I could tell you how many steps make up the streets rising like stairways, and of the degree of the arcades' curves, and what kind of zinc scales cover the roofs; but I already know this would be the same as telling you nothing. The city does not consist of this, but of relationships between the measurements of its space and the events of its past...A description of Zaira as it is today should contain all Zaira's past. -Italo Calvino, Invisible Cities

Tuesday, April 18, 2006

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.

1 comment:

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