What medicines do we take more and why? What do we expect from the medicines we consume?
In times of collective doping, I think it´s good to reflect on these types of issues. We know that people have always used substances for different reasons. Recent discoveries also point out that neanderthals had used penicillium or acid salycilic to heal themselves. But humans havent only used drugs to heal themselves, other times they used them to alter their consciousness, or even better, to do both simultaneously. For example opium and its derivatives were the first analgesics, but, as everyone knows, they have also been a lethal drug of recess. Today, the consumption of opium and heroin is illegal, while the patches of fentanyl or morphine that many people have on their arms are socially accepted. The fine line between legal and illegal is materialized in a slight change of radicals. That is, by changing a part of the chemical structure (imperceptible to the human eye). Then it becomes a medicine and subsequently, we normalize its consumption.
Im currently studing a Master’s Degree in “Research and Rational Use of Medicines” at the University of Valencia. For those who are not familiar with the concept of “Rational use of medicines” I leave here the official definition:
“It is understood by Rational Use of Medications that patients receive the medication appropriate to their clinical needs, in the doses corresponding to their individual requirements, for a suitable period of time and at the lowest cost possible for them and their community. The treatment must also be safe, effective and of a proven quality. ” (WHO, Nairobi, 1985).
Had you heard about this concept before? Do you think that we generally make a rational use of medicines? Perhaps you are surprised to learn that, according to official data, so-called “developed” countries make less rational use of medicines than those “developing” countries. My view is that the reasons for this to happen are well deserving the attention of an anthropologist. Now that I have put you in context about what Im going to talk to you about and why, let’s talk about our great friend: the legal drug.
What do we expect from medication?
What does society expect from medicines? Western society has developed drugs almost for anything. If your head hurts, take an aspirin. You’re sad? Take a Prozac! If you are having problems in bed… Viagra. We can formally group the things that society expects from drugs in four:
- Cure of diseases.
- Relief of pains and diseases that have no cure.
- Modification of physiological functions in healthy people (such as hormonal contraceptives)
- Improvement of physiological functions in healthy people (such as med for alopecia)
We even medicalize diseases that do not yet exist! (Such as when we take pre-diabetes or pre-cholesterol medications). Western culture, in which biosanitary culture plays a very important role, makes us believe that medicines are the solution to everything. The big soma. Medications are no longer just for the sick. We medicate healthy bodies to regulate them. We live in a context that tends to drive us into intensive medicalization. Understanding medicalization as “the conversion into pathological processes of situations that are and have always been completely normal and the pretension to solve by means of medicine situations that are not medical but social” (Palop, 2012; own translation).
This process of disease mongering has been denounced for decades by thinkers such as Michel Foucault, Ivan Illich and William James. Medicalization includes a number of categories of the most implausible. From cellulite to moodiness at the wheel, from pregnancy to aging, from boredom to hangover …
But it is so strong that many people feel better simply when taking drugs, regardless of the physiological effect of it. Hence the placebo effect. It is an act of faith.
What does the medicine we take on us say about us?
According to the data of the annual studies of the National Health System, the medicines that we most take in Spain are:
- Omeprazole: It is very curious that this drug is the most consumed of all. This medication is used to treat gastroesophageal reflux disease, for people with a stomach ulcer or who are taking many medications at the same time. However, its prescription and demand have been tremendously high, due in large part to that it was presented to society as a “stomach protector.” And who can refuse to take something that “protects”?
- Analgesics and anti-inflammatories (paracetamol, ibuprofen).
- Drugs for hypercholesterolemia, hypertension and diabetes.
- Antiaggregants (aspirin).
- Tranquilizers and antidepressants (whose consumption has tripled in the last decade).
- Antibiotics (their consumption is leading to problems of bacterial resistance, identified as a very serious problem by WHO).
What does this say about us? If the human race were extinguished and evidence of these data remained, those who find them would think that we were beings with many pains, very inflamed, depressed and altered. And they probably were not too wrong.
If, as Foucault says, the body is a Biopolitical reality; Medicine is a Biopolitical strategy. Medications are forms of biocontrol that we invoke with each open blister. As Paul B. Preciado would say: “When we swallow a pill, we are swallowing the biopower.” It is not only the matter of the pill that acts, it is not only its active ingredient and its excipient. We must know that we are swallowing a chain of social and cultural signifiers.
Is the drug a social good?
While there is a great deal of improvement in the way we consume medicines, there is no denying the positive effect they have had on societies that have had access to them, helping to eradicate many diseases and improving the health of Subjects. But there are major inequalities in drug use worldwide. 80% of the drugs produced are consumed by 20% of the world’s population, which justly coincides with the healthiest population on the planet. Meanwhile, in many countries in Africa and Latin America there is still a shortage of medicines.
It is clear that when we talk about this subject we are opened many other questions. How does the pharmaceutical industry? Are they heroes or villains? How does the consumption of drugs affect the way they are financed? And advertising? Why do blisters bring 40 tablets if we only need to take three? Are off-label really as good as comercial brand drugs? How are we dealing with adiction to legal drugs? I will deal with these issues in future articles. Today I will finish giving some reasons why I think we need more anthropologists in this field:
Health anthropology can contribute much to the debate and analysis of this situation of hyper-medicalization, with special emphasis on the social consequences resulting from the commercialization and consumption of drugs in a society.
It is necessary that the “rich” countries carry out a work of awareness and training to both professionals and patients on the rational use of medicines and demedicalization when this is positive. On the other hand, it is important that medicines get where they need to go, and that this issue should be a priority in the international agendas of agencies charged with overseeing global health.
Anthropologists play a key role in the coming changes. Whether it is by being part of the ethical committees of human research, actively participating in public policies and international health programs, analyzing and acting on “aesthetic medicalization or habits of hypermedicalization”, identifying corporate interests and colaborating with them so that their programms born out of corporate responsability, have a bigger impact. Anthropology must provide its holistic understanding to all of these issues. In addition, its ethnographic methodology can help the health fields in obtaining something very fashionable in the field of pharmacoeconomics: Real World Data (data obtained from real evidence, not from studies controlled in laboratories).
Working in this line we find Martha Milena Silva Castro, who applies her anthropological knowledge in her profession as a Pharmaceutical. In his academic works as “Pain treated with medication. The pharmacotherapeutic experience of analgesic users “one perceives the overall vision that the author has about the care process and the health care of the patients. The author also points out the importance of in-depth interviews and sensitivity to how environmental and identity factors influence patients.
Only by encompassing the different ways humans understand, produce and consume, we can move towards a rigorous understanding of the (i)rational use of medicines. The anthropology of health has in the human relationship with medicines and its consequences one of its greatest fields of study in the future.