Why is Diversity So Important?

Because cultural diversity affects us all.

Cultural influences shape the framework through which people view the world and operate in their everyday approach to life. Culture impacts the distinct ways people define and organize their lifestyle, guiding beliefs, and basic assumptions about life. Culture is an important guiding force in how individuals live and shape not only their perceptions, but their relationships with people and the world around them. In many cases, individuals will form social and peer groups based on cultural similarities. These cultural groups share values, belief systems, symbols, behavioral patterns, and other characteristics that distinguish them from other groups. Cultural groups can provide a source of belonging, identity, mutual help, validation, and self-esteem.

Furthermore, these cultural groups are not always mutually exclusive, and an individual may hold simultaneous memberships within different groups.

Understanding cultural diversity involves gaining a greater awareness of the ways cultural heritage and background influence values, assumptions, thought processes, and relationships. The process of learning about cultural diversity begins with moving away from a single cultural perspective that devalues differences at the interpersonal, personal, institutional, and cultural levels and moves toward a pluralist cultural perspective that practices acceptance, valuing, utilization, and celebration of both similarities and differences.

In a global business environment, managers and executives will undoubtedly interact with individuals and groups from other cultural backgrounds. One of the most effective ways to achieve an appreciation and understanding of cultural diversity is by taking advantage of opportunities to develop genuine relationships with individuals who are culturally different. Learning about the experiences and perspectives of those who see things through a different cultural framework can be of benefit both professionally and personally.

Inclusion = WIN/WIN

Patient advocacy groups provide valuable insight and are necessary to help patients overcome barriers. The information they provide pharma focuses on the needs and rights of patients worldwide and this helps attain appropriate linguistic and cultural responses. Patient advocacy groups are not only knowledgeable about all facets of drug development including discovery, research, clinical studies and education, but they are dedicated experts on the standards of care, patient needs and the rights of all patients from every possible angle. Drug development impacts the global patient population and patient advocacy groups are mindful of cultural diversity and language as an effective means to educate. The desired result is to treat, cure or fight disease and help patients obtain quality of life instead of suffering or from dying prematurely.

All patient populations could benefit from the collaboration between patient advocacy groups and pharma. Increasingly, patient advocacy groups play a crucial role in educating the marketplace on new medicines and treatments and most purport that drugs should have universal access. Globally, millions of patients represent a myriad of countries with hundreds of languages and thousands of cultures. Such advocacy groups guide us in the fundamental need for addressing patients in their native language and indicate that culture does matter in order to have a positive affect on patient communication. The right kind of communication can only optimize the patient population as a whole.

Pharma has much to gain from the insightfulness of patient advocacy groups. The FDA promotes the value of patient advocates while some pharmaceutical manufacturers rely on their perspective. Pharma would be wise to delve into what these groups imply about inclusion of culturally diverse patient populations when it comes to drug development. Let us not lose sight of the critical role of patient advocacy groups. They offer unparalleled insight and true collaboration means that the pharma companies would act upon their message and implement what is right. This is a valuable partnership. More importantly, it is a huge benefit for the global patient. This is a win-win situation!

MUR

Create Understanding with an Interpreter

For non-native speakers in a foreign country, there may come a time when you need to use an interpreter. Interpreters assist with the accurate communication of ideas between two parties. They can also be very helpful cultural interpreters as well giving either party clarification on actual or potential cultural misunderstandings. If there are problems, do not be afraid to ask the interpreter for advice.

When using an interpreter, there are several items that should be considered:

· If possible, hire an interpreter knowledgeable about the subject to be discussed.

· Speak clearly and slowly.

· Avoid little known words and the use of idioms.

· Explain the main idea of the discussion more than once to make the point clear.

· Speak only a minute or two before allowing the interpreter to speak.

· If necessary, allow the interpreter time to take notes about the dialogue or clarify the meaning of obscure points.

· Do not interrupt the interpreter as they are speaking – misunderstandings could result.

· Avoid using long sentences, double negatives or negative wordings if a positive wording will work.

· Avoid being superfluous.

· Support your verbal message with expressions and gestures.

· To double check understanding, write out the main points discussed and confirm in writing what was agreed to in the discussion.

· Allow the interpreter a break after two hours and consider using a second interpreter if the event will last all day.

Lastly, understand interpreters are people. Understand if they make a mistake, and do not panic if they need to consult a dictionary or if the interpreter covers in 30 seconds what it took the speaker 5 minutes to express. Being patient and deliberate with an interpreter can go a long way and results in a discussion everyone can understand.

When will the medicine kick in?

A recent study in a series by the non-profit Commonwealth Fund showed that while Americans pay far more per capita for healthcare, they are unhappier with the results and less healthy than people in other rich countries. Unhappy because the costs are out of reach; Less healthy because we cannot afford the price of good health. Surely, this resonates with everyone. Our great country can offer so much by way of the most advanced technology, miraculous breakthroughs in medicine and the brightest scholars. But when it comes to health care, no one can deny that conditions are harmful for many, deplorable for the poor and dreadful for minority groups who suffer from more widespread diseases and dismal economic conditions.

An estimated 157 million adults have health insurance through their employer. Another 45 million over 65 and older including the disabled have Medicare coverage. Recently, the U.S. Centers for Disease Control and Prevention estimated that 59 million Americans had no insurance for at least some of the beginning of 2010. This is an increase from 58.7 million in 2009 and 56.4 million in 2008. Of those without health insurance, 15 million had high blood pressure, diabetes or asthma. Some of these illnesses are more prevalent in minority groups, which also tend to have higher uninsured rates in the United States.

The problems related to health care costs are insurmountable for many. If we cannot pay for health care, we forego medicine, treatment not to mention prevention. Diseases that go undetected end up costing more and the rate of disease continues to rise. Hospitalizations that could have been avoidable could become the norm, which leads to outrageous costs. The outcomes are disastrous. In addition to unnecessary pain and suffering, the results can be loss of homes or bankruptcy because of unreasonable costs and lack of options. We have grave problems when there are simply fewer funds to maintain one’s health, something necessary for survival. Why does the U.S. lag behind other countries in something so vital? When will we start to feel better?

MUR

Impact for Some, But Not All

According to the Pew Research Center’s Internet & American Life Project, 61% of today’s adults search online for health information compared to the 2000 findings of only 25%, which indicates the increase of online users. Beyond online health queries, social media is a medium that can be advantageous for patients from all backgrounds, but it can be much more useful for minority populations who find doctors to be trustworthy and consider their opinions important. The online impact on decisions or actions is a positive one, but it may prove to be more important for ethnic groups who view the doctor as the absolute authority figure when it comes to health care. The right kind of social networking can make an impact.

Numerous studies reveal disparities among ethnic minority groups with reported higher incidence and chronic health conditions compared to the White population. Therefore, reaching ethnic populations via social media could make a significant impact on their health. Culture is a crucial component of the effectiveness of health care delivery and the high regard for the doctor’s opinion will affect the medical intervention. A physician via a social network would help the patient understand and manage their illness, change risky behaviors and make informed treatment decisions. This could play a major role in medical decisions for some groups such as Hispanics or Asians.

Social media can be a powerful tool between a health care expert and a patient willing to act upon the information to improve his or her health. Patients linked to their doctors seems more effective than random online visits for health queries that need to be deciphered and may or not be the best source of information. The ethnic patient will likely adhere to their doctor’s advice. Social media may be the next best link for non-mainstream populations to impact the health of a minority group not always connected to health care access. Communication is key. The doctor connection is crucial. Social media can help. Let’s stay focused on the goal: to improve the patient’s health. Will social media make an impact?

One Language Barrier at a Time

Why do Hispanics experience disproportionately higher rates of disease, fewer treatment options, and reduced access to care? Some of the factors include low-income status, being uninsured or under-insured and communication barriers with health care professionals. These are all major deterrents to health care access, which is vital to good health. Monolingual Spanish-speakers cannot understand the law, their options or the costs associated with insurance coverage. Recently, Health and Human Services (HHS) launched a new website called CuidadoDeSalud.gov that offers health care information in Spanish. The language, often complicated by various dialects, is easy enough to read and understandable.

According to HHS Secretary Kathleen Sebelius, "CuidadoDeSalud.gov will give Latinos across the nation better information about the choices they have, how much they cost, and what they can expect from their doctor – specific to their life situation and local community." The new website is a resource for Hispanics who may not be able to obtain regular annual physical exams or preventative tests that detect the early onset of cancer, diabetes, heart and kidney disease. These are prevalent diseases in the Latino community. According to a recent government report on health disparities, the evidence shows higher rates of disease in the Hispanic population. For example, 14% of Hispanics suffer from adult onset diabetes compared to 8% of the White population. Another fact is that Hispanic women contract cervical cancer at twice the rate of White women. Other statistics show similar findings to support these disproportionate rates.

The Spanish-speaking population has gained technological access to critical information that provides options about health care choices. Individuals challenged by communication barriers can finally begin to understand our complex health care system in their own language. All this is just a click away. We may be on the verge of a breakthrough. Now we wait for the relief of suffering and pain of this impoverished community. More importantly, it has everything to gain: access to health care.

(MUR)

When it Comes to Online Health Information, Culture Does Matter

According to a 2010 MARS Online Behavior Study, it appears that the worldwide web impacts online user behavior and that behavior is determined by the degree of seriousness of the medical condition. Dedicated websites hold a certain comfort level when there is a recent diagnosis or the user has a chronic condition. In this case, access to health care professionals provides a greater degree of trust over search engine researching. This is indicative of an online user who is more focused, serious and looking for comfort and ease from a trusted source. On the other hand, users afflicted with diabetes or less serious conditions not necessarily life-threatening, may use websites’ useful tools such as meal planning to influence a lifestyle change or they may use online community support. These users were more likely to be repeat users. Therefore, the severity of a health condition determines online behavior and reveals unique patterns.

The MARS study, however, does not address cultural differences surrounding online behavior. It is evident that what is true for the mainstream culture cannot hold true if you have a different view on health or behave differently as a result of a health threat due to a diagnosis. Different cultures view information differently and thus require different types of health information. And many cultures react differently to how medical information is presented. Other cultures take varying approaches in how they respond to an illness. Knowing how other cultures respond to online medical information could prove to be an enormous benefit to the entire health care community - allowing them to reach more people. Many questions come into play. Are other cultures using the Internet to help them alter their lifestyle, make a life decision or obtain support? If so, are there patterns of how health information sites help? What impact do these sites have? Considering cultural diverse societies, this does matter, does it not?

(MUR)

Convenient Access?… Not For Everybody

Patients of the new millennium have a strong desire for quick information and the Internet has made this incredibly convenient. One no longer needs to be on a desktop computer with increasingly popular wireless access via cell phones or the more common iPhone available. According to the Pew Internet & American Life Project, 83 percent of Internet users have looked online for health information. Any patient is now empowered to search online anytime, from anywhere, for valuable and sometimes critical information to help them learn about a medical condition or symptom and to search for viable options. The health concern may or may not be life-changing, but patients quickly want to learn their choices to help them reduce anxiety or allow them to plan ahead. They no longer have to wait for a medical appointment to obtain complex answers from their doctor rather they can quickly gain the necessary knowledge online to help them make an informed decision. The fact is that the Internet provides instant answers with options to empower the patient so that the least to the most educated patient can readily weigh the information. The question may not always be convenient, but the Internet sure is. This is a powerful pill.

Although the Internet is certainly convenient for the most sought after medical information such as herpes, pregnancy, depression, heart disease and breast cancer, many useful websites offer information only in English. Globally, millions of Internet users who seek health information are non-English speaking and speak an array of other languages. English-only sites that are well-intended may be counter-productive for those who speak other languages and could result in frustration, anxiety and fear. Language barriers pose challenges, prevent effective communication and remove the possibility of learning. This is the opposite of empowerment. People who speak other languages should be able to access valuable health information in their native language and gain the capacity to explore options. Why not give everyone a shot at this pill? Why not make it convenient for all?

(MUR)

Is a signature enough?

GlaxoSmithKline’s diabetes drug, Avandia has been under intense scrutiny recently. According to a study by cardiologist, Dr. Steven Nissen and Kathy Wolski, published in the New England Journal of Medicine, the drug increases the risk of heart attack by 43% and increases the risk of dying from cardiovascular causes by 64%.

In Europe, the European Medicines Agency has banned its use. In the US, however, the FDA has decided to keep Avandia available to patients. The FDA argues study data is not strong enough to remove it from the market. It currently requires restricted access under a risk evaluation and mitigation strategy (REMS). As such, patients currently taking Avandia who feel they are benefiting from the drug may continue taking it upon signing a consent form acknowledging the potential risks associated with the drug. The strategy only allows new patients to take the medication if it is truly the only option available to them to control their glucose levels, and again, upon signing a consent form.

"Patients will only be allowed to use [Avandia] if they acknowledge and document the risk of this drug," said Dr. Joshua Sharfstein, FDA principal deputy commissioner.

In essence, the FDA has pushed the responsibility of determining if risk outweighs reward to the patient and their doctor. We would argue the signing of the consent form shifts much of this responsibility to the patient, relinquishing the doctor and the manufacturer of liability. They were told the risks, they signed the form, what happens next is on the patient.

In a case where your risks include heart attack, stroke or even death, is simply signing a written consent enough? Shouldn’t there also be a check for actual understanding? A panelist on the FDA advisory committee, a researcher from Duke, Ruth Day, suggested patients should be required to take a quiz to check for understanding.

We would agree. Here is the reality: A patient sits in an exam room as a doctor rattles off a laundry list of “potential risks.” The eyes glaze over a little, there is a lot of nodding and affirmative responses. A doctor whom they trust implicitly says “sign here” and voila, consent is given. Is that true understanding? Especially in patients for whom English is not their first language, how do you know they really understand? Would it be wrong to make the patient run it back?

Taking this medication can cause which of the following side effects?
a) purple fingernails
b) bulging eyeballs
c) heart attack, stroke or possibly death
d) all of the above?

If doctors and the FDA are going to put the responsibility of the risk of death onto the patient, shouldn’t they be responsible for ensuring patients fully and clearly understand that responsibility?

Cuidado! Do you know?

On or about the first of May a warning went out to medicating parents everywhere: put down the children’s liquid medications. Cries of “but how will I get my kids to sleep tonight!” were heard across the country as viewers saw the warning on the CBS Evening News Bloomberg News and CNN, online over MedPage Today, HealthDay and WebMD and read about it in publications like the NY Times, Wall Street Journal, Chicago Tribune and the Washington Post.

The recall of pediatric formulations of children’s Tylenol, Motrin, Zyrtec and Benadryl was voluntary and mandated because of manufacturing deficiencies in the plant where the medicines were made. Consumers were advised “to stop using the medicine as a precaution.” Any children taking the recalled medicines and exhibiting “unexpected symptoms” were urged to contact a healthcare professional.

People in the healthcare industry love a good study, both clinical and academic. Here’s a suggestion for a study we’d like to see. In the United States, packaging for over the counter medicines is mostly printed in English. That’s fine. English is official language of the United States and most non-English speaking parents can probably go to the drug store and piece together the English they know to pick out pain relief medicine for their children.

What about this recall? Was information about the recall presented in other languages and to what degree?

How many non-English speakers are purchasers of these liquid children’s medications and what was the customer service rate of inquiry for non-English speakers for the recall? Do non-English speakers even realize there was a recall? Is the Russian mother of three who buses tables at the restaurant around the corner reading the NY Times and watching CNN? How do non-English speakers know to stop taking these medicines?

More Than a Hangover

January’s post, I Know Not What I Pour, noted how excessive alcohol consumption may not be a conscious decision and can affect your health. There is further evidence that heavy alcohol consumption yields more than a hangover the next morning. An NHS Confederation report from this year states hospital and ambulance costs associated with treating heavy drinkers in the UK have doubled over the past five years.

According to Professor Ian Gilmore, President of the Royal College of Physicians, “The nation’s growing addiction to alcohol is putting an immense strain on health services, especially in hospitals, costing the NHS over ₤2.7 billion each year. This burden is no longer sustainable.”

According to Steve Barnett, chief executive of the NHS Confederation, “This report shows that not only are we drinking too much but that the cost to our health services is increasing.” He notes that of 18 people, who are addicted to alcohol, only 1 receives treatment. He believes more needs to be done to effectively identify, assess, and treat patients and calls for a “reappraisal” of social and cultural attitudes towards drinking.

The International Center for Alcohol Policies (ICAP) would agree. In 2008, they sponsored a focus group centered study on alcohol consumption in Europe, Brazil, China, Nigeria, Russia, and South Africa. As reported in the September 23, 2008 issue of Science Daily, they found “cultural influences are a dominant factor in youth attitudes about drinking and drunkenness.”

Attitudes towards drinking varied by country and the lower rates of heavy drinking were found in Mediterranean countries versus heavy drinking rates in Northern Europe (including the UK.) For some countries, Spain, Italy and France for example, drinking moderately on a daily basis is a way of life.

It will take a little more than a Bloody Mary and a bottle of Advil to cure this hangover. Whether you drink or not, the increasing costs associated with caring for those who do will be passed on to everyone. The answer will lie in doing more than simply identifying and treating patients addicted to alcohol. To be effective, preventative measures able to change attitudes towards drinking need to be implemented. These preventative measures can only be effective if they are based on an awareness of the cultural factors contributing to the high levels of alcohol consumption in the first place.

Want to know more about the ICAP study? No sweat! They wrote a book about it: Swimming with Crocodiles: The Culture of Extreme Drinking.

Branded Generics?

Our last blog discussed the rise in popularity of generic prescription drugs domestically without mentioning their status overseas. Since most consumers outside the US market pay for drugs out of pocket and cannot afford expensive name brands, generics are very popular internationally. With the drop in brand name drug market share domestically, pharmaceutical companies are more than willing to fill this desire for low cost drugs.

Emerging markets are set to overtake US markets in overall sales. Pharmaceutical revenue in China in particular, with its current strides towards universal health coverage and improving its healthcare infrastructure, is predicted to double by 2013. Much of the growth in emerging markets (i.e., China, Brazil, Russia and India) is driven by low-cost generic drugs.

As a result, many pharmaceutical companies are now hawking branded generic drugs in overseas markets. While the term “branded generic” may seem at odds, it is actually becoming quite a lucrative market.

Americans, because they have been “brand washed” so extensively, tend to view generic drugs as lower in quality than brand name products, despite containing the same active ingredients. Marketed to less extensively, overseas populations are less biased against lower cost, generic formulations.

Branded generics make sense. There is no additional cost for a company to attach their company name to a generic formula, instilling consumer confidence in a less expensive formulation without adding millions in cost to marketing and promoting a specific brand name.

Companies approach this tactic differently. Some associate their main brand with the generic, while others purchase local overseas generic companies to sell their products under a different name.

“We are able to create different tiers of products at prices they haven’t previously seen with our stamp of approval,” Andrew P. Witty, the chief executive of GlaxoSmithKline told the NY Times.

According to the same article, “It definitely represents a change in thinking,” said David Simmons, the president of Pfizer’s established products business unit, whose company has already added over 200 generic products to its portfolio.

Discounted or Abandoned... What's a brand name pharmaceutical to do?

According to a recent study by Pharma Insight, released by Wolters Kluwer Pharma Solutions, in 2009 there were 2.6 billion prescriptions filled for generic drugs and only 1.3 billion for brand-name medications. In a down economy, more people turn to generics as a way to save money. This can cost the pharmaceutical industry billions of dollars every year.

Increased request for generics over brand names is not the only trend seen in the drug market. Abandonment is the term for prescriptions left at the pharmacy that are never fulfilled. Last year the abandonment rate for new prescriptions of brand name drugs was 8.6%, a 23% increase over the rate in 2008 and a 68% increase since 2006.

According to Dea Belasi, consulting practice leader of managed markets for Wolters Kluwer Pharma Solutions, “What’s peculiar is that the rate of increase among patients walking away is almost unprecedented. The [abandonment] trend that we are seeing is just going up and up.”

Belasi suggests macroeconomic factors such as the housing crisis, current recession and lower household incomes are behind the rising rate of prescription noncompliance. Consumers are trying to save money by self-medicating or reducing overall drug consumption.

For more on how the economy is affecting patient compliance in healthcare, please read our current online issue of CONNECT. To subscribe to this free, online newsletter, click here.

What Would You Do? Cost and Ethic Concerns in National Children's Health Study

If a stranger knocked on your door and politely asked if they could collect your toenail clippings, body fluids and dust from your sheets for the sake of science, what would you say?

The National Children’s Study is doing just that. Its goal is to enroll 100,000 pregnant women across the country, then monitor them and their babies from before they are born until they turn 21.

The study involves collecting copious amounts of extremely detailed information in hopes of connecting patterns between environment (natural and man-made); biological, chemical, and social factors, physical surroundings, behavioral development, genetics, cultural and familial influences and geographic locations to see how they interact to effect a child’s health.

As you can imagine, the magnitude of the study has been compared to that of a lunar landing but critics are crying foul on the escalating cost of the study as well as ethical issues surrounding its structure.

Part of the cost escalation comes from enrollment issues. Instead of receiving a “yes” from roughly one in fourteen potential participants as initially predicted, the reality is one in forty. Let’s be honest. Twenty-one years is a long time and the quantity of information gathered during visits is burdensome and prohibitive. Many do not want to be bothered.

Racial and cultural issues slow enrollment as well. Study locations are chosen based on having diverse populations with a high number of births. The melting pot that makes our country great also makes recruiting in urban areas more difficult. A wide variety of languages and cultures are encountered, requiring translation services to communicate with potential study participants. With good reason, non-English speakers are suspicious of random strangers knocking on their doors and are tentative at best opening them.

Economics also effect enrollment. It is easier to draft participants in cash rich areas. Movie theatre ads and obstetricians reach potential patients. For a study to be comprehensive and inclusive though, you cannot exclude women unable to afford life’s little luxuries or prenatal care. Reaching these populations takes more time and finesse, and thus, money.

Ethics in information access are another criticism in the structure of the study. Protocol restricts study employees from urging participants to change their health habits. Is it right to make the effort to reach specific populations and not take time to educate them?

How much information should the study provide to participants and their communities? If a genetic mutation is discovered that may or may not appear, and holds no cure, should the participant be notified? Is it worth the worry (perhaps unnecessary) it could cause? If an environmental trigger is suspected to cause a medical condition within a community, should it be reported? The study provides an opportunity to help people and communities but how do you do it without skewing study data?

This is a lot to consider over the course of twenty-one years. If not on target from the start, a lot of time, energy and money will be wasted. For the time being, those heading up the study are taking the criticism seriously. At the moment, most of the study is currently on hold while the scientific community considers these issues.

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The National Children’s Study will examine the effects of environmental influences on the health and development of 100,000 children across the United States, following them from before birth until age 21. The goal of the Study is to improve the health and well-being of children.

For more information, visit their website: www.nationalchildrensstudy.gov

I Say Medicine, You Say Midewin

Think about the word, “medicine.” What does it mean to you? Do you think of multicolored pills? Your doctor? The pharmacy down the street?

If you are an American Indian from the Ojibwe tribe, the word for medicine is “midewin” (pronounced ma-DAY-win) and it means ‘from the Earth.’ It’s subtle, but the difference is clearly there. For American Indians, wellness does not come from a pill. Healing comes from plants and herbs that treat disease. Not viewed as a physical response with a cause rooted in the laws of science, disease encompasses a patient’s spirit, family, community and environment.

Dr. Doreen Wiese, who is of the Ojibwe tribe, is trying to revive the Ojibwe language precisely because of this difference. In the United States especially, native languages have withered up and died for two main reasons: first, because parents felt their children needed to learn English to become successful in American culture and second because until the 1940's, Native American children taken from their homes were forced to only speak English.

A PhD from Northern Illinois University who studies oral history and the ways in which learning is passed through generations, Dr. Wiese believes, “…language is the thread that keeps culture together. Language is woven into our brains and psyches and memories.”

It’s true. Language reflects culture. While the words can be translated into English, the meaning behind the words may change. An Ojibwean story about “midewin” takes on a new meaning when the word becomes “medicine.”

Dr. Wiese’s goal is to write down the Ojibwe language so it can be taught to others. Not an easy task. Part of her impetus in doing so came when she attended a religious ceremony where a speaker claimed God gives everyone a native language. “He said that if you can’t pray in your native language, the Creator cannot hear you. I wanted to learn how to pray in Ojibwe. I wanted to learn how to tell our stories in Ojibwe. That’s the only way we can be whole again as a native people.”

I Know Not What I Pour

As a translation agency that specializes in medical and life science translation, we work on a lot of patient targeted materials. Often these communications hope to elicit patient compliance in some form or another. Many aspects about a patient influence their compliance: culture and language, education level, style of commucation they receive.

A recent experimental study through the Know Your Limit campaign in the United Kingdom indicates that a patient’s noncompliance may not always be a conscious decision.

When asking men and women in the U.K. to pour what they thought was a single serving equivalent of alcohol (25ml, about an ounce in the US), the average pour was 38ml (in reality one and half servings).

The experiment found men to be the most generous in measuring their spirits: 43ml was the average manly pour versus an average of 32ml poured by women. Wine is a different story altogether, in this case women are more generous, averaging a 186ml pour, which is 2.4 times the standard wine serving of 76.25ml (2.5 ounces in the US).

Studies show drinking more than the recommended limit for daily alcohol consumption; (2-3 units for women and 3-4 units for men in the U.K.) dramatically increases their risk of heart and liver disease, cancer, and stroke.

Anyone tracking their alcohol consumption for the purpose of maintaining their health may not be doing as well as they thought. While this finding does not affect the outcome of a clinical trial or important health study, it is an insight into patient behavior. The truth is patient compliance is affected by many aspects, some conscious, some not.