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EVIDENCE-BASED MEDICINE: AN EMIC VIEW
Since the mid 1970's Nina Etkin has been studying the use of medicines in a rural Hausa village in northern Nigeria. When the studies began in the middle years of that decade, the Hausa used largely botanicals. By the mid 1980's, however, she noted the widespread use of pharmaceuticals bought either through the formal biomedical clinics and chemistís shops but also from itinerant herbalists. Despite the anticipation of health planners, the pharmaceuticals did not replace the existing pharmacopoeia, but became part of it. Also the use of the drugs differed significantly from that proposed based on biomedical knowledge (see Table below). The Hausa not only adapted Western medicines to their own use but demanded a different evidence for efficacy. The emic view of efficacy differed significantly from the etic one.
Drug Biomedical Application Hausa Use Rifampin Capsule Tuberculosis Cough, Jaundice, Hepatitis, Schistosomiasis Phenolphthalein tablets Laxative Jaundice, Hepatitis, Schistosomiasis Chloramphenicol capsule Bacterial Infections Measles, Chickenpox, Abortion, GI disorders, Itching Codeine Tablet Pain, Cough Energy, Strength Ferrous Sulphate Tablet Anemia, malnutrition, pregnancy Blood Tonic, Jaundice, Hepatitis, Schistosomiasis Tetracycline capsule Bacterial infections Measles, Chicken-pox
Etkin NL (1981) A Hausa herbal pharmacopoeia: biomedical evaluation of commonly used plant medicines. J Ethnopharmacol 4:75-98.
Etkin NL et al (1990) The indigenization of pharmaceuticals: therapeutic transitions in rural Hausaland. Soc. Sci. Med 30:919-928
Etkin NL (1992) 'Side effects': cultural constructions and reinterpretations of Western pharmaceuticals. Med Anthropol Quarterly 6:99-113
Etkin NL et al (1999) In Anthropology in Public Health Edited by Hahn, RA. Oxford University Press, Oxford
The term evidence-based medicine is bandied around with abandon these days, particularly at McMaster. I wanted students to confront this issue by forcing them to deal with the meaning of the term evidence as seen from different perspectives. Etkinís study offered an excellent opportunity. Students recognised that all systems of medicine, however primitive, were evidence-based. It is what constitutes evidence that was debatable. The problem also served to highlight the reason why people use drugs. Students in this course had dealt with the term efficacy in molecular terms and were now asked to look at it from a different perspective. Students used the information to look at a variety of issues, such as the WHOís list of essential drugs, the contrast between indigenous and modern systems of medicine, access to drugs, the role of pharmacists, herbalists and other health professionals etc.
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