ABSTRACT
Culture and ethnicity are powerful determinants of an individual’s response to psychopharmacology, as are inter-individual variations within a defined cultural or ethnic group. Long-term adverse drug reactions are of little clinical relevance in palliative medicine. Desperate symptoms may demand assertive dosing and the rapid introduction of medicines. Alternatively, the frail ill may only require minuscule doses of a medicine such as a tricyclic antidepressant to achieve a therapeutic response. Firm pharmacological guidelines are inappropriate in this patient population. Patient acceptance of the need for medication and even the colour and size of the tablets can obliterate the placebo effect or contribute to non-pharmacological adverse effects. Complementary and alternative medicine (CAM) includes acupuncture, massage, a variety of psychotherapies, transcutaneous nerve stimulation as a cohort of medicines, including medicinal teas, herbal, vitamin, nutritional, mineral, traditional and homeopathic therapies. CAM users, when the treatment fails, are prone to hold themselves responsible for this failure, adding psychological insult to an already failing physical state.
