Abstracts 23 ( 2 )

SPECIAL ISSUE: “Life stages of Medicines”

Theme articles / Thema-artikelen

Medico-marketing between use value and exchange value: How political economy sheds light on the biography of medicines

Medicines usually attract public attention when they cause death: almost every decade, a new pharmaceutical scandal leads the French government to reshape its regulatory institutions. But the more fundamental dual nature of all medicines as commodities – their everconflicting use value and exchange value – remains invisible. Based on ninety interviews and ethnographic fieldwork in a pharmaceutical corporation, both in a factory and at the commercial head office, this article intends to shed light on the under-analysed pharmaceutical division of labour. The description of industrial, marketing and sales professional activities for a wide-spectrum antibiotic challenges the cultural anthropologists’ definition of biography of medicines. Medicines are not only exchanged and consumed, they are produced and marketed. Before prescription, medical use value adapts to the exchange value.

[pharmaceutical corporation, social biography, use value, exchange value, Pristinamycin, marketing]

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Mastering time: How doctors and pharmaceutical sales representatives interact and communicate

The relationship between pharmaceutical representatives and doctors can be described as one involving solicitation of a dominant professional. I examine how the imbalance of positions in this relationship is manifested in the doctors’ mastery of conditions of daily interactions in their offices or at the hospital. In detailing how doctors control the frequency of visits, waiting time, and visit duration of pharmaceutical representatives, I elucidate the means at the disposal of the ‘dominated’ – pharmaceutical representatives – to regain a measure of control over the interactional environment, which is necessarily linked with the quality of their work conditions. The article is based on interviews with ethnographic observations of pharmaceutical representatives from a large multinational company, plying their trade in France.

[pharmaceutical sales representatives, doctors, interaction, drug marketing, time control, France]

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Communicating with patients:
How can information leaflets for medicines be made more readable?

The European Commission Directives and Guidelines appeal for increased readability of patient information. Legibility, readability, understandability are requested. Applying the basic rules of clear, structured, user- and task-oriented documentation provides patients with functional, user-friendly package leaflets that can be used safely.

[pharmaceuticals, Patient Information Leaflet, readability, EU directive 2004/27/EC, technical communication]

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‘Treatment as prevention’: Exploring the views of Quebec HIV specialists on its implications for individuals and society

Therapeutic guidelines in the province of Quebec as in several developed countries now allow for antiretroviral treatment to be prescribed as a means of restricting HIV transmission, given its efficacy in reducing infectiousness. The prospect of widespread adoption of antiretroviral ‘Treatment as Prevention’ (TasP) raises important questions about its benefits and risks for individuals and for society. To explore these issues, ten Quebecois specialists in the clinical and biomedical aspects of HIV were recruited to participate in a focus group on the implications of TasP for four groups: HIV-positive individuals; their HIV-negative partners; health professionals; and ‘society’. Altruism as an adjunct concept was also examined. Qualitative analysis of the focus group transcript sought the identification of major areas of consensus and disagreement. The findings were subsequently validated by participants, and showed that specialists disagreed about beginning treatment earlier than traditionally prescribed and were ambivalent towards TasP. This study’s findings underscore the tension between the numerous perceived risks and benefits of implementing TasP. Altruism was seen as an appealing yet imperfect concept on which to draw for implementing, understanding and ensuring the success of TasP.

[HIV, antiretroviral treatment, prevention, altruism, Quebec]

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Local/global articulations and the high use of pharmaceuticals in Cotonou, Benin

This paper deals with two life stages of pharmaceuticals: their distribution and their use. It examines how global and local processes increase the use of pharmaceuticals in Cotonou, the economic capital of Benin. During anthropological research between 2005 and 2007, I studied the link between information from health professionals practicing in Cotonou and ‘traditional’ knowledge passing from generation to generation. The intertwinement of these two sources of information constitutes popular knowledge about health, disease and the use of medicines. The commercial character of pharmaceuticals and their form of delivery also play an important role in the current use of pharmaceuticals. These different factors, which have local and global characteristics, lead to a high intake of pharmaceuticals, mostly through self-medication. I discuss how this arises and consider the implications of such medication use in health care.

[drug use, pharmaceuticals intake, popular knowledge, local, global, self-medication, commodification, Benin]

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Forms of resistance to medications within New Zealand households

Although considerable research documents resistance to medicines, much of this focuses on specific types of medication, particularly psychotropic medication, and seeks to classify users of medication, frequently as resisters or rejecters. However, this research tends to overlook the varieties and subtleties of resistance to medications that can occur. In this paper, we explore the varied forms of resistance to medications reported by lay people taking diverse forms of medication. Data were gathered within fifty-five diverse households using multiple methods. Findings document the wide range of ways that medications are resisted. These are discussed in terms of the variability of resistance, its functionality and the logic of care that resistances can manifest.

[medications, drugs, households, resistance, medication-taking, New Zealand]

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Non-theme articles

Attentive care in a hospital: Towards an empirical ethics of care

This article is an introduction to our research on attentiveness in hospital care. It presents the theoretical framework in which we carried out our qualitative empirical research, thereby providing an insight into the combination of the ethical and the empirical perspectives. This is done (1) by exploring the different definitions of attentiveness and thereby developing our own definition, and (2) by explaining our empirical approach to attentiveness. ‘Habitus’ comes to the fore as a fruitful research instrument, and attention is shown to be part of the core business of medicine. However, attention has many facets, and not all of these are equally present in hospital care. It becomes clear that attentiveness can only have its good meaning and effect if it is the right kind given at the right time. Caregivers frequently succeed in showing the proper attention, yet this is often done tacitly: attention is not an easily accessible subject matter, and caregivers do not always use the term ‘attention.’ Several fieldwork cases are presented through which the complexity of attention becomes evident.

[attentiveness, ethics of care, empirical ethics, health care, habitus]

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Over problemen met het ongewone: De verstarde gezichtsexpressie van mensen met ziekte van Parkinson als voorbeeld

On problems with the uncommon: The stiff facial expression of people with Parkinson’s disease as an example. The common is the ground of any society. It is generally known, taken for granted, and noticed as such only if people show uncommonness in appearance or behaviour. The common is the ground for the feeling of everyday security. The reasons and consequences of their uncommon appearance have been studied through the life stories of 23 people with Parkinson’s disease. People in interaction relate to each other by speech and watching each other’s facial expressions. The facial expression of men and women with Parkinson’s disease gradually rigidifies as a consequence of lack of dopamine production in the brain. The research suggests that people with Parkinson’s disease feel impeded in their interactions with others. The uneasiness appears especially during anonymous meetings in the public world and in informal meetings. In their stories, both parties show three signs of what Goffman labels as ‘interaction uneasiness’. Firstly, there appears to be a difference in labelling between the public and people with the disease. The second sign of this uneasiness has been found in the life stories: lack of culture, of the uncommon and lack of knowledge of the culture of Parkinson’s. This second sign has two aspects: people with the disease show difficulties in expressing their inner feelings and thoughts, and they feel their face does not fit the situation they are in. And thirdly, people with Parkinson’s disease are inclined to retreat from public interactional situations. Parkinson’s disease thus appears to be a threat to customary social life.

[chronic illness, parkinson’s disease, uncommon, interaction uneasiness]

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Gender, eating habits and body practices in Medellín, Colombia

The Western ideal of maintaining a thin body is common to wealthier populations in developing countries. However, despite trends of globalization, societies maintain different conceptions of the ideal body image. These ideas have health repercussions, especially among adolescents. In Latin America, the ideal body for women is also shifting towards thinness. It is assumed that one of the reasons adolescent girls desire a body image characterized by extreme thinness is due to their aspirations of conformity to American and European beauty patterns. However, there are differences in the way teenage girls give meaning to this social demand. In order to better examine the phenomenon of the ideal body, there are intracultural and intracommunity differences that need to be explored. In Medellín, Colombia, not only does thinness represent the ideal body, but curves are also valued. With the intention of acquiring this ideal, body practices of numerous girls in Medellín are considered to be extreme. This article focuses on the political and gender influences that pressure teenage adolescents to acquire a body ideal in this Colombian city.

[ideal body, gender, socioeconomic status, eating patterns, Colombia]

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Granting wishes to terminally ill children: A rite of passage

Parents and care providers often struggle to give meaning and support to children in the terminal phase of their disease. What are these children’s needs when hope for a cure fades and how can they continue to make their lives meaningful? Recently, volunteer organizations, such as the Make-a-Wish NL Foundation, have organized services to fulfil these children’s last wishes. When children are approaching death, parents and care givers can experience anxiety when speaking about serious matters and considering the child’s future. Can the child’s serious disease be forgotten for even a moment? When a child’s wish is granted by one of these organizations, temporal negation of the disease allows for a happy experience. The wish can be considered as an ante-mortem ritual. Action with respect to a seriously sick, and sometimes both mentally and physically handicapped child, cannot be undertaken without adequate preparations. It requires careful cooperation between families, hospital and volunteers. The fulfilling of a wish can be considered as a ‘rite of passage’ and the remembrance of the event will be meaningful for the family, even after the child’s death. We describe how care givers together with the Make-a-Wish NL Foundation select children and work to make their wish come true. We address the importance of this ‘ritual’ by presenting comments from children who have been granted such a wish.

[terminal illness, children, last wish, rite of passage]

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