We are beginning to come to grips with the after-effects not only of the pandemic itself, but of the ill-considered policy responses to it. The moment presents an opportunity to critically reassess the broader social meaning of institutions like science and medicine—indeed, to finally acknowledge that they do carry a socially constructed character and are not apolitical.
Throughout the Covid-19 era, many of the nonconforming left’s engagements with pandemic authoritarianism have been under-appreciated—less charitably, excised from the public record. Within this context especially, we must take care to distinguish the left from liberals and progressives, who have unabashedly defended many of the most anti-democratic, socially disastrous, and economically inequitable examples of Covid-19-era public policy. Pandemic policy is one of a number of cases in which the moderate left or center left, those who wield political power, split especially sharply from the more radical left; the latter group was far more able to see the discriminatory character of more extreme and authoritarian Covid-response policies. Many on the left have noticed that the ills associated with lockdown policies were not evenly distributed. Professor Alex Broadbent, who teaches philosophy of science at Durham University, has contended that the lockdowns were fundamentally racist in effect. Noting that the supposed science on which they were based emerges from “traditional seats of colonial power,” Broadent and others have urged a reconsideration of lockdowns in light of other social and economic factors.
As we begin to bring these other factors into the analysis, we start to see a picture of how the Covid-19 response fits into much larger frameworks of power and class. In her book Biomedical Imperialism: Lessons Learned from the COVID-19 Pandemic, Barbara Katz Rothman, who teaches sociology and women’s studies at CUNY, argues that understanding the public policy response to Covid-19 requires a more well-developed appreciation of—and, importantly, critique of—“the role of biomedicine in contemporary society.” A globally connected complex of state and corporate institutions tightly controls key aspects of our lives, a fact conspicuous at times of birth and death—the “medical management of the gates of life.” We are sorted and numbered like widgets in what is essentially an industrial factory system, placed within a tiered structure that aligns with other social and economic divisions. Rothman calls this system “biomedical imperialism” and argues that it has colonized more and more spheres of life, functioning today “almost as a global religion, as well as one of the most productive economic industries on the planet.”
As a social, political, and economic system, this Biomedical Empire exercises extraordinary power over our bodies and our lives. It is imbued with the character of a religion, with a rarified group of initiates transcending the limits of normal social practice. The empire colonizes not only knowledge, but our bodies themselves, as important aspects of our personal dignity and bodily autonomy are taken. Far too often we move through the healthcare system (which, Rothman notes, has little to do with either genuinely supporting good health or caring for people) alienated, alone, and afraid. The biomedical imperialism that is such a dominant feature of our social landscape is itself situated within modernity’s tendency to exalt the credentialed expert. Everything is to be administered impersonally, by experts, through giant industrial bodies. As we move through such bodies, quick and quiet compliance is the expectation. What we are telling our children is that “when you’re a patient, you cease to be a full human being.”
In case it’s not obvious, Rothman’s critical deconstruction of our shared faith in the Biomedical Empire is not a call to reject vaccines, nor does it underplay the role this system played in ending epidemics of polio and smallpox. She is instead interested in calling attention to the fact that our relationships with hospitals, the medical profession and medical staff, and the insurance and pharmaceutical industries are relationships of power existing within social and economic hierarchies. At threshold moments in our lives, biomedicine and its new priesthood have supplanted religion, now enjoying pride of place. Covid-19 marks a turning point in our relationship with this burgeoning empire because the pandemic both underscored its weaknesses and internal contradictions and hinted at some of its most dangerous inclinations. The pandemic inured us to being watched and monitored, to submissively yielding to the authorities. The world’s states saw their opening and seized on the opportunity to test the latest implements of total surveillance, leading to a global crisis of human rights violations.
Rothman’s description of the medical-industrial complex as a growing international empire extends and develops the ideas of scholars like Peter Conrad, whose work has been central to the conversation on the socially constructed nature of illness and of the practice of medicine itself. Her thesis also fits within the more general acknowledgement that because science is an undertaking of humans, it too is built of various kinds of social practices, many arbitrary and power-serving. It therefore proceeds along the lines of critical challenges to “the scientific establishment’s claims to political neutrality,” to the idea that scientific practice exists in a vacuum, apart from “social, political, and economic power structures.”
During the pandemic, this critical posture receded almost to a vanishing point, at least within the popular conversation. The shameful upshot of this fact is that we largely missed out on perspectives highlighting the class character and implications of Covid-19 policies. The dominant perception of these policies within the political and economic elite did not (and still does not) reflect the experiences of at-risk groups and the poor. We talked a lot about “frontline workers” during the pandemic, but as Rothman observes, we seldom admitted “[t]hat ‘front’ is the bottom, disproportionately poorer, nonwhite, and economically vulnerable.”
We are indeed in the lessons learned stage of the Covid-19 experience, at least we should be. But we can’t draw the appropriate lessons—really any lessons—unless we honestly confront the connection between biomedical imperialism and other systems of social, political, and economic power. Historian Sigrid Schmalzer, who helped revive Science for the People, emphasizes the demystification of science, which means not only the explanation of the scientific concepts themselves, but the active subversion of power structures that attempt to hold certain groups of people in a state of ignorance. Policy choices during the pandemic show once again that we can’t just be “for science,” whatever that may mean. There is a pressing need to approach science and medicine as tools of social power and hierarchy, even if we may hope for the ideal of politically neutral hard sciences. At the global level of analysis, it is clear that the Biomedical Empire will continue to colonize new areas of knowledge and social practice. Given the technological sophistication of its tools and its infrastructures, the global biomedicine complex is well-positioned to aid the world’s most powerful states in keeping track of everything about you. Rest assured their reasons are good.