Police Reinforcement: The Anti-Politics of Organizational Life
Linsey McGoey
In 2004, David Ross, a former medical officer at the Food and Drug Administration, watched news coverage of one of the highest-profile pharmaceutical controversies in recent years: Merck’s withdrawal of Vioxx, its bestselling painkiller drug, from the global marketplace. At the time, David Ross railed to his wife about the actions of David Graham, an associate director of drug safety at the FDA who drew international attention for testifying before the U.S. Senate about the FDA’s handling of Vioxx. Graham said his supervisors ignored warnings that Vioxx could lead to cardiac arrest, and asked him to change his conclusions on an internal report about Vioxx’s risks.
Today, David Graham is still at the FDA. David Ross is not. But something both have in common is a concern that FDA has not amended policies much in the wake of the Vioxx controversy, and may be, in some ways, seeking to police internal criticism more strictly.
I met for an interview with Ross in Washington DC in November 2010. He told me that when he first witnessed David Graham publicly criticizing the agency in 2004, he said to his wife, ‘How dare he!’, with the implication being, how dare he publicize concerns better handled internally.
Two years later, Ross revised his own perceptions of Graham’s actions after struggling himself to convince supervisors about the risks of Ketek, an antibiotic drug linked to kidney failure. Ross’s efforts to flag Ketek’s risks embroiled him in a bureaucratic battle that threatened his own impartiality and credibility the more his concerns proved correct, impugning his authority and undermining his professional position the more influential his warnings turned out to be.
In this chapter, drawing on interviews with current and former FDA staff, I look at this paradox, exploring an obvious and yet underappreciated truism of organizational life: the way that individuals who call attention to regulatory errors are often vilified more than those who quietly perpetuate them. Within large bureaucracies, and within democratic politics more generally, an emphasis on the moral authority of objectivity limits opportunities for effective dissent by constraining the pool of legitimate dissenters to those who can convey a lack of personal commitment or interest in the stakes at hand, thereby enrolling themselves in a form of politics which succeeds most when actions are perceived as having as little effect as possible, when an action cannot be traced to a single instigator.
It is a politics that tends to succeed best at its own expense; a politics that reaches its pinnacle, to paraphrase an insight from Jacques Rancière, as its possibilities are diffused; a politics that reaches fulfilment only at its end (Rancière 2007). The problem is not that individuals are barred from voicing dissent, but the sheer act of doing so impugns their impartiality, rendering their arguments proportionately more dismissible the louder and more persistently they are voiced.
One of Rancière’s key arguments is the distinction he draws between the police and politics, suggesting politics is a mode of action which ‘perturbs the forms of perception’ established by police, by instituting a ‘contradictory theatre of its “appearances” [. . .] [politics] is the production, within the determined, sensible world, of a given that is heterogeneous to it’ (Rancière 2004a: 226). Stressing the insightfulness of Rancière’s distinction, this chapter explores cases where attempts to disturb divisions of the sensible have the unintended result of strengthening, rather than challenging, the authority and dominance of the police. In the case of drug controversies, the necessity to speak in a language comprehensible to the ‘police’ requires an adoption of the police’s language – a concession that undermines the effort to establish an act ‘heterogeneous’ to the perceptual field one wishes to disturb.
This point helps to address a paradox common to contemporary politics, which is how political acts that are most successful in attaining legitimacy tend to have the simultaneous effect of effacing or diffusing their own efficacy. Politics defeats politics. The self-effacing nature of politics, while neither absolute nor inescapable, is more pervasive than most, including Rancière, tend to acknowledge.1
Against popular conceptions of ‘the political’ as an arena where, through reaching consensus over conflicts about authority, communication, engagement and governance, local, national and international governmental bodies engage in the art and science of administration, Rancière posits politics as, in essence, the antithesis of how the political is typically perceived. To Rancière, politics is the ground over which assertions of equality challenge established orders of classification, contesting configurations of the ‘police’, his term for the constellation of organizations and actors with the authority to determine distributions of the sensible in political and daily life. The police are those with the mandate to establish parameters between the sayable and unsayable, the visible and the invisible, the audible and inaudible; while ‘politics’ is the aesthetics which breaches such parameters: ‘it makes visible what has been excluded from a perceptual field, in that it makes audible what used to be inaudible’ (see Dillon 2005; Rancière 2004a: 226; 2004b).
There are useful parallels between Rancière’s conception of politics and recent work from the field of science studies which suggests that, in contrast to popular and sociological perceptions of the ubiquity of politics, the belief that politics can be found everywhere – in the everyday, in local life, in the bedrooms and boardrooms of nations – politics is actually, as Andrew Barry suggests, ‘a rather specialist activity’, contingent not on a diverse and plural range of actors, but to an ever-narrowing field of experts and advisors capable of arbitrating on technical and instrumental matters (Barry 2002: 268).
Barry proposes a distinction between ‘politics’, which he terms a ‘set of technical practices, forms of knowledge and institutions’, and the ‘political’, which he views as a barometer, or an index, of the space available for disagreement and contestation (Barry 2002: 270). In this light, an action can be viewed as political to the extent that it creates room and openings for the possibility for disagreement. Technical discussions, scientific deliberations, the minutia of debates over quantifiable measurements – phenomena which are regularly drawn on in political debates, can be seen as anti- political, in that they close the space for disagreement to those who have the expertise and scientific capital to involve themselves in technical decisions. Calculations and measurements ‘redraw the boundaries between politics and objectivity by purporting to act as automatic technical mechanisms for making judgements, prioritizing problems and allocating scarce resources’ (Porter 1995; Rose 1999a: 198).
At the same time, the very anti-political nature of measurements, the widespread assumption that calculations are untainted by political impurities or tampering, often creates unintended effects precisely through the appearance of being irreducible to politics or partisan policies. Through ‘disrupting the frame of politics, and creating a conduit for the cross- contamination of the economic and the political’ seemingly anti-political phenomena often create avenues and opportunities for disruption where they are least expected (Barry 2002: 268).
Barry offers the example of a rail crash at Hatfield, a station north of London, in October 2000. Investigations following the accident revealed that it had been caused by a broken rail, itself the result of ‘metal fatigue’, or deterioration of the rail track. Railtrack Plc, the owner of the track, had been informed of the problem in January 2000, months before the accident, but had chosen not to act, exposing the company as potentially liable for the accident. The measurements of metal fatigue had tangible political effects, inculpating Railtrack as an accomplice in an incident otherwise dismissible as an untraceable act of technical failure. Although such calculations were obviously ‘political demonstrations of a kind’, Barry writes, ‘they were not ones that could be associated with any identifiable political actors. As a result, they were much more difficult to police than demonstrations conducted in the street’ (Barry 2002: 278; 2010). Through their sheer anonymity and irreducibility to any particular political camp, seemingly apolitical calculations fostered a form of politics that managed to escape its own constraints, to escape being identifiable with partisan positions or traceable to any sole player or group of players.
The political and anti-political effects of tools of measurement are often contingent on their location and tangibility within what Michelle Murphy calls ‘regimes of imperceptibility’: historically and socially constituted terrains of visibility and invisibility which render certain risks or benefits more perceivable, preventable or challengeable than others. A paradigmatic example is the tacit pervasiveness of white privilege in the United States in the later half of the twentieth century, in the era after desegregation rendered explicit forms of racism more illicit. In contrast to the early twentieth century, Murphy writes, when those both capitalizing from and subject to white privilege frequently named and invoked it, the post-segregation refashioning of ‘race’ as a social category, and the explicit disavowal of institutionalized racism ‘encouraged U.S. citizens to suspend their awareness of persistent racialized distributions of privilege and to look only for expressions of racialized disadvantage. White privilege operated through this regularized suspension of perception – in other words, through a regime of imperceptions [. . .] white privilege was generated, like white noise, precisely by “seeming not to be anything in particular” ’ (Murphy 2004: 268).
Legal desegregation had the unintended effect of shifting partitions of the sensible in ways that rendered ongoing systematic racism and white advantage less obvious than in previous decades. The parameters of what constituted racism or prejudice had been altered; the very explicitness of newfound awareness of the ways non-white individuals had been systematically disadvantaged under segregation made it harder to perceive or articulate the way continued forms of white privilege persisted and flourished in the post-segregation era, nourished by the very illusion of their absence. To challenge or disturb partitions of the sensible today, a political act would have to convince a dominant strata of society that their ‘whiteness’ was not the unraced identity they had deemed it, and that, not only had their hopes for a meritocratic, ‘colour-blind’ society not come to pass, its establishment had been forestalled by their assumptions of its imminent arrival through the banishment of segregation. An act of politics today has more layers of the unsayable and the unperceivable to breach than in the past when racism was more blatant.
Murphy and Barry’s work highlights the anti-political consequences of seemingly political acts, the way that passing new laws – even welcome ones – can forestall or preclude disagreement and contestation by rendering injustices less obvious, thereby leaving ‘people shorn of a vocabulary of protest’ (Thrift 2007). Their work helps illustrate some of the mechanisms through which individuals are stripped of a language for disturbing the sensible; the mechanisms through which individuals are left ‘on the shores of the politics’, displaced and diffused as threats to the imperturbability of police life (see Labelle 2001; Rancière 2007; Rancière and Panagia 2000). ‘By resigning positions and the passions that target them, by altering the perception of those positions and the emotions attending that perception, politics presides over its own erosion’, Rancière writes. ‘Depolicization is the oldest task of politics, the one which achieves its fulfilment at the brinks of its end’(Rancière 2007: 18–19). This is a sentiment that has received recent criticism. Jodi Dean, for example, suggests the argument that ‘politics has been foreclosed, excluded, prevented from emerging, is childishly petulant’. She insists that it is particularly inapplicable to the United States in the post-9/11 environment, where, if anything, there has been an explosion of engagement in the form of new political movements over climate change or evolution, where:
polls taken daily, even hourly, during the long U.S. presidential campaign of 2008 differ from each other; consumers of political news ingest numbers that differ from each other, call each other into doubt, rendering the very categories of polling unstable. Indeed, the gap between polls and electoral outcomes, the failure of exit polls accurately to predict the votes tallied (an issue in both the 2000 and the 2004 elections), and the politicization of this gap as corruption, crime, theft, and racist disenfranchisement of African-American voters express a politics [that is irreducible, she argues, to what she sees as Rancière’s vision of a post-political] triumph of consensus. (Dean 2009: 23–4)
Dean misses the point. Rancière’s argument is not that attempts to disturb the sensible are rare, or that evidence of political engagement is absent in contemporary democracies. His point is how rarely they succeed in perturbing ‘the determined, sensible world’, partly because the forms of political expression listed above – opinion polls, electoral voting – are part of the constellation of actions sanctioned and encouraged by the police themselves. To insist, as Dean does, that the mere appearance of public engagement is evidence of politics, that shifting opinion polls provide proof of a vibrant public, is to remain rooted in the banal slogans of a regrettable sociological fallacy, a sociology where politics are naively and optimistically assumed to be everywhere.
As Kristin Ross suggests, politics, for Rancière, is not a matter of illusion or disillusion, nor of a dialectic between governors and the governed, nor of movements deemed ‘conservative’ or ‘progressive’. It is an interlocutory event, one that reconfigures the parameters of what counts as a political act, one that is ‘still exceptional or scarce’ and one that often occurs beyond the arenas where politics are typically assumed to be found (Ross 2009: 28). Rancière stresses this point in a recent article, asserting that for him
‘disagreement’ and ‘dissensus’ do not imply that politics is a struggle between camps; they imply that it is a struggle about what politics is, a struggle that is waged about such original issues as: ‘where are we?’, ‘who are we?’, ‘what makes us a we?’ . . . where the question ‘how is this thinkable at all?’ points to the question ‘who is qualified for thinking at all?’ (Rancière 2009: 116)
Politics is the act which reconfigures assumptions of who has the credibility to define and articulate visions of what politics could be, or ought to be. Examples may be scarce, but they can be found. One example is the explosion of activity in the mid-1980s onward surrounding the development of new treatments for HIV/AIDS. As the sociologist Steven Epstein writes, a striking aspect of the conduct of AIDS research in the United States is the diversity of players with the credibility to influence how clinical trials are carried out and which political and financial mechanisms are useful in expediting new treatments to the public. Within literature on drug regulation, AIDS activists are often upheld as an example of how a politicized patient group, united around a shared cause, can affect regulatory processes. They are typically credited, for example, as being one of the largest influences on the FDA’s 1992 decision to introduce user fees, making the FDA less reliant on federal funds and more reliant on direct financing by the pharmaceutical industry in exchange for drug licensing. Whatever the eventual costs of this shift – and many suggest the effect has been quite pernicious, making the U.S. regulator overly beholden to the industry it is meant to be regulating – it is indisputable patient activism played a decisive role (see Daemmrich 2004; Epstein 1995; Greene 2007).
Epstein suggests the novelty of AIDS activists is not merely that they influenced regulatory policies, but that they radicalized notions of what counts as scientific credibility and which groups have the legitimacy to contribute to the production of scientific facts:
My point in stressing the breadth of participation in claims making is not simply to say that AIDS research is heavily politicized or that it has a public face. More profoundly, this case demonstrates that activist movements, through amassing different forms of credibility, can in certain circumstances become genuine participants in the construction of scientific knowledge – that they can (within definite limits) effect changes in both the epistemic practices of biomedical research and in the therapeutic technique of medical care [. . .] AIDS activists did not achieve influence simply by amassing political muscle of the conventional sort (although that did prove necessary at points along the way). In addition, they found ways of presenting themselves as credible within the area of credentialed expertise. At the same time, these activists succeeded in changing the rules of the game, transforming the very definition of what counts as credibility in scientific research such that their particular assets would prove efficacious. (Epstein 1995: 409)
Sufferers proclaimed their right to be heard as equals, not through insisting their expertise was on par with scientists, but through reconfiguring notions of what constituted expertise itself. In the face of a crisis shrouded in unknowns, magnified by the sheer mystery surrounding the scale and aetiology of the disease, activists harnessed the uncertainty surrounding potential treatments to their advantage. Their status as ‘treatment activists’ in medical experiments testing novel therapies enabled them to wield unprecedented influence over the design and interpretation of clinical trial methodologies, effectively challenging FDA policies over who had the right to enrol in trials with unknowable medical risks (Epstein 1995: 416).
‘There is no hierarchy in ignorance’, Ranciere once wrote, and the strategies of AIDS activists seem to reflect this aphorism (Rancière 1991: 32). Pointing out how little experts knew about the origin and treatability of AIDS helped them to challenge the epistemological privileging of scientific over ‘lay’ expertise. They mobilized ignorance itself in order to defend their status as equal pioneers in the discovery of new therapies. This strategy, however, had its limits. One of the key tactics for amassing credibility was to become as literate as possible about the science of HIV treatment. Many activists, even while asserting the importance of ‘nonscientific’ imperatives – the cultural effort to challenge the stigmatization of AIDS as a ‘gay’ problem, for example – ‘nonetheless assumed that the capacity to speak the language of the journal article and the conference hall is a sine qua non of their effective participation’ (Epstein 1995: 417). So, over time, as activists themselves became more knowledgeable about the science of AIDS, many of them came to place increasing faith in the cultural frames of mainstream biomedicine, some developing a more ‘fastidious’ perspective on the superiority of clinical trials over other forms of evidence, partly because of the need to acquire ‘hard data’ that could be of use politically. The need to speak in a language persuasive to scientists and other authorities, to point to hard facts in order to lobby for more R&D funding, has had the unintended effect of discrediting the tactics of an earlier wave of activists, those who harnessed the fragility and vulnerability of scientific knowledge in order to assert their equal footing in devising new research hypotheses and trial methodologies (Epstein 1995: 424).
This problem is similar to debates over climate change, where to be persuasive, both sceptics and adherents of the need to tackle global warming often frame their political arguments in technical terms, something that typically earns scientific credibility at the expense of precluding or foreclosing discussions of the social impact of environmental degradation. ‘Too often’, as David Demeritt writes, ‘policy decisions are legitimated in purely technical terms, leaving opponents with only scientific grounds for contesting policies that they oppose for other reasons’ (Demeritt 2006: 473). The problem also emerges in drug regulation, as the recent controversy over the safety of Ketek illustrates.
Ketek is an antibiotic drug manufactured by Sanofi-Aventis for the treatment of upper respiratory tract infections such as sinusitis and bronchitis. In 2000, when Aventis first sought an FDA licence for the drug, a number of FDA reviewers grew concerned when a patient treated with Ketek developed severe liver damage. In April 2001, an FDA advisory committee stipulated that the company should conduct a large clinical trial to help determine Ketek’s safety before a licence could be granted. The trial, known as study 3014, involved dozens of research sites and thousands of participants across the United States. Early on during the trial, a routine FDA safety investigation uncovered grave violations of good clinical practice at the lead research site where the study was being carried out, such as the fact that most of the participant consent forms appeared to have been forged. Despite knowing that data from the trial was compromised by these violations, the FDA presented results to an FDA advisory committee without mentioning that data had been distorted by trial investigators. Unaware of the unreliability of data, the advisory group recommended approval of Ketek (Hundley 2007; Ross 2007).
The FDA awarded a licence for Ketek in 2004. Between 2004 and 2006, more than five million prescriptions were written for the drug in the United States. During those years, 14 adult patients suffered liver failure after taking Ketek, at least four of whom died. Dozens of others suffered serious liver injury – most of them otherwise healthy individuals (see Harris 2006; Ross 2007). In 2007, the FDA implemented label changes for the drug, banning its use for two of its three previously approved indications, acute sinusitis and chronic bronchitis, and insisting on a black box warning for its third: community-acquired pneumonia. The FDA has stated there was no intention to ‘deceive the advisory committee or the public regarding our review of study 3014’, and that it had chosen not to reveal concerns over the integrity of study 3014 in order to avoid compromising an investigation into possible fraud. The agency defended its earlier decision to license Ketek in 2004, and suggested that as soon as reports of serious liver toxicity emerged, the agency moved swiftly to impose a bolder safety warning on the drug (Soreth et al. 2007: 1675).
David Ross, now working at the U.S. Department of Veterans Affairs, disputes the FDA’s insistence that the agency acted swiftly, pointing out that the FDA did not move to relabel Ketek until 16 months after the first case of severe liver toxicity emerged. Throughout 2005 and 2006, as reports of liver toxicity increased, Ross pleaded with supervisors to take action. In June 2006, a number of FDA reviewers, including Ross, were summoned to a meeting with the FDA Commissioner at the time, Andrew von Eschenbach. During the meeting, von Eschenbach compared the FDA to a football team and told staff that if they publicly discussed problems with Ketek outside the agency, they would be ‘traded from the team’.2
Ross is not the first FDA officer to face internal threats for raising concerns about a drug’s risks. As the New York Times reports, since 2003, at least four FDA safety reviewers have been punished or discouraged for uncovering previously undetected risks, including Andrew Mosholder, a safety officer barred from presenting data to an FDA advisory committee which suggested antidepressants lead to suicidal reactions in children, and Rosemary Johann-Liang, who left the agency after raising concerns over the safety of drugs such as Ketek and Avandia, a diabetes drug linked to heart failure (Harris 2007).
Their experiences suggest a pattern. Typically those who have been most vocal in flagging risks have been the same individuals most discredited or resented by peers or employees reluctant to revise earlier positions on a drug’s safety. The resentment of ‘whistleblowers’ who publicize a drug’s risks is often palpable regardless of whether concerns prove correct. In fact, quite ironically, particularly in scientific arenas, where, as Nikolas Rose writes, ‘impersonality rather than status, wisdom or experiences’ (Rose 1999b: 208) provides the measure of truth, the more persistently and relentlessly someone seeks to call attention to flawed policies or practices, the more they erode perceptions of their own impartiality – therefore sacrificing their own credibility the more influential their warnings turn out to be. Had David Ross been wrong about Ketek, his concerns might have elicited less resistance from supervisors concerned with maintaining public trust in the agency. The gravest risk in voicing dissent is typically not being wrong but being right.
Why would the FDA be slow at detecting side effects, and slow to disclose risks once they are apparent? The reasons are numerous and interrelated. One stems from the 1992 decision to introduce user fees from industry for drug licensing. Although seen as a welcome move by many, drug manufacturers stipulated certain conditions. They refused to let their money be spent on post-market safety studies, and insisted drug reviews be completed within six months, leading critics to suggest the agency has come to value speed over safety (Harris 2007). Another factor is reputational concerns, where regulators have seemed reluctant to act swiftly on risks for fear of drawing attention to earlier regulatory lapses in licensing the drug in the first place (see Abraham and Sheppard 1999; Carpenter 2006; McGoey 2007; McGoey and Jackson 2009). A third reason is less explicitly self- interested. In fact, it emerges from the opposite impulse, from the effort to minimize partisan or commercial biases on drug licensing. Historically, clinical trials have been valued precisely because, through the use of control groups, they can guard against biased results, determining whether the drug itself, or an external variable, has produced a particular effect. Clinical trials, like other tools of measurement, are valued for their seeming imperviousness to political bias or manipulation (see Greene 2007; Marks 1997).
Even though it is widely known that many clinical trials are too short in duration and have too few participants to demonstrate adverse risks that might appear during post-market epidemiological studies, faith in the superiority of clinical trials over observational or anecdotal evidence has led to a situation where, as one FDA staff member said to me, agency staff:
will only believe – this has been said to me more than once by people from the Office of New Drugs, very high level people – they will only believe that an adverse effect is real when a controlled clinical trial has been done that shows an effect with a p value of less than 0.05.
At first glance, the reliance on clinical trials seems to foreclose avenues for regulatory disagreement by narrowing the scope for challenge to those who can draw on clinical trial data to support their arguments, a problem when a drug’s risks are not apparent on the trials used to test it. But, just as, as Barry’s work illustrates, assumptions of a technology’s imperviousness to political tampering can have deeply political effects through appearing free of partisan influence, harnessing perceptions of the superiority of clinical trials can be useful even to those who wish to challenge the dominance of these methodological tools. By calling attention, for example, to the fraudulent factors that undermined the reliability of study 3014, Ross and others were able to bolster support for their detection of post-market adverse effects, effects that might have otherwise been dismissible because they did not appear on clinical trials. A similar example appears with antidepressant drugs such as Prozac, where suggestions of a suicidal risk were first scoffed at, and then confirmed when a series of re-analyses of company-held clinical trial data revealed statistically significant risks between antidepressants and suicidal reactions, risks that had been dismissed during earlier regulatory inquiries because they were not detected on available trial evidence (see Lenzer 2006).
Ross and other FDA insiders succeeded in exposing the fragility of what Barry calls ‘metrological regimes’, systems where the standardization of measurements enables a cross-fertilization of political deliberations and market transactions in ways that often diffuse the potential for political confrontation. The reliance on clinical trials within drug regulation offers an example of a metrological regime. Drugs reach the market through a complex process linking clinical trial participants, drug manufacturers and regulators together through a process that thrives through the illusion of the inability of individual actors to unduly bias trial results. Precisely because metrological regimes derive credibility through appearing free of bias, they are always vulnerable to the very elements that lend them strength. By exposing the ‘weaknesses of measurement and the uncertainties of economic and scientific calculation’, individuals can pierce the impenetrability of regimes which depend on the perception of being above or beyond politics (Barry 2002: 276).
Drawing attention to the fragility of measurements has its pitfalls. The mere act of exposing uncertainties often erodes perceptions of an individual’s disinterestedness or impartiality, diffusing the value of the criticisms the moment they are voiced. As the case of Ketek suggests, political actions often incriminate their own efficacy through the sheer act of being articulated. Politics defeats itself just as often, if not more often, than it manages to escape its own limitations. Most of the FDA staff who raised concerns about Ketek have since left the agency. The ones I spoke with called attention to an inescapable bind. Either they could stay at the agency, vocalize concerns with current licensing procedures, and sacrifice opportunities for career advancement, or they could leave the agency and lose the credibility to draw attention to regulatory shortcomings at their former place of work. As one former officer said to me, ‘we’re painted as disgruntled former employees and nothing we say matters’.
In some ways, of course, the pacification of opinion – the way that one’s authority is eroded through the sheer act of drawing on it publicly – is hardly a new story. As Rancière notes, Alexis de Tocqueville was one of the first to identify how the emergence of a new sociality within modern democracies, a sociality insistent on an equality of condition among all citizens, managed to mitigate the political effectiveness of individual opinion by encouraging all citizens to believe in their ability to make their views known. As a direct result of faith in their own freedoms – of speech, assembly, of the press – individuals within democracies forge their own constraints. Their assurance of their capacity to speak out publicly both weakens the imperative to do so and indicts the credibility of the few who do. The authority allocated to each citizen by her peers decreases in proportion to the freedom to express opinions. Dissent is stifled through the assumption of one’s equal right to be heard (see de Tocqueville 1848: 184; McGoey draft; Rancière 2007: 20).
Paying more attention to the politics of testimonial credibility in political and organizational life could help to examine a paradox: the question of why calling attention to regulatory errors is often treated as more of an aberration of correct procedure than quietly perpetuating them. The cynical view is that all forms of regulation – and all partitions of the sensible, for that matter – are necessarily dependent on the deliberate, pernicious suppression of any criticism that might impede the efficiency or impugn the reputation of an organization. Another perspective, the one favoured in this chapter, is the less cynical, but also far more intractable possibility that dissenting opinions are persistently ignored because of the assumption that they should be: because of the subtle distaste for the voicing of opinion in arenas where tools of quantification are revered for the democratic ability to decide without appearing to decide.
Notes
1.Versions of this chapter were presented at a workshop on Experimental Subjects, Lancaster University, January 2010, and a seminar at the Institute for Cultural and Social Anthropology, Oxford University, February 2010.
2.The meeting with von Eschenbach is described by Ross during testimony before the U.S. House of Representatives’ Committee on Energy and Commerce, which launched a series of hearings in 2007 and 2008 to determine whether a range of parties, from the FDA to Aventis, knew about the adverse risks of Ketek and chose to ignore or conceal them.
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