Fainzang Sylvie
Inserm/Cermes3, Site Cnrs, 7 rue Guy Môquet, 94801, Villejuif, France,
Drug Saf. 2014 May;37(5):333-42. doi: 10.1007/s40264-014-0153-z.
The practice of self-medication is exemplary in raising the question of medicinal uses and risks. In contrast to the biomedical or pharmacological view of self-medication, the anthropological approach looks to understand the logics that underpin it.
Therefore, I wished to question how users choose the medicines they take and how they construct the modalities of their use. However, not only are the users conscious of the risks associated with pharmaceutical use, they even devise strategies that specifically aim to reduce these risks. Based on research carried out in France on how people use medicines in the context of self-medication, I examined the strategies they adopt in order to reduce the risks connected with such use.
This study relies on qualitative research. It combines interviews with users and anthropological observation, both conducted at the participants' homes, to reveal their uses, their decisions, their hesitations and the precautions they take regarding their medicines.
The logics underpinning the management of risks associated with medicinal consumption are varied. Thus we find quantitative and qualitative logics, in virtue of which users choose to limit their medicines depending on the number of different medicines or on their intrinsic qualities. Their choices hinge on a logic of cumulation and a logic of identity, where, in the former, users seek to increase or reduce their medicinal consumption to augment the efficacy of a medicine or, in the latter case, they aim to reduce the risks in relation to their personal characteristics. In the same way, the perception of risk that underpins consumption practices is organised according to the notions of risk in itself and risk for oneself, where risk is either considered to be inherent to the medicine or to be linked to the incompatibility between a given substance and a person's body. Managing risk is thus done in parallel to managing efficacy, where a balance is sought between maximising the latter and minimising the former. This either leads patients to limit the consumption of medicines because of their adverse effects, or, on the contrary, to consume them precisely for these effects. Risk reduction strategies often consist of verifying, experimenting with, and personalising treatments.
Although users sometimes resort to practices that do not comply with biomedical recommendations, they do so in order to attain the values and exigencies of biomedicine as regards the validation or personalisation of treatments. However irrational and peculiar these practices may appear, the mechanisms on which they are based do not necessarily break away from medical recommendations. Therefore, anthropologically speaking, we cannot oppose good and bad practices in terms of medicinal uses, since what health professionals would consider to be bad practices are thought by patients to be in keeping with good use.
自我药疗的做法堪称引发了关于药物用途及风险问题的典型例子。与自我药疗的生物医学或药理学观点不同，人类学方法旨在理解其背后的逻辑。
因此，我想探究使用者如何选择他们服用的药物以及他们如何构建用药方式。然而，使用者不仅意识到与药物使用相关的风险，他们甚至还制定了专门旨在降低这些风险的策略。基于在法国进行的关于人们在自我药疗背景下如何使用药物的研究，我考察了他们为降低此类使用相关风险而采取的策略。
本研究依赖于定性研究。它结合了在参与者家中对使用者进行的访谈和人类学观察，以揭示他们的用药情况、决策、犹豫之处以及他们对药物所采取的预防措施。
支撑药物消费风险管理的逻辑多种多样。因此我们发现了定量和定性逻辑，据此使用者根据不同药物的数量或其内在特性选择限制用药。他们的选择取决于累积逻辑和身份逻辑，在前一种逻辑中，使用者试图增加或减少用药量以增强药物疗效，而在后一种情况下，他们旨在根据自身特征降低风险。同样，支撑消费行为的风险认知是根据风险本身和自身风险的概念来组织的，在这种认知中，风险要么被认为是药物固有的，要么与特定物质和人体之间的不相容性有关。因此，在管理疗效的同时也在管理风险，即在最大化疗效和最小化风险之间寻求平衡。这要么导致患者因药物的副作用而限制用药，要么相反，恰恰因为这些副作用而用药。风险降低策略通常包括核实、试验和个性化治疗。
尽管使用者有时会采取不符合生物医学建议的做法，但他们这样做是为了在治疗的验证或个性化方面实现生物医学的价值观和要求。然而，这些做法可能看起来多么不合理和奇特，其背后的机制不一定背离医学建议。因此，从人类学角度讲，我们不能从药物使用方面区分好的和坏的做法，因为健康专业人员认为是坏的做法，患者却认为符合良好用药原则。
