Next | Previous | Contents

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 chemist’s 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

References:

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
 

Comments:

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. Etkin’s 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 WHO’s 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.