Abstract: By David Finer. IHCAR Karolinska Institute, Stockholm, Sweden. Licentate thesis. Available through author directly, David Finer, Department of Public Health Sciences, Division of International Health (IHCAR), Norrbacka Building, Karolinska Institute, S-117 76 Stockholm, Sweden. E-mail: [email protected] Vietnam is a complex society. Having conducted research into health insurance there, I understand a little about the mixture of influences resulting from socialist and market economic thinking, Confucianism, Buddhism and Taoism, in a country that bridges a vast range of environmental conditions. Given this, attempting to understand the dynamics of the health sector in Vietnam is a question of adding new pieces to the jigsaw. David Finer’s study adds a piece into that jigsaw with his analysis of health and medicinal drug information in the Vietnamese press. He examines this in relation to the expressed need of consumers. Given that around 50% of treatments are self-treatment with pharmaceuticals, and the importance of issues such as irrational drug use and growing drug resistance, the focus on pharmaceutical usage is highly relevant. Finer is particularly interested in the extent to which both risks and benefits are detailed in the media, together with lay perceptions of the role of mass media, and of the Vietnamese Government. A drug communication framework is presented including the source, or sender of information, the content of the message, the channel through which the message is disseminated, and characteristics of the receiver. Finer considers each aspect in turn though does not address the effects of this process. Whilst it is difficult to establish the impact of the different characteristics of each element, or actor, on consumer behaviour, this is clearly the key to informing policy decisions in the pharmaceutical arena, and weakens the study. Since doi moi, or economic liberalization in Vietnam, private pharmacies have been legalized. Coupled with the collapse of the Soviet Union which had supplied the country with subsidised pharmaceuticals, the number of drug companies operating in Vietnam has increased to over 400. The drugs market is effectively unregulated. Self-medication is the norm, with average drug expenditure $5 per capita per annum. The presence of drug information in the marketplace is analysed through four key publications. In Vietnam over 300 newspapers and journals exist, a dramatic increase from 54 in 1965. The role of media, however, remains heavily influenced by Confucian tradition, which sees it as fulfilling a key function in the preservation of the State. Whilst doi moi has led to a relaxation of press controls, they have since been tightened with censorship taking place primarily post-ante. Three key sources of information are used for the study, including a content and discourse analysis of relevant material in four key publications, including ‘Health’, ‘Women in Vietnam’, ‘Vanguard’ and ‘Great Unity’. In addition, an in-depth analysis of the ‘Lunar New Year’ issue of ‘Health’ is analysed. Finally, focus group discussions are held amongst 45 Hospital patients in Nha Trang. Out of 620 drug-related articles identified in the four publications, across 1993/4, 50% provided advice or education. Ninety percent of the articles talked about indications, 50% about the dosage that should be used, and a relatively small amount (12–13%) mentioned contraindications and side effects. The price of drugs is mentioned in only 2% of articles. Overall the research concludes that information was imbalanced, biased in favour of positive or neutral messages, with only 6% providing negative analysis regarding a product. The in-depth study of ‘Health’ found that 11 out of 18 health articles were concerned with plant medicines and seven on pharmaceuticals. Vietnamese culture heavily influences the tone and messages in the information found. Fertility and longevity, two key concerns in Vietnamese culture, influences material, for example with a focus on the search for a longevity drug. Strong moral values also pervade information, resulting in generally positive messages rooted in traditional values. Risks and benefits are communicated through the language of fear and hope. Southern traditional medicines, more popular amongst the elderly, are promoted as part of reliving Vietnamese culture, and remaining loyal to Ho Chi Minh’s vision of the county’s health system. Interestingly, drug companies are not seen as a direct source of most information, 50% of which are about Ministry of Health vaccination campaigns. Some useful observations on behaviour are also noted, such as patients taking inadequate doses of foreign antibiotics due to perceptions that they are high risk, and side effects often seen as a positive indication of the potency of a drug. Finer concludes that given the nature of media control in Vietnamese society, trust in the government is vital for trust in the source of information, sometimes referred to as ‘source credibility’. He considers that the jury still to be out on whether or not controlled or free media creates greater benefits with regard to drug consumption in a predominantly private market. This is clearly difficult to judge without some attempt to link behaviour with the various configurations of source, message content, medium of dissemination and receiver profile. Finer’s call for more professional and independent journalism is a little naive, given that this is perhaps the most politically sensitive issue in the country. Much can be achieved in Vietnam without wholesale political change. Despite this, Finer provides a useful study, relevant to a broad range of countries.