Brief comment: Efficacy in the hands of clinical trial participants

by Gideon Lasco, MD, MSc

"...it is not only medical professionals who are determining the efficacy of these pharmaceuticals. So too are the individuals enrolled in the trial. Any pharmaceutical or medical product will most likely only be used if people consider it to be effective and appropriate." - Gelling medical knowledge: innovative pharmaceuticals, experience, and perceptions of efficacy (Saethre and Stadler, 2009) 

In their paper, Saethre and Stadler (2009) give voice to participants in a clinical trial of a vaginal microbicidal gel in South Africa, saying that these participants and their partners ascribe various parameters to the gel independently of and prior to the establishment of the gel’s effects by the scientists, and regardless of what they were actually getting – the gel itself or a placebo. These parameters, they suggest, draw on local notions of gynecology and physiology, as well as their own ‘felt’ experiences of using the gel.

Theoretically, there is nothing new in this concept of efficacy that has been conceptualized and applied in various settings (Etkin, 1988; Tan, 1999; Nicther, 1995 to name a few examples). As Whyte, van der Geest, and Hardon note: "In real life, efficacies are assessed not by pharmacologists but by social actors." However, the innovativeness of this paper lies in its application of notions of efficacy to clinical trials, which are interesting because they are the site of first contact between novel products and lay individuals. In a more applied and collaborative research, Pool (2011) looks at clinical trials as ‘cultural trials’, asserting the importance not just of controlled measurements but also what the patients feel about the drug in evaluating new pharmaceuticals. Montgomery and Pool (2011) echo the same rationale, essentially calling for ‘representation’ in the process of developing drugs for prevention.

The benefits of this ethnographic voice in making drugs ‘better’ make me reflect on the role of anthropologists in the pharmaceutical industry in general, mindful of the underlying political economy. What guideposts do anthropologists have in this kind of work? How do we draw the line between the anthropology of pharmaceuticals and anthropology for pharmaceuticals?

Amsterdam
October 2013

The two waves of sociocultural evolutionism in anthropological thought

by Gideon Lasco, MD, MSc

Social evolutionism (also cultural evolution or social evolution), in the context of society and culture, is the view that societies progress from one stage of development to another, and that culture is an adaptation; a survival strategy at the level of the species. In the history of anthropological thought, this idea gained currency twice, in two similar but distinct forms. The first, which we now term as unilineal or classical evolutionism, developed during the 1870s-1890s, amid much interest in Darwinian philosophy, espoused by Edward Tylor and Lewis Morgan. The second, neoevolutionism, was espoused by Leslie White, Julian Steward, Marvin Harris and others in the middle of the 20th century and to some extent remains influential in contemporary anthropological thought via cultural ecology.

The first wave of evolutionism came during a time when Western thinkers were seeking to explain social changes, heavily influenced by the rapid transformations that were occurring in their society at the time. Industrialization and technological advances were supporting larger cities which in turn created unprecedented social conditions – incidentally also inspiring Marx and Engels to craft their own explanations that eventually led to another evolutionary perspective: historical materialism. The colonial enterprise also introduced Western thinkers to what they conceived as ‘primitive societies’, giving rise to archaeological and ethnographic endeavors and subsequently, comparative studies, which was what Tylor and Morgan engaged in.

The epistemological context at the time was a heavily positivistic one, which held that in the same way that there are natural laws that describe biology, chemistry, and physics, similar laws can also be found for societies. Thus when Darwin’s theory of evolution among organisms spread in the intellectual world, social scientists were inspired to look at similar processes among societies. It was not unprecedented to examine societies in terms of processes. The Scottsh economist Adam Smith did the same one century earlier, offering four stages of social development. The contribution of Edward Tylor was to offer various cultures to support a view of evolution – a comparative method - claiming that cultures follow distinct phases of development, using various features such as religion as markers of that development, much as biological evolutionists would look at bipedalism or mammary glands.

Lewis Morgan developed a similar view, holding that features of culture like kinship, system of government, and concept of property can be used to measure different societies’ stage of development. By adopting a unilineal view of evolution, classical evolutionists assumed that “primitive cultures” such as the tribes in Australia – the site of Morgan’s fieldwork – were in an earlier stage of development.

Classical evolutionism was criticized as unsupported by ethnographic data, vigorously attacked by likes of Franz Boas, but the view that ‘culture’ is an adaptation to the environment, and Morgan’s view that material considerations are the driver of cultural change was resurrected in another generation. The important distinction between this new generation and the old evolutionism, however, was that most of them did not believe that cultures have to pass through the same stages of evolution. Instead, each culture takes a different course depending on its environment. Moreover, instead of the comparative method, they used empirical approaches. Gone were the ‘conjectural histories’ as Radcliffe-Brown described the classical evolutionists of old. Harris, for instance, used calculations of energy efficiency in analysing India’s ‘sacred cow’. Leslie White even placed energy consumptiom as a measure of cultural development.

Eventually, neoevolutionists’ focus on material culture and technology would influence latter-day cultural ecologists.

REFERENCES

Harris, M. (2001). The rise of anthropological theory: A history of theories of culture. AltaMira Press.

Stocking, G. W. (1968). Race, culture, and evolution: Essays in the history of anthropology. University of Chicago Press.

Social media and the 2016 elections

by Gideon Lasco

How exactly will social media shape the upcoming elections?

It was US president Barack Obama who demonstrated the usefulness of social media in 2008, when his campaign used Facebook to penetrate young people’s social networks and encourage them to vote. Two years later when Noynoy Aquino ran for president, social media was not as big in the Philippines: in mid-2010, there were only 10 million Facebook users in the country, compared to 40 million today.

The 2013 elections did attract the attention of netizens - remember the Nancy Binay memes - but it was a mid-term election, sans the fanfare that usually accompanies the vote to determine the highest office in the land. With the presidency at stake, 2016 is promising to become the most “trending" of Philippine elections. Here are some ways social media is making its mark:

A more participative platform
Social media is a platform for candidates and voters alike to engage in the political process in a more direct way. Through their fan pages, candidates can directly share their thoughts and photos without being filtered by traditional media. As Mar Roxas learned in his “happy anniversary” faux pas (a topic I addressed in “Social media advice for Mar Roxas”; PDI 09/15/2015), social media engagement has its pitfalls - but it can also be a rewarding way to connect with voters, especially the youth.

Voters, for their part, through their posts, comments, and annotated “shares”, can influence their social networks - a hypothesis that has received support from a 2012 study published in Nature, which demonstrated that what Facebook users see in their “news feeds” can affect their voting patterns. While others have argued that it has only amplified partisanship (i.e. we only read and share the articles we agree with), it has undeniably made the public more involved and aware of what’s happening.

Aside from expressing ideas, the direct access to (and by) the public can be a tool for change - as showed by the anti-pork “Million People March” in 2013, largely organised through social media. Though the “million people” did not materialise, it nonetheless offered a glimpse of what social media can enable.

(Mis)information wars
Websites and Facebook pages can easily be set up, and made to look like respectable news outlets, while subtly espousing an political agenda. Of course, already-established websites and blogs are not immune from the influence of politics and can also contribute to misinformation.

Sometimes, the truth will be sacrificed for the sake of virality. Articles will go for the shareable, the scandalous, the dramatic. They will follow the format of articles guaranteed to attraction your attention (i.e. “Ten reasons not to vote for Binay” or “The shocking truth about Grace Poe”).

But social media can also offer a venue for people to fact check the information they’re overloaded with. In the US, websites like FactCheck.Org are fulfilling this role, and their articles are widely shared in traditional and social media.

Cyber-‘hakot’ and online vote buying
As of this writing, Binay has 230,000 Twitter followers, Roxas has 505,000; Grace Poe has 45,200. In an age when influence is measured by the number of followers you have on social media, expect this numbers game to be closely watched - and contested. Through paid-for “sponsored posts” in Facebook and Twitter - and with the help of online entrepreneurs who “sell” likes and followers - candidates can appear more influential, more famous, and yes, more vote-worthy (everybody loves a winner).

It is not just “likes” and “follows”; even comments can be manufactured or “planted”. One study showed that 1/3 of all customer reviews and comments online are fake, and it won’t be surprising if the same can be said of political comments.

These, of course, are old political tricks, the logical extensions of the “hakot” crowds and actual vote buying employed in traditional politics. But they also raise issues of legality and transparency:  can the COMELEC keep track of campaign expenditures online, and monitor cyberspace for violations?

Will Facebook ‘likes’ translate to votes?
Ultimately, it will be the actual votes, not Facebook ‘likes’ - or Twitter ‘favorites’ - that will matter (that is, of course, assuming that vote buying isn’t a factor). Though it is projected that 60% of Filipinos will have access to the Internet by 2016, it will not be representative of the population: the poor and those living in rural areas will be underrepresented. Thus social media sentiment - or online surveys, for that matter - cannot be taken to be the voice of the nation.

But social media itself can increase voter turnout  by turning the elections into a social, shareable, fashionable activity - a phenomenon that some scholars call “digital peer pressure”. In the same 2012 study I cited above, another key finding was that people were more likely to vote if they saw a message showing their Facebook friends had voted.

How else will social media affect the elections? Will an ingenious campaign jingle, “break the Internet”? Will a YouTube video or a tell-all blog post, revealing a hitherto unseen side of a candidate, go viral days before the elections and affect his or her chances? Because of its relative novelty - and the ever-changing world of Philippine politics - it is unwise to make further predictions.

All we can say at this point is that social media will definitely be a key battleground where the elections will be fought.

What is a rant? Reflections on social media negativity

by Gideon Lasco

Ranting is such a common behavior nowadays that many rants are devoted to ranting. In our age when expressing one’s opinion is as easy as typing a few lines and pressing a button, no one wants to be called a ranter - or a whiner or a hater - but a lot of people actualy rant without acknowledging that they are, in fact, ranting. Thus many people, overwhelmed with the negativity, are distancing themselves from Facebook; while some go on a “social media holiday”. One of my friends has even deactivated his social media accounts completely, lamenting that the world has been ran over by a “generation of ranters.”

But what, exactly, is a rant? According to the Merriam-Webster dictionary, a rant is “to talk loudly and in a way that shows anger; to complain in a way that is unreasonable.” This definition is a good starting point, telling us that a rant is a way of communicating or complaining that is (1) loud (2) angry (3) unreasonable.

How can one be “loud” in social media? The most obvious is the lavish use of ALL CAPS, but there are other ways to be loud. Making use of a photo, for instance, makes one’s message “louder” - images can be very powerful and memes are the poetry of our time. Ranting goes for the dramatic, the sensational.

As for “anger”, we can easily see this with the choice of words. Curse-words - although their currency has been grossly inflated and they don’t have the same gravity anymore - are staple fare for rants. But a rant can also incite to anger by insulting others through witticisms, name-calling, or logical-sounding arguments. Directing the anger at someone also makes it more weighty (so-called “open letters”), and ranting is at its best when it is not just angry, but accusatory.

The crucial test of ranting, however, is whether something is “unreasonable” or not, and this is where its subjectivity lies. Many Filipinos won’t say that the Philippines is ranting about the Spartlys dispute - we would think that our claims are reasonable, and our anger warranted. Neither will many consider as mere “rants” the online posts expressing outrage over repressive regimes that gave rise to the Arab Spring. As these examples show, one man’s “rant” is another’s “grievance”.

Perhaps the non-confrontational attitude of Filipinos makes social media a particularly suitable venue to express our sentiments. Psychologist John Suler termed this the “online disinibition effect”, which draws from the sense of anonymity and distance to free people from their inhibitions, thinking that there will be little backlash for what they would say.

Rants are oftentimes signs of helplessness; people do not rant if they think there are other ways to communicate their message. Indeed, ranting satisfies the need to release one’s negative emotions, while at the same time offering the chance that the addressee would actually listen. On the other hand, oftentimes enmeshed in this need to communicate is a desire to get noticed by the social media universe; the desire to go viral. Thus instead of being a last resort, it becomes the first. Consequently, it feeds a culture of outrage, where attention is validation.

***

IN THE multitide of ideas and sentiments floated on social media, there are many ways to stand out. You can inspire people with beautiful pictures, enlighten them with a well-written thinkpiece, or make them laugh with your pet’s funny expressions. Psychological studies, however, have shown that “negative emotions are more contagious than positive ones”, as Finnish scholar Harri Jalonen puts in. This “negative bias” makes it understandable that many people resort to ranting.

The criteria for reason, however, should give us pause for what we label as “rants”. While some posts are clearly rants, there simply is no objective criteria we can apply for the “reasonability” of every post. During the APEC week, when people in Metro Manila were thrown into miserable traffic conditions, I observed that the people who experienced the traffic themselves “liked” and “shared” posts that gave voice to their predicament, while those living elsewhere were more likely to dismiss them as “rants”. This subjectivity of what constitutes a rant reminds us that in the act of labeling people's viewpoints (either as rants or “painful truths”; “whining” or “telling it like it is”), we engage our own ideologies, politics, and (limited) knowledge.

We should strive to move away from a “ranting culture” by delivering our messages in a way that does not incite people to more anger. If social media is social, then we must abide by social conventions: respecting others’ points of view, not taking different opinions personally, and if called for, arguing with reason, not with anger. And if social media is media, then we are all journalists now, and if we express outrage, we must do so with a committment to truth and fairness.

As for those who are in the receiving end of a rant, we should likewise exercise restraint - as well as an openness to what might actually be a valid argument. Dismissing something as a “rant” will only inflame its source. Ranting about a “rant”, like fighting fire with fire, is equally unhelpful. The cycle of ranting, ranting about ranting, and so on, ends when someone on the receiving end of a rant reads through the rant and tries instead to find out where it’s coming from.

Do we, then, need a new set of values - in this age of social media? I don’t think so. I think we just need to bring back the old ones - starting with humility.

Manila
December 11, 2015