Alice Dreger, Galileo’s Middle Finger: Heretics, activists and one scholar’s search for justice, Penguin Books, 2016, Rs 389, Paperback, ISBN-13:978-0143108115

Galileo’s middle finger?! And how exactly is Galileo or his middle finger relevant to heretics, activists and social justice?

The relic of Galileo’s middle finger, author Alice Dreger tells us, is preserved in Florence, Italy, placed pointing skywards – something which she has interpreted aptly and humorously as a message from Galileo, the heretic, to the world at large. Subsequently, this mummified member is perceived by the author as a personal talisman: are minder (albeit a mythical one) of Galileo “as a person who could see beyond his own needs”. She adds that it may “take a hundred years and a thousand people” to sort out who or what is right; that maybe the best that can be done at this time is to share the truth as you see it with all. Seeking the truth and justice at all costs is the central focus of this book however arduous that journey might be.

As a historian of medicine and science, and as an activist, the author weaves together her knowledge of the past with contemporary scholarship and activism, presenting important intersections and polarisations.

Dreger has written the book as a personal account of her involvement in a series of controversies and struggles. Through this account, she discusses critical issues and challenges in the spheres of science, activism, feminism, ethics and rights and their implications for the search for truth and justice. The personal narrative form allows the reader toconnect with and share her journey through the spectrum of issues raised here. Reading the 287-page book can take longer than expected because, at each page, one has to frequently contemplate and contextualise the arguments that Dreger makes. Although the content of the book is situated in the USA, where the author lives and works, it constantly resonates with the histories of science, ethics, scholarship and activism elsewhere, including in India.

While the author discusses several controversies, she dwells on five of them in some detail. The first of these arises from Dreger’s involvement in the intersex rights movement in America in the 1990s. This push into “contemporary sex politics and contemporary medical activism” follows from the author’s doctoral thesis on how Victorian British doctors dealt with cases of “doubtful sex” – to “protect long-standing social distinctions between men and women” and tried to obliterate “true hermaphroditism”. The author, who was involved in the campaign against doctors who performed unnecessary and harmful genital surgeries aimed at “normalising” children born intersex or with “ambiguous genitalia”, and prescribed hormone treatments etc, brings to the fore the medical fraternity’s deep-seated biases about sexuality and gender. She also discusses the obfuscation of the truth by medical institutions, families, and others that kept several intersex children in the dark about their bodies. This had serious physical and psychological implications for intersex adults and gave rise to profound feelings of shame among them. Dreger describes in some detail the journeys and narratives of intersex adults who mobilised collectively to win their rights, and the sustained search for evidence that would serve to bring them justice. The author’s elaboration of the advocacy and activism to change the medical system’s perception and treatment of intersex persons gives us an insight into the multiple strategies that the movement adopted. With regard to essentialised identity, here intersex, the critical arguments presented by the author pertain to the understanding that if the work/campaign results in the care of intersex persons to their satisfaction there will be no need for a movement for intersex identity, and the recognition of the human rights of intersex persons.

The author then moves on to the Bailey transsexualism controversy which arose from a book by Michael Bailey, The Man Who Would be Queen: The Science of Gender Bending and Transsexualism, published in 2003. The author tells us that in his book, Bailey, while rejecting the idea that “anybody was simply male or simply female in the brain”, suggested that “gender identity is probably not a binary black and white characteristic”. He presented the understanding of male-to-female transgender on the basis of sexual orientation rather than gender identity, along the lines of a previous work by a Canadian scholar, Blanchard. He termed this type of male-to-female transsexualism “autogynephilia”, for which there is also a French phrase, “love of oneself as a woman”. The scholarship that Dreger presents is extremely varied and interesting. She traces the politics of transgender versus transsexualism through this controversy, putting forward clearly the trans activists’ rationale for rejecting or moving away from the focus on sexual orientation to that on gender identity.

The manner of opposition and protest by some transgender activists, however, flag serious concerns, according to the author. Some examples that she shares are those of gate keeping and misinformation by the activists who were opposed to the theory; non-proven charges of sexual assault on transgender persons whose narratives were featured in the book; personal attacks through the use of sexually abusive language; and pictures of Bailey’s children. Dreger, however, emphasises the role of activists who were supportive – not necessarily in agreement with Bailey’s views, but against the curtailment of free speech and against censorship.

Dreger then moves on to an arena that involves another book, A Natural History of Rape, by the anthropologist, Craig Palmer, and Randy Thorn hill. The book “explored biological explanations for forced sex”. Dreger elaborates that the co-authors stated that rape “had a sexual component to it and contrary to several feminists, rape wasn’t an expression of unadulterated power”. The authors clarified that they did not wish to condone rape or those who commit it, and they hoped that the understanding emerging from their work would contribute to the prevention of rape and the prosecution of rapists. Dreger’s narrative follows the consequences faced by the authors – ranging from public and media bashing to serious death threats (which she urges the reader to contemplate). She warns against the danger of silencing such scholarship, which many may not agree with but which should be allowed to thrive in a milieu of freedom of thought and speech.

Dreger’s reputation and engagement with controversies precedes her, it seems. People, particularly in academia and in difficult circumstances due to their work and scholarship, reach out to her for support in bringing out the facts, the truth. Thus, Dreger is called upon for her support in another controversy that involved Napoleon Chagnon, an anthropologist who had worked with the Yanomamo tribe in South America. Allegations of atrocities (discussed in detail in the book) on the Yanomamo people were levelled against Chagnon by a journalist, Patrick Tiernay, in his book. Dreger’s unravelling of the evidence indicates deep-running falsification of data and information. She is particularly disheartened by the fact that Chagnon was given no room to present his side of the story in the search for the truth and, therefore, justice. Dreger acknowledges the support of some peers who attempted to find the truth and counter the allegations being made, while reflecting on the substantial number of peers who remained silent or complicit with the counterfactual.

The final controversy, relating to prenatal “off-label” use and administration of dexamethasone in the case of congenital adrenal hyperplasia to prevent intersex development in female foetuses, centres around Dr Maria New, a paediatric endocrinologist. Dreger highlights a range of very serious ethical violations, ranging from harmful non-evidence-based practice to “normalise” children, to violations of the norms of informed consent, to misrepresentation of the treatment given to pregnant women as being proven rather than experimental and several other issues. The practising physician as a researcher conducting a trial/research and the ethical implications for informed consent are some of the other concerns dealt with. The fact that the weak or non-functional systems of ethical review which, according to Dreger, did not spot and take action against those seriously flouting ethical norms, despite a whistleblower raising an alarm, points to the veritable rot in the system – in the academic institution, as well as within regulatory and oversight agencies set up at the highest tier to uphold truth, ethics and justice. In such a scenario, bioethicists would be expected to be on the side of truth and justice, but this controversy has shown up tremendous violations in the areas of publication ethics, conflicts of interest and non-transparency in reporting such conflicts.

Summing up, Dreger reiterates the need for activists and scientists to work collectively fortruth and justice to prevail. She acknowledges that the line between activists and scientists has become increasingly nebulous: activist groups are collecting data and conducting research, and academia is using research that it has carried out and the data collected for advocacy to further the truth and justice. The author opines that “justice cannot be advanced by letting truth be determined by political goals”.

Dreger cautions that advocacy and scholarship face serious threats today: Academic tenures have been undergoing a radical transformation for the worse. She is sceptical about the false sense of strength and organisation that the social media and Internet may be giving rise to, and the way in which the space for activists and advocacy is shrinking. She also reflects on certain assumptions and biases that we hold, for example (from the above controversies), the perception of “white male scientists” as bad and evil “soldiers of the old establishment” and “we”, on the other hand, as progressive and on the side of social justice. However, these “white male scientists” had progressive views on transgender rights and were actually willing to be involved in complex scholarship. They, according to the author, cared about social justice and also about what was true.

The following are some of the several concerns raised by the book for readers to contemplate. Should/can justice for the oppressed be built on false information and allegations? What are the ethical imperatives that social justice movements and scientific research should be founded on? Although truth and justice are in some ways inseparable, does truth (as in this instance, Bailey’s theory) automatically enable justice, or are there multiple “truths” (for example, regarding the focus on sexual orientation versus gender identity) that need strategic and contextual consideration? Does truth always precede justice or does justice also determine the truth? These and other areas, such as the hegemony of knowledge and scholarship within countries, may have benefited from some more unpacking and analysis.

Finally, as Dreger says: “If you want justice, you must work for truth and if you want to work for truth, you must do a little more than wish for justice.”