The Contingent Power of Experts: Public Health Policy in the United States, Britain, and France

Journal of Policy History

Volumn 19, Issue 1, 2007, Pages 71-94

  Nathanson, Constance A ^a  

^a Mailman School of Public Health Columbia University ^*  (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 79959714615     PISSN: 08980306     EISSN: 15284190     Source Type: Journal    
DOI: 10.1353/jph.2007.0005     Document Type: Article

References (87)

1. In my approach to this analysis I draw on three theoretical traditions, that of the symbolic interactionists, Herbert Blumer, Joseph Gusfield, and others who have written about the construction of public problems: Herbert Blumer, “Social Problems as Collective Behavior,” Social Problems 18 (1971): 298-307;
2. Joseph R. Gusfield, The Culture of Public Problems: Drinking-Driving and the Symbolic Order (Chicago, 1981)
3. Peter Conrad and Joseph W. Schneider, eds. Deviance and Medicalization: From Badness to Sickness (St. Louis, 1980)
4. social movement scholars' elaboration of framing processes: David A. Snow, E. Burke Rochford Jr. Steven K. Worden, and Robert D. Benford, “Frame Alignment Process, Micromobilization, and Movement Participation,” American Sociological Review 51 (1986): 464-81;
5. Doug McAdam, “Culture and Social Movements,” in E. Larana, H. Johnston, and J. R. Gusfield, eds. New Social Movements (Philadelphia, 1994), 36-57;
6. Sidney Tarrow, Power in Movement: Social Movements and Contentious Politics, 2d ed. (Cambridge, 1998)
7. and the work of Mary Douglas and her colleagues and students, who have studied the impact of political cultures on constructions of risks to the environment: Mary Douglas and Aaron Wildavsky, Risk and Culture: An Essay on the Selection of Technological and Environmental Dangers (Berkeley and Los Angeles, 1982)
8. Mary Douglas, Risk and Blame: Essays in Cultural Theory (London, 1992)
9. Michael Thompson, “Postscript: A Cultural Basis for Comparison,” in Risk Analysis and Decision Processes: The Siting of Liquified Energy Gas Facilities in Four Countries, ed. Howard C. Kunreuther and Joanne Linerooth, 232-62 (Berlin, 1983)
10. Brian Wynne, Risk Management and Hazardous Waste: Implementation and the Dialectics of Credibility (Berlin, 1987).
11. The recent work of Karen Litfin on the science and politics of global environmental risks has been particularly valuable: Karen T. Litfin, Ozone Discourses: Science and Politics in Global Environmental Cooperation (New York, 1994).
12. Francois Haas and Sheila Sperber Haas, “The Origins of Mycobacterium Tuberculosis and the Notion of Its Contagiousness,” in William N. Garay and Stuart M. Rom, eds. Tuberculosis (Boston, 1996), 3-19.
13. Pierre Guillaume, Du Désespoir Au Salut: Les Tuberculeux Aux 19e et 20e Siécles (Paris, 1986). Villemin's conclusion that tuberculosis was contagious was rejected first in 1865, as I have stated, and again in 1889 (post Koch). Mandatory notification of tuberculosis cases to public health authorities was rejected by the Academy in 1902 and again in
14. Hermann Pidoux (1867), cited in David S. Barnes, The Making of a Social Disease: Tuberculosis in Nineteenth-Century France (Berkeley and Los Angeles, 1995), 46.
15. Litfin, Ozone Discourses.
16. Intergovernmental Panel on Climate Change (1990)
17. cited in Intergovernmental Panel on Climate Change 193 and 191.
18. The Constance A. Nathanson, Disease Prevention as Social Change: The State, Society, and Public Health in the U.S. France, Great Britain, and Canada (New York, 2007).
19. Senator James Inhofe of Oklahoma has gone so far as to claim that “there is scientific evidence that global warming is a 'hoax.'” Cited in Howard J. Silver, “Science and Politics: The Uneasy Relationship,” Open Spaces Quarterly 8, no. 1 (2005).
20. Royal College of Physicians of London, “Smoking and Health” (London, 1962)
21. U.S. Department of Health, Education, and Welfare, “Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service,” Public Health Service publication no. 1103 (Washington, D.C. 1964).
22. Allan M. Brandt, “Blow Some My Way: Passive Smoking, Risk, and American Culture,” in S. Lock, L. A. Reynolds, and E. M. Tansy, eds. Ashes to Ashes: the History of Smoking and Health (Amsterdam, 1998), 164-80.
23. Royal College of Physicians of London, “Smoking and Health,” S6–7.
24. National Research Council, Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects (Washington, D.C. 1986)
25. U.S. Department of Health and Human Services, “The Health Consequences of Involuntary Smoking: A Report of the Surgeon General,” DHHS publication no. (CDC) 87-8398.
26. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health (Rockville, Md. 1986).
27. Virginia Berridge, “Passive Smoking and Its Pre-History in Britain: Policy Speaks to Science?” Social Science and Medicine 49 (1999): 1183-95.
28. The “Frogatt report” was the fourth report of the Independent Committee on Smoking and Health, a committee of “scientists and public health interests” appointed in 1973 by then Secretary of State for Health and Social Services, Sir Keith Joseph (Social Science and Medicine 1187).
29. Maurice Tubiana, “Tabagisme Passif: Rapport et Voeu de L'Académie Nationale de Médicine,” Bulletin de L'Académie Nationale de Médicine 181, no. 4 (1997): 3-43.
30. See, for example, Richard Kluger, Ashes to Ashes: America's Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris (New York, 1996). Scientific controversy over the health effects of passive smoking continues to this day. In what was clearly intended as a definitive blow to the credibility of skeptics, Barnes and Bero stated that “the only factor associated with concluding that passive smoking is not harmful was whether an author was affiliated with the tobacco industry.”
31. D. E. Barnes and L. Bero, “Why Review Articles on the Health Effects of Passive Smoking Reach Different Conclusions,” Journal of the American Medical Association 279, no. 19 (1998): 1566-70;
32. U.S. Department of Health and Human Services, “Reducing the Health Consequences of Smoking: Twenty-Five Years of Progress. A Report of the Surgeon General,” U.S. Department of Health and Human Services publication no. (CDC) 89-8411 (Rockville, Md. 1989), 189.
33. Jesse L. Steinfeld, “Women and Children Last? Attitudes Toward Cigarette Smoking and Nonsmokers' Rights, 1971,” New York State Journal of Medicine 83, no. 13 (1983): 1257-58;
34. Unless otherwise noted, all the narrative accounts that follow are drawn from my own research. See, for example, “Social Movements as Catalysts for Policy Change: The Case of Smoking and Guns,” Journal of Health Politics, Policy and Law 24, no. 3 (1999).
35. The Ventilator (1971), 1.
36. The concept of “organizational field,” meaning “those organizations that, in the aggregate, constitute a recognized area of institutional life,” was introduced by DiMaggio and Powell in 1983: Paul J. DiMaggio and Walter W. Powell, “The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields,” American Sociological Review 48 (April 1983): 148.
37. Clara Gouin, “Nonsmokers and Social Action,” Proceedings of the ACS/NCI Conference (DHEW publication no.[NIH] 77-1413), 353–56 (Washington, D.C. 1977), 355.
38. P. Hanauer, G. Barr, and S. Glantz, Legislative Approaches to a Smoke-Free Society (Berkeley and Los Angeles, 1986).
39. Kenneth E. Warner, “Cigarette Smoking in the 1970s: The Impact of the Antismoking Campaign,” Science 211, no. 4483 (1981): 729-31.
40. Science 730.
41. J. Slade, S. A. Glantz, D. E. Barnes, L. Bero, and P. Hanauer, “Nicotine and Addiction: The Brown and Williamson Documents,” Journal of the American Medical Association 274, no. 3 (1995): 225-33.
42. Roy Porter, “Concluding Remarks,” in Ashes to Ashes, ed. S. Lock, L. A. Reynolds, and E. M. Tansey, 221–28;
43. David Simpson, “ASH: Witness on Smoking,” in Ashes to Ashes, ed. S. Lock, L. A. Reynolds, and E. M. Tansey, 208-12.
44. The British aversion to the issue of passive smoking is well illustrated by the fact that in 1985 at the annual meeting of the British Medical Association a motion calling for a Tobacco Act to ban all advertising and sponsorship passed by “a massive majority,” while a motion to ban smoking on National Health Service property failed by 20 votes out of 194 on the grounds that such a ban would be cruel to smokers in mental hospitals. British Medical Association, Smoking Out the Barons: The Campaign Against the Tobacco Industry (Chichester, 1986), 69.
45. Berridge, “Passive Smoking and Its Pre-History in Britain,” 1190. On Valentine's Day 2006, Parliament voted 453 to 125 in favor of a total ban on smoking inside “virtually every enclosed public place and workplace” throughout England.
46. Michael White, “MPs Vote to Stub Out Smoking in Public,” The Guardian, 24 February 2006, 13.
47. “Indoor Pollution; Restricting Smoking,” British Medical Journal 303 (1991): 669-70.
48. The first paper on the harmful effects of passive smoking generally recognized as being scientifically “authoritative” appeared in the British Medical Journal in 1981. T. Hirayama, “Non-Smoking Wives of Heavy Smokers Have a Higher Risk of Lung Cancer: A Study From Japan,” British Medical Journal 282 (1981): 183-85.
49. Virginia Berridge, “Science and Policy: The Case of Postwar British Smoking Policy,” in S. Lock, L. A. Reynolds, and E. M. Tansey, eds. Ashes to Ashes, 157.
50. Jacques Normand, David Vlahov, and Lincoln E. Moses, Preventing HIV Transmission: The Role of Sterile Needles and Bleach (Washington, D.C. 1995).
51. As early as 1986 an elite committee of the National Academy of Sciences, in its first report on the AIDS epidemic, urged the expansion of drug treatment and “experimenting with removing legal barriers to the sale and possession of sterile, disposable needles and syringes.” Institute of Medicine/National Academy of Sciences, Confronting AIDS: Directions for Public Health, Health Care, and Research (Washington, D.C. 1986).
52. Kenneth J. Meier, The Politics of Sin: Drugs, Alcohol, and Public Policy (Armonk, N.Y. 1994), 4.
53. Scottish Home and Health Department, “HIV Infection in Scotland: Report of the Scottish Committee on HIV Infection and Intravenous Drug Misuse,” Scottish Home and Health Department (Edinburgh, 1986).
54. Scottish Home and Health Department 4.
55. U.K. Department of Health and Social Security, “AIDS and Drug Misuse: Report by the Advisory Council on the Misuse of Drugs” (London, 1988), 1.
56. AIDS and Drug Misuse: Report by the Advisory Council on the Misuse of Drugs 2.
57. Gerry V. Stimson, “AIDS and Injecting Drug Use in the United Kingdom, 1987-1993: The Policy Response and the Prevention of the Epidemic,” Social Science and Medicine 41, no. 5 (1995): 699-716;
58. J. Parsons, M. Hickman, P. Turnball, T. McSweeney, G. V. Stimson, A. Judd, and K. Roberts, “Over a Decade of Syringe Exchange: Results from 1997 UK Survey,” Addiction 97, no. 7 (2002): 845–50; 845. Syringe-exchange programs were a major policy innovation. To complete the picture of HIV-prevention facilities available to injection-drug users in Britain, it is important to point out that there are no legal barriers either to overthecounter sales of syringes or to the prescription of oral or injectable methadone.
59. Susanne MacGregor, “The Public Debate in the 1980s,” in Susanne MacGregor, ed. Drugs and British Society (London, 1989).
60. John Street and Albert Weale, “Britain: Policy-Making in a Hermetically Sealed System,” in David L. Kirp and Ronald Bayer, eds. AIDS in the Industrialized Democracies: Passions, Politics, and Policies (New Brunswick, N.J. 1992), 185-220.
61. Gerry V. Stimson and Rachel Lart, “The Relationship Between the State and Local Practice in the Development of National Policy on Drugs Between 1920 and 1990,” in J. Strang, and M. Gossop, eds. Heroin Addiction and Drug Policy: The British System (Oxford, 1994), 331-41.
62. “Ultimately,” Berridge observes, “both the tabloid press and public opinion had no effect on policy.”
63. AIDS, the Media and Health Policy
64. My account of French drug treatment professionals' ideology and its implications for their confrontation with AIDS is based on published sources and on my interviews with several of the actors involved. Published sources include: Anne Coppel, “Les Intervenants en Toxicomanie, le Sida et la Réduction des Risques en France,” in Vivre avec les Drogues (Paris, 1996), 75-108;
65. Alain Ehrenberg, L'Individu Incertain (Paris, 1995)
66. Roger Henrion, Rapport de la Comission de Réflexion sur la Drogue et la Toxicomanie (Paris, 1995)
67. Emile Malet, ed. Santé Publique et Libertés Individuelles (Paris, 1993).
68. Monika Steffen, “France: Social Solidarity and Scientific Expertise,” in David L. Kirp and Ronald Bayer, eds. AIDS in the Industrialized Democracies: Passions, Politics, and Policies (New Brunswick, N.J. 1992), 221-51;
69. Aquilino Morelle, La Défaite de la Santé Publique (Paris, 1996).
70. Mary Douglas, Risk and Blame, 32.
71. Sheila Jasanoff, “American Exceptionalism and the Political Acknowledgment of Risk,” Daedalus (Fall 1990): 61-81;
72. Stephen G. Brint, In an Age of Experts: The Changing Role of Professionals in Politics and Public Life (Princeton, 1994), 200.
73. Brian Wynne, Risk Management and Hazardous Waste, 421.
74. Decisions to appoint a committee of the “great and the good” and the choice of committee members are not, of course, made in a political vacuum, nor are the deliberations and decisions of these committees apolitical. For an excellent account of their use to suppress and distort “knowledge” in the case of mad cow disease, see: David Miller, “Risk, Science and Policy: Definitional Struggles, Information Management, the Media and BSE,” Social Science and Medicine 49 (1999): 1239-55.
75. Brint, In an Age of Experts, 195.
76. Ezra N. Suleiman, Elites in French Society: The Politics of Survival (Princeton, 1978), 4.
77. Michèle Lamont, Money, Morals, and Manners: The Culture of the French and American Upper-Middle Class (Chicago, 1992).
78. Bruno Jobert, “Mobilisation Politique et Système de Santé en France,” in Les Politiques de Santé en France et en Allemagne, ed. Bruno Jobert and Monika Steffen, 73-81 (Paris, 1994).
79. See, for example, Eric A. Feldman and Ronald Bayer, eds. Blood Feuds: AIDS, Blood, and the Politics of Medical Disaster (New York, 1999).
80. Litfin, Ozone Discourses, 37.
81. Constance A. Nathanson, “Disease Prevention as Social Change: Toward a Theory of Public Health,” Population and Development Review 22, no. 4 (1996): 609-37;
82. “Social Movements as Catalysts for Policy Change: The Case of Smoking and Guns,” Journal of Health Politics, Policy and Law 24, no. 3 (1999).
83. Robert A. Kagan and David Vogel, “The Politics of Smoking Regulation: Canada, France, the United States,” Smoking Policy: Law, Politics, and Culture, ed. Robert L. Rabin and Stephen D. Sugarman, 22–48 (New York, 1994), 126.
84. Given this history, plaintiffs' tobacco litigation experts were understandably concerned that individuals bringing suit be portrayable, and be portrayed, as “innocent” of responsibility for their claimed injuries. Richard A. Daynard, “Catastrophe Theory and Tobacco Litigation,” Tobacco Control 3 (1994)
85. The New School, “Science & Politics.” Web page, February 2006 [accessed 10 March 2006]. Available at http://www.socres.org/polsci;
86. see also Howard J. Silver, “Science and Politics: The Uneasy Relationship,” Open Spaces Quarterly 8, no. 1 (2005).
87. Silver, “Science and Politics” (n.p.). Silver has been the executive director of COSSA (Consortium of Social Science Associations), the principal lobbying group for social science, since 1988.