How are you feeling (where you are)?

The world of medicine and pharmaceuticals research is sometimes thought of as best left to the natural scientists, with little need for understandings of emotion or culture. Our experience reveals just the opposite. Patient and healthcare professional research dealing with medical topics often reveals some of the richest and most emotionally laden cultural insight.

In fact we’d go so far as to say it’s impossible to really understand patients’ behaviours and attitudes without a rooting in cultural context. Looking at behaviours, needs, desires through the lens of culture—by which we mean conventions, shared beliefs, value systems, ideologies, myths—is essential if we are to derive real insight. This is every bit as much the case in pharma as in FMCG. And it’s every bit as much the case for research among patients as for research among healthcare providers (for they’re human too).

While the physiological phenomenon of a given disease may be universal, cultural context is specific and greatly affects the emotional impact that a disease can have on a patient. Japan brings alive vividly the importance of cultural context specificities on individual experiences of disease.

In a society like Japan, where there is great pressure put on the individual to meet strictly defined social expectations, the amount of stress caused by highly visible skin symptoms is magnified. With origins in the principles of Zen Buddhism and Shinto, the cultural emphasis put on cleanliness means that any apparent lack of cleanliness (in the form of skin flaking onto clothing or visible skin issues) can be interpreted as a flaw of character, a lack of discipline and respect, and an anti-social unwillingness to adhere to social norms. The shame and stress that the patient experiences on a daily basis strongly diminishes quality of life.

In a similar manner, the impact of joint pain can take on a unique form in Japan. Particularly in traditional homes, there are many occasions to sit on the floor with one’s legs folded underneath the thighs (seiza). This style of sitting is considered necessary in formal situations and is required on many public occasions such as funerals and other ceremonies. Not being able to kneel on the floor, due to knee pain, can therefore lead to more embarrassment and frustration in Japan than in other cultures where sitting in chairs is the norm.

Cultural factors may also play a role in shaping patient attitudes towards treatment and medication. In contemporary Japan, a form of Eastern medicine called kanpo continues to exist as an institutionalised system, just as established and accepted as Western biomedicine. OTC products made of herbal ingredients can easily be found in drug stores, and acupuncture clinics can be spotted throughout Tokyo. As a medical system, kanpo does not offer specialised drugs for specific pathogens—it ascribes illness to an imbalance in the body as a holistic entity.

In this context, the reason that many Japanese patients eschew biomedical drugs, even in the face of great pain, becomes clearer: they believe it is a foreign substance that does not ‘naturally’ belong to the body. We see this amongst many older patients who display unwillingness to take anti-inflammatory drugs to relieve pain.

Every society has its own beliefs, ideologies and values that impact on the way disease is experienced.

It’s probably always been important for drug companies to understand this thing called culture in their marketing approaches. Without understanding culture, the question of how a patient is feeling is pretty much meaningless. And so is the question of how the healthcare provider is feeling about the patient and the patient’s treatment. But as new drugs compete for the spends of healthcare providers with finite budgets, understanding culture is probably more important than ever.

Once again Japan provides a striking illustration of these dynamics. Traditionally a deeply provider-focused healthcare culture, Japan is now allowing greater agency for individuals in their treatments. Japan’s Ministry of Health, Labour and Welfare announced earlier this year that all major hospitals will be required to publish their performance reviews, in an attempt to encourage competition among medical institutions and to give people the power to choose what's best for them.

As populations age at increasing rates, keeping oneself healthy becomes more and more a personal focus. Smartphones come with health-tracking apps, supplements are readily available, and the internet has turned individuals into self-diagnosers.

In a world where patients have ever greater expectations, knowledge (however flawed) and agency, understanding the underlying cultural forces at play has never been more important.

Atsuyoshi Ishizumi is project director at Flamingo Tokyo