What accounts for the prestige of quantitative methods? The usual answer is that quantification is desirable in social investigation as a result of its successes in science. Trust in Numbers questions whether such success in the study of stars, molecules, or cells should be an attractive model for research on human societies, and examines why the natural sciences are highly quantitative in the first place. Theodore Porter argues that a better understanding of the attractions of quantification in business, government, and (...) social research brings a fresh perspective to its role in psychology, physics, and medicine. Quantitative rigor is not inherent in science but arises from political and social pressures, and objectivity derives its impetus from cultural contexts. In a new preface, the author sheds light on the current infatuation with quantitative methods, particularly at the intersection of science and bureaucracy. (shrink)

This article provides an overview of the analysis of technological zones. A technological zone can be understood as a space within which differences between technical practices, procedures and forms have been reduced, or common standards have been established. Such technological zones take broadly one of three forms: (1) metrological zones associated with the development of common forms of measurement; (2) infrastructural zones associated with the creation of common connection standards; and (3) zones of qualification which come into being when objects (...) and practices are assessed according to common standards and criteria. The article argues that technological zones can have more or less clear borders, but such borders increasingly do not correspond to the borders of nation-states. Through a discussion of the global oil industry, some of the ways in which the formation of technological zones has become critical to contemporary economic and political life are examined. (shrink)

In 1995, the Dutch Minister of Health proposed that a randomized clinical trial (RCT) with heroin-maintenance for severe abusers be conducted. It took nearly four years of lengthy debates before the Dutch Parliament consented to the plan. Apart from the idea of prescribing heroin, the minister and her scientific advisers had to defend the quite high material and non-material costs that would arise from employing the randomized controlled design. They argued that the RCT represented the truly scientific approach and was (...) the royal way to unambiguous results. In the present article, I question this common dual justification of RCTs. First, I situate the historical origins and the basic assumptions of the ideal experiment in 20th-century economic liberalism. Secondly, using the Dutch heroin experiment as an example, I discuss human-science experimentation as an attempt to create reality rather than merely record it. Finally, I discuss some surprising responses by heroin users. These responses display the assumptions of RCTs discussed in the historical section, and underline the importance of the culture of heroin use. In the epilogue, I suggest that cultural aspects of heroin consumption can best be studied by thorough ethnographic research. (shrink)

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. (...) Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm. (shrink)

Does it work? This question lies at the very heart of the kinds of controversies that have surrounded complementary and alternative medicines (such as herbal medicine) in recent decades. In this article, I argue that medical anthropology has played a pivotal and largely overlooked role in taking the sham out of the placebo effect with important implications for what it means to say a therapy or drug `works'. If pharmacologists and clinicians have corporeally located the concept of efficacy in terms (...) of bio-availability, pharmacodynamics and pharmacokinetics, and herbalists in terms of a herbal revitalizing of the body's own vis medicatrix naturae, from the early 20th century onwards medical anthropologists (especially those who became interested in the `savage mind') have built up an equally rigorous theory of symbolic efficacy in terms of narratives, symbols and a kind of cognitive homeostasis. It was precisely as a mediating link between the somatic and the symbolic that I suggest a decriminalized placebo effect (as opposed to suggestion) could emerge in the middle of the 20th century. Taking the example of St John's Wort, I go on to show how notions of symbolic efficacy, spillover placebo efficacy and bio-efficacy co-circulate in recent attempts by herbalists, clinicians and pharmacologists to address the question of whether or not this herbal remedy `works' in the treatment of depression. (shrink)

Defacement asks what happens when something precious is despoiled. In specifying the human face as the ideal type for thinking through such violation, this book raises the issue of secrecy as the depth that seems to surface with the tearing of surface.