Artifacts: A Historical and Sociological Perspective
by Dr Philippe Tellier
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.
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.
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: 1835-1837.
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