Inconsistent pharmaceutical practices Culturally determined medical practices Ethnic discrimination in health Medical prejudice on the basis of cultural norms
Medical culture plays an important role in both the approval and marketing of drugs leading to national differences which inhibit efforts to harmonize standards of drug prescription and use. Treatments for the same ailment vary radically from one country to another. The rate of surgical operations also varies enormously from country to country. Differences in clinical testing procedures may also affect the availability of the same drug in different countries. Practice seems to be determined less by scientific logic than by national character traits, with difference being so extreme that standard treatment in one country could be regarded as malpractice in another.
Drugs requiring a prescription in some countries (such as codeine-based products in the USA) are sold freely in others (such as Italy), because local medical tradition assesses the risks differently, possibly because of lack of experience. Local traditions of payment for drugs, and the relation to the national health plan, may also be important in how a drug is approved. In countries where more importance is attached to drug safety (such as Germany) rather than efficacy (such as France), many more drugs may be available but more cautiously used: Germans do not use antibiotics for minor respiratory complaints, but do use low doses of the powerful heart drug digitalis for vague feelings of tiredness, apparently to good effect. French interest in food and wine perhaps explains their attention to the liver and gastroenterology; and their preference for rectal temperatures and suppositories, both avoided in the UK where cleanliness is paramount and the mouth is usually used for taking drugs and temperatures. Surgical solutions, particularly removal of diseased parts, are far more likely to be recommended in the USA than other countries.
A UK resident of Pakistani origin died from cancer of the colon after cultural miscommunication. He had visited his GP in the UK complaining about abdominal pains and fever. Asked if he had blood in his stool he replied "No". To reply "I don't know" is a weakness in Asian cultures, but neither did he actually know because examining one's faeces is taboo for Hindis and Sikhs. The patient was given an appendix examination at the local hospital but refused a rectum examination -- another cultural taboo. On his return to the GP's surgery, he was given iron tablets and a blood test. He failed to return for the results.
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