Low-intensity epistemic war. Medical communities and the development of legitimate knowledge in times of radical uncertainty

The Covid-19 pandemic offers an unprecedented opportunity to investigate knowledge-making practices and associated epistemic conflicts. In addition to the conflict between the scientific community and social groups that opposed controversial positions, we argue that the pandemic has been the backdrop of a less visible ‘epistemic war’ within the medical field, as the radical uncertainty paved the way to challenge the postulated universality of the hierarchy of evidence underlying Evidence-Based Medicine. Given this background, the study focused on the emergence of several physicians’ networks providing home treatment in the early stages of SARS-CoV-2 infection in Italy. Such communities of practices produced and shared knowledge and, in some cases, sought external legitimacy from the scientific community, policymakers and public opinion, thus acting as an epistemic community and coming into conflict with dominant epistemic agencies. In this ‘low-intensity epistemic war’, disputants intended to reaffirm or challenge the balance between the parties and not to annihilate the other side. By focusing on different epistemologies and practices in contemporary medicine, this study offers a more articulated and nuanced framework in which the claim of what is ‘true’ is shaped in a broader set of professional relations, ongoing scientific debates, and epistemic and political institutions