Principles and Practice of Pharmaceutical Medicine

Medical culture

Differing perceptions of health and disease by
patients, healthcare providers, and governing and
regulatory bodies are the primary elements of med-
ical culture (Riphagen, 1992). Aspects of medical
culture of particular importance to the pharmaceu-
tical industry are those affecting drug develop-
ment, approval and marketing, including those
that may determine whether a drug should have
prescription or over-the-counter status. Other
aspects of concern are the type of healthcare fund-
ing favored by a particular culture – private insur-
ance or public funding through taxation.
An attempted convergence of medical cultures is
currently under way in the area of drug develop-
ment and regulatory approval, under the auspices
of the International Committee on Harmonization
(ICH). Note that this regulatory harmonization will
probably have no influence whatsoever on increas-
ing the uniformity of prescribing behavior. Con-
vergent thinking is also seen in a worldwide effort
to control healthcare expenditure. The various
cost-cutting approaches have included

reduced prescribing volume;

decreased price of medicines;

decreased reimbursement for medicines;

delisting of medicines from reimbursement lists;

encouragement to parallel trade;

control of overall company profitability;

drug formularies;

encouragement of generic substitution;

encouragement of therapeutic substitution;

assignment of pharmaceutical budgets to institu-

tions and individuals.

encouragement of self-medication.

Despite theprima facieattraction of cultural con-

vergence in medicine, there are not only major

differences in the incidence and prevalence of

many diseases between countries but also in expec-

tations of these different cultural groups of

patients. Even in a relatively homogeneous region

such as Western Europe, the incidence of adverse

drug reactions to a standard therapy varies drama-

tically from country to country. The perception of

Table 50.1 Cultural influences on life issues

Cultural approaches

123

What is the character Man is evil Man is a mixture of Man is good
of human nature? good and evil
What is the relationship Man is subject to nature Man is in harmony Man is master
of man to nature? with nature of nature
What is the temporal To the past To the present To the future
focus of life?
What is the modality Activity that gives Activity that Activity that is
of man’s activities? spontaneous expression emphasizes as a goal motivated primarily
to impulse and desires the development of toward measurable
all aspects of the self accomplishments
What is the relationship Lineal – group goals are Collateral – group goals are Individual – the individual
of man to man? primary and an primary. Well-regulated goals are most
important goal continuity of group important (modified
is continuity relationships through from Kluckhohn and
through time time is not critical Strodtbeck, 1961)

646 CH50 THE MULTINATIONAL CORPORATIONS