Infernal Alternatives and Alternative Medicines: Navigating the Post-Factual with William James and Bruno Latour

Introduction

In today’s post-factual era, the proliferation of falsehoods and half-truths (Gess, 2021) alongside rampant conspiracy theories is thriving. As Margaret Levi argues, ‘ascendant populist parties around the world and Trumpism in the United States’ have ‘self-consciously “weaponized distrust”’ of many forms of authority, including scientific expertise (Levi, 2022). It is therefore not surprising that, as this culture threatens to engulf us in its maelstrom, those who strive to resist often do so – with good intentions, though not without pitfalls – by leaning toward the opposite stance: unwavering faith in scientific evidence and hard, unquestionable facts. Whether discussing the toxicity of electromagnetic waves (Prignot, 2025), the risks associated with new vaccines, the promises and perils of genetically modified organisms (Stengers, 2018), or so-called complementary and alternative medicines (Helmholtz Gemeinschaft, 2019), we are continually pushed to align ourselves with one of two opposing views: For or Against, Either/Or.

This pressure to take sides tends to conceal the fact that reducing complex realities to binary choices or seemingly clear-cut alternatives inevitably comes at the expense of nuance and differentiated understanding. The problems generated by these logics extend far beyond surface-level concerns; they accumulate momentum and gain existential traction along the way. The Either/Or logic – regardless of which side we choose – exerts an authoritative and ultimately antidemocratic force demanding blind adherence. Consequently, my concern here is not to defend either pole – neither scientific rationality nor alternative medicine – but to examine how this structural reduction to two antagonistic positions has itself become a dangerous weapon shaping contemporary public life.

This raises several questions: How can we escape the reactionary and reductionist traps that Stengers and Pignarre (2021) describe as ‘infernal alternatives’? ¹ How to achieve this without directly or indirectly promoting the widespread dissemination of clearly manipulated, false – even though superficially scientific – claims about reality? And how can we counteract their spread without falling back into, however differently articulated, claims to neutral, value-free, independent, and universally valid scientific facts (Douglas, 2021; Haraway, 1988; Harding, 1991; Latour, 1988, 1993)? To put it differently, could the Fridays for Future rallying cry – captured in the widely used hashtag #UniteBehindTheScience – offer the kind of orientation we need? My answer is both ‘yes, certainly!’ and ‘no, absolutely not!’ Everything depends, as I will argue, on where and when the motto is invoked, and in relation to which concrete issue, on the one hand, and to which conception of science – whether with a capital ‘S’ or a small ‘s’, and in the plural – it refers, on the other.

In the political context of climate action, #UniteBehindTheScience undoubtedly constitutes a legitimate and necessary rallying cry against climate skeptics and other dubious lobbies with negationist agendas. Yet like any slogan, it risks becoming a predatory mantra when treated as a universal principle demanding unquestioning loyalty, detached from the situated reasoning that gives it meaning. First, it implicitly presupposes a unity among the sciences and their distinct modes of knowledge. Following justified demands – such as urging governments to align environmental policy with geoscientific research (a demand they too often ignore; Conway and Oreskes, 2010) – this presupposition, secondly, inadvertently fosters and revives an abstract cult of ‘neutral’ facts. And it does so although the epistemic inadequacy and the political perilousness of such an unrealistic cult – that goes hand-in-hand with the role experts play in our technocracies – has been repeatedly demonstrated by STS scholars. Such an attitude, as Sheila Jasanoff puts it, is expressed in a ‘discourse of truth’ that ‘seeks to abandon the messy battleground of epistemic pluralism by escaping to a position above the fray, seemingly untouched and untouchable by political winds’. It thereby ‘allows knowledge-makers to speak as if from a viewpoint untainted by cognitive bias, subjectivity, or special interest’ (Jasanoff, 2022). Jasanoff and other STS scholars have also shown that the pretense of speaking from ‘nowhere’ has actively contributed to producing populations marked by radical aversions to, and profound distrust of, the sciences. Nonetheless, this cult is – often for understandable, defensive reasons – today becoming increasingly celebrated in politically moderate, left-wing, and ecologist circles.

Seen from this vantage point, it appears that defending the authority of science as an impenetrable fortress – one that must never be questioned – paradoxically often inadvertently participates in undermining and eroding it. Put differently, by demanding indiscriminate adherence to Science with a capital ‘S’, such a posture risks further widening the very chasm of distrust that divides our societies and that it is meant to bridge. This chasm, however, has its roots, partly at least, in modern sciences’ long-standing habit of claiming exclusive access to reality, disqualifying all other ways of inhabiting and knowing the world as mere beliefs or opinions. It should not be surprising that ignoring the historical effects of this habit – especially concerning relations of trust between society and the sciences – allows old tensions, visible at least since the late 19th century, to catch up with us. This is why I argue that despite the well-meaning intentions that underscore calls for a generalized #UniteBehindTheScience, the rationales that animate such appeals deserve our critical vigilance.

Navigating these murky waters is no easy task. It is certainly impossible to create a universally valid compass that could consistently guide us toward a less violent and destructive journey. Therefore, this endeavor must be approached incrementally. Concretely, this article takes the exploration of what I consider a slippery transposition as its starting point: a new mode of disqualifying so-called complementary and alternative medical practices (CAM), particularly homeopathy, by invoking the authority of ‘Science’ justified through the need to counter climate change denial and other negationisms. Therefore, section two takes up a brief and seemingly marginal controversy from recent German health politics. It is precisely this marginal status that renders the episode a productive entry point for thinking beyond the discursive saturation generated by Trumpism. Suspending this noise temporarily is crucial if we are to clarify what is at stake in confronting the logics of ‘infernal alternatives’ imposed on us by contemporary right-wing populist formations and their hyper-liberal political imaginaries – alternatives that have come to structure our present with a seemingly unavoidable force. On closer examination, however, the controversy also proves paradigmatic. It shows how the injunction to ‘unite behind the science’, legitimate and necessary in climate politics, shifts meaning when transposed into another domain. Sections three and four trace these pitfalls back to broader developments in the history of science and epistemology since the late 19th century. William James – astute diagnostician of his contemporaries – provides a particularly revealing entry point for this. Following his diagnoses according to which the moderns’ measureless ‘love for method’ and their equally measureless ‘fear of being duped’ risk tearing a ‘hideous rift into the human world’, I argue that these characteristics gradually solidified into an increasingly powerful but nevertheless questionable epistemic convention over the course of the 20th century. The medical realm is paradigmatic in this respect. Accordingly, section five problematizes evidence-based medicine’s tendency to forget its own modes of abstraction, thereby turning methodological devices into ontological verdicts and defends the importance of methodological memory. In conclusion, by revisiting the ‘science wars’ and subsequent criticisms of constructivist approaches in STS, I argue – in the footsteps of William James and Bruno Latour – for the urgent need for a culture of the And that is at once stubbornly realist and constructivist. Such a culture, I propose, may help us resist infernal alternatives without reverting to the binary epistemic habits that nourish them.

‘Unite Behind the Science’?

In 2019, a group of predominantly young politicians from the German Green Party reignited a long-standing debate on whether the costs of alternative medical interventions and remedies, particularly homeopathy, should be covered by the public health insurance system. In a written motion addressed to their own party, these members opposed the continuation of reimbursements for homeopathy and other complementary and alternative therapies (CAM). Their argument rehearsed a familiar critique: because no effective substances in homeopathic globules can be verified at the molecular level using established scientific methods, the financial burden placed on the solidarity community for these remedies is unjustifiable. As they put it:

One of the principles of our policy is to take account of scientific facts and use them as a basis for policymaking. Neither should science determine policy, nor vice versa. Based on this fundamental conviction, we are calling for an update of green health policy. We advocate scientifically sound, evidence-based and solidly financed medical care for all. The financing of treatment methods that are demonstrably ineffective beyond the placebo effect is incompatible with this principle. (Motion German Green Party, 2019)

At first glance, there seems to be little new in this argumentation. And indeed, homeopathy has faced similar criticism ever since its inception. However, there was one small yet significant novelty in the 2019/20 debate that lends it a paradigmatic quality concerning the timely issues this article sets out to explore: the repeated invocation of the motto from Fridays for Future, ‘#UniteBehindTheScience’. For instance, in November 2019, an article in Der Spiegel stated:

‘Fridays for Future’ demand: ‘Listen to the science!’ And the Greens also refer to the findings of climate researchers in the fight against the climate crisis. In other areas, however, the party struggles with science-based policies. Since its foundation, the Greens have also appealed to voters who are sceptical of evidence-based medicine. (Der Spiegel, 2019)

A year later, in 2020, the Green Party’s Executive Committee dissolved the working group that had initiated the motion – presumably motivated by concerns about alienating part of its electorate. During this episode, the appeal to uphold ‘scientific findings’ in matters of CAM was reiterated yet again, this time by members of the Social Democratic Party (SPD). In a commentary responding to the dissolution, health expert and politician Karl Lauterbach – who would become the German Health Minister in 2021 – sharply criticized what he perceived as the Greens’ inconsistency:

In my view, it is a tragedy that the Greens cannot bring themselves to taking some distance from this humbug [. . .]. When it comes to climate protection, they rightly refer to science. Now they are stabbing science in the back when it comes to using completely ineffective, magical medical methods without any scientific basis to the detriment of patients. (Lauterbach, 2020)

According to Lauterbach, such behavior borders on the ‘schizophrenic’. While this accusation may appear coherent at first sight, a closer examination invites hesitation. What happens when the motto of Fridays for Future is transposed from climate politics to the domain of medical care? What does it mean to treat this transposition as self-evident, as if no conceptual or practical consequences were at stake? Does this not presuppose – contrary to decades of Science and Technology Studies – an unrealistic and politically risky unity of ‘the sciences’ as an unquestioned premise?

Indeed, this unexamined transposition is problematic in at least two respects. First, it indiscriminately aligns CAM users and practitioners with contemporary forms of negationist propaganda, placing them in the shadow of climate denial despite profound differences in motivation, organization, and power. Second, decreeing a generalized obligation to ‘trust science’ – without specifying which science, in which context, on what grounds, and in relation to which adversaries – risks functioning as an authoritarian gesture. That is because it is a stance that, implicitly at least, presupposes that its agents no longer have the obligation to justify their position. On the contrary, it tacitly suggests that some actors ‘know’, while others merely ‘believe’, whether they are climate change skeptics or homeopathy users. Despite the good intentions that underpin attempts to protect citizens from misinformation and charlatanism, the reference to climate change and its skeptics – and the transposition of the hashtag #UniteBehindTheScience – raises concerns about the right and necessity to continuously interrogate all knowledge practices, including biomedical ones. The implied suspension of critical analysis regarding research protocols, universal criteria of evidence, or the situated validity of clinical practices – criteria that should supposedly be accepted identically by everyone and everywhere, independently of experiences to the contrary – is epistemologically, ethically, and politically indefensible. Faced with postfactual infrastructures and their destructive effects, it is therefore crucial to resist the reflex of demanding unconditional trust in ‘Science’, no matter the context or stakes. Such an ‘enlightenment-driven’, defensive massification of science and truth, as a reaction to reactionary positions, risks indeed exacerbating a destructive tendency inherent in the tradition of modern scientific rationality – one that we cannot afford to overlook.

The full extent of this destructive force first became visible toward the end of the 19th century, particularly in relation to the then-nascent life sciences. Among the thinkers who recognized the multiple dangers of a scientific posture that demanded blind adherence to its methods was the physician, experimental psychologist, and founder of American Pragmatism, William James. He warned that such an authoritative stance would inevitably foster social disintegration and mistrust in the sciences – a process he believed was already underway. According to James, the sciences were indeed at risk of shooting ‘a hideous rift into the human world’ (James, 1987 [1896]), and they would need to exercise extreme vigilance if they wished to prevent this rift from widening into an unbridgeable chasm. James identified what he called ‘the fear of being duped’ (James, 1956 [1897]), along with an excessive desire for respectability, as key catalysts of these developments – catalysts that largely continue to shape contemporary controversies and form part of the epistemic traps examined in the next sections.

The Fear of Being Duped

In The Will to Believe, James puts forward an intriguing diagnosis concerning the moderns, and his contemporaries in particular: They are, James says, to an exorbitant degree driven by the fear, or even the ‘horror of being duped’ (James, 1956 [1897]). This fear serves them as something like a founding myth, and a shield supposed to protect them from becoming prey to the persuasiveness and seductive risks they consider to be inherent to irrational attachments, ill-founded beliefs, subjective interests and imaginations which they judge – in the name of progress – as historically (and culturally) overcome, or rather: to be yet and again overcome. Overcoming them means fighting against all forms of obscurantism: charlatans, spiritualists, believers of all kinds must be silenced. The fear of being duped, according to James, haunts the sciences and the humanities alike; it surfaces whenever they are faced with enigmatic facts, ambiguity, equivocation – in short, with puzzling phenomena that cannot be domesticated and accounted for by their pre-established abstractions. Rather than adjust their concepts to these recalcitrant realities, James argues, most scientists prefer to turn a blind eye, thereby insuring the status quo (James, 1956 [1897]).

The shield against the fear of being duped is made of excessive forms of rationalism, a measureless love for method, and not least gestures of disqualification that hide an inability to deal with equivocations that goes hand-in-hand with an exaggerated taste for what I have proposed to call ‘infernal alternatives’: something exists, or it does not exist – it is either subjective or objective, imaginary or real, either a belief or a fact. The scientific, presumedly neutral perspective seems to ensure a position of control. As such, it is not a mere preference for careful inquiry; rather it shapes the very self-image of modern scientific culture as the domain of those who know, in contrast to others who merely believe. The moderns, James continues, have become so preoccupied with the need to protect themselves from dupery that they have become ready to pay whatever price it takes for this protection (Debaise and Stengers, 2021; Solhdju, 2023). And taken up by this protective enterprise they have lost sight of the necessity of paying attention to the effects their fear-driven obsession entails and which, according to James, can be characterized by a generalized atmosphere of skeptical mistrust and sarcasm.

It may be important to note that William James, known as one of the first experimental psychologists in the United State and one of the founding fathers of Pragmatism, wrote The Will to Believe (first published in 1897) while he was holding the presidency of the Society for Psychical Research (SPR). In this position he was particularly familiarized with accusations of irrationality, subjectivism, a-modernity and the procedures of disqualification regarding so-called purely imaginary experiences that accompanied them. In his presidential address to the SPR one year before the publication of The Will to Believe, James launches a call for good science, for good method, and against dogmatism. Literally, his call is directed against what he identifies as the mainstream scientific laziness with respect to the research carried out on telepathy, mediumship, ghosts and ‘disturbances in haunted houses’ at the time: ‘Science may keep saying such things are simply impossible; yet, so long as the stories multiply in different lands, and so few are positively explained away, it is bad method to ignore them’ (James, 1987 [1896]). He adds:

Science means first of all a certain dispassionate method. To suppose that it means a certain set of results that one should pin one’s faith upon and hug forever, is sadly to mistake its genius, and degrades the scientific body to the status of a sect.

James’s point is not anti-scientific. He stands firmly for in-depth inquiry and, in multiple venues, called for more stringent – not looser – methods. But he was equally insistent that scientific rigor should not be confused with a generalized habit of disqualification. He thus drew a distinction that remains crucial. There are, he wrote, two basic imperatives that confront anyone seeking knowledge: pursue truth and avoid error. These are often treated as if they were equivalent, but they are not. On the contrary, how one prioritizes them ‘colors our whole intellectual life’ (James, 1956 [1897]). If the higher duty is always to shun error, then withholding assent becomes the default posture; if the higher duty is to seek truth, then inquiry must sometimes risk belief, or at least provisional commitment, where the evidence is incomplete, but the stakes are real. James captured this with a simple image: some truths can only be grasped if we ‘meet them halfway’ (1956 [1897]). An epistemic culture that refuses this risk systematically may preserve its sense of security but at a cost James called the ‘thinning out’ of reality (Debaise and Stengers, 2023).

This diagnosis did not amount to a license for credulity. James criticized both credulity and dogmatic skepticism. His charge was methodological: when scientists, in the name of discipline, refuse even to look at certain classes of phenomena, they are not defending method but degrading it, reducing science to a ‘sect’ defined by a fixed set of acceptable results rather than a commitment to follow where experience leads (James, 1987 [1896]). In this sense, the fear of being duped can become self-defeating. It starts as caution but hardens into a passion that licenses a priori exclusions. From there, James argued, it acquires political force: exclusion becomes a habit, then a norm, then a convention with institutional weight. This sequence helps to explain why, in our own time, calls to ‘trust the science’ – however justified in the realm of climate policy and elsewhere – can mutate into a generalized injunction that commands assent beyond its contextual bearings, delegitimizing inquiry into practices and experiences that do not square with standardized evidentiary regimes.

At the close of the 19th century, James was, however, not only preoccupied with the SPR’s inquiries but also with the systematic marginalization of alternative healers, already highly prominent in the United States at the time. In 1898 he testified before a Massachusetts legislative committee against a bill that was on the brink of restricting medical practice to university-trained physicians. Indeed, the bill was publicly couched as a defense of science against quackery. James did not dispute the dangers of charlatanism, nor did he doubt the need for education. He rather objected to the underlying logic: the proposed solution would, he argued, institutionalize ignorance by foreclosing investigation into practices about which little was yet known, precisely where in-depth inquiry was needed most (James, 1987 [1898]). He urged legislators to distinguish between protecting patients and protecting a professional monopoly, and he warned that the latter, if conflated with scientific rigor, would corrode the very conditions of medical knowledge and patients’ trust in it. The lesson was not that ‘anything goes’ but that medical truth – like all truth for a radical empiricist – must be constructed case-by-case with attention to its effects on the lived experiences of those concerned by it, not inferred in advance from static methodological rules treated as self-authenticating.

‘A Hideous Rift’

James’s framing resonates with later reflections on the culture of method that emerged in the 20th century. For example, Naomi Oreskes and Erik Conway, in reexamining how scientific communities reckon with uncertainty in the context of climate change, argue that the 20th century consolidated a strong preference for avoiding so called type I errors (accepting something false) over type II errors (failing to recognize something true). Operationally, this preference is embodied in statistical conventions – famously, the Fisherian 95% confidence rule – used as thresholds for accepting claims (Oreskes and Conway, 2013). Certainly, reflecting on our initial discussion, climate skeptics have strategically employed this statistical convention to justify inaction. They argue that ‘believing’ in human-caused climate change would compel them to act on knowledge that is not proven with complete certainty. Considering this assumption, it is indeed perplexing to acknowledge that the general disqualification of CAM-practices, and homeopathy in particular, is motivated by the same unsettling injunction: believing, or more accurately, acting upon something that lacks absolute certainty and may ultimately be proven ‘incorrect’ (type I error), as the ultimate horror, the horror of being duped.

Looked at through James’s lens, the codification as such, however, is not intrinsically harmful; caution is often justified. But when avoidance of false positives is elevated to the supreme virtue irrespective of context, the costs of false negatives – missed truths, delayed recognition, and paralyzed response – are discounted as if they did not exist. This asymmetry matters politically. In climate science, hyper-cautious norms historically contributed to conservative consensus statements and reticence in risk communication; empirical patterns that most citizens could feel as changing were carefully hedged in political discourse because the evidence did not yet satisfy internal thresholds. In medicine, the same asymmetry is frequently invoked to disqualify complementary and alternative practices that many patients experience as beneficial, without asking whether the available methods are calibrated to detect the specific kinds of effects and relational processes at stake. The parallel is not an equivalence; the material stakes, institutional dynamics, and power relations differ importantly across these domains. Climate denialism has been nourished by powerful actors and well-funded infrastructures, whereas CAM practices are heterogeneous, often local, and rarely backed by commensurate political or financial resources. The point is rather that a common epistemic reflex, or convention – prioritizing error avoidance abstractly – travels, in the name of science’s authority, across contexts, with markedly different and sometimes perverse consequences.

Because James anchors method in experience, he is attentive to how epistemic habits mold worlds. The refusal to ‘meet truths halfway’ can be more than a missed opportunity; it can help produce the very ignorance from which one then infers that nothing is there to be known. James put the problem bluntly when reflecting on colleagues who wished to suppress inconvenient evidence lest it disrupt the ‘uniformity of nature’: such a stance, he suggested, was less about nature than about preserving an intellectual order (James, 1956 [1897]). The real fear, one might infer, is not only being duped but losing orientation altogether. This fear can express itself as cognitive conservatism disguised as rigor. One symptom is the quickness with which the moderns attribute belief to others (as prejudice or delusion) while reserving knowledge for themselves. Another is the reappearance of what Stengers and Pignarre have called ‘infernal alternatives’: binaries that transform complex situations into stark, moralized choices – science or superstition; objectivity or subjectivism; facts or beliefs – where to hesitate is to betray reason (Stengers and Pignarre, 2021).

It is precisely here that the unreflected transfer of #UniteBehindTheScience from climate politics to the medical realm becomes troubling. As a climate slogan, the call aims at pushing governments to align policy with the best available geoscience; it functions as a countermeasure to organized campaigns that seek to cast doubt on robust findings. But as a universal epistemic principle detached from domain specific contexts, it risks becoming a predatory mantra: it presupposes a unity of ‘the sciences’, it encourages an authoritarian gesture in which some actors are said to know while others merely believe, and it tacitly suspends the need to specify which science, for what question, with what evidence, and to whom it is accountable. This suspension flattens the plural ecology of scientific practices into an abstract figure – Science with a capital ‘S’ – whose authority then stands in for the labor of inquiry. It is in the name of this figure that CAM practitioners and users can be assimilated to climate skeptics, despite the profound difference in their motivations, organization, and power. The consequence is less clarity than the substitution of one infernal alternative for another.

James’s counterproposition is not a credulous romance but a call to recenter inquiry on experience and consequences. Indeed, the pragmatist criterion asks what difference a claim makes in practice, for those directly or indirectly concerned. If, as James argued, truth is something that happens to an idea when it is ‘verified’ in the broad sense – tested in use, made to work in the world – then some truths will require a readiness to act under uncertainty with the possibility of correction. This is not an abandonment of but a shift in the temporality and ethics of evidence. Inquiry becomes iterative and responsive rather than purely adjudicative. The question is not simply whether a proposition has passed a threshold, but how our ways of testing are themselves implicated in making certain relations and effects appear or disappear. In other words, James’s insistence is at once epistemic and ethical: a culture that exclusively valorizes the avoidance of error tends to withhold trust and to erode the very relations it would need to learn from – relations among investigators, between experts and publics, and between practitioners and patients.

James’s worried concern for these questions is not accidental. Late 19th-century scientism, emboldened by the early successes of laboratory method and by a philosophical desire for unified knowledge, fostered a view from nowhere that confused abstraction with neutrality. James had already seen that this posture was as passionate as what it condemned. It claimed disinterest but was charged with a powerful affect: the relief of standing on seemingly solid ground. When he warned that such a stance would produce a ‘rift in the human world’, he named its social and political effects: sarcasm toward lay reasoning, mistrust as the default relation to others’ experiences, and a willingness to exclude inconvenient realities as the price of respectability. Our contemporary impasses – paralyzed responses to ecological disaster, the policing of therapeutic diversity in the name of standards that are real but not self-sufficient, the oscillation between demands for blind trust and resentful refusals – are intelligible as the downstream effects of such habits.

None of this denies the indispensability of disciplined science, nor the urgency of countering disinformation in climate politics. Rather, it widens the aperture within which those truths can do their work. The Jamesian wager is that a radically empiricist culture – one that refuses premature exclusions, takes seriously the plurality of sciences and the plurality of phenomena they engage, and calibrates its standards to the questions and relations at hand – would be more, not less, capable of guiding collective action. Such a culture would retain the capacity to say ‘no’ to harmful or ineffective claims, but not by drawing an abstract line in advance of experience. It would say ‘no’ from within a process that has first tried to ask what, if anything, is there to be learned, how effects are situated, what kinds of evidence are appropriate to the processes under investigation, and what stakes are in play for those involved.

In this light, the parallel between climate politics and medical controversies clarifies rather than conflates. In the climate case, the cost of excessive caution is underreaction to high impact risks; here the precautionary principle must counsel action without absolute certainty because the asymmetry of consequences is extreme. In the medical realm, the cost of excessive caution may be the foreclosing of practices that deliver meaningful relief to some patients – even if they do not fit established models – or the failure to recognize domains where relational, contextual, or expectancy effects are part of what makes interventions work. In both cases, the relevant question is not whether to ‘trust science’ abstractly, but how to bring the right resources, in the right configurations, to the specific problem at hand, while maintaining critical openness to phenomena at the margins of established frameworks.

James’s testimony against premature closure in general and medical closure in particular at the end of the 19th century thus returns with contemporary urgency. To treat the authority of science as a synonym for methodological uniformity and professional exclusivity is to confuse means with ends. If the end is well-founded care and the growth of medical knowledge, then the means must include responsiveness to experience, calibration of method to object, and a willingness to revise conventions where they impede learning. This does not amount to dissolving standards, it rather asks who gets to set them, how they are justified, and how they may need to be adapted across distinct contexts. It also asks us to be explicit about power asymmetries: who benefits from a particular configuration of standards, who is silenced by it, and who bears the burden of proof when lived realities refuse to fit.

Finally, returning once more to James’s two imperatives, it becomes clear why the fear of being duped can never serve as an adequate compass for collective reasoning. When avoidance of error dominates, we orient ourselves by negation. We then easily accept the ‘missed opportunity’ of truths that do not yet look like truths to our existing instruments. We accept, in other words, the thinning of reality as a reasonable price for security. But if the role of science is not only to protect us from error but to widen and stabilize the field of what can be known and acted upon, then the criterion must include the positive work truths do – their capacity to enrich the world’s articulations and to make it more inhabitable. This positive criterion implies, at minimum, that inquiry remains answerable to experiences that standardized procedures might overlook, and that it resists the temptation to convert situated judgments into universal obligations.

The next section turns to evidence-based medicine (EBM), where these tensions become concrete. EBM emerged to discipline clinical reasoning and to enable medical action despite uncertainty. Yet, as currently practiced, it often reifies its hierarchies of evidence and treats their outputs as if they could eliminate uncertainty. A James-informed STS perspective does not reject hierarchies; it asks how they are constructed, to what ends, and with what side effects. Above all, it asks how to balance error-avoidance with the pursuit of truths whose verification depends on attention to context, relation, and the lived consequences of care.

The Drama of Reification

If the modern fear of being duped helps explain how epistemic habits solidify into infernal alternatives, contemporary medical epistemology offers a vivid arena in which to watch this dynamic unfold. This chapter examines how such habits take shape within institutionalized regimes of clinical evidence production and how their reification narrows what is permitted to count as real. In this regard, it is illuminating to revisit an interview with a pediatric psychiatrist that Fanny Charrasse conducted in the context of her anthropological work on magnetism in contemporary France. The stance taken by this practitioner contrasts sharply with biomedical orthodoxy. Rather than assume that magnetism is ineffective unless proven otherwise through randomized, double-blind clinical trials (RCTs), he begins from the relief reported by patients. For him, this relief is not an embarrassment, an illusion, or a purely ‘psychological’ artefact, but a form of empirical evidence – evidence that may remain unproven, or even unprovable, within the frameworks that define evidence-based medicine (EBM), where RCTs and their meta-analyses are the unquestioned gold standard.

His reflections go further and advance a crucial step in the argument developed here. RCTs, he reminds us, were born out of a necessity to deal with ignorance, or rather, uncertainty. Randomization, in this view, does not produce identical groups; it produces groups that are ‘comparable’ in a precise statistical sense. What comparability means is the capacity to apply a test and to accept a known risk (classically 5%) that observed differences may be due to chance. The psychiatrist underscores the subtlety of this intellectual move, and how easily it is forgotten. Statistical efficacy, he notes, often concerns an ‘average subject’ – a construct that ‘doesn’t exist’ as an individual – yet average effects remain indispensable when strong causal theories are unavailable. EBM is thus both necessary for dealing with uncertainty and limited; it provides useful knowledge without ever telling the ‘truth’ in any total sense (Charrasse, 2023).

Following this argument, it is not the existence of RCTs that should be questioned. They fulfil a clear task with striking efficiency. The problem, rather, is the collective forgetting of the necessities and modalities that gave rise to this carefully constructed way of producing clinical evidence. When the mode of abstraction introduced to advance amid uncertainty is hidden away – consciously or not – it is often used to declare other practices null and void, or at best to relegate them to the status of ‘mere placebo’. What occurs, and keeps occurring, is what might be called the careless reification of a methodological stance (Debaise, 2017). The careful statistical compromises introduced to cope with the limits of knowledge are obscured, and the outputs of the method are mistaken for transparent windows on reality. The method comes to appear more real than the world it approximates. By forgetting the specificities that a statistical method, invented to navigate uncertainty, necessarily omits, conventional medicine infers that the worlds of health, disease, and therapeutic intervention are – or can be – exhaustively accounted for through its instrumentation. In other words, a technique devised to mitigate uncertainty is transformed into an ontological verdict: only what resists this procedure truly exists.

From such a vantage point, alternative forms of evidence – relational, experiential, contextual, embodied – are relegated to illusion. Practices that operate with different ontologies of illness, or whose effects depend on relational specificity or yet on the power of the imagination rather than on reproducible averages, are ruled epistemically suspect before the conversation even begins. This is where the fear of being duped narrows reality. What is sacrificed is not only openness to new phenomena but also the capacity to understand how different forms of knowledge construct their objects. When the origins and limits of RCTs are forgotten, when their modes of abstraction are mistaken for literal descriptions of therapeutic reality, a tool designed to navigate uncertainty becomes a mechanism for producing a false sense of certainty. The psychiatrist’s critique is therefore not an attack on EBM but could much rather be characterized as a defense of methodological memory.

To deepen this line of thought, Pignarre’s analysis of what a medication is proves invaluable. In Qu’est-ce qu’un médicament ?, he argues that biomedical therapeutics are not simply discovered but constructed through a series of operations that detach symptoms from persons, universalize them, and attach them to pharmacological entities stabilized through large-scale experimental infrastructures. None of this implies relativism or pure ‘social’ constructivism; on the contrary, pharmaceuticals’ effectiveness depends precisely on these constructional processes. Construction, here, is not a pejorative term but names the labor that makes drugs work.

Recognizing this constructedness yields a second insight: different therapeutic practices construct their objects differently. To demand that homeopathy – or magnetism, etc. – prove themselves through RCTs is not merely to impose a neutral test; it is to require the abandonment of their epistemic and ontological commitments. It is to insist that therapeutic worlds conform to a particular way of carving and stabilizing reality. This is precisely what James warned against: forcing heterogeneous phenomena into a single conceptual schema and treating the resulting exclusions as proof for their nonexistence. It is the triumph of Either/Or over the subtler logic of the And. Concretely, to apply evaluation logics that categorically exclude the imagination or other so-called confounding effects as a therapeutic instrument across diverse drug-based practices enforces a priori criteria that preempt the possible centrality of these effects within those practices’ constructions. Pignarre counters such blanket prohibitions: if certain professionals know how to ‘maximize’ placebo effects, this competence should not brand them as quacks; on the contrary it should push us to adopt non-pejorative terms and to treat these successes as objects of rigorous inquiry rather than dismissing them as irrational (Pignarre and Dagognet, 2005).

Extending this stance to complementary and alternative medicine (CAM), Pignarre urges a symmetrical, meticulous accounting of each practice’s modalities of constructing patients, symptoms, and remedies. His tentative case is homeopathy, where every element diverges from the biomedical model. Symptoms are not abstracted and universalized; they remain personal and situated. Remedies are often prepared by practitioners themselves, tailored to particular patients rather than to statistical averages. Illness, in this ontology, is not a general category into which individuals are slotted but a singular configuration expressed by a specific body at a specific moment. The homeopathic encounter thus constructs a therapeutic world that cannot be meaningfully evaluated through RCTs. Pignarre’s answer to the incessant question ‘does homeopathy work?’ is provocative. He writes: ‘It necessarily works, since it creates actors consistent with the constructing object’ (Pignarre, 1997). The point is not triumphalism but analytic clarity: actors co-constitute the therapeutic object and are in turn constituted by it. Effective therapies depend on such reciprocal processes of instauration, even though their modalities differ across practices.

To call for a culture of the And in this context is not to defend every practice indiscriminately. It is to insist on criteria appropriate to different modes of constructing therapeutic realities. The question is not whether homeopathy ‘works’ in the way antibiotics work (Brives, 2022) – that would reproduce the infernal alternative – but whether it works according to its own exigencies and obligations (Stengers, 2010): whether it helps some patients in some contexts; whether it constructs its objects responsibly, whether it generates forms of relief, recognition, or transformation unavailable elsewhere. In other words, evaluation must be attuned to the ontologies and practical logics through which a therapeutic world is enacted.

This approach does not undermine biomedicine; it clarifies its strengths and limits. It recognizes that biomedical therapeutics are extraordinarily powerful within the reality they have helped to construct, and that RCTs are indispensable within that domain. But it also recognizes that not all therapeutic realities are structured in this way. Some rely on singularization rather than universalization, on relational specificity rather than statistical abstraction, on the power of the imagination rather than on its systematic exclusion. A robust, historically and culturally aware empiricism must be able to handle both. This brings us back to James. For him, truths are not fixed essences but outcomes of relations between ideas and the experiences in which they find their consequences. A truth that emerges only for an ‘average’ subject that exists nowhere outside a statistical model may be useful, but it is not the only kind of truth that matters. To insist that only truths of this form are genuine is to participate in the thinning of reality he feared. Conversely, to acknowledge the plurality of ways in which truths may emerge is to expand the field of what can be known and acted upon.

It should have become clear how therapeutic realities are constructed, stabilized, and enacted; how evidentiary demands shape what can appear as real; and how forgetting the constructedness of these demands leads to questionable reification. Ultimately, this reification – when method becomes ontology – transforms a pragmatic device for navigating uncertainty into a rigid framework that polices the boundaries not only of particular practices but of reality itself. To resist this, a Jamesian stance calls for cultivating a radically empiricist culture of the And. Such a culture neither retreats into the comfort of infernal alternatives nor does it collapse into indiscriminate acceptance. It recognizes that different therapeutic practices construct different worlds, and that these worlds may coexist without being reducible to one another. It acknowledges that biomedicine’s strength lies in producing reliable interventions across populations, while alternative practices may produce effects that are relationally or contextually specific. And it keeps open the possibility that both can be true – each according to its own commitments and ways of knowing.

In this sense, the drama of reification is not only a medical issue but also a philosophical and political one. It concerns how we understand the relation between method and world, construction and reality, experience and evidence. It asks whether we allow the fear of being duped to narrow the horizons of the real, or whether we cultivate the intellectual generosity needed to meet truths halfway wherever it is required.

These considerations return us to the broader stakes of this article: how to describe and evaluate knowledge practices without succumbing to the Either/Or reflexes that infernal alternatives impose, and how to foster a more generous empiricism capable of sustaining a stubbornly realist culture. It is precisely here that William James’s path meets Bruno Latour’s proposition for a reconfiguration of critique.

Conclusion: Thinking in ‘Ands’ or Becoming Stubbornly Realist

Latour’s shift from ‘matters of fact’ to ‘matters of concern’ that, according to him, requires a stubbornly realist attitude inspired by William James’s radical empiricism is indeed an explicit reaction to the polemical charge that constructivism (and STS more broadly) had abetted relativism, thereby enabling the post-factual spread of half-truths and conspiracy thinking. Latour’s ‘Why Has Critique Run Out of Steam’ (Latour, 2004) explicitly confronts that claim – not only as an unfair simplification, but as an aftershock of the Science Wars – and it does so early and directly by reckoning with climate skepticism and the infrastructures that sustain it.

Latour’s intervention is not a repudiation of either critique or constructivism but a proposition to reorient both. He observes that a certain habit of critique has too often hardened into a one-way method of subtraction. It unmasked, deflated, and debunked, until its solvents were easily redeployed to corrode any claim whatsoever, including those most in need of collective protection.

For Latour, ‘matters of fact’ are a thin and polemical rendering of reality; taken as the whole of what is given, they invite a defensive metaphysics in which truth must be shored up by invoking an abstract ‘Science-with-a-capital-S’. Against this trajectory, he proposes the shift to ‘matters of concern’: things described together with their attachments, obligations, and conditions of maintenance. Facts, on this view, are not monoliths but fragile achievements held together by cascades of equipment, procedures of verification, trained bodies, institutional routines, and practices of care. Crucially, this is a Jamesian and pragmatist move: ‘matters of concern’ take relations seriously – the conjunctive tissue, the ‘and’, ‘with’, and ‘between’ through which things hang and work together – and they treat these relations as part of what is real, not as mere psychological or linguistic additions. To defend ‘matters of concern’ so understood, a radically constructivist critique must get ‘closer to them, not fighting empiricism but, on the contrary, renewing empiricism’ by adopting a ‘stubbornly realist attitude’ (Latour, 2004).

This reorientation entails methodological symmetry. Latour dissects the incoherence that results when critique alternates opportunistically between three repertoires – anti-fetishism for what others value, positivism for what our disciplines produce, and naïve realism for what we already care about – applying each to different topics so that their mismatch remains hidden. A symmetrical approach, by contrast, requires that we describe all states of affairs in the same fair way: both scientific and non-scientific objects come into existence through work, instrumentation, conventions, and alliances. The aim is not to flatten differences but to render them explicit and comparable, so that we can judge which assemblages deserve protection, which require revision, and which we should refuse. In this sense, Latour’s diagnosis that critique has run out of steam – because it reduced itself to universally applicable debunking – does not announce an end to critique; rather, his Jamesian proposition to become stubbornly realist aims to give critique new steam. This steam is made of additions to reality: of the ‘ands’ that a relational, pragmatist and carefully constructivist empiricism is able to make emerge when it keeps attachments, obligations, and conjunctive pathways in view.

For James as for Latour, conjunctive relations are just as real as the things themselves: the ‘ands’, ‘withs’, and ‘betweens’ are constituents of experience no less than the terms they connect (James, 1996). A world rendered only as isolated ‘matters of fact’ is consequently a world thinned; a world described with its conjunctive tissue, on the contrary, becomes empirically richer and politically more navigable. Reframed in this double light – Latour’s ‘matters of concern’ and James’s ‘ands’– the parallels and differences between the climate and medical cases become clearer. In climate politics, the asymmetry of consequences justifies action without (impossible) certainty. And the demand to unite behind the science should accordingly best be understood as a demand to sustain the practices, instruments, and institutions that make climate knowledge hold, and to bind it to the domains where it must guide policy. In medicine, evidence-based hierarchies remain indispensable within the therapeutic reality they have helped to construct, but they are tools, not ontological verdicts. Randomized trials abstract toward average effects and ‘model patients’ to enable comparisons – powerful within their remit, but not exhaustive of therapeutic reality. Other practices – homeopathy among them – construct different therapeutic worlds, singularized, relational, context-bound. Requiring them to ‘work’ independently of those commitments is not a neutral test; it transforms the object and then declares the remainder unreal. A stubbornly realist ² stance would instead ask how different practices construct their objects, what kinds of effects they are answerable for, how those effects can be responsibly assessed, and what stakes are in play for those concerned.

This is not a plea for credulity. It preserves the capacity to say no – to harmful claims, to ineffective interventions, to organized denialism – but it says no from within inquiry, not in advance of it. It replaces the abstract command to trust Science with specific accountability: which sciences, for which problems, with which standards, and under whose obligations. It resists the comfort of infernal alternatives and fosters a culture of additions in which multiple modes of constructing reality can be examined on their own terms, brought into productive friction where appropriate, and governed by criteria responsive to context.

If the Science Wars taught us anything, it is that debunking alone cannot sustain worlds worth inhabiting. In a post-factual age, the more exacting task is to add reality: to widen our evidentiary sensibilities, to describe objects with their attachments, to keep conjunctive relations in view. Becoming stubbornly realist is not a compromise between science and belief; it is a demand that science remain radically empirical enough to learn where its methods are strong, where they are limited, and how they can be adapted – without collapsing into Either/Or. That is the work required to resist infernal alternatives and to orient collective action – on climate, on care, and beyond – without risking thinning the world we must, together, inhabit.