Money and Medicine, Part II: Economic Culture Shock

A sign whose likes you will never see in Germany. Taken in Mountain View, CA; August 2009.


You know what’s really fun? Being sick and in pain, up the middle of the night, trying to decipher the directions inside a box of pain medication, in a language you don’t really understand that well. I got to enjoy that experience about six weeks ago, with a recurrence of the same problem that made it excruciating for me to walk back in July, prompting the first Medicine and Money post. This time, there was prescribed pain medication involved—hooray—but it was of a kind that could kill you if you took too much. So reading and understanding the package directions was actually important. Imagine my surprise to open that package in my hour of need and find that the insert contained pages of directions, but only in German. Not one word in any other language: as if it never occurred to the manufacturer that non-German-speakers might find themselves in Germany, sick and in need of this common pain medication. As if there were no such thing as a tourist, or an immigrant worker.

In case the reasons for my surprise aren’t clear, I should point out that Germany is a relatively small country (by American standards) surrounded by neighbors who speak other languages: French, Italian, Dutch, Danish, Polish, etcetera. Internally, Germany also has a large number of immigrant groups in its population, the largest of which is Turkish. But was there any Turkish, or French, or Italian to be found on that package insert? Nein! A thousand times nein! Because anyone lucky enough to get into Germany should have the courtesy and intelligence to read German, right? Especially medical German, of the kind printed on the package insert for this pain medication.

So I sat in the bathroom with a dictionary at 3am, barely able to focus my eyes from the pain, trying to figure how to avoid killing myself by accident with the pills that were supposed to bring relief. Obviously, all’s well that ends well: I am not blogging from beyond the grave. But it got me thinking wistfully about the ways in which American drug manufacturers and pharmacies go way out of their way to avoid this sort of situation happening in the US. When I was in California a few weeks after wrestling with the pain meds, I stopped by a CVS and had to smile at images like the one above, of the Asian pharmacist with the caption in Spanish, and this sign—displayed near the prescription drop-off window—explaining to customers how to get help in 21 different languages, including English, Laotian, Polish, Portugese and German! (Please forgive the poor quality of my camera phone shots.)


 

Now this kind of outreach to non-English-speaking populations obviously doesn’t occur just as a humanitarian gesture: it’s a business decision by firms that want to make money by reaching out to the widest possible customer base. This means eliminating obstacles to the use and purchase of medical products—like language barriers. Despite all the crummy pockets of English-only activism in the US, American firms still want to make money, and that keeps them printing signs and package directions in lots of non-English languages—because they recognize the reality that many people in the United States, whether tourists or immigrants, don’t speak English at all, or don’t speak it well enough to decipher things like dosage directions while in pain in the middle of the night.

The question is: why don’t German firms recognize that? Why don’t they recognize that non-German-speakers within Germany have money to spend, and try reaching out to them—for instance, by making package directions available in other languages? Leaving aside the safety issues—it says something about German culture and its stance on foreigners that potentially dangerous medications are not labeled in any language other than German, or even in pictograms, which are commonly used elsewhere in the world as a language barrier workaround—it seems that German firms are forgoing some profits by making their products hard to use by non-German-speakers.

At root, I believe, this is about culture. Shortly after my arrival in the country, many Germans told me to be prepared for the total absence of American-style service culture. But that was only part of the story: after three years in Germany, what I notice is not just the absence of something like service orientation, but the presence of a cultivated user-unfriendliness, in which making things difficult and exclusionary is very much an explicit goal rather than an unintended consequence.

This is one of the many instances where conventional economic wisdom—all businesses wants to maximize profits—breaks down, and economic sociology can be very helpful. Because it’s not that hard to find places where entities nominally called businesses seem hell-bent on making it difficult for people to buy and use goods and services. The whole culture of capitalism as Americans know it is not universal, even though many US political and economic leaders would have us believe that those norms and values are shared everywhere that business is transacted. If you’ve ever been to a socialist or communist country, you know this already; but it is perhaps more surprising that one finds such substantial deviations from American, customer-oriented norms in countries known as developed capitalist democracies.

Like Germany—where two of my German friends recently got “fired” from their long-time health club because they complained to the owner that her employees were 10-15 minutes late almost every morning at opening time, leaving a crowd of members waiting around for the front doors to open. So instead of apologizing or trying to remedy the situation, the club’s owner told my friends that they were banned from the club henceforth as complainers who “upset the staff” with their unreasonable demands for things like reliable opening hours. Now that’s customer service! (I did find a tiny speck of consolation in this story: I thought that kind of thing only happened to foreigners like me, whose accents and grammatical errors while speaking German gave us away as members of a lower caste.)

Economically, this is just insane: what kind of business owner fires her own customers when they complain about her business failing to live up to its commitments? Wouldn’t it seem easier just to make sure the doors of the club got opened on time, rather than losing the revenue stream from customers of years’ standing? I suppose an economist would say that the club owner was maximizing her utility—whatever that means in this case. The utility of being able to cut off her nose to spite her face? To “win” a power play, but lose money in the process? Certainly, many people are willing to pay dearly for the experience of power and dominance over others. But whenever this sort of thing gets explained in terms of economic theory, I find the term “utility” deeply unsatisfactory: like a giant black box in which economists throw everything that they don’t understand.

Sociology is sort of like dumpster-diving in that black box: that’s where all the interesting stuff can be found. Like the costly, irrational stuff people do in the name of culture and preferences. There are a number of different definitions of culture across the social sciences, but I see it as the broad set of social values, practices, norms, roles and expectations people have because of the setting in which they were raised, or in which they live. Nothing happens without culture, including capitalism. And this is a major insight of economic sociology: there is no one universal capitalism, but numerous local variations, dependent upon culture. (Paging Max Weber—again.) So I come from a world in which the business norm is “the customer is king”—whether or not an individual transaction actually lives up to that ideal, I can call upon it within the US and most people will a) know what I’m talking about, and b) acknowledge that it’s the ideal to which business should aspire.

Go to Germany, however, and both a) and b) would cease to apply: there is no shared cultural agreement that customers are the most important people in a business transaction. That changes everything about the lived experience of economic activity there: things that would be unthinkable in the US can happen in Germany, like the gym owner firing my friends for their service complaints.

This produces a special kind of culture shock, of the specifically economic variety. It’s not something I’ve ever seen described, either in the scholarly literature or the popular press. But I’d venture that it happens to most of us, even when we travel outside our home countries: every time you find yourself in a new country, wondering if you’re supposed to leave a tip, and if so, how much, you’re experiencing a minor form of economic culture shock. But the phenomenon manifests itself in a variety of other ways that are hard to fully appreciate until you move to that new country and start working there, buying groceries, and going to the doctor.

Having shared a few stories about the way that economic culture shock has affected me, I’d be interested to hear from you–what forms have you encountered, and what did you make of those experiences?

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3 Comments

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3 responses to “Money and Medicine, Part II: Economic Culture Shock

  1. Pingback: Culturally-Relative Capitalism | The Global Sociology Blog

  2. Thomas George

    Very interesting article – I came across this blog while googling economic sociology.

    I am from India and the “customer is king” way of doing business is only starting to penetrate here.But that said,an Indian owner would have apologized profusely to the customer,promised an immediate solution and would have made him/her feel that his complaint has been noted.

    But be assured that nothing would change.After sometime the customer would adapt by coming at the time the gym actually opens.

    Thank you for the article and for making economics interesting.

  3. Jared

    i love stuff like this. when you can think to yourself, “i’ve never seen this described before”, you’ve hit on something considerable. great article.

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