Linsey McGoey

Strategic unknowns: towards a sociology of ignorance

Abstract Developing an agenda for the social study of ignorance, this paper introduces the sociology of strategic unknowns: the investigation of the multifaceted ways that ignorance can be harnessed as a resource, enabling knowledge to be deflected, obscured, concealed or magnified in a way that increases the scope of what remains unintelligible. In contrast to theoretical preoccupations that underlie the study of knowledge accumulation, a focus on the importance of strategic unknowns resists the tendency to value knowledge over ignorance or to assume that the procurement of more knowledge is linked in an automatic or a linear fashion to the attainment of more social or political power. Refining and challenging the assumption that modern liberal societies inevitably thrive on the accumulation of information about the public personas, private psyches, consumer habits or political proclivities of citizens, the papers in the special issue explore how the cultivation of strategic unknowns remains a resource – perhaps the greatest resource – for those in a position of power and those subject to it.

On the will to ignorance in bureaucracy

Abstract Drawing on narrative interviews with psychiatrists and health analysts in Britain, the article provides an analysis of debates over the safety of SSRI antidepressants such as Prozac and Seroxat. The focus of the article is on what I describe, drawing on Foucault, Nietzsche, Niklas Luhmann and Michael Power, as a ‘will to ignorance’ within regulatory bureaucracies which works to circumvent a regulators ability to carry out its explicit aims and goals. After a description of the regulatory processes that have influenced the efforts of patients and practitioners to reach conclusions on the risks and benefits of antidepressants, I conclude by suggesting that the articles analysis of the regulation of SSRIs carries theoretical insights for the study of regulation and bureaucracy in general.

The logic of strategic ignorance

Ignorance and knowledge are often thought of as opposite phenomena. Knowledge is seen as a source of power, and ignorance as a barrier to consolidating authority in political and corporate arenas. This article disputes this, exploring the ways that ignorance serves as a productive asset, helping individuals and institutions to command resources, deny liability in the aftermath of crises, and to assert expertise in the face of unpredictable outcomes. Through a focus on the Food and Drug Administrations licensing of Ketek, an antibiotic drug manufactured by Sanofi-Aventis and linked to liver failure, I suggest that in drug regulation, different actors, from physicians to regulators to manufacturers, often battle over who can attest to the least knowledge of the efficacy and safety of different drugs - a finding that raises new insights about the value of ignorance as an organizational resource.

Rationalities of ignorance: on financial crisis and the ambivalence of neo-liberal epistemology

Abstract The financial crisis of 2007–8 was experienced and reflected upon as a crisis of knowledge, the perennial question being why nobody accurately understood the risks that were being taken within the financial sector. In the wake of the crisis, there have been demands that rational economic knowledge be extended further and more vigorously, to prevent such ignorance being possible in future. At the same time, there have been demands for a new, softer rationalism, which factors in the possibility of errors and systemic complexities. What neither approach recognizes is that ignorance is not simply the absence of rational economic knowledge, but is a productive force in itself, something that is actively nurtured and exploited, both by neo-liberal theorists such as Hayek and by expert actors who have been implicated in the financial crisis. We explore how ignorance has been alternately an albatross, a commodity and an institutional alibi to financial actors and the scholars who study them.

The philanthropic state: market–state hybrids in the philanthrocapitalist turn

Over the past decade a new form of philanthropy has emerged, termed ‘philanthrocapitalism’. Champions of philanthrocapitalism suggest that private giving can fill the void left by diminished government spending on social and development programmes. Critics suggest that philanthropy is no substitute for strong governmental support for social welfare. Both arguments perpetuate a dichotomy between the public and the private, implying that philanthrocapitalism operates in a vacuum largely divorced from governmental interventions. In this article I challenge that assumption, exploring how new philanthropic initiatives have compelled increased financial support from governments toward the private sector. Drawing on three cases – advanced market commitments (amcs) in drug development; impact investing; and direct philanthropic and governmental grants to corporate entities – I illustrate the ways that governments remain one of the most powerful – if not the most powerful – philanthropic actors in the philanthrocapitalist turn.

Pharmaceutical Controversies and the Performative Value of Uncertainty

In September 2004, the global pharmaceutical manufacturer Merck & Co. removed Vioxx from the US market. The company soon faced almost 30,000 lawsuits over the alleged concealment of adverse effects. Despite suspicions that the Vioxx scandal would cripple the companys profitability, Mercks shares more than doubled between 2005 and 2007. Drawing on this case, I describe how scientific uncertainty surrounding the effects of Vioxx has been legally useful for Merck executives in exonerating their culpability for failing to disclose the adverse effects of the drugs. Extrapolating from this, I suggest uncertainty is generative and performative: it creates a demand for resolutions to the ambiguity it perpetuates, often strengthening the authority of those who have advanced a position of uncertainty to begin with. Finally, I argue paying more attention to the value of ‘capitalized uncertainty’ helps to nuance earlier work on the manufacture of risk and uncertainty.

An Elusive Evidence Base: The Construction and Governance of Randomized Controlled Trials

In 1987, just a year before his death, the British epidemiologist Archie Cochrane gave one of his last public interviews. Cochrane had led an illustrious career, helping to establish the fields of epidemiology and public health in Britain and internationally.

Profitable failure: antidepressant drugs and the triumph of flawed experiments

Drawing on an analysis of Irving Kirsch and colleagues’ controversial 2008 article in PLoS [Public Library of Science] Medicine on the efficacy of SSRI antidepressant drugs such as Prozac, I examine flaws within the methodologies of randomized controlled trials (RCTs) that have made it difficult for regulators, clinicians and patients to determine the therapeutic value of this class of drug. I then argue, drawing analogies to work by Pierre Bourdieu and Michael Power, that it is the very limitations of RCTs — their inadequacies in producing reliable evidence of clinical effects — that help to strengthen assumptions of their superiority as methodological tools. Finally, I suggest that the case of RCTs helps to explore the question of why failure is often useful in consolidating the authority of those who have presided over that failure, and why systems widely recognized to be ineffective tend to assume greater authority at the very moment when people speak of their malfunction.

Seroxat and the suppression of clinical trial data: regulatory failure and the uses of legal ambiguity

This article critically evaluates the Medicines and Healthcare products Regulatory Agency’s announcement, in March 2008, that GlaxoSmithKline would not face prosecution for deliberately withholding trial data, which revealed not only that Seroxat was ineffective at treating childhood depression but also that it increased the risk of suicidal behaviour in this patient group. The decision not to prosecute followed a four and a half year investigation and was taken on the grounds that the law at the relevant time was insufficiently clear. This article assesses the existence of significant gaps in the duty of candour which had been assumed to exist between drugs companies and the regulator, and reflects upon what this episode tells us about the robustness, or otherwise, of the UK’s regulation of medicines.

Global Health and the Gates Foundation — In Perspective

In 2009, the Lancet published an issue with a provocative question on its cover: ‘What has the Gates Foundation done for global health?’ Featuring a research paper (McCoy et al., 2009), an editorial (Black et al., 2009), and a commentary (Lancet, 2009), the papers argued that, despite the Bill and Melinda Gates Foundation’s (henceforth the Gates Foundation) much lauded and significant funding of various health projects and causes in low- and middle-income countries, a number of questions and concerns about the Foundation needed to be aired and debated.