Drug therapy adherence: from obedience to knowledge, ethics, and culture

Abstract

The therapeutic adherence to drugs continues to be exercised by the health systems with dogma and paternalism, degenerating sometimes into punishment, coercion or fear and relegating the patient to position themselves in terms of obedience or disobedience. An update of the theoretical paradigm in health would favor a multicultural approach to the management of dissent that implies a lack of adherence to pharmacological treatments. Anthropological and artistic practices would allow the exploration of the conflicting meanings that underlie health processes. Conflict, far from being an instance of risk for disobedience, is a phenomenon that generates knowledge and culture that can be incorporated into health practices, in order to manage the health of communities in an ethical way. In this article, conceptual resources and theoretical proposals are introduced that may serve to unlock frustrated situations in which we are involved daily, excluding ourselves from a space governed by obedience and dogma, and placing us in a jungled world of meanings and knowledge as a way of saving an ethical use of drug therapies. Health studies that have addressed the possible causes behind this lack of adherence by the population, place them in the sphere of the “subjectivity” of consumers and users. Some authors mention the "pharmacotherapeutic experience", defined as the sum of all the events and experiences associated with medication throughout life, as the most determining factor on the behavior of taking medications chronically. Others mention the "belief and value system" towards drugs as the major determinant of the "attitude" to consume them. These findings suggest a “cultural” determinism towards the behavior of taking chronic medications, which places the intervention strategies on adherence within the socio-cultural sphere. At the same time, interventions must be ethical and respectful if they aspire to be therapeutic. 

KEY WORDS: Medication Adherence; Anthropology, Cultural; Art; Community Participation; Ethics