Kamat V R, Nichter M
Department of Anthropology, Emory University, Atlanta, GA 30322, USA.
Soc Sci Med. 1998 Sep;47(6):779-94. doi: 10.1016/s0277-9536(98)00134-8.
Studies of pharmaceutical practice have called attention to the role played by pharmacists and pharmacy attendants in fostering self-medication and medicine experimentation among the public. Left undocumented is the extent to which clients passively follow the advice of pharmacy personnel or question their motive or expertise. While research has focused on pharmacists and pharmacy attendants as agents encouraging self-medication and medicine experimentation, adequate attention has not been paid to pharmacist-client interactions that are sensitive to the social, cultural, and economic context in which medicine sales and advice occur. This paper highlights the context in which pharmacy attendants engage in "prescribing medicines" to the public in Bombay, India. An ethnographic description of pharmacies and pharmaceutical-related behavior in Bombay is provided to demonstrate how reciprocal relationships between pharmacy owners, medicine wholesalers and pharmaceutical sales representatives (medreps) influence the actions of pharmacy staff. Attention is focused on the role of the medicine marketing and distribution system in fostering prescription practice, pharmacy "counter-pushing" and self-medication. In documenting the profit motives of different players located on the drug sales continuum, it is argued that the economic rationale and the symbiotic relations that exist between doctors, medreps, medicine wholesalers and retailers, need to be more closely scrutinized by those advocating "rational drug use".
药学实践研究已引起人们对药剂师和药房工作人员在促进公众自我用药和药物试验方面所起作用的关注。未记录的是客户在多大程度上被动听从药房人员的建议，或者质疑他们的动机或专业知识。虽然研究集中在药剂师和药房工作人员作为鼓励自我用药和药物试验的推动者，但对于在药品销售和建议所处的社会、文化和经济背景下敏感的药剂师与客户互动，却没有给予足够关注。本文重点介绍了印度孟买药房工作人员向公众“开药”的背景。提供了对孟买药局及与制药相关行为的人种志描述，以展示药房老板、药品批发商和药品销售代表（医药代表）之间的互惠关系如何影响药房工作人员的行为。重点关注药品营销和分销系统在促进处方行为、药房“柜台推销”和自我用药方面的作用。在记录处于药品销售链上不同参与者的盈利动机时，有人认为，倡导“合理用药”的人需要更密切地审视医生、医药代表、药品批发商和零售商之间存在的经济原理和共生关系。
