Culture, morbidity, and the effects of drugs

In the evaluation of drug efficacy, despite the customary device of randomization, regional differences of prevalence of a given disease, unique culturally determined practices in treatment, and differential tolerances to side effects are complicating factors in transcultural pharmacology that must be taken into account in the interpretation of efficacy and toxicity. This thesis is documented by illustrations from psychiatric practice, e.g., prevalence and morbidity of alcoholism, cultural differences as to prevalence, diagnosis, and symptomatology of schizophrenia, even to the point of widely discrepant diagnosis of a given patient, depending upon whether the examination was done by an American or British psychiatrist. Similar differences concerning the existence of disease entities other than psychiatric are cited, e.g., hepatic insufficiently considered common in some Latin populations; low blood pressure a recognized and treatable condition in Eastern Europe. The incidence of side effects from the same drug may also vary in different cultures, making the interpretation of their significance difficult, and cross-cultural comparisons hazardous. To avoid some of these pitfalls, it is essential to recognize (1) the many complexities inherent in trials involving differing cultures and (2) to design the studies insofar as possible to include measurement of population variables.