Skip to main content

Medical compliance and social issues

There is a contest here to find interesting things patients do to increase their adherence to their drug regimens. That is of course the 6 million dollar question that the whole medical profession is asking, and there are even international conferences around it.

As an anthropologist, I find the more interesting question is why people are not compliant. My friend Ari Shapiro did an interesting study on this, noting that "Ethnography opens up the issue by entering the private space of pill-taking to understand the beliefs, relationships, and activities that contribute to patient (non-)compliance." The abstract for his paper is available at the EPIC website, but you have to be a member of Anthrosource to get the whole thing.

His study, as well as many articles in the popular media, point to the fact that compliance is about much more than remembering to take pills at the right time. Medications can make people feel awful, or look awful, or be unable to participate in important family events. Teenagers with cancer don't really believe they might die. The list goes on.

Interestingly, in my (admittedly very cursory) research, it looked like HIV/AIDS patients are a constituency which overall is very concerned with being compliant, but it is difficult because of all the cocktails and combinations of meds that must be taken at different times. I found several instances of people looking for community solutions (say text messaging each other) to help remember. I am not sure why this is different that other diseases (if in fact it is, or just a sampling error in my own research) but it is interesting nonetheless.

Comments

Anonymous said…
There is a large biomedical literature on this topic. although I haven't seen many applied anthropologists examing this issue. Most work is not systematic and there is little descriptive or formative work. Most interventions are not very empowering, which means that persons taking medications (especially for chronic diseases) have to examine their realities (including aspects of daily life (time management), quality of life, finances, cultural values and beliefs, etc.; and then come up with their own solutions collectively (as did the people with HIV who text message each other). People also have to believe that the treatment is effective (that it works) compared to the effects of the medications. For example, it is well known that the discomfort with hypertension medications is high because there are no or few symptoms when one does not take them. In addition, survival may not be that important to the elderly given their declining quality of life. People do need information support (reminder) systems. As applied anthropologists, we have to be careful ethically in our studies because we should not be taking the side of commercial biomedical establishment, and dedicate ourselves to promoting questionable medical practives and products.
Jose Arrom j.arrom@comcast.net
9:50 AM
Post a Comment

Popular posts from this blog

Storytelling

A couple of years ago I organized a conference session on storytelling as a means to communicate anthropological findings in non-academic environments. Storytelling is central to anthropology as a discipline—not only do we all study some aspect of human story, the stories of the cultures we study are key to our understanding of them. Stories become mechanisms for collaboration and change, as well as carriers of history. But we don’t always stop to think about the stories we tell, even though anthropologists regularly use storytelling as a communication device. In order to be relevant in settings dominated by non-anthropologists, we must not only pass on the data we have gathered, but convey its importance and convince decision makers in business, design, development, public policy, environment, and a myriad of other fields. Constructing these stories involves editing and carefully choosing what to relay to our audience. Delivering the stories involves performance on many scal...
6 comments
Read more

Kids Day and India

Last Friday was bring your kid to work day at Pitney Bowes. It's all very fun, begins with breakfast and a magic show, followed by tours for the older kids, then a big outdoor picnic. I was a tour stop, "Let's Travel to India." They put the kids in groups by age, since some of the stops are better for older or younger ones...I ended up with groups ranging from about 8-13 years old. It was fun but exhausting. I figured the point was more fun than educational, so pretty much I set up a slide show to talk about the fact that we invent stuff by understanding how people live and work, and asking what they knew about India. Answers: lots of people, cows...Showed them pics of cellphones, malls and offices and lots of things that look pretty similar in India as in the US, then pictures of things that look different. Fun to see their reactions. They all noticed the Subway in the mall, and they all recognized the well in the village and understood what it was for and that...
6 comments
Read more

Fishies

Today I am reflecting more on ichthyology than anthropology. Our big event last weekend was setting up an aquarium--10 gallon, freshwater tank. Did a bit of research beforehand, mostly consisting of asking people with some existing knowledge what we should do, but arguably, not very much prior investigations, other than when I was a kid we had several aquaria in the house (not to mention dogs, turtles, birds, snakes--we were pretty well supplied with pets). So, a week ago Saturday we got the tank, set it up, got the water in. Next day went to get fish, relying on the guy at the Petco who assured us our choices were OK for a starter tank. Get home, introduce them to the tank, Kurt decides to read up some more on our new friends. Learn one is in fact not such a friendly species and might torment the others--so back to the pet store for a fish exchange. At that point, we did more web research, which I have to say is more confusing than anything else--a case of too much information and som...
4 comments
Read more