Compliance, cultural influences

Because the prescription and subsequent use of medications is shrouded in symbolism and social meaning, it is reasonable to expect that culture will exert powerful influences on pharmacological response. The clinician faces a series of obstacles when evaluating a Hispanic patient. Formulation of a diagnosis often proves extremely difficult, especially when the patient is unaccul-turated and language and other communication barriers are manifest. There are a number of adjustments psychiatrists can make, however, to maximize diagnostic accuracy and subsequent medication compliance. 

Culture also plays a major role. For instance, physician bias, placebo effects, compliance factors, and patient beliefs and expectations all can influence the clinical effects of psychotropic agents (Smith et al. 1993). It has been reported that because of psychiatric practitioner bias, severe psychiatric illnesses are often diagnosed in African American patients, who are then prescribed high doses of neuroleptics (Price et al. 1985). It has also been reported that Caucasians tend to be more responsive than non-Caucasians to placebo (Escobar and Tuason 1980). 

The majority thought that more formal procedures should be followed. Yet the threat of disciplinary action did not have a positive influence upon staff because it was not seen as a credible threat. This said there was no suggestion of ideological resistance to compliance (cf. Whitehurst, 1977) or of a normative culture which encouraged deviance (cf. Massey, 1979). 

The tensions between the culture of production and the safety culture are undeniable and some companies are undoubtedly powerful and exploitative. It is for such reasons that companies breed suspicion in themselves with respect to the extent of their power locally, nationally, and globally and in relation to less powerful groups who may be harmed by corporate activities, for example, consumers and employers (see Ch. 1). It also leads some commentators to speculate that companies use their power and influence to escape regulation, most especially criminal sanctions. But even when they are prosecuted, taken to court, and sanctioned, the fact is that regulatory offenders are not necessarily regarded as criminal (Hutter, 1997 Tappan, 1947). There are a variety of potential explanations for this, some relating to the class position of offenders, some to the difficulties in assigning responsibility within corporations, and some to the fact that the technicalities of the breaches make it difficult to appreciate the potential effects of non-compliance (Baucus and Dworkin, 1991). 

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