Scientific Hegemony and the Field of Autism

Abstract

Autism is one of the twenty-first century’s most contested illnesses. Early controversies around vaccine harm have irrevocably structured the field of autism science. Despite incredible investment in genetic research on autism over the past 30 years, scientists have failed to identify a set of “genes for” autism, and genomic causality has become more complex. Yet, orthodox genetic explanations for autism have retained dominance over a vociferous field of heterodox experts pointing to a series of environmental insults (vaccines, heavy metal exposure, overuse of antibiotics, toxic pollution) as the main causes of autism. To make sense of this puzzling trend, we develop a novel theoretical synthesis combining a Bourdieusian field analysis with a Gramscian conception of hegemony, centered around the concept of “subsumptive orthodoxy.” Analyzing multiple years of archival data from the Interagency Autism Coordinating Committee, we argue that when faced with heterodox challenges, dominant members of the field shore up hegemony by incorporating environmental causal factors into the genome, thus engaging in subsumptive orthodoxy. This move gives rhetorical space to environmental explanations without providing them substantive causal weight, which renders particular environmental causes (like vaccines) impossible. This article traces the strategies dominant members of the field use to retain control over the definition and etiology of autism. We develop the broader implications of the study within autism science and beyond.

Technologies of Expertise: Opioids and Pain Management’s Credibility Crisis

“…A growing body of sociological work examines the conditions that precipitate and insulate against crises of expert credibility (Alexander 2018;Decoteau and Daniel 2020;Eyal 2019;Panofsky 2014). In his work on the "societalization of social problems," Alexander (2018Alexander ( :1049 argues that the "societalization" of problems happens "only when [problems] move outside their own spheres and appear to endanger society at large."…”

The bad expert

“…Finally, the bad expert – or how cultural figures are mobilized to do things related to credibility, knowledge and professions – could be used to explicate other cases. In the case of autism science, for example, Andrew Wakefield, who erroneously linked autism to vaccines and was later stripped of his medical license, could be theorized as a kind of bad expert figure against whom mainstream autism science reacts (see Decoteau and Daniel, 2020). 3 Bad expert figures need not be so public or controversial, however.…”

From Medicine to Health: The Proliferation and Diversification of Cultural Authority

“…Medical professionals and agencies, such as the National Institutes of Health’s National Center for Complementary and Integrative Health, have also aimed at controlling alternative medicine by subjecting treatments and supplements to rigorous studies of safety and efficacy. Yet CAM proves a slippery object to control (e.g., Decoteau and Daniel 2020). Studies show that most patients do not disclose their use of alternative treatments to their physicians (Chao, Wade, and Kronenberg 2008; Cohen, Cerone, and Ruggiero 2002), and the actual use has not diminished.…”