidence we’d all get along. That activists would stop attacking scientists as anti-social justice, and scientists would stop practicing medicine that was contrary to human well-being. I’m just not sure it’s that’s simple.
Hanna: I had never heard of the author before this book. She’s an excellent storyteller. She does a very good job at breaking apart some very complicated scientific-cultural concepts, particularly walking through the vagaries of intersex really well without giving the sense of talking down to the reader — really common in this genre of popular science writing. Or of being bored having to stop and explain the basics — she is still finding explaining these concepts really interesting, which communicates itself on the page.
In terms of the conception of science, she’s very positivist about how evidence should be treated, like if you have evidence showing one thing or another go with that! We found this thing and it’s great! It reads as if she’s found a very satisfactory trial-and-error system for herself. But just presenting the evidence doesn’t always lead people to your way of thinking.
Anna: I hadn’t thought about it with that framing, as a very historically-specific view of empirical data collection. For me it was a question of, well, saying “evidence-based” is great, but evidence is never pure, it’s never without a bias or perspective. Like, at one point she writes about “the dangerous intellectual rot occurring within certain branches of academe – the privileging of politics over evidence” (139). Yes, sometimes one group of people is making claims completely not grounded in data. But sometimes we’re looking at the same data and drawing different conclusions! I’m not sure where these “certain branches of academe” are that she’s talking about — and she never really persuasively documents that level of “rot.”
What Galileo does offer are some pretty spectacular case-studies of personal vendettas and in-fighting in fields like anthropology, psychology, medicine — I don’t think this amounts to a pattern of retreat from the evidence so much as it does examples of shitty human behavior even in professional contexts.
Hanna: Nobody looks at evidence in a vacuum — you look at it in a whole collection of how else you see the world … ideologically, institutionally, ad lib into infinity. Pure research is not pure research, nor are conclusions, and none of those are presented in a scientific-cultural bubble. Popularizations add a whole separate level of complexity. They may not in the control of the person doing the original research, but know what you’re getting into — and don’t act surprised if people are upset about the way your research is used in the real world!
Anna: A scientist who draws an unpopular conclusion shouldn’t be professionally pilloried, okay, but it felt sometimes like Dreger glossed over the ways in which some of the individuals she profiled may have done sound science and faced unjust harassment — but perhaps for reasons that shouldn’t be overlooked. I don’t think Dreger, as an activist and patient advocate overlooks those effects — but in the space of these narratives it often feels like she’s constructed stories with scientific martyrs and social justice villains. Which I think unfairly undermines her larger point!
Hanna: It’s like she’s talking, at times, to what I think of as “the old school” of activist? Like she was talking to the people who told my college therapist she couldn’t couldn’t be a feminist because she was a dyke! Like, who quotes Camille Paglia anymore?
Anna: Well, Camille Paglia quotes Camille Paglia these days, but … ! Yeah, I mean, I felt like she was talking to a very particular set of academics and activists from the 1980s and 90s who had very firm sway on select subcultures within both academia and politics — but were never actually hegemonic. Like the chapter in which she talks about the researcher who supposedly attracts the ire of feminists for his theory that rapists are partially motivated by sexual desire in committing rape. I don’t think the “rape is violence, not sex” theory was ever as simplistic as she glosses it to be — nor do I think it saturated American jurisprudence and popular culture to the extent she argues. The people I know who do work in sexual violence prevention don’t seem to be arguing that sexual violence is not, on some level, sexual violence. It felt like a very forced dichotomy — scientists vs. feminists! — that doesn’t match with my own reading or observation in terms of how these conversations play out across multiple communities and platforms.
Hanna: Theory junkies. I mean, there are a few in every college. Either you were a fanboy for that sort of thing or you weren’t, and you took classes accordingly.
Anna: I guess what I felt like reading Galileo was, there’s this privileging not just of evidence — which I’m in favor of! — but also a privileging of certain ways of interacting with the evidence. I think of sitting in a discussion class and requiring students to ground their arguments in the week’s readings: “Where do you see this in the reading?” “Where are you getting this from?” But it’s important to allow for a multiplicity of lenses through which to look at the readings, and understand that people will make sense of a body of evidence in diverse ways.
Hanna: Dreger has got about three or four ginormous subjects — they’re book-length subjects and they’re huge and they’re complicated and whether it was her decision, or something she worked out with a publisher, she’s only got the space to nod toward all the complexities. And she nods — I don’t think it’s that she doesn’t know the complexity there! But I think this also goes back to what you were saying that you felt it was more of a book that was a collection of essays.
Anna: It’s really episodic – I felt more grounded as a reader when I thought of it as a collection of essays grouped around a common theme. She makes the case for robust science journalism at the end, and that kind of felt like a forced conclusion coming out of left field — related to the other pieces, but not necessarily a culmination or conclusion.
Hanna: There was no clear transition between topics. Every time I realized there was a shift, I wanted to say, “Wait! We were in the middle of something interesting with– Wait a minute!” I didn’t want to be led by the hand — I wish she’d picked any one topic because she was interesting on all of them! It’s not like she was suffering for lack of material.
Anna: And in each of the episodes, it felt like there was a martyr and a villain.
Hanna: Which is a problem. Why are we here discussing who was right or who was wrong in some of these cases? Because that shouldn’t be happening in a book like this — You shouldn’t be creating a martyrology then you’re stuck with a really inflexible framework.
Anna: Even starting out with the anecdote about Galileo’s finger on display in Florence —
Hanna: — That was wonderful! I think it’s totally worth pointing out that that was a wonderful anecdote!
Anna: It was! But framing the book with the story of Galileo’s martyrdom sets the stage for seeing these case-study characters as martyrs in the cause of truth … which means some of the effects of their work are glossed over. I’m totally against the type of harassment and baseless accusations some of these individuals faced; character assassination should not be the way forward. But character assassination happens across the political spectrum, and happens both to researchers and activists. It’s not always one camp against the other.
Hanna: In fairness, over-simplification is another hazard of trying to write about science for a popular audience — it’s very hard to know when you’ve explained enough. When can I stop explaining people? When am I treating people like they’re idiots? When is something common knowledge?
Anna: I guess what I mean is “define your terms”? Because take a term like “politically correct” or “identity activism,” both of which she uses. There’s no collective agreement about what that means, and when you employ that language you’re invoking a whole host of very polarizing arguments about whether those are useful terms — and for whom and to describe what. Maybe I’m just agreeing with you that it needed to be at least two books — maybe more!
Hanna: I’d say in the end result, we’ve certainly had a number of fruitful conversations around it, so it’s definitely worth the read.
Anna: I do agree — I think it’s a thoughtful and passionate contribution to the discussion about medicine and human rights, about expectations in different disciplines around research and evidence, and about how these conversations are (or aren’t) brought out of academia into the public sphere.
Thank you to both Hanna and Anna, and to Alice Dreger, whose works have offered such incredible discussions! As someone who writes for the public, I can attest personally to the difficulties of compressing time–and express appreciation for the engagement of fellow colleagues and scholars.
We hope you enjoyed this “Review Conversation” as much as we did! Read more about Dreger’s work here.