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.


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

Popular posts from this blog

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…

Anthropology and advertising?

I read an interesting article on trend forecasting today. I've always found this fascinating (and wonder how much anybody checks later to see if the forecasters were right). The only thing that bothered me about this one, and this is not new, is the claim that what they do is like cultural anthropology. This is not a diss on advertising, marketing, trend forecasting, or any of the other fields that claim to be like anthropology--these folks to interesting work.

I am just annoyed at the claim itself. Granted, we anthropologists are not always good at advertising that we offer a holistic approach, and theoretical insight based on our training. So anybody who observes people is now an anthropologist. Or is it just that Americans are so used to sound bites that they don't understand the nuanced differences in anything?


Tweets and Yams

I originally signed up for Twitter (@lxmack) a while ago, but didn't really do anything with it--no tweets, no followers. Then had a couple of friends sign up to follow me...still didn't do anything. A few weeks ago I thought that I should give it more of a try...and I have to admit that I still don't get it.
I suppose I could come up with plenty of things to tweet about (the process of buying a new washer, the mystery of the blood in the house) but it seems time consuming and I am not sure who wants to know. My colleague John Braun very kindly encouraged me and gave some great advice, the most intriguing of which was his comment that Twitter can act like a group brain--ask a question and get an immediate answer.
On the flip side, I joined Yammer about the same time I tried to get active on Twitter. Best quick explanation of Yammer is that it's like Twitter for inside a company (you have to have a valid email address on your corporate domain), without the 14o character…