Side effects: cultural constructions and reinterpretations of western pharmaceuticals.

In drug development and marketing multinational companies tend to patronize developing countries and even raise health risks by distributing products of questionable utility. The World Health Organization has pushed for standardization and quality assurance of drugs to compel companies to fully disclose adverse reactions. Clinical trials use small and unrepresentative samples thus longterm side effects are not taken into consideration such as steroid-induced hypertension in asthma patients. Unintended side effects are true side effects in the view of some (hair loss and lacrimation in anticoagulant therapy). Reactions that encompass primary and secondary effects include allergic reactions hypersensitivity and the corollaries of differential drug metabolism (serum albumin polymorphisms G6PD deficiency hemoglobinopathies and hepatic enzyme irregularities). Primary action and side effects are subject to interpretations as the antihistamine Benadryl causes drowsiness when used for allergies but as a sedative its ability to induce drowsiness is the primary action. Minoxidil promotes hair growth but it was originally developed as an oral hypotensive and it also could treat impotence. RU-486 or mifepristone the abortion pill has been used for glaucoma and brain tumor treatment. The Hausa of Nigeria use both indigenous plant medicines and drugs but their cultural interpretation of drug effects can lead to confusion: bitter plants have been used as abortifacients and the bitter drugs chloroquine penicillin and chloramphenicol have also been endowed with such qualities. Stomach aliments are treated with chile pepper coffee senna and balsam apple along with erythromycin and salicylates to induce purging. The tooth discoloration caused by tetracycline therapy is imputed to witchcraft. A more relativistic approach concerning the side effects of drugs is needed as their perception in many cultures is conceptually different.