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Prescribing and Drug Ingestion Symbols and Substances
... Prescribing is a social act. It demonstrates the physician's concern (155,185). Through prescriptions, doctors show their patients that they recognize their complaints and are trying to help them. The concreteness of the prescription paper presages the concreteness of the medicine. ...
... The leading role of pharmaceuticals in clinical practice is nowhere more convincing: The available medicines create the possibility of the doctor's most therapeutic act-writing a prescription-and urge him to perform it. Pellegrino (155) called it the doctor's "benediction." ...
... The prescription is not yet the medication, but for many it nearly is (61,107,155). Samuel Butler wrote in one of his Notebooks: "I read once of a man who was cured of a dangerous illness by eating his doctor's prescription." ...
▪ Abstract This review discusses pharmaceuticals as social and cultural phenomena by following their “life cycle” from production, marketing, and prescription to distribution, purchasing, consumption, and finally their efficacy. Each phase has its own particular context, actors, and transactions and is characterized by different sets of values and ideas. The anthropology of pharmaceuticals is relevant to medical anthropology and health policy. It also touches the heart of general anthropology with its long-time interest in the concepts of culture vs nature, symbolization and social transformation, and its more recent concerns with the cultural construction of the body and processes of globalization and localization. The study of transactions and meanings of pharmaceuticals in diverse social settings provides a particularly appropriate empirical base for addressing these new theoretical issues.
... The idea of transformation has also been used in relation to medical prescribing, suggesting that a prescription not only provides access to treatment but also possesses symbolic value which legitimises and transforms the presenting problem into a problem worthy of medical treatment (Pellegrino 1976). ...
... In summary, the GP uses the Internet as a source of information similar to the previous examples; however, also transforms the information from something that the patient could find themselves via a web search to a printed version shared in the consultation and endorsed for use outside of the consultation. The action of providing a printout may be seen as comparable to the 'gifting' involved in issuing a prescription for a medicine (Cooper 2011, Pellegrino 1976. ...
In an increasingly connected world, information about health can be exchanged at any time, in any location or direction, and is no longer dominated by traditional authoritative sources. We consider the ways information and advice given in consultations by doctors transcends the boundary between the clinic and the home. We explore how information that is widely accessible outside the consultation is transformed by General Practitioners (GPs) into a medical offering. Data comprise 18 consultations identified from 144 consultations between unselected patients and five GPs. We use conversation analytic methods to explore four ways in which GPs used online resources; (i) to check information; (ii) as an explanatory tool; (iii) to provide information for patients for outside the consultation; (iv) to signpost further explanation and self‐help. We demonstrate the interactional delicacy with which resources from the Internet are introduced and discussed, developing and extending Nettleton's (2004) idea of ‘e‐scaped medicine’ to argue that Internet resources may be ‘recaptured’ by GPs, with information transformed and translated into a medical offering so as to maintain the asymmetry between patients and practitioners necessary for the successful functioning of medical practice.
... For the doctor, it is the most effective way to deal with the persistent problem of shortage of time and the 'overload' of patients. Writing a prescription can best be described as a closing ritual which is intended-and often succeeds-to send the patient away with hope and positive feelings towards his medical problem, himself and the doctor (Pellegrino 1976). Moreover, it provides the patient with an official legitimisation towards his environment that he is really sick. ...
... The nurse's act is magical in its technical quality. The physician writing a prescription shows the patient a token of his concern (Pellegrino 1976), and the operation is at the same time an amalgam of ritual acts and messages that help the medical staff to perform well (Katz 1981). Biomedicine is rational and technical. ...
This article proposes to look at the ritual dimension of hospital work, a chain of words and acts, which fill patients with hope for a 'future life'. Conventional boundaries between magic, science and religion are reconsidered. The author argues that biomedi-cine, far from being a cultural no-man's land, represents the basic values of culture. It provides a space where doctors, nurses and patients find their deepest convictions and values demonstrated and confirmed. Medical words and interventions express and re-create people's belief in the canons of science and biomedicine as ultimate truth. Pointing out the religious dimension of medicine in no way belittles medicine's role and therapeutic efficacy. Rather it provides us with a better understanding of the 'mechanics' of recovery. Hospitals in the 'Western world' have been characterised as places of secularisation at the fringes of life. While it has been commonly observed that religion becomes more prominent when life is in jeopardy, the opposite seems to happen in modern hospitals where religious agents have become nearly out of place, at least in my own society, The Netherlands. Medical scientists and technicians have taken over the role of priests and other religious specialists in times of crisis and in the face of death. Such, at least, is the popular view. Medicine has become thoroughly secularised. The purpose of this article is to point out that this view of hospitals as unreligious places is based on a misunderstanding of what religion and science are. The con-ventional definition of religion as faith in supernatural beings typifies the naiveté of the—supposed—non-believer. My argument is that secularisation and medicalisa-tion constitute processes of cultural change within religion, as hospital care addresses people's ultimate concerns regarding the purpose of life.
... source of self-medication information (Sorofman, Prescribing of medicines has been identified as a 1992; Vuckovic, 1995). During an illness episode, symbol of doctors' control and power to heal individuals commonly seek information and advice (Bush, 1977; Pelegrino, 1976). For some patients, from a lay referral network (Friedson, 1961) or however, a prescription for medications may signify therapy management group (Janzen, 1987). ...
... They deflect attention away from need to resolve the underlying causes of the symptoms . There is a need to research how "chemical what the products actually do contain, including an coping" (Pelegrino, 1976 ) through medicine use array of "pharmaceutical manufacturing necessities" such as artificial flavorings and preservatives affects perceptions of acceptable risks and opporwhich may create iatrogenic effects for individuals tunity costs. How does such behavior temper response to occupational and environmental health who are allergic to them (Consumer Reports concerns? ...
In the United States, contradictions related to medicine use abound in a social environment in which the pursuit of health has become a cultural project. In a marketplace where over half a million health products are available, choices at once seem to foster agency and encourage dependency on medical fixes. The aggressive marketing of medicines as indispensable commodities co-exits with rising concerns among the lay population about what is safe in the short- and long-term. In this paper we broadly consider medication-related practice in the United States as it is affected by social, cultural, and political-economic factors. We direct attention to changes in medicine use related to product proliferation, lowered thresholds of discomfort, the economics of health care, and a revival of the self-help ethic. We also consider the manner in which the demand for and use of medications reflect deeply embedded cultural ideals and emergent perceptions of need. We juxtapose two trends in American thinking about medicines: (1) the perception that "more is better," associated with cultural impatience with illness; and (2) a growing doubt about medicine necessity, safety, and efficacy.
... (b) The cultural context As Pellegrino (1976) has noted, the act of prescribing cannot be disengaged from the larger cultural context. In order to understand recent trends in benzodiazepine tranquillizer prescribing we therefore need to consider the extent to which these may be related to changes in the degree of discomfort which is seen as tolerable in a developed society, people's beliefs about the safety of medical technology and the advantages of alternative medicines and their attitudes towards the medical profession. ...
... One source of such substances was the doctor-a person who was held in high regard for his or her knowledge and skills-and this person was increasingly turned to for help as the gatekeeper to a much-valued medical technology. It was in this era of 'pharmacological enthusiasm' (Pellegrino, 1976) that benzodiazepine tranquilllizer prescriptions grew dramatically. ...
This paper outlines a sociological approach to benzodiazepine tranquillizer prescribing. The analysis focuses on both the micro level of the doctor-patient relationship and the macro level of those political, economic and cultural factors which structure the prescribing process. This makes it possible to account for both the overall decline in benzodiazepine prescriptions in the 1980's and the fact that they are still being prescribed on a long-term basis to a significant number of people.
... Within the medical profession, the issue of drug product advertising has stimulated a literature which addresses its functional, social and ethical impact on physicians' attitudes and practices. Concerns in this literature include whether these ads disseminate spurious, inaccurate, and incomplete information about drug entities [3,4]--a concern amplified by how these ads tacitly fulfill an educational function in the profession [4,5]; that appeals are too frequently non-rational [6] or symbolic [7]; that images and content in these ads frequently build on, and perpetuate, social/sexual stereotypes [3,8]. While health professionals have focused on advertising's effects on prescribing, there has also been a residual awareness that a more significant and long-term sociological impact of these ads may be on modes of diagnosis. ...
... Reviewing psychotropic drug advertising, Stimson [29] observed that similar ads encouraged 'at-a-glance diagnosis', a form of diagnosis which corresponds to the way physicians read the ads themselves. Emphasis on an ideology or mystique of the healing powers of pharmaceutical technology [7]: (a) encourages routine use of chemical substances to deal with the experience of depression as if there existed an automatic relationship between ingestion and cure, (b) encourages physicians to discount the personal histories of patients, although individual variation is important both physiologically and psychologically. Physiologically, individual metabolism varies widely. ...
Advertisers have adopted the use of highly abstract visual metaphors and symbols in addressing physicians about antidepressant drugs. Campaigns built around an abstract visual aesthetics are designed to generate cognitive connections between named drug entities and the meaning of abstract visual images: these connections are called 'carry-over symbols'. In this study we critically dismantle and analyze the encoding practices used in two recent ad campaigns for antidepressants. In addition to asking what the ads mean, we ask how they mean it. This analysis is joined to a comparison of the information provided by these ads with the pharmacological and therapeutic properties of the drugs themselves. Our analysis suggests this style of drug advertising produces, as a social side-effect, a reified and medicalized account of psychiatric illness (depression). It also poses an obstacle to scientific discourse and understanding; privileges certain types of social knowledge concerning mental illness, psychiatric patients, and drug taking; and discourages professional d debate regarding therapeutic approaches to treating illness. These ads reflect a positivistic conceptualization of mental illness and doctoring as mind mechanics.
... Prescribing is an essential element of the medical management of most illnesses. The prescriber typically authorizes the patient to use restricted substances and treatments (Pellegrino, 1976). As of 2020, more than 131 million people-66% of all adults in the United States-use prescription drugs (Health Policy Institute, 2022). ...
Prescribing is a significant activity undertaken by physicians, physician associates/assistants (PAs), and nurse practitioners (NPs). We analyzed prescribing data to understand better the growing presence of PAs and NPs in older adults. A trend in frequently prescribed medications was compared with other physicians. All prescriptions in Medicare Part D were grouped into broad categories of drugs and linked to each type of provider. The analysis spanned 9 years (2013–2021). The results revealed that all five providers similarly prescribed the top three main drug classes (antacids, antihypertensives, and statins). In addition, there was a decline in the number of unique prescribers and prescriptions for all three types of physicians (family medicine, internal medicine, and general practice physicians). Concurrently, the number and share of prescriptions for NPs and PAs increased yearly. The findings are consistent with data that PAs and NPs are backfilling physician shortages in treating older adults.
... As others have argued, however, while prescribers and health researchers often refer to "Patient demand" as an independent factor, the desire for medicines may be better understood as relational (Britten 2008;Rodrigues 2020). Prescribing has long been understood by social scientists as a social exchange that goes beyond strictly medical purposes (Hall 1980;Pellegrino 1976;Stevenson et al. 2002), often not only meeting patients' needs but also reaffirming doctors' authority and expertise, even in the face of diagnostic uncertainty; "the repeated argument that the over-prescription of antibiotics is mainly driven by 'patient demand' needs to be further deconstructed and analyzed in concrete contextual circumstances" (Rodrigues 2020:9). ...
RESUM
Relacionada amb l’ús extensiu d’antibiòtics i altres antimicrobians, la resistència als antimicrobians és un dels principals reptes de la salut del segle XXI. Les taxes de consum d’antibiòtics a Espanya es troben entre les més altes d’Europa. A partir de la recerca realitzat a la comunitat autònoma de Catalunya, aquest article informa de les conclusions del treball de camp etnogràfic i de les entrevistes semiestructurades amb metges, amb professionals que han treballat en política i recerca d’antibiòtics i amb residents de Barcelona. Defensem que la circulació d’antibiòtics s’ha d’entendre en relació amb els processos històrics més amplis i els sistemes deficients d’atenció sanitària i social que s’han produït al llarg d’aquests.
... With medicines occupying an increasingly central place in modern contexts of ill-health management, the act of prescribing as a 'closing ritual' at the end of a consultation constitutes another (often) effective form of communication (Whyte et al., 2002). It shows that the patients' concerns are being addressed and that a solution is being provided, even when uncertainty about the diagnosis prevails (Comaroff, 1976;Pellegrino, 1976). Yet, while in some situations a prescription alone may fulfil both providers' and patients' goals and expectations (cf. ...
Interactions between healthcare users and providers are an essential but often problematic element in therapeutic processes. In many settings worldwide, there has been a general recognition of the importance of adopting care approaches that understand patients as active agents, moving away from traditional paternalistic forms of interaction. Research shows that improving the quality of communication in therapeutic encounters fosters mutual understanding and cooperation in healthcare processes, helping to create the grounding conditions for building trusting relationships. But what are the communicative mechanisms through which trust in healthcare providers is cultivated? Going beyond the traditional ‘doctor-patient’ dyad analysis, and using data from a mixed-method study on medicine use in Maputo, Mozambique, this paper explores healthcare users' expectations and experiences of interactions with public healthcare professionals (medical doctors and prescribing nurses) and community pharmacy workers (pharmacists, technicians and other attendants). The analysis evolves around various communicative and relational aspects, emphasised by users as meaningful and underpinning different qualities of care, competence, integrity and trustworthiness. These attributes were assessed based on a combination of verbal conversation and information exchange, together with the use of other (non-verbal) situationally valued artefacts such as biomedical tools and communicative rituals performed by providers. This study shows that despite healthcare providers' different attributes of competence and authority, it is mainly their communicative performances during interactions that influence whether (symbolic) trust has the space to evolve or crystallise. Moreover, while performing certain rituals may be an effective form of communication, the lack of other (verbal and non-verbal) communicative elements during the interaction may compromise patient trust in what is being prescribed or advised. Efforts to improve the quality and responsiveness of healthcare services centred around citizens' needs should take users' perspectives into account and pay particular attention to these communicative and relational dimensions.
... [71] Recognizing this, some doctors are inclined to prescribe an antibiotic to maintain good social relations with the patient; the symbolic act of prescribing a medicine eclipses treatment guidelines. [72] In LMIC, antibiotics are often seen as "strong," magical medicines, capable of both curing and preventing a range of illness. [73] However, there is considerable confusion among the public about which drugs are antibiotics. ...
Worldwide, antibiotic use is increasing, but many infections against which antibiotics are applied are not even caused by bacteria. Over-the-counter and internet sales preclude physician oversight. Regional differences, between and within countries highlight many potential factors influencing antibiotic use. Taking a systems perspective that considers pharmaceutical commodity chains, we examine antibiotic overuse from the vantage point of both sides of the therapeutic relationship. We examine patterns and expectations of practitioners and patients, institutional policies and pressures, the business strategies of pharmaceutical companies and distributors, and cultural drivers of variation. Solutions to improve antibiotic stewardship include practitioners taking greater responsibility for their antibiotic prescribing, increasing the role of caregivers as diagnosticians rather than medicine providers, improving their communication to patients about antibiotic treatment consequences, lessening the economic influences on prescribing, and identifying antibiotic alternatives.
... Prescribing is a social exchange (Hall, 1980) and "cannot be easily disengaged from its larger social and cultural contexts" (Pellegrino, 1976). Its legitimacy is contextually assessed, by both patients and prescribers, based on social and medical factors (Stevenson et al., 2002) and thus the act of prescribing at the end of the therapeutic encounter often goes beyond strictly medical purposes. ...
Self-medication, as a form of self-care, is a common practice worldwide, and often involves the use of both over-the-counter and prescription-only medicines, including antibiotics, anti-malarials and others. Increasing concerns over the global emergence and spread of antimicrobial resistance point to the need to reduce and optimise the use of antimicrobial medicines, both in human and animal health. Over the past few decades, numerous studies on self-medication with antibiotics have sought to determine the prevalence, risks and/or factors related to ‘inappropriate’ use in different parts of the world. Yet much of this literature tends to follow a rather normative approach, which regards such practices as problematic and often irrational, frequently overlooking structural aspects, situated circumstances and individuals’ own reasoning. Based on a mixed methods social science research project in Maputo, which included a household survey, observations in pharmacies and interviews with users and healthcare providers, this paper aims to discuss self-medication in light of local users’ everyday practical reasoning. While situating self-medication within local contextual contingencies, the analysis highlights the ways in which personal and socially shared experiences, articulated with forms of knowledge and information provided by different sources, shape and inform practices of and attitudes towards self-medication with antibiotics. By looking at self-medication beyond (non-)prescription use, and by examining individuals’ decisions within their socioeconomic and therapeutic landscapes in Maputo, this study sheds light on the structural and relational factors that contribute to certain consumption practices that do not always follow biomedical recommendations of ‘rational’ or ‘appropriate’ use, helping to deconstruct and further problematise the various legitimate meanings and understandings of ‘responsible’ use.
... 27 Few human experiences have as many symbolic connotations as the act of prescribing and ingesting medicines. 44 Because of their status as symbols of illness 2,10,17,18 medications were experienced as adversity by Flora, Sara and even João, who could not clearly describe what bothered him, saying that it was "a matter of the mind". The problem does not lie in the technologies themselves, but in objectification, 45 i.e., individuals perceive their body as a "broken machine". ...
Background:
Subjective experiences with medication use are individual experiences that can impact health outcomes by contributing to problems related to such use.
Objetives:
The aim of the present study was to understand the experiences of chronic hepatitis C patients who were taking chronic medications, based on the phenomenology proposed by Merleau-Ponty and connection among this experience with the essential structures of the experience.
Methods:
Data were gathered from interviews conducted with ten individuals taking long-term medications at the Viral Hepatitis Outpatient Clinic of the Alfa Gastroenterology Institute of the Hospital das Clínicas, Federal University of Minas Gerais, Brazil. The content of field diaries kept during the interviews were also used. Thematic analysis was employed, enabling the identification of the ways in which individuals experienced their medication routines, which were then reorganized to encompass the essential structures of the experience.
Results:
The researchers identified four ways patients experience daily medication use, all anchored in corporeality: resolution, adversity, ambiguity, and irrelevance. The first three were based on the perspective that daily medication use is more than a mere mechanical action, involving changes in the phenomenal body, relieving, eliminating or causing symptoms in the physical body, normalizing life and symbolizing the disease.
Final considerations:
The present study allowed the researchers to infer that the same individual can even simultaneously experience daily medication use in different ways, depending on the disease and the medication in question. It also allowed for the understanding of the cyclical nature of experience with daily medication use, being that the introduction of a new medication can give rise to a new experience. The results point to the complexity of this experience, which requires formal education and places health professionals as responsible for this aspect of care.
... The drug-centred model can support psychiatrists to rationalise and reduce medication when it is ineffective or harmful and to resist inappropriate prescribing. Doctors often feel an expectation to prescribe, with some patients viewing a prescription as an acknowledgement of their suffering and non-prescription as a denial (Pellegrino, 1976). The disease-centred model can reinforce these expectations, and patients may become trapped in a cycle of ever-increasing medication, because the social and personal drivers of symptoms are obscured. ...
Aims
This article explores an alternative understanding of how psychiatric drugs work that is referred to as the drug-centred model of drug action. Unlike the current disease-centred model, which suggests that psychiatric drugs work by correcting an underlying brain abnormality, the drug-centred model emphasises how psychiatric drugs affect mental states and behaviour by modifying normal brain processes. The alterations produced may impact on the emotional and behavioural problems that constitute the symptoms of mental disorders.
Methods
Arguments are put forward that justify the consideration of the drug-centred model. The research necessary to support the prescription of drugs according to such a model is explored.
Results
Evidence from neurochemistry and comparative drug trials do not confirm the disease-centred model of drug action. Since psychiatric drugs are recognised to have mind- and behaviour-altering properties, the drug-centred model constitutes a plausible alternative. The drug-centred model suggests that research is needed to identify all the alterations produced by various sorts of drugs, both acute and long term, and how these might interact with the symptoms and problems associated with different mental disorders. This requires detailed animal and volunteer studies and data from patients prescribed drug treatment long term, along with placebo-controlled and comparative trials that look at the overall impact of drug-induced alterations on well-being and functioning as well as symptoms. Research is also needed on alternative ways of fulfilling the function of drug treatment. The moral aspect of using drugs to modify behaviour rather than treat disease needs honest and transparent consideration.
Conclusions
It is hoped this discussion will encourage the psychiatric and pharmaceutical research community to provide more of the information that is required to use psychiatric drugs safely and effectively.
... La nature même de cet objet technique permettrait de réifier la maladie, la douleur, et de faire converger des perspectives profanes et professionnelles éventuellement divergentes vers cette issue concrète (Van der Geest et al. 1996 ;Sachs et Tomson 1992). Peu d'expériences humaines ont une puissance symbolique aussi manifeste que les actes ordinaires de prescrire et d'ingérer des médicaments (Pellegrino 1976). Les significations attachées à ces actes dépassent de beaucoup les propriétés proprement pharmaceutiques attribuées aux substances. ...
Résumé
Cet article emprunte une approche socioculturelle de la problématique de la vieillesse par rapport au médicament. Il appréhende avec un regard critique le phénomène « médicament » à travers trois énoncés de relations : le « médicament-obligation » comme qualificatif de la relation des personnes âgées au médicament ; le « médicament-concession » en tant que trame de fond de la relation thérapeutique entre médecin et patient âgé ; le « médicament-compassion », enfin, comme métaphore du rôle des médicaments psychotropes en lien avec le statut de la vieillesse dans nos sociétés occidentales avancées.
... l committed to the strict dichotomies of the eighteenth century. Some consider placebo "a kind of gratifying fraud, pleasant but useless"; some assume it does not work for any purpose except those already proven one by one in clinical 13 Kaptchuk et al. 2010 ;Kaptchuk 2013, esp. p. 331. 14 Kaptchuk 1998a, 1998b, all quotations from 1998b, 1724-1725. Pellegrino 1976 writes of the placebo effect as "closely related to the aura which surrounds ingestion of any chemical substance properly invested with healing powers by the ritual of prescribing" (p. 628). 15 Moerman 2002 , 94. tests. For others less narrow-minded, the question is not "whether placebos work but rather … how they work." 16 Some of the ...
Historians have tended either to avoid asking whether the therapies described in their ancient sources had any curative value, or to assume that they were effective to the extent that modern biomedicine can validate them. But today’s knowledge is not the only reliable criterion. This chapter, on the basis of recent studies in medical anthropology and sociology, observes that the success of therapy in every culture depends on three kinds of response by patients: the autonomous response (the tendency of the body heal itself), the meaning response (“the biological consequences of knowledge, symbol, and meaning”), and the specific response to biological, chemical, or physical intervention. The book’s analyses of therapeutic instances look for the first two responses (the third played only a small role in pre-modern therapy). It also notes that the medical disorders and even the symptoms of ancient China were different from those of biomedicine. Recorded judgments of the efficacy of care in the eleventh century came as regularly from members of patients’ families as from physicians. Examples suggest that in order to use biomedical knowledge productively, it is essential first to understand the sources on their own terms.
... Where medication is seen as the essence of medical practice, prescribing is the main activity expected from a doctor (Pellegrino 1976). Often, a non-prescribing physician is seen as a contradiction. ...
Because health information technology (IT) requires interacting with people and inevitably affects them and their workflow, understanding health IT requires a focus on the inter-relation between technology and its social context. A sociotechnical perspective aims to do just this and recognizes the complex interactions between people and technology and seeks to unravel these in order to improve the design and implementation of technological applications (Berg et al. 2003).
... While alcohol may afford a sense of control for disadvantaged and deprived people it is less likely to be so for more privileged groups. It is more likely to relate to the growing use of what Pellegrino (1976 ) and Warburton (1978) refer to as "chemical comforters" and part of a culture which involves an absence of anxiety, anger or stress. Despite being aware of the negative consequences of excessive consumption, participants in the Mc Cambridge et al (2004) study saw few reasons to change their behaviour. ...
The article reports the alcohol-related findings of a qualitative study that examined health beliefs and behaviours among Irish people in London. The findings elicited though key informant and lay focus groups and semi-structured interviews, illuminated the social and socioeconomic background to excessive alcohol use among middle-aged Irish men who left Ireland in the 1960s and 1970s. The findings describe the economic role of the pub and alcohol for men in the construction industry as well protecting them from homesickness, isolation and alienation in an unwelcoming and hostile environment. They illustrate the use of alcohol later in life to cope with physical and psychological pain, social stress and the symptoms of mental illness. The use of alcohol as a culturally sanctioned coping strategy is considered, exploring the ambivalent culture of alcohol in Ireland and in particular the tolerance of excessive consumption among men. The article explores the possibility that tolerant attitudes to alcohol in Ireland persist on migration to Britain and are then confounded by a culture of binge drinking among young people in general. The conclusion argues for further research and for culturally sensitive healthcare and health promotion strategies that take account of cultural and structural factors impacting on young Irish men in Britain. Current NHS policies on equality, alcohol and suicide offer timely opportunities to address alcohol misuse in order to improve physical and mental health and reduce the incidence of suicide among Irish men in Britain.
Medications can cause bodily changes, where the associated benefits and risks are carefully assessed based on the changes experienced in the phenomenal body. For this reason, the phe-nomenology of Merleau-Ponty is an important theoretical framework for the study of experience related to the daily use of medications. The aim of this study was to discuss the contribution of a recently developed framework of the general ways people can experience the daily use of medications resolution , adversity, ambiguity, and irrelevance-and present reflections about the little-understood aspects of this experience. However, some issues raised throughout this article remain open and invite us to further exploration, such as (1) the coexistence of multiple ways of experiencing the use of medications, by the same individual, in a given historical time; (2) the cyclical structure of this experience; (3) the impact of habit and routine on the ways of experiencing the daily use of medications; and (4) the contribution of the concept of existential feelings to this experience and its impact on patients' decision-making. Therefore, the experience with the daily use of medications is a complex and multifaceted phenomenon that directs the decision-making process of patients, im-pacting health outcomes.
The main aims of this contribution are to discuss and describe the role that the performing arts and storytelling play in the treatment of mental health problems and their utility as a teaching tool in undergraduate and postgraduate health education.
This study examines the perceptions of mental illness identity among a group of emerging adults based on their retrospective experiences with diagnoses and psychotropic medication use during their earlier formative adolescent years. A short questionnaire was administered via online social media platforms to volunteers between the ages of 19 and 30 and who self-identified as having taken psychotropic medication between the ages of 12 and 18 (N = 46). Correlation analysis revealed that several variables were associated with a stronger illness identity, including participant’s happiness with their medication experiences, the belief that medication made them more like their “true” selves, and the belief that their diagnosis was accurate. Content analysis of participant narratives suggested themes related to discontinuation and barriers to adherence. These results contribute to the growing knowledge base around lived experiences of psychiatric medication use and suggest further study on how to advance more informed and compassionate mental health care.
Historians avoid studying the efficacy of therapy before the age of the double-blind randomised trial. A related topic that has been the cause of great confusion is the meaning of the placebo effect and the efficacy of placebos. Medical anthropology and sociology, although they do not usually study the past, offer extremely useful tools for dealing rationally with both issues. This study uses their methods, among others, to argue that the body's response to specific therapy is only one component of understanding efficacy, and that the others are much more useful in historical studies, especially those of other cultures. The case studies given in this paper are based on largely medical texts from sixteenth-to seventeenth-century China.
Objective: The study attempts to examine the demand and pattern of antibiotic purchase by customers patronizing community pharmacies in southwestern Nigeria. Method: A retail prescription audit was carried out in a selected sample of pharmacies using interview schedules over a period of three months. The instrument elicited responses on types of drugs purchased, indications, recommenders, doses and other drug use variables and demographic data. Data entry, coding and analysis were performed using SPSS. Setting: The study was carried out in 800 community pharmacies located in five states in southwestern Nigeria. Key findings: The study showed that 64.5% of the total drug purchases were antibiotics. The most frequently purchased antibiotics had the lowest average cost and were found to be tetracycline(22%), ampicillin (20%), and co-trimoxazole (18%) respectively. They were used in the treatment of fever, diarrhoea and cough. Eighty seven percent of the antibiotics were in the form of tablets or capsules and 40% were bought on the strength of a doctor's prescription while 31% were self-prescribed. Only 15% of the customers purchased a full course (5 daily doses) of antibiotics while 22.3%, 23.5%, and 17.7% purchased one, two, and three daily doses respectively. Conclusion: The widespread unauthorized and unsupervised use of cheap antibiotics purchased from pharmacies is likely to contribute to the reported high incidence of acquired antibiotic resistance in the study environment.
Uppers. Crank. Bennies. Dexies. Greenies. Black Beauties. Purple Hearts. Crystal. Ice. And, of course, Speed. Whatever their street names at the moment, amphetamines have been an insistent force in American life since they were marketed as the original antidepressants in the 1930s. On Speed tells the remarkable story of their rise, their fall, and their surprising resurgence. Along the way, it discusses the influence of pharmaceutical marketing on medicine, the evolving scientific understanding of how the human brain works, the role of drugs in maintaining the social order, and the centrality of pills in American life. Above all, however, this is a highly readable biography of a very popular drug. And it is a riveting story. Incorporating extensive new research, On Speed describes the ups and downs (fittingly, there are mostly ups) in the history of amphetamines, and their remarkable pervasiveness. For example, at the same time that amphetamines were becoming part of the diet of many GIs in World War II, an amphetamine-abusing counterculture began to flourish among civilians. In the 1950s, psychiatrists and family doctors alike prescribed amphetamines for a wide variety of ailments, from mental disorders to obesity to emotional distress. By the late 1960s, speed had become a fixture in everyday life: up to ten percent of Americans were thought to be using amphetamines at least occasionally. Although their use was regulated in the 1970s, it didn't take long for amphetamines to make a major comeback, with the discovery of Attention Deficit Disorder and the role that one drug in the amphetamine family-Ritalin-could play in treating it. Today's most popular diet-assistance drugs differ little from the diet pills of years gone by, still speed at their core. And some of our most popular recreational drugs-including the "mellow" drug, Ecstasy-are also amphetamines. Whether we want to admit it or not, writes Rasmussen, we're still a nation on speed.
This paper explores the symbolic and boundary object value of the traditional paper prescription in the context of the planned move to the wider use of electronic prescribing in primary care in the UK and many other countries. It is argued that the traditional paper prescription possesses symbolic value and has been occasionally recognised but more often ignored in favour of the ultimate social object that is the medicine. This paper argues that considering the physical prescription as a boundary object within Star and Griesemer’s typology as a ‘standardised form’ recognises its significance for a range of actors, including not just doctors and patients, but also pharmacists and other stakeholders, in areas such as professional authority, the ceremony of the medical consultation, patient autonomy, surveillance, financial income, as well as medicine supply. The paper goes on to reflect on this boundary object interpretation in the context of the current move to the electronic transfer of prescriptions and it is argued that this may threaten the existing boundary object and its associated value. It also raises broader concerns as to what happens when boundary objects are modified or replaced.
Background and Purpose: Researchers in social work and beyond have urged those in mental health to more fully embrace research into the subjective experience of pharmacotherapy among people with serious mental illness (Floersch et al., 2007, Jenkins et al, 2005; Mintz, 2001). Often using symbolic interactionism as a theoretical frame, previous studies have examined, for example, patient-staff communication (Rhodes, 1984), the use of metaphors (Helman, 1981), issues of self-identity (Carder et al, 2003), medication as a symbol of hope, struggle, and control (Usher's 2001), and, importantly, as an avenue to normality (Knudsen, Hansen, Traulsen, & Eskildsen, 2003). This study attempts to build on that body research with a specific client group served in a local community program, and then immediately transform the findings into program enhancement.
This community-based qualitative inquiry asks: what is the meaning and impact of taking psychiatric medications in the lives of people with severe mental illness living in a residential program. The specific study objectives are (1) to create a typology of meaning and (2) use the findings to enhance specific programming to better reflect the role and importance of medication issues in the everyday lives of residents.
Method: Consistent with related inquiries, the research derives from an interpretive paradigm and relies on a thematic analysis of semi-structured interview data. A staff-resident Advisory Panel guided the research. Participants were 21 adults with extensive histories of mental illness, numerous hospitalizations, currently taking multiple medications. In addition to the interviews, participants each created a color drawing related to their experience with medication, which they titled and interpreted themselves. In addition to a member check, a peer consultant supervised the audit trail of data reduction to support rigor.
Findings: The main results are the distillation of themes into a typology of meaning with 7 dimensions:
Psychiatric medication as
1. a positive force across several dimensions of experience.
2. as tolerated fact of life.
3. as primarily an internal and individual experience.
4. as a prominent part of the story and evolution of one's mental illness.
5. as basis of gratitude and source of victory over past struggles.
6. as necessary for prevention of relapse and protection of humanness.
7. as a symbol of differentness and dependency.
Conclusions & Implications: Among this group of residents, it is clear that taking medication is not a benign act. Rather, taking psychiatric medication is something that incites meaning, influences identity, and impacts life. There is also conundrum: medication can be an avenue to full humanness and a more positive life experience, but also can be the source of felt differentness, resignation and melancholy. The Advisory Panel generated 12 different initiatives for program change, currently being implemented. These include sponsoring a Summer Book club for staff and residents, publishing a collections of life stories, conducting skills training sessions on how to talk with your prescriber about psychiatric medication, and changing intake assessment forms to allow new residents to talk more about their experience with medications and the evolution of their mental illness.
This community-based qualitative inquiry asks: what is the meaning and impact of taking psychiatric medications in the lives of people with severe mental illness living in a residential program. Participants were twenty-one adults with extensive histories of mental illness, numerous hospitalizations, currently taking multiple medications. In addition to a thematic analysis of semi-structured interviews, participants each created a color drawing related to their experience with medication, which they titled and ‘interpreted’ themselves (see http://blog.vcu.edu/kbentley/). The main finding is a distillation of themes into a seven dimension typology of the meaning. A staff-resident Advisory Panel guided the research, and final results take into account participant feedback and member checking. Included here are plans and hopes for using the findings to enhance specific programming at the residential program to better reflect the role and importance of medication issues in the everyday lives of residents.
The ready availability and extreme popularity of Western pharmaceuticals in developing countries poses important general issues for medical anthropology. In attempting to explain why medicines are so attractive in so many different cultures, this article suggests that they facilitate particular social and symbolic processes. The key to their charm is their con-creteness; in them healing is objectified. As things, they allow therapy to be disengagedfrom its social entanglements. Medicines are commodities which pass from one context of meaning to another. As substances, they are “good to think with” in both metaphoric and metonymic senses. They enhance the perception of illness as something tangible, and they facilitate communication about experiences that may be difficult to express. In the course of their transaction, they bear with them associations to authoritative professionals and the potency and potential of other cultural contexts of which they once were a part.
L'Auteur de cet article examine divers cas d'emploi de symboles verbaux et non verbaux dans des groupes de guérison alternatifs au sein de la société moderne. Des « mots-rituels » se caractérisent par le fait que leurs usagers les dotent d'un pouvoir et d'une efficacité de guérison qui va au-delà de leur sens littéral. Dans plusieurs des groupes étudiés, on insiste sur l'auto-guérison obtenue de la sorte et, dans ce sens, le rituel de guérison a ten- dance à être relativement individualisé, créatif et fluide.
This article attempts to test Ulrich Beck's theoretical concept of risks as presented in his work Risk Society . It questions whether the risks of modern drugs can be explained and understood through the theoretical framework of a Risk Society. Based on a case study of the psychotropic drug fluoxetine, better known as Prozac ®, we show how risks associated with modern drugs are induced by socially constructed technological artefacts and are capable of producing risk on an objective as well as non-objective global level. Here, risks are invisible to individuals and sometimes to social perception as a consequence of their non-objective nature. The transformation of side-effects from a traditional individual level (physical and psychological) to a collective level (economic, societal and ethical) illustrates the new dynamics of risk associated with modern drugs. We conclude that the risks of modern drugs fall within Beck's definition of risks of modernity, and that risk of drugs is expanding beyond control mechanisms and the fixed understandings of relations between medicine and society. As a sociological diagnosis of contemporary society, Risk Society appears to be the theoretical framework which best explains the risk trends of social medicine and pharmacy.
This paper examines some of the many dimensions of meaning that psychotropic drugs can have for those that use them on a long-term basis. It aims to shed light on the problem of psychological dependence on these drugs, and the different forms this dependence can take. To put this study in context, some of the recent literature on psychotropic drug use is reviewed, before reporting the findings of the pilot-study. From this data a classification of chronic users into three different ‘types’—called ‘Tonic’. ‘Fuel’ and ‘Food’—has been developed, each of which embodies a different perspective on psychotropic drugs, their symbolic meanings, and modes of usage. It is hoped this classification will be useful to clinicians and others working in this field.
The rights and obligations of the sick role model are postulated as fundamental elements in the social control of illness behavior (2). However, after more than 25 yr. of research on the sick role, most dealing with individual sociodemographic variations and exceptions (1, 5), many questions still remain unanswered (4). The present exploratory study determined the effects of severity of mental illness and presence of a prescription medication (as validating mechanism) on individual evaluar~on of rwo rights components of the sick role, exemption from normal duties and obl~gat~ons and freedom from blame for one's illness condition. A convenience sample of 100 university students was given forms containing three vignettes, each describing an individual with a typical mental disorder: personality disorder, neurosis and psychosis. These were conceptualized to represent three major categories of mental illness along a severity dimension. Half of the students received the additional information that the subject had received a prescription medication for his condition. Severicy was significant for both the question of exemption from normal duties (PC.? = 14.87, p < .001) and the question of freedom from responsibility for one's condition (Fn.3 = 14.94, p < .001). Medication was also significant for both questions (K.1 = 4.31, p < .05; K.1 = 14.45, p < ,001). There was no significant interaction. The findings, if they were supported by larger, more representative studies, would lead us two directions. First, the lay public seems to be able to discriminate among levels of severity for mental disorders and is more likely to grant sick role rights accordingly (to those with more severe disorder). Second, patients who receive a prescription medication are ceteris paribus more likely to be granted these rights (3). This study suggests the importance of society's influences over the mechanisms of social control for illness behavior.
This article reports the author's experience of designing, teaching and evaluating a weekly lunchtime seminar series for Family Medicine Programme trainees in Gippsland. After reviewing the objectives of the seminar series and characteristics of the participants, the article outlines the process and content of the course. Particular emphasis is given to seven seminars on key aspects of general practice/family medicine, which highlight the differences between the models, concepts and attitudes of specialists and teaching hospitals, and those of general practice. Results of evaluations of seminar series from the beginning of 1986 to the present time are reported and discussed. Overall, the seminar series has been found to be effective in helping trainees to develop an appropriate understanding of key aspects of general practice/family medicine; facilitating the transition for trainees from hospital practice to general practice; and in encouraging active participatory learning.
The purpose of this literature review is to develop a model of methods used to influence prescribing. This article reviews well-controlled studies of educational efforts, describes and relates theories of human inference to these studies, and delineates a model of methods for influencing prescribing. The model can be used to help explain the success or failure of various programs and as a framework for developing and testing methods to influence prescribing.
The purpose of this study was to investigate medical and psychosocial factors that may be used to identify patients at risk of psychotropic drug use. Population-based surveys were completed by 278 elderly health maintenance organization (HMO) patients in August 1984. Physical and mental health status and social support were measured in the survey. Automated prescription records from the year prior to and the year after the survey were linked to data from the survey. Patients received 737 prescriptions for psychotropic drugs during the two-year period under study. Doxepin (20.2 percent), flurazepam (15.2 percent), and diazepam (14.8 percent) were dispensed most frequently. Nearly 30 percent of the patients received a prescription for at least one psychotropic drug during the two-year period, and 14 percent received at least one prescription during both years. Three significant predictors of subsequent psychotropic drug use were: prior use (odds ratio = 17.2, 95% CI = 6.25, 47.33), the number of physical impairments (OR = 1.73, 95% CI = 1.05, 2.84), and the respondent's rating on the Alameda Health Scale (OR = 1.65, 95% CI = 0.99, 2.75). Patients' self-reported mental health status and sociodemographic characteristics were not significant predictors of subsequent use.
The purpose of this literature review is to develop a model of methods to be used to influence prescribing. Four bodies of literature were identified as being important for developing the model:
(1) Theoretical prescribing models furnish information concerning factors that affect prescribing and how prescribing decisions are made. (2) Theories of persuasion provide insight into important components of educational communications. (3) Research articles of programs to improve prescribing identify types of programs that have been found to be successful. (4) Theories of human inference describe how judgments are formulated and identify errors in judgment that can play a role in prescribing. This review is presented in two parts. This article reviews prescribing models, theories of persuasion, studies of administrative programs to control prescribing, and sub-optimally designed studies of educational efforts to influence drug prescribing.
A study was made of the effect of one-to-one educational meetings between prescribers and a pharmacist on the prescribing of antiulcer agents for outpatients in a health maintenance organization (HMO). Ten-minute presentations were developed that communicated the same basic facts through the use of case studies (vivid interventions) or statistical data (nonvivid interventions). After a control group (n = 8) was selected, prescribers (n = 16) were randomly assigned to receive vivid interventions or nonvivid interventions. Data on the prescribing of cimetidine, ranitidine, and sucralfate were collected for one month before the interventions and for two months afterward. Three clinical pharmacy professors independently evaluated prescriptions for appropriateness of indication, dosage, and duration. No differences in appropriateness were found between the two intervention groups, but in the first postintervention month the mean rate of inappropriate prescribing per control practitioner was 80%, versus less than 32% for the intervention groups (p less than 0.01). Each prescription in the first postintervention month entailed a mean cost of $31 per control practitioner for inappropriate prescribing, compared with less than $12 for the intervention groups (p less than 0.01). Mean costs of inappropriate prescriptions per practitioner per patient visit were $0.88 and less than or equal to $0.41 for the control and intervention groups, respectively (p less than 0.05). During postvisit month 2, inappropriate prescribing for both intervention groups increased slightly and was no longer significantly less than that in the control group. One-to-one educational meetings improved the prescribing of antiulcer agents for outpatients in an HMO.
An inquiry into the role metaphor plays in personal and societal conceptions of drugs and drug taking reveals that drug metaphors and symbols are quite pervasive in individual thinking, social discourse, and the cultural media. They appear to influence beliefs and attitudes regarding drugs, the nature and meaning of drug experiences, and the reasons behind drug-taking behaviors. Some drug metaphors are common to different cultures and historical periods, while others are specific and exclusive to particular individuals and groups or drug-taking situations. These metaphors can carry positive as well as negative connotations. Further study is needed to delineate the metaphorical structuring of our thinking about drugs, and the process whereby these metaphors are generated and spread throughout society.
This paper examines instances of ritual use of words in a diverse selection of alternative healing groups in a modern society. These words are distinguished by their users' belief that they are endowed with a power, an effectiveness, separate from and in addition to their literal meaning. Three specific features of ritual language contribute to its effectiveness: (1) its function as an objectification of power, (2) its transformative functions--especially its metaphoric and metonymic usages, and (3) its performative aspects. This paper argues that one of the key factors in healing illness is mobilizing resources of power, especially enhancing the ill person's sense of personal empowerment. Ritual language use in alternative healing is one of the foremost elements in this empowerment, because it both represents and objectifies power. Within a belief system in which they are significant, words of power indeed have the power to effect healing.
Ethnomedicine is an intellectual area which embraces theoretical concerns that are relevant to both the social and biological sciences. The relation which exists between disease, social behavior, and human adaptation constitutes the primary subject matter of ethnomedicine. This relation is examined in terms of man's unique capacities for symbolization and culture. Since ethnomedical generalizations explain how social groups deal with a generic disease, they can be used to examine contemporary problems which involve the organization and practice of medicine as well as problems that stem from relations of the medical system with other subsystems in the group. Recasting contemporary social problems in this way may help to clarify their roots and sources (13,28). In focusing on fundamental properties of disease in man, ethnomedicine can also help to clarify the effects and meanings of disease and thereby make its control more rational. A theory of disease, an ultimate aim of ethnomedical inquiry, will serve as an explanatory device with wide-ranging applications.
During recent hearings of the Senate Health Subcommittee on the "Kennedy Drug Bill" a curious numbers game was played with the ultimate in adverse drug reactions: those that kill the patient. Initially, wide publicity was given to an unsubstantiated estimate of 30,000 deaths resulting from drug therapy each year in the United States. Subsequently, this mythical number was gradually inflated to 140,000 on the basis of misleading extrapolations from two recent surveys on acute medical services. In 1971 the Boston Collaborative Drug Surveillance Program reported that for 27 (0.44 per cent) of 6199 consecutively monitored medical patients in eight teaching . . .
Prescribing levels are determined by converging interests of manufacturers, doctors, and others.
Joyce: Repeat Prescriptions in General Practice–Treatment or Diagnosis? Travistock
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