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Session IV. Prevalence and variability of disease; Culture, morbidity, and the effects of drugs

In the evaluation of drug efficacy, despite the customary device of randomization, regional differences of prevalence of a given disease, unique culturally determined practices in treatment, and differential tolerances to side effects are complicating factors in transeultural pharmacology that must be taken into account in the interpretation of efficacy and toxicity. This thesis is doeumented by illustrations from psychiatrie practice, e.g., prevalence and morbidity of alcoholism, cultural differenees as to prevalenee, diagnosis, and symptomatology of schizophrenia, even to the point of widely discrepant diagnosis of a given patient, depending upon whether the examination was done by an American or British psychiatrist. Similar differenees concerning the existence of disease entities other than psychiatrie are cited, e.g., hepatic insufficiency eonsidered eommon in some Latin populations; low blood pressure a recognized and treatable condition in Eastern Europe. The ineidence of side effeets from the same drug may also vary in different cultures, making the interpretation of their significance difficult, and cross‐cultural comparisons hazardous. To avoid some of these pitfalls, it is essential to recognize (1) the many complexities inherent in trials involving differing cultures and (2) to design the studies insofar as possible to include measurement of population variables.