The politics of the surgical mask: Challenging the biomedical episteme during a pandemic

Abstract COVID‐19 has seen politicians use a selective ‘science’ to justify restrictions on mobility and association, to mandate the wearing of face masks, and to close public infrastructure. There seems to be no role for health humanities scholars as yet, but perhaps there should be. This paper considers the fate of a health humanities article on surgical mask use that was published in a biomedical journal in 2016. This article, which did not operate from within the biomedical episteme but which was in conversation with the episteme, was misappropriated on both sides of the political spectrum to justify personal beliefs around mask use in the pandemic. This mistaken misappropriation is not only evidence of the utility of the common ground shared between biomedicine and the health humanities, it is also evidence of the possibilities inherent in a future interdisciplinary involving biomedicine and the health humanities.


| INTRODUCTION
The recently published Routledge Handbook of the Medical Humanities states that it will look at its subject as 'network and system, therapeutic, provocation, forms of resistance, a way of reconceptualising the medical curriculum, concerned with performance and narrative, mediated by artists as diagnosticians of culture through public engagement'. 1 From this list one can easily abstract the general, simple, and necessary purpose of the medical humanities, which is to critique and counterbalance the cultural primacy of biomedicineor, as Paul Crawford puts things in this introduction to a different text, the Routledge Handbook of the Health Humanities, to act as a kind of 'creative public health'. 2 * In this era in which biomedicine governs the way most people think about health, a basic function of any medical humanities work is to resist that dominance by challenging the episteme. Defining my terms for a moment, and relying on the work of Norman Sartorius as I do, I intend 'health' to mean a state of balance, an equilibrium that an individual has established within himself and between himself and his social and physical environment 3,p. 663 and not the historical one in which 'health is the absence of any disease or impairment' because the former is in excess of biomedical techniques of measurement whereas the latter is entirely adjudicated by biomedicine. Or as Sartorius explains, 'If health is defined as the absence of disease, the medical profession is the one that can declare an individual healthy'. 3,p. 662 The medical humanities put forward an alternative set of methods and a different vision for what it means to be 'healthy', but the key overarching intervention remains that the field, by virtue of its mere existence, insists on contributing to a definition of what being 'healthy' means. In this article, I will consider a purpose of medical humanities scholarshipto resist biomedicine - In 'On Evidence and evidence-based medicine: Lessons from the philosophy of science', an article that unpacks the reasons behind the 'shortcomings of biomedicine for properly addressing women's health needs, as articulated by feminist scholars and allies of the women's health movement', 5,p. 2627 Feminist epistemologist Maya Goldenberg points out that biomedicine is largely an effort to manage the unruly social world in which medicine is practiced via objective scientific procedure, the movement appears to be the latest expression of 'scientism', modernity's rationalist dream that science can produce the knowledge required to emancipate us from scarcity, ignorance, and error. That society has been medicalized is a phenomenon welldocumented by scholars like Ivan Illych, 6 Thomas Szasz, 7 and Peter Conrad. 8 However, what is germane about that fact for my purposes is that such efforts tend to disguise political interests in the authority of so-called 'scientific evidence'. As Goldenberg explains, the configu- Because lockdown circumscribes the social lives of citizens largely to the space of their immediate confinement, our thinking as social beings was effectively put into quarantine because our bodies are placed in quarantine and/or social distancing. In consequence, fear comes to masquerade as 'best evidence' or, more often, as the interpretation of said evidenceyet the evidence is problematic, as are the interpretations of the evidence. ‡ Biomedicine becomes bulwark against, but also a projection of, fear. The question of to mask or not to mask, or lockdown or not to lockdown, § was run through this same process, of a confusing and contradictory evidentiary debate by scientists and, as will be seen, by people at home capitalizing on different findings and interpretations in order to justify their political orientation, broadcasting same on social media and via email correspondence. That broadcast is largely fear-driven.
Individuals with pre-existing political differences will use biomedical information to accomplish disparate political goals, abetted by the nature of data, for it is not in the nature of biomedicine to be an arbiter of anything except a numeric truth. The cultural power of biomedicine will be co-opted to serve atavistic political agendas and some of the tools required to inform the corrective -I use the word with all its baggageare the disciplines of the humanities and social sciences in general, and perhaps the field of the health humanities in particular.
For our own good, we must temper biomedicine with some alternative 'common sense'; specifically, we could bring out the inherent qualities of the qualitative approach and permit science to speak in a different way.

| CURIOUSER AND CURIOUSER: THE CULTURAL FATE OF A HEALTH HUMANITIES ARTICLE PUBLISHED IN A BIOMEDICAL JOURNAL
In his introduction to the Routledge Companion to Health Humanities, Paul Crawford writes that the 'health humanities adopt an interdisciplinary, inclusive, applied, democratizing, and activist approach to the arts and humanities in informing and transforming health care, health, and well-being'. 2,p. 3 Though the number of ways the health humanities can disrupt biomedical hegemony are numerous, the one I will develop in this article is inverse to that which Crawford encourages: rather than artisfy medicine, I wish to emphasize the contact point the health humanities already has with biomedicine. Though the fields are homologous in terms of health, they are irreconcilable in terms of their respective 'tenets', and in accentuating the common ground both fields have, one can seespeaking metaphoricallya bridge to alternative possibilities. Reveal biomedicine as an important but not total contributor to a larger concept of health and biomedicine's totalizing disguise of 'common sense' is revealed as a normative preference that poorly serves the non-normative, but which poorly serves normative demographics also. In the context of this article, itself reflective of the rise of the health humanities and a cultural phenomenon in which health humanities research is increasingly placed in conversation with biomedicine, we are positioned to critique the 'common sense' aspect of biomedicine when it comes to pandemic response.
'Common sense' is a dead metaphor to explain a dead cultural logic, a concretization of thought such that norms are assumed. The humanities and the social sciences reveal common sense's normativity, and when that exposure is done effectively enough, the humanities and social sciences face pushback. It is exactly this ratifying pushback that serves as the 'best evidence' scholars in the humanities and social sciences have concerning their contributions to public life. Via this short summary, I engaged with biomedicine on its terms so that there could be a productive conversation between fields. I brought biomedicine's data into the realm of the humanities so that both could be used, together, to make a new kind of argument, this being the work and unique contribution of the health humanities. between health humanities and public policy. The false common ground is one that operates as 'evidence' with concern to 'health'. As will be seen, this false common ground can also be thought of as a misapplication of biomedical methodologies to health humanities findings. In this misapplication, the cultural logics of one field are misappropriated for a political purpose as it concerns human health. In other words, what follows is the result of a collision between misapplications of scholarship and politics as both concern human health.
On 16 April 2020, I received the first piece of pandemic-related correspondence about the article. I wish I could provide the entirety of it as one long block quote, or even quote from a part of it, but I am wary of doing so because I would need to ask for permission for the right of quotation, this being a private missive. Based on how my article has come to be used since, I do not want to offer any encouragement for further misuse, nor do I want to provide a quote that could be further misused on social media. My first emailer reasonably pointed out that though many States mandated mask use, based on his own observations in stores he felt that shoppers and staff were touching products and their own masks so frequently that his interpretation of my articlethat surgical masks might be a falsely reassuring symbol of protectionwas true. Moreover, he added that COVID-19 was a pretense for an attack on liberty, privacy, and free enterprise due to strategically exaggerated fear by government. org. 16 The web article expands upon the nonsensical idea that surgical masks cause people to rebreathe relatively concentrated CO 2 to deleterious effects. The article uses my CMAJ piece as justification for its larger purpose, to discourage mask use, by invoking the fact that his article was 'peer reviewed', that it is found on the 'National Institute of Health's website', and that it is written by an 'M.D.' 16 The theme of the article is personal freedom, and a sinister light is thrown upon the machinations of government: 'Thus, the government's goal to encourage the continued use of facial masks is to reinforce fear so that their own risk management problems can be intensified. This, in pure terms, is nothing short of psychological manipulation and it has nothing to do with health or keeping people safe' 16 The use of the close quote at the end is particularly misleading because the implication is that it is my words which are being transcribed, but I did not write this paranoid vision. I would like to turn this argument on its head and convert the common ground of biomedicine and the health humanitiesthat both overlap via the common concern of 'health', meaning that this thematic relation can be appropriated in an overruling or dominating fashion for biomedicine's gain, as shown above on both sides of a political spectruminto more of a concept of interdependence. As I think I have shown in brief, and as feminist epistemologists like Linda Fisher have F I G U R E 1 Screenshot of a tweet from Marcos Boyington that tries to erroneously reject a health humanities paper about surgical masks for biomedical and credentialist reasons F I G U R E 2 Screenshot of a tweet from an anonymous account that derides a health humanities paper about surgical masks on the basis of its author's identity as a PhD student in "cultural studies" conclusively shown, 22 unopposed biomedical thinking as 'common sense' has caused a fair amount of harm. During the pandemic, we failed to protect the most vulnerable; poor racialized people are disproportionately getting sick. Though the plight of living in real time is that we would never know otherwise how much good has been done if we had not adopted biomedicine's imperatives, we have to admit that pure biomedicine has abdicated its role as singular driver of good outcomes.
Canadians need a fuller picture of how to respond to a pandemic, including the input of social scientists and humanities scholars, not just epidemiologists and physicians. As Mathew Mercuri has explained in an editorial that questions the rhetorical claims of what science is when governments use the term, the pandemic response thus far has been 'restricted to health fields, in particular virology, immunology, clinical medicine, epidemiology, and public health. . . [s]eemingly absent from the conversation and press briefings were (and are) experts and data from other fields, such as sociology, behavioural science, and economics'. 23 An irony of the pandemic response has been the marginalization of science within science, not only the marginalization of social sciences and humanities. I expand Mercuri's list to include personnel that could contribute to a 'creative public health' as suggested by Paul Crawford. 2 The interdependence of health humanities and biomedicine is necessary, otherwise we will continue to make the same kinds of mistakes based in 'common sense'. † † Scholars in the health humanities know that they can always be overruled in general culture if they get their biomedical information incorrect. Demonstrating a general competence with regards to the biomedical literature when generating arguments based on biomedical precepts, traditions, and oppression in humanities articles is always already open to co-optation when conclusions serve one political agenda or another, just as biomedical information itself is interpreted to justify political agendas daily. Biomedical conclusions seem to have greater currency than the humanities-based argument that surround perceived simplistic conclusions. But if a pandemic forces information-starved people, out of fear, to willfully misread a health humanities article in a prestigious biomedical journal, then we obviously are in the midst of a crisis bringing opportunity. The present moment is forcing disparate communities and motivations into relation. There is a willingness to consume information that, thus far, biomedicine has not provided an answer for on its own, that it cannot on its own. Yes, there is an unfortunate premium put on biomedical information, no matter how illegitimate it is, as long as it serves desired political ends. My adventure in biomedical co-optation and invalidation is evidence that the common 'theme' of health in the health humanities and biomedicine requires fully realized visions from both fields in order for the theme itself to be achieved in Canadian society.
It is evidence of an opportunity to try to explain what is lacking in our collective imaginations. To have a fuller understanding of health, we need to stop making the category error; it is worthwhile to point out to biomedicalists that they, too, make a category error when considering health only in terms of numbers. As scholars, we need to keep critiquing biomedicine while publishing alongside biomedical papers. In time, the dominant belief that the body-is-data may shift slightly towards an understanding that the body-is-embodiment. Just as the 'science is shifting' in the pandemicthe justification for changing public health recommendationswe need to shift science too, for the good of public health.

CONFLICT OF INTEREST
Author declares there is no conflict of interest. ENDNOTES * There is currently a branding war happening in the field, whether 'health humanities' or 'medical humanities' is a more appropriate designation for what is ultimately the same kind of work done by the same people. I personally see the rhetorical benefit in preferring 'health humanities' insofar as it is a more inclusive term, not privileging the institutions of medicine itself (ie medical education for one) but ultimately I think it a potato/potatoe battle, thus I use the terms interchangeably and on purpose in this article and in life. † As Maya Goldenberg has pointed out, a key elision at the heart of biomedicine's perpetual success, perhaps especially during a pandemic in which the scientific evidence from which one makes recommendations is limited: 'By framing the problems of biomedicine as problems of (lack of) evidence exclusively, the assumptions, methods, and practices of scientific medicine go unquestioned'. 5,p. 2630 The ultimate political maneuver is to obscure the terms of the debate themselves such that we are already operating within the preferred episteme. ‡ What seems like 'best evidence' one moment is thrown out the next.
Canada's Chief Medical Officer of Health Dr. Teresa Tam has had to walk back the claim that wearing facemasks is not an effective public health measure in pandemics. 10 § Canada first imposed lockdowns before it endorsed the use of face coverings. ¶ So much critique of the institution of medicine comes from the health humanities while failing to recognize that reparations require a two-way street. It is tempting to say that the institution of medicine requires almost reflexive pushback, but more wisely, it is biomedicine that deserves an almost-reflexive pushback. I distinguish the episteme and practice from the people who do both kind of work.
** Circa 2016. The literature review was completed pre-covid 19, an event which would throw out a lot of accepted notions. † † Perhaps the most obvious first intervention concerning masks and the health humanities might be to flip the perception of masks as symbols of fear to, instead, symbols of care and concern for others.

DATA AVAILABILITY STATEMENT
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.