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This essay questions, with regard to medicine, the idea of progress as technological development by focusing on people rather than things. It analyzes how the predominance of such an idea of progress converts today's societies to techno-fetishism that degrades community life and medical practice, contributing to the medicalization of social life. It is argued that the realization of technological potentialities depends on their forms of use; that the main motive of technological development is unlimited profit and that priority developments are those that enhance the social control that maintains the status quo. The intelligence as an intelligence quotient is criticized by proposing it as an attribute of the human being as a whole, manifested in the ways of thinking and proceeding of people in their circumstances, where affectivity and critical thinking are essential for their development; it is emphasized that its antecedent is the harmonic concert of planetary life that contrasts with the prevailing human disharmony. It is proposed that artificial intelligence is the most recent creation of techno-fetishism that deposits vital attributes in technology and that its forms of use will accentuate the degradation of human and planetary life. Another idea of medical progress is proposed, based on forms of organization conducive to the development of inquisitive, critical and collaborative skills that promote permanent improvement, whose distant horizon is dignifying progress: spiritual, intellectual, moral and convivial sublimation of collectivities in harmony with the planetary ecosystem.

Este ensayo cuestiona, a propósito de la medicina, la idea de progreso como desarrollo tecnológico al centrarlo en las personas y no en las cosas. Se analiza cómo el predominio de tal idea de progreso convierte a las sociedades actuales al tecno-fetichismo que degrada la vida comunitaria y la práctica médica contribuyendo a la medicalización de la vida social. Se argumenta que la realización de las potencialidades tecnológicas depende de sus formas de uso, que el móvil principal del desarrollo tecnológico es el lucro sin límites, y que los desarrollos prioritarios son los que potencian el control social que mantiene el statu quo. Se critica la idea de inteligencia como cociente intelectual al proponerla como atributo del ser humano como un todo, manifiesto en las formas pensar y proceder de las personas en sus circunstancias, donde la afectividad y el pensamiento crítico son imprescindibles para su desarrollo. Se destaca que su antecedente es el concierto armónico de la vida planetaria contrastante con la disarmonía humana imperante. Se plantea que la inteligencia artificial es la más reciente hechura del tecno-fetichismo que deposita en la tecnología atributos vitales, y que sus formas de uso acentuarán la degradación de la vida humana y planetaria. Se propone otra idea de progreso médico basado en formas de organización propicias para el desarrollo de aptitudes inquisitivas, críticas y colaborativas que impulsen la superación permanente, cuyo horizonte lejano es el progreso dignificante: sublimación espiritual, intelectual, moral y convivencial de las colectividades en armonía con el ecosistema planetario.

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This essay challenges the idea of progress as technological development in relation to medicine by focusing on people rather than things. It analyzes how the prevalence of such an idea of progress leads contemporary societies to a technofetishism that degrades community life and medical practice, contributing to the medicalization of social life. It is argued that the realization of technological potentialities depends on their forms of use, that the main motive of technological development is unlimited profit, and the priority developments are those that enhance social control which maintains the status quo. Intelligence as an intelligence quotient is criticized by proposing it as an attribute of the human being as a whole, manifested in the ways of thinking and acting of human beings in their circumstances, where affectivity and critical thinking are essential for their development; it is emphasized that its antecedent is the harmonic concert of planetary life, which contrasts with the prevailing human disharmony. It is proposed that artificial intelligence is the latest creation of technofetishism, which deposits vital attributes in technology, and that its use will accentuate the degradation of human and planetary life. Another idea of medical progress is proposed, based on forms of organization that is conducive to the development of inquisitive, critical, and collaborative skills that promote permanent improvement, whose distant horizon is dignified progress: the spiritual, intellectual, moral, and convivial sublimation of collectivities in harmony with the planetary ecosystem.

Este ensayo cuestiona, a propósito de la medicina, la idea de progreso como desarrollo tecnológico al centrarlo en las personas no en las cosas. Se analiza cómo el predominio de tal idea de progreso convierte a las sociedades actuales al tecno-fetichismo que degrada la vida comunitaria y la práctica médica contribuyendo a la medicalización de la vida social. Se argumenta: que la realización de las potencialidades tecnológicas depende de sus formas de uso; que el móvil principal del desarrollo tecnológico es el lucro sin límites y que los desarrollos prioritarios son los que potencian el control social que mantiene el statu quo. Se critica la idea de inteligencia como cociente intelectual al proponerla como atributo del ser humano como un todo, manifiesto en las formas pensar y proceder de las personas en sus circunstancias, donde la afectividad y el pensamiento crítico son imprescindibles para su desarrollo. Se destaca que su antecedente es el concierto armónico de la vida planetaria contrastante con la disarmonía humana imperante. Se plantea que la inteligencia artificial es la más reciente hechura del tecno-fetichismo que deposita en la tecnología atributos vitales y que sus formas de uso acentuarán la degradación de la vida humana y planetaria. Se propone otra idea de progreso médico basado en formas de organización propicias para el desarrollo de aptitudes inquisitivas, críticas y colaborativas que impulsen la superación permanente, cuyo horizonte lejano es el progreso dignificante: sublimación espiritual, intelectual, moral y convivencial de las colectividades en armonía con el ecosistema planetario.

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Resumen Este ensayo cuestiona, a propósito de la medicina, la idea de progreso como desarrollo tecnológico al centrarlo en las personas y no en las cosas. Se analiza cómo el predominio de tal idea de progreso convierte a las sociedades actuales al tecno-fetichismo que degrada la vida comunitaria y la práctica médica contribuyendo a la medicalización de la vida social. Se argumenta que la realización de las potencialidades tecnológicas depende de sus formas de uso, que el móvil principal del desarrollo tecnológico es el lucro sin límites, y que los desarrollos prioritarios son los que potencian el control social que mantiene el statu quo. Se critica la idea de inteligencia como cociente intelectual al proponerla como atributo del ser humano como un todo, manifiesto en las formas pensar y proceder de las personas en sus circunstancias, donde la afectividad y el pensamiento crítico son imprescindibles para su desarrollo. Se destaca que su antecedente es el concierto armónico de la vida planetaria contrastante con la disarmonía humana imperante. Se plantea que la inteligencia artificial es la más reciente hechura del tecno-fetichismo que deposita en la tecnología atributos vitales, y que sus formas de uso acentuarán la degradación de la vida humana y planetaria. Se propone otra idea de progreso médico basado en formas de organización propicias para el desarrollo de aptitudes inquisitivas, críticas y colaborativas que impulsen la superación permanente, cuyo horizonte lejano es el progreso dignificante: sublimación espiritual, intelectual, moral y convivencial de las colectividades en armonía con el ecosistema planetario.

Abstract This essay questions, with regard to medicine, the idea of progress as technological development by focusing on people rather than things. It analyzes how the predominance of such an idea of progress converts today’s societies to techno-fetishism that degrades community life and medical practice, contributing to the medicalization of social life. It is argued that the realization of technological potentialities depends on their forms of use; that the main motive of technological development is unlimited profit and that priority developments are those that enhance the social control that maintains the status quo. The intelligence as an intelligence quotient is criticized by proposing it as an attribute of the human being as a whole, manifested in the ways of thinking and proceeding of people in their circumstances, where affectivity and critical thinking are essential for their development; it is emphasized that its antecedent is the harmonic concert of planetary life that contrasts with the prevailing human disharmony. It is proposed that artificial intelligence is the most recent creation of techno-fetishism that deposits vital attributes in technology and that its forms of use will accentuate the degradation of human and planetary life. Another idea of medical progress is proposed, based on forms of organization conducive to the development of inquisitive, critical and collaborative skills that promote permanent improvement, whose distant horizon is dignifying progress: spiritual, intellectual, moral and convivial sublimation of collectivities in harmony with the planetary ecosystem.

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Resumo: Partindo da leitura lacaniana de que a ascensão do discurso científico produziu uma mudança na posição do médico, interrogam-se os efeitos do estabelecimento do evidence-based como paradigma para a prática médica. Se a inferência estatística exemplifica a convergência entre matematização e objetividade, lança-se mão de uma vinheta relativa à prática em um ambulatório de Distúrbios da Diferenciação Sexual para interpelar os impasses relativos à designação do sexo nesses casos. Pretende-se evidenciar a diferença entre a práxis da psicanálise e a abordagem médica que se orienta na direção da universalização, situando assim seus limites frente ao real do sexo.

Abstract: From the Lacanian interpretation that the rise of scientific discourse produced a change in the physician's position, the effects of the establishment of evidence-based as a paradigm for medical practice are examined. If the statistical inference exemplifies the convergence between mathematization and objectivity, an example related to the practice in a Sexual Differentiation Disorders clinic is used to question the impasses related to the designation of sex in these cases. It is intended to highlight the difference between the praxis of psychoanalysis and the medical approach that is oriented towards universalization, thus placing its limits related to the real of sex.

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Research in clinical practice arises as a constant need for improvement to provide better care to patients, train better human resources and make a daily reflection on the amount of scientific information we receive every day. We want to reflect on how the Centro de Adiestramiento en Investigación Clínica (CAIC) from our healthcare activity changed our practice.

La investigación en la práctica clínica surge como una necesidad constante de mejora, a fin de dar una atención de mayor calidad a los pacientes, formar recursos humanos más preparados y hacer una reflexión diaria ante la cantidad de información científica que recibimos todos los días. Queremos hacer una reflexión de como el Centro de Adiestramiento en Investigación Clínica (CAIC) desde nuestra actividad asistencial cambió nuestra práctica.

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The ethical barriers involved in the practice of pediatric palliative medicine remain high and challenging. In terms of medical ethics, attention should be paid to culture, religion and family values, in order to promote adequate care for caregivers, even in case of loss of a patient, promoting a bereavement process with less suffering. The data were qualitatively analyzed by IRAMUTEQ software, with a high degree of significance of essay responses on ethics related to palliative care in pediatrics. Discussions about prognosis, goals of care, and treatment options can be very difficult, as legally supported palliative care alternatives may diverge from the wishes of the family. We conclude that divergences exist between the application of palliative medicine and ethics regarding acceptance and end-of-life management of pediatric patients. Ethical challenges are constantly complex situations in which palliative physicians must relate legal concepts, knowledge and family values, which often conflict. The quality of palliative care depends initially on the ability of specialized professionals to identify and explain the ethical issues that generate conflict or uncertainty, in addition to raising discussions with the family about the medical, moral and legal issues surrounding the difficult situation.

Las barreras éticas involucradas en la práctica de la medicina paliativa pediátrica siguen siendo altas y desafiantes. En términos de ética médica, se debe prestar atención a la cultura, la religión y los valores familiares, con el fin de promover una atención adecuada a los cuidadores, incluso en caso de pérdida de un paciente, promoviendo un proceso de duelo con menos sufrimiento. Los datos fueron analizados cualitativamente por el software IRAMUTEQ, con un alto grado de significación de las respuestas de los ensayos sobre la ética relacionada con los cuidados paliativos en pediatría. Las discusiones sobre el pronóstico, los objetivos de los cuidados y las opciones de tratamiento pueden ser muy difíciles, ya que las alternativas de cuidados paliativos legalmente respaldadas pueden divergir de los deseos de la familia. Se concluye que existen divergencias entre la aplicación de la medicina paliativa y la ética en relación con la aceptación y la gestión del final de la vida de los pacientes pediátricos. Los retos éticos son situaciones constantemente complejas en las que los médicos paliativos deben relacionar conceptos jurídicos, conocimientos y valores familiares, que a menudo entran en conflicto. La calidad de los cuidados paliativos depende inicialmente de la capacidad de los profesionales especializados para identificar y explicar las cuestiones éticas que generan conflicto o incertidumbre, además de plantear debates con la familia sobre las cuestiones médicas, morales y jurídicas que rodean la difícil situación.

As barreiras éticas envolvidas na prática da medicina paliativa pediátrica ainda são grandes e desafiadoras. No que diz respeito à ética médica, deve-se prestar atenção à cultura, religião e valores familiares, a fim de pro-mover um cuidado adequado para os cuidadores, mesmo em caso de perda do paciente, promovendo um pro-cesso de luto com menos sofrimento. Os dados foram analisados qualitativamente pelo software IRAMU-TEQ, com um alto grau de significância das respostas dos ensaios sobre ética relacionada aos cuidados palia-tivos em pediatria. As discussões sobre prognóstico, objetivos de cuidados e opções de tratamento podem ser extremamente desafiadoras, uma vez que as alternativas de cuidados paliativos legalmente suportadas podem divergir dos desejos da família. Nosso estudo conclui que existem divergências entre a implementação da medicina paliativa e a ética em relação à aceitação e manejo do fim da vida de pacientes pediátricos. Os desa-fios éticos são constantemente situações complexas em que os médicos paliativistas devem relacionar concei-tos legais, conhecimento e valores familiares, que frequentemente entram em conflito. A qualidade dos cuida-dos paliativos depende inicialmente da capacidade de profissionais especializados identificarem e explicarem as questões éticas que levam a conflitos ou incertezas, além de levantar discussões com a família sobre ques-tões médicas, morais e legais que cercam a situação difícil.

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Resumen Se estudia a la institución jurídica de la interrupción voluntaria del embarazo como una práctica médica segura, tal como ocurre con otros procedimientos clínicos y quirúrgicos, caso concreto el trasplante de órganos, la inserción de micro y nanochip en la persona humana, el cambio de sexo, por lo cual, apartando el debate sobre la moralidad pública cristiana, debe ser despenalizado a partir de lo consagrado en la Constitución Política de Colombia de 1991, en los artículos fundamentales como lo son el libre desarrollo de la personalidad, artículo 16 y el derecho fundamental a la salud integral, artículo 49, dado que si se despenaliza y se trata jurídica y clínicamente como un asunto de salud pública, no se vulnera la prohibición de tratos crueles, inhumanos y degradantes como se establece en el art. 12 superior.

Abstract The legal institution of abortion is studied as a safe medical practice, as it happens with other clinical and surgical procedures, specifically organ transplantation, the insertion of micro and nanochip in the human person, the change of sex, for which, setting aside the debate on Christian public morality, it should be decriminalized based on what is enshrined in the Political Constitution of Colombia of 1991, in fundamental articles such as the free development of personality, article 16 and the fundamental right to health integral, article 49, given that if it is decriminalized and treated legally and clinically as a matter of public health, the prohibition of cruel, inhuman and degrading treatment as established in art. 12 Superior.

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BACKGROUND: To evaluate the impact of coronavirus disease 2019 (COVID-19) on the clinical practice, health, and quality of life of Brazilian hand surgeons when only essential services and emergency procedures were being provided. METHOD: A questionnaire of 50 questions was sent to members of the Brazilian Society of Hand Surgery addressing work and life routines before the pandemic and during the initial quarantine period from April to August 2020. RESULTS: Two hundred ten hand surgeons answered the questionnaire; 55.2% lived in the southeast region and worked in the capital and metropolitan regions, in both the private and public systems. Thirty-eight percent of the sample had other sources of income besides medicine, and due to a drop of 50% or more in the volume of consultations and surgeries, one-third had to apply for financial loans or access personal savings, and 69% made financial cuts in their domestic and life routines. More than 40% gained weight and stopped doing physical activities, while 20% lost weight and started physical activities. Approximately 30% were diagnosed with COVID-19, 92% of whom had mild symptoms and quarantined at home, and 89% had psychological symptoms such as anxiety, fear, insecurity, and insomnia. CONCLUSIONS: Coronavirus disease 2019 had a significant impact on the lives of Brazilian hand surgeons by drastically reducing the number of consultations and surgical procedures, generating not only financial difficulties but also changes in the exercise routine, changes in body weight, associated psychological symptoms, and changes in the family/life routine.

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Resumo O artigo retrata os interesses de uma escritora inglesa do século XVII sobre cuidados médicos, e as razões que a levaram a publicar textos sobre essa matéria. Hannah Woolley tecia orientações sobre diversos assuntos do âmbito doméstico, entre os quais receitas para preservar a beleza e a saúde. O artigo investiga os princípios que regiam o preparo dessas receitas, as intenções de Woolley ao escrever sobre o tema, e a maneira como a medicina acadêmica era traduzida e praticada por mulheres no cotidiano da época. O delineamento dessas questões ajudará a elucidar o cenário de atuação das curadoras letradas e a natureza das relações que teceram com os médicos eruditos.

Abstract This article describes a seventeenth-century English woman writer's interests in medical care and the reasons that led her to publish texts on this topic. Hannah Woolley offered guidance on a wide variety of topics in the domestic sphere, including recipes for health and beauty. Here we investigate the principles that governed the preparation of these recipes, Woolley's intentions in writing on this topic, and the way in which academic medicine was translated and practiced by women routinely during this period. Defining these issues will help shed light on the scenario in which literate female healers worked and the nature of their relationships with learned physicians.

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Resumo Conhecimentos de ética médica e bioética são fundamentais para o correto desempenho do profissional médico. Neste trabalho, procuramos conhecer e avaliar discussões a respeito de ética médica e bioética entre estudantes de um curso de medicina por meio da aplicação de questionário. Foi verificado que, em sua maioria (89%), esses alunos consideram o tema extremamente importante. Para apenas 9,2% o desenvolvimento do tema foi ótimo, para 34,5% foi bom, 34,5% consideraram regular e 21,8% ruim. Eles afirmam que o assunto é melhor debatido em atividades práticas ou na discussão em pequenos grupos. Conclui-se que a temática ética médica e bioética foi considerada de elevada importância por quase todos os participantes, sendo preciso identificar os parâmetros considerados adequados, bem como especificar como a temática é entendida pelos estudantes para haja uma abordagem adequada na formação médica.

Abstract Knowledge of medical ethics and bioethics are fundamental for the correct performance of the medical professional. This study sought to understand and evaluate discussions about medical ethics and bioethics among students of a medical course via the application of a questionnaire. Most (89%) students consider the theme extremely important. For only 9.2% the approach to the theme was great, for 34.5% it was good, 34.5% considered it regular and 21.8% bad. They claim that the subject is best approached in practical activities or in discussions in small groups. This study concludes that the theme of medical ethics and bioethics was considered of high importance by almost all participants, and it is necessary to identify the parameters considered appropriate and to specify how the theme is understood by students to have an adequate approach in medical education.

Resumen Los conocimientos de ética médica y bioética son claves para el correcto actuar del profesional médico. Este trabajo pretende conocer y plantear discusiones sobre ética médica y bioética entre estudiantes de medicina a través de la aplicación de un cuestionario. Se constató que la mayoría (89%) de estos estudiantes consideran el tema muy importante. Solamente el 9,2% consideró el desarrollo del tema excelente; el 34,5%, bueno; el 34,5%, regular y; el 21,8%, malo. Los estudiantes sostienen que hay una mejor discusión del tema en las actividades prácticas o en discusiones en grupos pequeños. Se concluye que el tema de la ética médica y la bioética fue considerado de gran importancia por casi todos los participantes, lo que es necesario identificar los parámetros adecuados y precisar cómo los estudiantes entienden el tema para aplicar un enfoque adecuado a la formación médica.

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BACKGROUND: Achondroplasia is the most common bone dysplasia associated with disproportionate short stature, and other comorbidities, such as foramen magnum stenosis, thoracolumbar kyphosis, lumbar hyperlordosis, genu varum and spinal compression. Additionally, patients affected with this condition have higher frequency of sleep disorders, ear infections, hearing loss and slowed development milestones. Considering these clinical features, we aimed to summarize the regional experts' recommendations for the multidisciplinary management of patients with achondroplasia in Latin America, a vast geographic territory with multicultural characteristics and with socio-economical differences of developing countries. METHODS: Latin American experts (from Argentina, Brazil, Chile and Colombia) particiáted of an Advisory Board meeting (October 2019), and had a structured discussion how patients with achondroplasia are followed in their healthcare centers and punctuated gaps and opportunities for regional improvement in the management of achondroplasia. RESULTS: Practical recommendations have been established for genetic counselling, prenatal diagnosis and planning of delivery in patients with achondroplasia. An outline of strategies was added as follow-up guidelines to specialists according to patient developmental phases, amongst them neurologic, orthopedic, otorhinolaryngologic, nutritional and anthropometric aspects, and related to development milestones. Additionally, the role of physical therapy, physical activity, phonoaudiology and other care related to the quality of life of patients and their families were discussed. Preoperative recommendations to patients with achondroplasia were also included. CONCLUSIONS: This study summarized the main expert recommendations for the health care professionals management of achondroplasia in Latin America, reinforcing that achondroplasia-associated comorbidities are not limited to orthopedic concerns.

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In this unpublished work by Ricardo Bruno Mendes Gonçalves, a key figure in the field of collective health, the relationship between epidemiology and medical practice is considered. The text is based on an inaugural lecture delivered on December 16, 1988 as part of a seminar called "Clinical epidemiology: possible scientific field or new medical ideology?" organized by the Department of Preventive Medicine at the Federal University of Bahia School of Medicine, Brazil. This manually transcribed version of the lecture was prepared, revised, and in many cases rewritten by Naomar de Almeida Filho and Jose Ricardo Ayres, who always sought to preserve the original meaning and colloquial tone that was characteristic of his lectures.

Se presenta un texto inédito de Ricardo Bruno Mendes Gonçalves, referente del campo de la salud colectiva, en el que aborda la relación entre la epidemiología y la práctica médica. Se trata de la conferencia dictada el 16 de diciembre de 1988, en el marco de la apertura del seminario "Epidemiología clínica: ¿campo científico posible o nueva ideología médica?", organizado por el Departamento de Medicina Preventiva, de la Facultad de Medicina de la Universidade Federal da Bahia, Brasil. Esta versión ha sido desgrabada y transcripta manualmente, revisada y, en muchos casos, reescrita por Naomar de Almeida Filho y Jose Ricardo Ayres, buscando siempre preservar el sentido original y el tono coloquial característico de sus conferencias.

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This editorial centers on a previously unpublished work by Ricardo Bruno Mendes Gonçalves, recently published in Salud Colectiva, in which he considers the relationship between epidemiology and medical practice, arriving at a novel interpretation of the health sciences as a foundation for democracy. The text is based on an inaugural lecture delivered on December 16, 1988 as part of a seminar called "Clinical epidemiology: possible scientific field or new medical ideology?" organized by the Department of Preventive Medicine at the Universidade Federal da Bahia, Brazil.

Este editorial se centra en un texto inédito que Salud Colectiva publicó recientemente, en el que Ricardo Bruno Mendes Gonçalves aborda la relación entre la epidemiología y la práctica médica, y realiza una interpretación original de las ciencias de la salud como sustrato de la democracia. Se trata de la conferencia dictada el 16 de diciembre de 1988, en el marco de la apertura del seminario "Epidemiología clínica: ¿campo científico posible o nueva ideología médica?", organizado por el Departamento de Medicina Preventiva, de la Universidade Federal da Bahia, Brasil.

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The Brazilian Federal Board of Medicine (CFM) issued resolution number 2294/21, which regulates human reproduction procedures in Brazil, bringing significant changes to clinical practice in assisted human reproduction, and it raised ethical, bioethical, and legal discussions between professionals and patients. This study aims to analyze these changes in different aspects, especially because some of them are controversial. Evidence-based knowledge resources were used to support the analyses of crucial points that were impacted by this change. A literature review was carried out to obtain information about guidelines and laws, as well as articles that contemplate ethical discussions on assisted reproduction. The search sites used were BVS, Pub Med, LILACS and Google Scholar. The keywords used were law, legislation, bioethics, reference guide and assisted human reproduction. Relevant official documents from the Brazilian State were also found and included in the survey. The new resolution regarding the use of assisted reproduction techniques brought important changes, with clinical implications for couples who wish to become pregnant, and there is a need for a broad discussion concerning these repercussions from clinical, ethical, bioethical, and legal points of view.

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Resumen A través de una etnografía basada en la observación, entrevistas a profesionales y el vaciado de documentación, en este artículo describo y analizo cómo, en la práctica clínica del Chagas, la infección es tratada como un riesgo latente. Sugiero que la gestión que se hace de este riesgo ha posibilitado la práctica clínica entre las personas clasificadas en la etapa indeterminada, añadiendo una dimensión de posibilidad (¿va a pasar?) y de potencialidad (¿cuándo y dónde?) que permite tomar acciones tales como la administración de un medicamento o una monitorización permanente. La reificación del riesgo latente como fenómeno gestionable a través de un proceso de medicalización se articula, a su vez, con otras concepciones y experiencias concretas del riesgo entre los grupos afectados. Situar la práctica clínica de dicho riesgo como objeto de estudio es un primer paso para poderlas describir e incluir como realidades en la organización del sistema de salud.

Abstract Drawing on observation-based ethnography, interviews of health personnel and document review, this article describes and examines how, in clinical handling of Chagas disease, infection is treated as latent risk. It suggests that how this risk is managed has enabled a clinical practice to be conducted among people classified as at the indeterminate stage, by adding a dimension of possibility (Is it going to happen?) and potentiality (When and where?). This allows measures to be taken, including administration of medication or permanent monitoring. The reification of latent risk as a phenomenon that is manageable through a process of medicalisation engages, in turn, with other conceptions and specific experiences of risk among the affected groups. Framing the clinical practices deployed to address this risk as objects of study is a first step towards being able to describe and include them concretely in health system organisation.

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ABSTRACTThe COVID-19 health crisis has so far involved enormous consequences in human pain, suffering and death. While biomedical science responded early, its response has been marked by several controversies between what appeared to be mainstream perspectives, and diverse alternative views; far from leading to productive debate, controversies often preceded polarisation and, allegedly, exclusion and even censorship of alternative views, followed by the pretense of scientific consensus. This paper describes and discusses the main controversies in the production of COVID biomedical knowledge and derived control measures, to establish if alternative positions are also legitimate from a 'normal science' perspective (rather than comparing them for superiority); explores potential non-scientific explanations of the alleged exclusion of certain views; and analyzes ethical issues implied. The operation of non-scientific factors in scientific and regulatory processes (e.g. various forms of subtle corruption) has been documented in the past; the intervention of such influences in the mishandling of controversies (i.e. on early management, non-pharmacological prevention and vaccination) cannot be ruled out and deserves further investigation. Some of these controversies, increasingly visible in the public domain, also involve ethical challenges that need urgent attention. Polarisation, censorship and dogma are foreign to true science and must be left behind.

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RESUMEN Introducción: los reclamos de los usuarios externos son oportunidades de mejora; su gestión adecuada permite alcanzar los resultados sanitarios finales. Objetivos: evaluar las características de los reclamos de los usuarios externos en un hospital general del Perú. Materiales y métodos: estudio descriptivo retrospectivo de los reclamos recibidos en la Plataforma de Atención al Usuario en Salud durante el año 2019, en un hospital general de Ica, Perú. Del Libro de Reclamaciones en Salud se elaboró una base de datos. Se calcularon medidas de frecuencia absolutas, relativas y promedios. Resultados: se tuvo un total de 993 reclamos. El 11,5 % de ellos fueron registrados en el Libro de Reclamaciones en Salud. El departamento más quejado fue el de Estadística, con 29,8 %. Respecto al personal quejado, el 46,4 % fue el administrativo, el 28,8 % los médicos, el 10,4 % las enfermeras, y el 14,4 % otros profesionales. Las causas de los reclamos fueron problemas de gestión (82,7 %), problemas en las relaciones proveedor-paciente (11,3 %) y problemas clínicos (6,0 %). El tiempo transcurrido para dar respuesta al usuario fue en promedio 20,5 días. Conclusiones: solo el 11,5 % de los pacientes insatisfechos que acuden a la Plataforma de Atención al Usuario en Salud, hacen uso del Libro de Reclamaciones en Salud. Las causas más frecuentes de reclamos son las relacionadas con la gestión, principalmente por problemas de demora en la atención y de acceso a los servicios.

ABSTRACT Introduction: claims from external users are opportunities for improvement; its proper management enables the attainment of final health outcomes. Objective: to evaluate the characteristics of external users claims in a general hospital in Peru. Materials and methods: a retrospective descriptive study of the claims received on the Healthcare User Care Platform in 2019, in a general hospital of Ica, Peru. A database was developed from the Health Claims Book. Absolute, relative, and average frequency measurements were calculated. Results: a total of 993 complaints were filed. 11.5 % of them were registered in the Health Claims Book. The most complained department was that of Statistics, with 29.8 %. With regard to the members of staff staff complained, 46.4 % were administrative workers, 28.8 % doctors, 10.4 % nurses and 14.4 % other professionals. The causes of the complaints were management problems (82.7 %), problems in provider-patient relationships (11.3 %) and clinical problems (6.0 %). The elapsed time to respond to the user was on average 20.5 days. Conclusions: only 11.5 % of dissatisfied patients who access the Healthcare User Attention Platform make use of the Health Claims Book. The most frequent causes of complaints are those related to management, mainly due to problems of delayed care and access to services.

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Resumo O artigo analisou as implicações do Ato Médico na ordenação das relações entre as profissões de saúde e em aspectos relacionados ao controle do campo de conhecimento médico, à prática profissional e ao mercado de trabalho em saúde. Por meio de pesquisa qualitativa, investigou-se o Ato Médico mediante análise documental de material proveniente de 18 edições do Jornal Medicina do Conselho Federal de Medicina (CFM) (223 edições consultadas entre 1998 e 2018). Foram evidenciados interesses particulares no processo de negociação e de efetivação da Lei do Ato Médico, reconhecida como instrumento de controle profissional decorrente das transformações ocorridas no sistema de profissões da saúde e no mercado de trabalho em saúde. A regulamentação profissional dirigida ao exercício exclusivo de atos profissionais considerados atos médicos aparece como uma vantagem para a corporação médica. Ao pretender a exclusividade da prática médica em múltiplas abrangências, o Ato Médico termina por intensificar conflitos com profissões da saúde que compartilham seus atos profissionais. Foi concluído que o Ato Médico poderia ser também entendido enquanto resultado de um movimento pela valorização das bases liberais de atuação, objetivando a defesa da prática individual, da livre escolha, do custeio dos serviços pelo cliente e da prestação direta dos serviços.

Abstract The article analyzed the implications of the Medical Act in ordering the relations between health professions and in aspects related to the control of the field of medical knowledge, professional practice, and the health labor market. With qualitative research, the Medical Act was investigated by documentary analysis of material from 18 editions of the Jornal Medicina do CFM (223 editions consulted between 1998 and 2018). Particular interests were evidenced in the process of negotiation and enforcement of the Medical Act Law, recognized as an instrument of professional control resulting from the changes that occurred in the health professions system and in the health labor market. Professional regulation aimed at the exclusive exercise of professional acts considered to be medical acts appears as an advantage for the medical corporation. In seeking the exclusivity of medical practice in multiple areas, the Medical Act ends up intensifying conflicts with health professions that share their professional acts. The article concludes that the Medical Act could also be understood as the result of a movement for the valorization of the liberal bases of action, aiming at defending individual practice, free choice, the payment of services by the client, and the direct provision of services.

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La actividad médica se puede ver en dos contextos diferentes, tanto en la práctica clínica como en la investigación científica. El concepto de práctica clínica es todo acto realizado sobre un paciente con el objetivo de diagnosticar o tratar enfermedades. Por otro lado, la investigación clínica cuestiona diferentes aspectos relacionados con la salud humana. Este estudio busca inicialmente esclarecer los aspectos y componentes que orientan la relación y comunicación médico-paciente, definiendo los valores éticos de esta práctica, donde el profesional médico modela su carácter, mediante una relación entre los principios abordados en el ámbito de la ética de los profesionales de la salud. La demostración de una adecuada y sana relación de los profesionales médicos con sus pacientes es necesaria y fundamental a través del respeto y principalmente a través del principio de autonomía, ya que todo ser humano debe ser reconocido como fin y dueño de sí mismo, donde las actividades médicas comprenden procesos que involucran vida, salud e integridad física. Así, el presente trabajo abordará los diversos aspectos de la ética médica, en relación con el contexto de la práctica clínica del médico.

The medical activity can be seen in different contexts, both in clinical practice and in scientific research. The concept of clinical practice is every act performed on a patient with the objective of diagnosing or treating illnesses. On the other hand, clinical research questions different aspects related to human health. This study initially seeks to clarify the aspects and components that guide the doctor-patient relationship and communication, defining the ethical values of this practice, from which the medical professional models its character, through a relationship between the principles addressed in the scope of their ethics. health professionals. The demonstration of an adequate and healthy relationship between medical professionals and their patients is necessary and fundamental through respect and mainly through the principle of autonomy, since every human being must be recognized as an end and duen of symbolism, hence medical activities include processes that involve life, health and physical integrity. Thus, this work will address the various aspects of medical ethics, in relation to the context of the clinical practice of the doctor.

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Introduction It is known that cancer care is best approached by a multidisciplinary team (MDT). This became specifically true in the Covid-19 pandemic in which choices for urological cancer treatment are influenced by many factors. In some cases, delayed treatment may have consequences regarding the patient's oncological outcomes. The aim of the present article is to report our experience throughout the Covid-19 pandemic treating patients with urological neoplasms at a high-volume center. Methods We used a convenience sampling method. Cases were evaluated and discussed on an individual basis at the MDT meetings, and, after a consensus regarding delaying or scheduling treatment, patients were scheduled according to the risk of postponing the procedures. The Medically Necessary, Time-Sensitive (MeNTS) scoring system was measured in each patient; all patients answered the Centers for Disease Control and Prevention (CDC) Covid-19 self-screening questionnaire prior to surgery. The Covid-19-free survival rate was estimated. Results A total of 194 patients were assessed by themultidisciplinary team and finally treated, with median follow-up of 4 (interquartile range [IQR]: 2.75 to 6) months. Only two patients had Covid-19 confirmed by real-time polymerase chain reaction (RT-PCR). In total, 54 patients underwent oncological surgery, 129 were treated with radiotherapy, and 11 were treated with intravenous chemotherapy. Themedian age was 66 years (IQR: 59 to 94 years), and the median MeNTS score in the surgically-treated cohort was 35 points (IQR: 31 to 47 points). Conclusions The evaluation and treatment of urological cancer should be conducted by an MDT; this is of utmost importance, especially during the Covid-19 pandemic. The data collected in our institution showed that most patients could be safely treated by taking all necessary precautions and discussing each case individually in the MDT meetings and performing a close follow-up.

Introduccion La atención del cáncer se aborda mejor con un equipo multidisciplinario (EMD), aspecto que se tornó más importante en la pandemia por Covid-19, en que las opciones para tratar el cáncer urológico están influenciadas por muchos factores. En algunos casos, el tratamiento retrasado puede tener consecuencias en los resultados oncológicos del paciente. El objetivo de este estudio es describir nuestra experiencia en un centro de referencia y de alto volumen para el tratamiento de neoplasias urológicas durante la pandemia por Covid-19. Métodos Realizamos un muestreo por conveniencia. Posteriormente, los casos fueron evaluados y discutidos de forma individual en las reuniones del EMD. Posterior a la obtención de un consenso sobre el tratamiento del paciente, los pacientes fueron programados según el riesgo individual de posponer el manejo. Se midió la puntuación de cada paciente en el sistema Medically Necessary Time-Sensitive (MeNTS, "Médicamente necesario, sensibles al tiempo"). Todos los pacientes respondieron el cuestionario de autoevaluación del Centers for Disease Control and Prevention (CDC) COVID-19 antes de la cirugía. Se estimó la tasa de supervivencia libre de Covid-19. Resultados Un total de 194 pacientes fueron evaluados por el EMD y finalmente tratados, con una mediana de seguimiento de 4 (rango intercuartil [RIC]: 2,75 a 6) meses. Solo dos tenían Covid-19 confirmado por reacción en cadena de la polimerasa en tiempo real (RCP-TR). Un total de 54 pacientes fueron sometidos a cirugía oncológica, 129 fueron tratados con radioterapia, y 11 fueron tratados con quimioterapia intravenosa. La mediana de edad fue de 66 años (RIC: 59 a 94 años), la puntuación mediana en el MeNTS de la cohorte tratada quirúrgicamente fue de 35 puntos (RIC: 31 a 47 puntos). Conclusiones La evaluación y el tratamiento del cáncer urológico debe ser realizado por un EMD durante la pandemia de Covid-19. Los datos recopilados en nuestra institución mostraron que la mayoría de los pacientes podrían ser tratados de manera segura, discutiendo cada caso individualmente y haciendo un seguimiento cercano.

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