Decisions, decisions . . .

Hmm, had a spam comment from from some schtickdreck hawking vicodin. Yuck.

Anyway, a question that very much interests me is the relationship between people's rationale for undertaking a treatment, and the likelihood that they will stay with it and/or be adherent. If anyone's personal experience seems relevant to this issue, I'd love to hear from you.

In interviewing people with HIV, and older people about whatever pills they might be taking or have had prescribed, I basically find people in the following categories -- people who put people into categories, and those who don't. Oh no, that wasn't it. It's these:

1) I just do whatever my doctor tells me. Nowadays this seems to be a distinct minority, but it used to be considered more or less the norm. Why are you walking backwards on the golf course, Norm? Doctor's orders. People in this category generally express a low demand for technical information about their condition and treatment, and may even actively reject it. They've got other problems to think about.

2) What I will call non-biomedical heuristics. People I know did it and it worked/didn't work, went fine/gave them agita; Magic Johnson is doing it; my spouse would give me a dope slap if I didn't. That sort of thing. Could actually be more important than people are likely to tell me, but those who say this sort of thing explicitly in interviews are only a few percent.

3) People who believe in non-allopathic healing modalities (as we say in the medical sociology biz); people who reject biomedicine as a conspiracy against the public, a money making plot, an offense to nature. I try to stay free of all drugs. The important thing is to have order and harmony in my life so I'm pursuing Reiki therapy. They Ayurvedic doctor pours ghee up my nose and has me eat lots of cucumbers and that's what really works for me. Again, it's a small percentage who do this in place of officially sanctioned scienterrific medicine, although a lot of people do it in addition to . . .

4) People say they made the decision or shared it with their doctor on the basis of a biomedical rationale. Nowadays, this is by far the most common kind of response. However, when I actually ask people to articulate that rationale, the degree to which it matches what I happen to know their doctor actually thinks is extremely variable. Some people give scientific explanations that are basically accurate, others give what they no doubt believe are scientific explanations, but really do not match up at all.

Some of your post-modernists and critical theory types believe that, as a social scientist, I'm just supposed to ignore this mismatch since all knowledge is socially constructed anyway but, err, no. Especially since what the people are actually doing as a result of this non-scientific belief is what scientists tell them to. The only reason anybody believes that she or he is, for example, HIV infected, has dangerously high levels of low density lipoprotein in the blood, has glucose resistance, or has high blood pressure, is because a medical professional wearing a white coat performed a test on them using a fancy machine or a lot of laboratory equipment with centrifuges and enzymes and electrophoresis and what not and then told them so. That they go on to think of their HIV as a mother virus continually having babies is a contradiction. Sorry.

But how does accurate understanding and decision autonomy and so on relate to whether or not people take the pills? I think that's a complicated story.