Artifacts: A Historical and
Sociological Perspective
by Dr Philippe
Tellier CMNA Clinique Sainte Catherine
Arras, France According
to the Webster dictionary on-line, artifacts can be defined in six ways: i) any
object made by human beings, especially
with a view to subsequent use; ii) a handmade object, as a tool, or the remains
of one, as a shard of pottery, characteristic of an earlier time or cultural
stage, such as an object found at an archeological excavation; iii) any
mass-produced, usually inexpensive object reflecting contemporary society or
popular culture, such as artifacts of the pop rock generation; iv) a substance
or structure not naturally present in the matter being observed but formed by
artificial means, as during preparation of a microscopic slide; v) a spurious
observation or result arising from preparatory or investigative procedures; vi)
any feature that is not naturally present but is a product of an extrinsic
agent, method, or the like, such as statistical artifacts that make the inflation
rate seem greater than it is. Only
one word and at least six definitions which include a lot of “subdefinitions”.
It is time to have another look on artifacts and such an approach deserves an
historical perspective which underlines the subtle and everlasting interactions
between facts and artifacts. Facts are included in artifacts in a way that
reflects the know-how and intelligence of humans at a given time or in a given
paradigm when they decode or analyze complexity in order to survive and to
define strategic adaptations to an unpredictable environment which is more and
more remodeled by... artifacts themselves. Far from the beginning: a new kind
of artifacts
At the beginning,
artifacts were only handmade objects or simple tools and archaeological
research is looking for them in order to understand the history of human kind
or the habits of a cultural community. Following this primordial stage, more
and more complex techniques developed and new artifacts appeared, which were
more and more related not only to technology and methodology, but also to
conceptualization as those artifacts are included in the “common sense” under
the pressure of the “dogmatic thought”. Nowadays,
the time has come to consider methodological artifacts as a new concept that
has drastic consequences from an individual and social point of view. From
facts to artifacts, there is the ghost of mystification and manipulation and
such an historical evolution needs to be taken into account. It is time to
consider that methodological artifacts are everywhere in science, medicine and
society, from medical images to all the other areas of human knowledge more and
more dependent on technology. Their
major sociologic impact has to be analyzed in depth, as they may become
autonomous social constructs which are able to hide themselves everywhere and
to dissimulate reality to everybody, leading to the implementation of a
deleterious social “false-consciousness”. Artifacts as
reflections of an historical paradigm From
a phograph’s point of view, reflections belong to the human imagination and
imaginary as much as reality and their ephemeral nature is an incentive to
pursue them. Reflections hide themselves there where the eye does not enter,
except in moments... of intense reflection. Let us develop this analogy between
artifacts and reflections with a sociologic point of view. Artifacts
are the reflections of interactions between human imagination and imaginary
representations, and the real world itself. They look like the photography of a
given historical paradigm with its uncertain limits and moving shapes that are
determined by driving forces coming from the society and his main actors, such
as science, media and public power. Moreover, artifacts are not always
accidental, because they might be predetermined by unconscious processes which
result in the bad choice of erroneous methodologies resulting in bad data and
hypothesis that are transformed into incredible certitudes with the help of
mediatic tom tom and public power. The principle of precaution as the new “gold
standard” in the approach of innovation and novelty plays a major role into
this process, as the more and more powerful conservative lobbies are involved
in an incessant benchmarking of artifacts which deserve their more fundamental
interests. The
sociological impact of artifacts is going to increase, as techniques and
methods become more and more sophisticated, more and more uncontrollable and
hermetic. Moreover, only a few specialists are able to understand those
techniques and methods which escape to universal criticism and are more and
more separated from the community of knowledge. Some artifacts are those new
social constructs, those ideas which might appear to be natural and obvious to
those who accept them. An artifact might be invented by some classes of the
society, those who have power and knowledge, in other words, some experts and
politicians leading the same struggle against truth and objectivity. The
notions of real and unreal are themselves social constructs, of course and real
things might just be a matter of social convention, everybody knows that, but
is it necessary to aggravate such a pitiful situation? Artifacts
are becoming major players of the social construction of reality. They hide
themselves there where the critical sense, the eye of science and epistemology
cannot enter. Impact of artifacts in Biology and
Medicine
In 1988, Nature
published a famous paper about high dilution experiments (2) which resulted in
the controversy on « the mind of water ». Secondly, in 1997, the British
Medical Journal published a case-control study which established « convincing
evidence in childhood leukemia of a causal role for environmental radiation
exposure from recreational activities on beaches » (3). The imperfections of
our methodological approach of more and more complex problems have been clearly
underlined by the conclusions of both affairs. Without critical sense and
validation of some data by other researchers, one might now consider that water
has some mind (4) and that living near a nuclear plant significantly increases
the risk of leukemia in childhood. «La Hague controversy» which ended by the
refutation of its conclusions by other more plausible epidemiological data
clearly underlines the limitations of a simplistic approach of complex
problems. Reports
of multiple sclerosis developing after hepatitis B vaccination have led to the
concern that this vaccine might be a cause of multiple sclerosis in previously
healthy subjects or lead to relapses of this disease. The results of two
negative large case-controlled studies recently published in the New England
Journal of Medicine (5, 6) provide some good evidence that: firstly, there was
no relation between the receipt of hepatitis B vaccine and the development of
multiple sclerosis; secondly, that the administration of vaccines against
hepatitis B, influenza, and tetanus did not exacerbate the clinical course of
multiple sclerosis in patients in whom the disease had already been diagnosed
(1). Those results confirm that hypotheses can become “facts’’ long before the
critical data are in our possession.
Nevertheless, in France, the problem is not solved and there are still
juridical debates and affairs about the role of hepatitis B vaccination in some
cases of multiple sclerosis or even other neurological disorders. The lobby
against vaccination is more powerful than in other countries and its social
impact is stronger. Another
affair concerns the hormonal treatment of menopause. For years, it was told to
women that this treatment was the best way to alleviate the functional and
physical consequences of menopause while preventing its complications.
Recently, the contrary was claimed. Why? Because of both methodological and
conceptual artifacts which answered to the confusing paradigm of everlasting
youth and financial interests where medicine is in one’s element. Observational
cohort or case-control studies which
represented 95 % of the available epidemiological information before the introduction of hormone
replacement therapy were... the cornerstone of the medical attitudes of beliefs
on this matter (7), instead of controlled studies which were published
thereafter and demonstrated that the ratio benefit/risk of hormonotherapy in
the treatment of menopause was unfavorable. “A more rigorous evaluation of
side-effects of hormone replacement therapy in the framework of long-term
controlled trials was therefore clearly required. The indications of such a
treatment should only rely on objective data... “(7). In
fact, contrary to some allegations, risk of breast cancer and cardiovascular
disease was significantly increased by such a treatment, whereas efficacy in
terms of prevention was really modest (8), and throughout the world, hormonal
replacement therapy in menopause was considered as undesirable, except in some
selected indications (8). The next example is chosen among another famous
affair which might be called: the saga of fenfluramines (1). As in others,
negligence of both human and technical factors resulted in artifacts and severe
errors of judgment which could be predicted by the current paradigm where the
principle of precaution is directed against innovation and risks. The
fenfluramines saga is an intellectuously well-orchestrated symphony where ultrasound
imaging and epidemiological methods play the most important role, but where are
the diagnostic standards that guarantee the validity of the whole partition?
The analytical dissection of the partition shows numerous contradictions and
pernicious artifacts which are not compatible with a scientific standpoint (1). From methodological artifacts to mystification From
a more general point of view, methodological artifacts is a term to be used in
order to describe those spurious observations which result from all the
techniques and methods, including models which are used in order to shape the
reality according to the scientific or politic beliefs characterizing an
historical period, i.e. its paradigm. An excessive trust in these sophisticated
tools is therefore characteristic of the past century, but this tendency will
continue for the following centuries, if those techniques are used without
critical sense and precaution (1). Artifacts
are obviously the most serious concurrent of facts and, more and more often, it
becomes difficult to distinguish those brothers and enemies, as they are
perfectly and “diaboliquement” intricated.
The interpretation of the results of a study or an experimentation is
sometimes too fast to allow any critical approach and these results in a
dramatic amplification of artifacts; through the overgrowing Internet. Moreover, when artifacts conceptually belong
to the current paradigm, they may be transformed by experts, media, politics
and lawyers into facts in order to support their personal convictions or
interests. Things are going faster when there is a whiff of scandal...
Artifacts when amplified by a higher and higher throughput of information
without any retroactive feed-back, such as critical sense contribute to the
merchandisation of science and medicine and in
fine to the destruction of scientific knowledge. As
wrote Thomas Fuller (1608-1661) “A lie has no leg but a scandal has wings”.
Some artifacts are in some way genuine lies, according to the level of
consciousness of the liar or the “artifacter” which depends not only of the
observer but also of his environment. The best arguments are from the best
data, which are not so easy to obtain since observation is nowadays indirect
and more and more dependent on sophisticated techniques and methods whose
limits are unknown, ignored or worse neglected. In
many cases, data are in fact largely insufficient to result in a reliable
approach of reality or scientific knowledge which remains one of the main
objectives of research and la raison
d’être of human kind. Let
us remember that artifact can be «a spurious observation or result arising from
preparatory or investigative procedures or any feature that is not naturally
present but is a product of an extrinsic agent, method, or the like». Let us also remember that methods which are
used in clinical research and science are far from perfect and that their
validation is often missing or incomplete, because “gold standards” which are
necessary to this process are rather difficult to obtain and easy to forget.
Methodological and conceptual artifacts appear to be closely related, as the
choice of methods depends of concepts that underlie the scientific approach of
a specific problem. For example, an epidemiologist will choose a case-control
study in order to avoid a fastidious longitudinal study, because, conceptually,
the first approach is easier to perform, cheaper, and commonly used to “publish
or perish”, although it is polluted by many biases that should not be ignored
in the interpretation of its results. In fact, social processes heavily
influence the very content of technology and methodology. The process of
constructing knowledge regulates itself, and since knowledge is construct,
rather than a compilation of empirical data, it is not possible to know the
degree to which knowledge reflects the ontological reality. Recent
“affairs” might recall us the major role of artifacts not only in Biology and
Medicine, but also in the shaping of reality and society, through amplification
processes that are modulated or activated by the media tomtom. Conclusion
Il it time to detect the
most modern artifacts and to understand how they are constructed, because of
their deleterious effects on the shaping of human knowledge and their major
impact on social attitudes and human behaviors. Overtrust in some techniques
and methods appears to be characteristic of the modern and the post-modern era,
particularly in biology and medicine. Dogmatic explanations are exactly the
premises of a new kind of mythology where machines and bad methodology are
deified under the pressure of media tom-tom transforming shy hypothesis into
dogmatic certitudes. Scientific knowledge might become the privilege of a
constellation of lawyers and financial trusts where science looks... like the icing on a cake. If Karl Popper
wrote “Science, scientific knowledge is always conjectural knowledge and the
method of science is the critical method...”, those words have been forgotten.
In fact, more and more often, the choice of methodology is guided by the
results that are awaited by the lobby promoting the research project. In such a
way, the artifact is conceptualized before it is confirmed by the bad data.
Such a method might be called “artifact with premeditation”. Methodological and
conceptual artifacts are emerging as a new entity requiring special attention
in the field of science and medicine, as tomorrow, with the development the
post-genomic and proteomic era, more and more artifacts are to be created, due
to the new methodologies that are being used, with major uncertitudes about
their exactitude, predictive value and reproductibility. This might be only the
beginning... A world of artifacts, both conceptually and methodologically
constructed under the pressure of social and financial driving forces might be
our bright future and this “artifactualization “of the world is our work. References
1. Tellier P. Fenfluramines,
idiopathic pulmonary primary hypertension and cardiac valve disorders: facts
and artifacts. Ann Med Interne 2001; 152: 429-436. 2.Davenas
E, Beauvais F, Amara J, Oberbaum M, Robinzon B, Miadonne A, Tedeschi A, Pomeran
B, Fortner P, Belon P, Sainte-Laudy J, Poitevin B, Benveniste J. Human basophil
degranulation triggered by very dilute antiserum against IgE. Nature, 1988; 333, 816-818. 3.
Pobel D, Viel JF. Case-control study of leukemia among young people near La
Hague nuclear reprocessing plant: the environmental hypothesis revisited. Br Med J, 1997; 314: 101-106. 4.Maddox
J, Randi J, Stewart WW. High dilution experiments: a delusion. Nature 1988; 334: 287-296. 5.Confavreux
C, Suissa S, Saddier P, Bourdès V,
Vukusic S. Vaccinations and the risk of relapse in multiple sclerosis. N Engl J
Med 2001; 344: 319-326. 6.Ascherio
A, Zhang SM, Hernan MA, Olek MJ, Coplan
PM , Brodovicz K, Walker AM.
Hepatitis B vaccination and the risk of multiple sclerosis. N
Engl J Med 2001; 344: 327-332. 7.
Tellier P, Godeau P. Ménopause et hormonothérapie substitutive. Rev Med Int
2000; 21: 445-457. 8.
Postmenopausal hormones – Therapy for symptoms only. New Engl J Med 2003; 348:
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