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PSYCHIATRY

Patient and Physician Attitudes to Using Medications with Religiously Forbidden Ingredients

Assistant Professor of Psychiatry and Associate Director of Residency Training, Creighton University/University of Nebraska; Staff Psychiatrist, Substance Abuse Treatment Center, Omaha Veterans Affairs Medical Center, Omaha, NE

Mohammed Shakeel Ahmed, MD

PGY4 Psychiatry Resident, Creighton University/University of Nebraska

James Madison, PhD

Assistant Professor of Psychiatry, Creighton University

Denise R Olsen, MSc

Research Coordinator, Omaha VA Medical Center

Subhash C Bhatia, MD

Professor of Psychiatry and Chief of Mental Health, Omaha VA Medical Center

Shahid Ellahi, MD

Clinical Instructor of Psychiatry, Brown University, Providence, RI

Farhan Majeed, MD

PGY2 Resident in Internal Medicine, University of Nebraska

Sriram Ramaswamy, MD

PGY3 Resident in Psychiatry, Creighton University

Frederick Petty, Phd MD

Professor of Psychiatry and Vice Chairman, Creighton University Department of Psychiatry; Associate Chief of Staff and Chief of Research, Department of Mental Health and Behavior Science, Omaha VA Medical Center

Daniel R Wilson, MD, PhD

Professor and Chair, Department of Psychiatry, Creighton University

Reprints: S Pirzada Sattar MD, Substance Abuse Treatment Center, Omaha VA Medical Center, 4101 Woolworth Ave. #116A, Omaha, NE 68105-1850, fax 402/449-0677, syed.sattar{at}med.va.gov

BACKGROUND: Over 1000 medications contain pork- and/or beef-derived gelatin and stearic acid as inert ingredients. Use of these medications in patients with religious beliefs against consumption of these ingredients might constitute an ethical conflict.

OBJECTIVE: To assess patients' and physicians' attitudes about using medications with religiously prohibited ingredients derived from pork and/or beef.

METHODS: In this pilot study, 100 patients and 100 physicians completed a survey designed to assess their knowledge and opinion on using medications that might contain inert ingredients derived from animals whose consumption offends followers of certain religions.

RESULTS: Of the 100 patients surveyed, most (84%) reported that they were not aware that several medications contained ingredients derived from pork and/or beef. About 63% of the patients wanted their physicians, and 35% of the patients wanted their non-physician healthcare providers (pharmacists, nurses), to inform them when using such medications. Thirteen percent of the patients shared religious reasons for not consuming pork and/or beef products. Approximately 70% of physicians were unaware that several medications contain ingredients that might be against their patients' religion, and most (70%) thought that it was important to inform their patients if such drugs were prescribed.

CONCLUSIONS: This pilot study suggests that both patients and physicians think that patients should be informed whenever medications that contain pork- and/or beef-derived products are prescribed. The use of medications with these ingredients is an ethical issue. Informing patients about this issue promotes respect for their religious beliefs and may promote therapeutic alliance; therefore, this might have public health implications and needs further research.

Key Words: adherence, culture, ethics, gelatin, informed consent, religion, stearic acid

Published Online, October 12, 2004. www.theannals.com, DOI 10.1345/aph.1E001

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