"We Always Live in Fear": Antidepressant Prescriptions by Unlicensed Doctors in India
"We Always Live in Fear": Antidepressant Prescriptions by Unlicensed Doctors in India
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DOI：
10.1007/s11013-014-9368-9
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发表时间：
2014-06-01
影响因子：
1.7
通讯作者：
Basu, Soumita
中科院分区：
文献类型：
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作者：
Ecks, Stefan;Basu, Soumita
在印度，精神药物已经深入到正规和非正规的医药市场，没有执照的“江湖”医生已经成为精神药物的现成处方者。这些人种学的见解困扰着旨在通过向低技能卫生工作者“转移任务”来缩小精神病药物治疗差距的政策，就好像药物只能通过公共部门精神科医生的处方获得。本文描述了这些医生，被称为农村医疗从业者（RMP），对精神药物的了解以及他们如何在日常实践中使用它们。无证医生通过与有证医生的交流，通过制药公司销售代表的访问，以及通过病人带来的处方来了解精神药物。尽管RMP存在于合法性的边缘之外，但它们受到与患者、执业医生、药剂师、药品批发商和政府代理人的关系网的限制。RMP不仅要开处方，还要配药，这导致了与持牌药品销售商的冲突。他们“总是生活在恐惧中”，因为他们是非法处方者，也因为他们是非法药品销售者。这篇文章表明，任何形式的战略无知的政策制定者对当地的重要性，非正式从业者在印度只能导致片面的干预。
In India, psychopharmaceuticals have seeped deep into both formal and informal pharmaceutical markets, and unlicensed "quack" doctors have become ready prescribers of psychotropics. These ethnographic insights trouble policies that aim at closing the treatment gap for psychiatric medications by "task shifting" to low-skilled health workers as if medications were exclusively available by prescription from public sector psychiatrists. This article describes what these doctors, known as rural medical practitioners (RMPs), know about psychotropics and how they use them in everyday practice. Unlicensed doctors learn about psychopharmaceuticals through exchanges with licensed doctors, through visits by drug companies' sales representatives, and through prescriptions brought by patients. Although the RMPs exist outside the margins of legitimacy, they are constrained by a web of relations with patients, licensed doctors, pharmacists, drug wholesalers, and government agents. The RMPs do not only prescribe but also dispense, which leads to conflicts with licensed medicine sellers. They "always live in fear" both because they are illegal prescribers and because they are illegal sellers of medications. The article shows that any form of strategic ignorance among policy makers about the local importance of informal practitioners in India can only lead to lopsided interventions.