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Background: Cancer has different explanatory theories that address its etiology and treatment. It is usually associated with pain and suffering. Recently, new technologies, knowledge, and therapies have been developed, which may have transformed the classic social representations of the disease. This study aimed to understand the social representations (SRs) of cancer in patients from Medellín, Colombia. Methods: This study used a grounded theory in 16 patients with cancer. The information was collected between June 2020 and May 2021. Information was analyzed following the open, axial, and selective coding stages. Results: SRs of cancer at the time of diagnosis evoke negative connotations. However, cancer is redefined as a positive event as the clinical course of the disease progresses, and patients interact with health professionals and respond to treatment. The resignification of the disease depends on the etiological models of the patients, which include genetic, socio-anthropological, psychosocial, and psychogenic factors. In line with the SRs of etiology, patients seek out treatments complementary to the biomedical ones that can be socio-anthropological and psychogenic. Conclusion: In this group negative representations about cancer persist, this way of understanding the disease is determined by the convergence of cultural meanings and personal experiences. The causal representation is connected to the actions and willingness of the patients to face their diagnosis. In this sense, two categories stand out: the first expresses that cancer is the consequence of a body subjected to excessive productivity; the second subsumes a psychogenic predisposition caused by the context where the ideology of happiness appears to be a social norm. This double saturation in which an individual is immersed results in new burdens that are not visible to caregivers and healthcare workers.

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To understand the influence of positive thinking ideology on cancer representations among physicians in the city of Medellín. METHODS: This qualitative study was conducted on the basis of the theoretical and methodological elements of Corbin and Strauss's grounded theory. Fourteen physicians were included and selected according to the criteria of maximum variation for education, years of study, and personal and family history of cancer. The information was collected through semi-structured interviews and analyzed with open, axial, and selective coding. RESULTS: the ideology of positive thinking has managed to permeate the medical discourse and the representations that they form about the etiology and treatment of cancer. Physicians place the mind, emotions, attitude, and positive thinking as determinants of the origin of the disease and the response to therapy. To argue this link, they use two strategies: (i) a sophisticated and specialized discourse that involves relationships among thoughts, genetics, the neurological, immune and endocrine system and (ii) a mystical and less rational discourse that emphasizes the omnipotence of the mind and thoughts. In no case was the idea of positive thinking rejected or in disagreement with this style of thinking expressed. CONCLUSION: The fact of linking the disease with mental factors refers to the mind-body dualism and generates a responsibility of the patients on the etiology and therapeutics of the disease, as well as an erasure of the social and political determinants of cancer. The technical discourse and the symbolic capital of physicians offer scientific legitimacy to these ideas and can become performative for patients.

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Purpose: This study has the following objectives: i) to construct an instrument to measure positive thinking ideology (PTI) regarding cancer, and to evaluate its psychometric properties, ii) to describe the effects of PTI on cancer risk and its treatment, and iii) to identify the associated factors with PTI in the study group. Methods: A cross-sectional study was conducted with 611 people from the Medellin, Colombia. Participants were selected through stratified sampling with proportional assignment. A survey with three constructs was applied: the role of negative emotions in cancer etiology, cancer as a redeeming event, and the effects of PTI in cancer treatment. Results: In negative emotions construct 47% considered that holding anger, resentment, and hatred represent a moderate or high risk of generating cancer. In redeeming power construct 46.5% found that cancer is a battle that the best warriors win. Concerning the treatment, 77.3% considered that facing the disease with a fighting spirit had a moderate to high positive effect in response to the treatment. The associated factors with PTI were reading self-help books and education level. Conclusion: The results show that PTI affects perceptions about the cancer, its etiology and treatment. This effect is greater in undereducated people and in self-help book readers. The instrument showed excellent reliability, internal consistency, discriminating power, content, and construct validity properties.

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Purpose: This study aimed to understand the lived experiences of patients with cancer that facing inequities in oncological care in the city of Medellín. Patients and Methods: A qualitative study was conducted based on the theoretical and methodological elements of the grounded theory, specifically the description and conceptual ordering of Corbin and Strauss. Sixteen patients with cancer, who belonged to low (n=5), middle (n=4) and high (n=7) social classes, were included by theoretical sampling with category saturation. Data were collected using semi-structured interviews and analyzed in a category system based on the three social classes. Results: The patients were aged between 23 and 71 years old, and they were diagnosed with different types of cancer such as breast, cervical, prostate, stomach, leukemia and lymphoma. Patients' experiences showed that diagnosis, specialized care, treatment and hospital discharge were different based on their social class. Conclusion: Patients' lived experiences associated with cancer reflect complex social situations, in which social determinants affect the level of citizens' empowerment and self-management against the risks of get disease and die. Being part of low and middle social classes meant being subjected to a dehumanized, cold, impersonal and discontinuous treatment, in which healthcare was focused on the disease instead of individuals' preferences and values. In contrast, patients belonging to the high class had the resources necessary to face risks, which ensured access to more humanized and individualized healthcare.

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PURPOSE: This study was conducted to understand the preferences of patients with cancer in Medellin, Colombia. METHODS: A qualitative approach based on the theoretical and methodological resources of the grounded theory was conducted. Between June 2020 and March 2021, patients over 18 years old with a confirmed diagnosis of cancer within the past 2 years treated in Medellin, Colombia, were selected. Theoretical saturation sampling was performed. Each participant was interviewed between 2 and 3 times in accordance with the open, axial, and selective coding of the grounded theory. RESULTS: A common preference set emerged in all patients related to the attributes of healthcare professionals and is a category that unites their scientific and humanistic aspects. On the other hand, very heterogeneous preferences were presented that were associated with the doctor-patient relationship and the therapeutic objectives. In the doctor-patient relationship, there are those who adhere to a paternalistic model and those who opt for an informative model. In therapeutic objectives, two subcategories emerged: those who are inclined to preserve life and those who accord more value to the quality of life. CONCLUSION: The categories that emerged illustrate the complexity and challenges of the preferences of patients with cancer in theoretical and experiential terms for social studies of medicine, philosophy, and bioethics. From medical social studies, it's emphasized that the experiences of dehumanization are constant, which generates shared preferences in the patients related to the ideal of the medical professional. From the philosophical perspective, the care received by patients coincides with what was called medicine for slaves in ancient Greece, insofar as patients are not assumed to be free subjects. With respect to bioethics, some ideas are raised contrary to the support of individual autonomy; relational autonomy and the respect for the person above the autonomy itself are advocated.

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En la formación en medicina existen múltiples textos sobre el futuro de la disciplina, la mayoría realizan la prospectiva a partir de temáticas específicas como las limitaciones en el conocimiento fisiopatológico, etiológico o terapéutico de algunas enfermedades, los usos de la investigación científica, la articulación con las ingenierías y el desarrollo tecnológico, la necesidad de una enseñanza y praxis que vincule los desarrollos científicos con consideraciones éticas y humanistas, entre otros. Sin embargo, son poco analizadas las tendencias de la formación y praxis médica con base en teorías de mayor amplitud o alcance. Por ello, este ensayo describe brevemente tres cuerpos teóricos que resultan útiles para pensar el presente y futuro de la medicina, estos son: la medicina basada en la evidencia y centrada en la persona, las humanidades médicas y los determinantes sociales de la salud, como tres grupos de teorías sólidas para la formación y praxis médicas en Colombia.

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En la formación en medicina existen múltiples textos sobre el futuro de la disciplina, la mayoría realizan la prospectiva a partir de temáticas específicas como las limitaciones en el conocimiento fisiopatológico, etiológico o terapéutico de algunas enfermedades, los usos de la investigación científica, la articulación con las ingenierías y el desarrollo tecnológico, la necesidad de una enseñanza y praxis que vincule los desarrollos científicos con consideraciones éticas y humanistas, entre otros. Sin embargo, son poco analizadas las tendencias de la formación y praxis médica con base en teorías de mayor amplitud o alcance; por ello, este ensayo describe brevemente tres cuerpos teóricos que resultan útiles para pensar el presente y futuro de la medicina, estos son: la medicina basada en la evidencia y centrada en la persona, las humanidades médicas y los determinantes sociales de la salud, como tres grupos de teorías sólidas para la formación y praxis médicas en Colombia.

In medical education, there are multiple texts on the future of the discipline, most of them make the prospective from specific topics such as the limitations in the pathophysiological, etiological or therapeutic knowledge of some diseases, the uses of scientific research, the articulation with engineering and technological development, the need for a teaching and praxis that links scientific developments with ethical and humanistic considerations, among others. However, trends in medical education and practice based on theories of greater breadth or scope are little analyzed; therefore, this essay briefly describes three theoretical bodies that are useful for thinking about the present and future of medicine, these are: evidence-based and person-centered medicine, medical humanities and social determinants of health, as three groups of solid theories for medical education and practice in Colombia.

No âmbito da educação médica, existem muitos textos sobre o futuro da disciplina, a maioria dos quais se centra em temas específicos como as limitações do conhecimento fisiopatológico, etiológico ou terapêutico de algumas doenças, os usos da investigação científica, a ligação com a engenharia e o desenvolvimento tecnológico, a necessidade de um ensino e de uma praxis que articule os desenvolvimentos científicos com considerações éticas e humanistas, entre outros. No entanto, é escassa a análise das tendências da formação e da praxis médicas com base em teorias de maior amplitude ou alcance; por isso, este ensaio descreve brevemente três corpos teóricos úteis para pensar o presente e o futuro da medicina: a medicina baseada na evidência e centrada na pessoa, as humanidades médicas e os determinantes sociais da saúde, como três grupos de teorias sólidas para a formação e a praxis médicas na Colômbia.

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Resumen El desarrollo de este artículo de reflexión surge tras el análisis de la práctica médica cotidiana donde se evidencian discrepancias entre estudiantes de medicina, docentes clínicos, médicos generales y especialistas en áreas médicas, en lo que corresponde a la marcada variabilidad en los enfoques terapéuticos en el personal clínico asistencial. Adicionalmente los conflictos derivados de la no aplicación de la medicina basada en evidencia por resistencia de ciertos profesionales de la salud, junto a las limitaciones de aplicabilidad de la misma en nuestro contexto socio-económico en particular, conduce al desarrollo de conflictos que dificultan la atención de los pacientes, distancian el personal médico, limitan el aprendizaje en las áreas clínicas, además de producir una perspectiva no integral ya que en la mayoría de las ocasiones se impone la decisión clínica sobre los valores y preferencias de los usuarios, cuestión además poco explorada dentro del ámbito académico. MÉD.UIS.2020;33(1): 59-65.

Abstract The development of this reflexion article emerges after the analysis of everyday medical praxis, where disagreements between medical students, clinical teachers, general practitioners and specialists in clinical areas are noted, which corresponds to the strong variability between therapeutic approaches from the clinical assistance personnel. Additionally, the conflicts deriving from the non-application of the Evidence-based Medicine due to the resistance of certain health professionals, along with the limitations in its applicability in our particular socioeconomic context, drives to the development of conflicts that make difficult the patient's attention, create distances between the medical staff, limit learning in clinical areas, and produce a non-integral perspective, because in the majority of occasions, clinical decision is imposed over the values and preferences of users, a matter that is rarely explored inside the academic scope. MÉD. UIS.2020;33(1): 59-65.

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RESUMEN Dentro de la salud pública y la práctica médica se ha pasado por alto consideraciones importantes referentes a la filosofía de la técnica en los estilos de vida y el fitness. Esto ha llevado a que dichas nociones suelan vincularse con perspectivas individualistas en las que se hace notorio un "vacío social". En este artículo presentamos una reflexión en torno a las tecnologías de optimización corporal. Dicho constructo busca resaltar la articulación de elementos técnicos, discursivos, simbólicos y políticos en la producción social del cuerpo; especialmente en el ámbito del fitness y los estilos de vida saludables. Realizamos un desarrollo conceptual de estos términos para efectos de explicitar el trasfondo político que los moviliza. Este trabajo reviste importancia para la salud pública y la medicina en la medida en que permite indagar por las concepciones individualistas subyacentes a la noción de estilos de vida vinculándolas a mecanismos biopolíticos más amplios que operan dentro de la agenda neoliberal.

SUMMARY Inside Public Health and Medicine have been ignored important considerations about philosophy of technique in lifestyles and fitness. This has meant that such notions be linked to individualistic perspectives where a social vacuum is highlighted. In this paper we present a reflection about Body Improvement Technology. This construct seeks to highlight the articulation of technical, discursive, symbolic and political elements in the social production of the body, especially in the field of fitness and healthy lifestyles. We carry out a conceptual development of these terms in order to make explicit the political mechanism that mobilizes them. This work is important for Public Health and Medicine insofar as it allows us to investigate the individualist conceptions underlying the notion of lifestyles, linking them to broader biopolitical forces that operate within the neoliberal agenda.

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Introducción: los discursos filosóficos y socioantropológicos sobre el cuerpo no han sido objeto de interés en la formación médica. Objetivo: caracterizar las representaciones sociales del cuerpo en estudiantes de Medicina, Medellín, 2014. Métodos: etnografía con 11 estudiantes seleccionados mediante muestreo teórico. Las representaciones sociales se estudiaron desde el enfoque procesual. Se aplicaron los criterios de rigor metodológico de credibilidad, auditabilidad y transferibilidad. Resultado: se describen tres categorías analíticas: 1) concepciones del cuerpo que incluyó las subcategorías ''dominio material'' y ''dominio simbólico''; 2) importancia del cuerpo descrita a partir de las subcategorías ''cuerpo como medio y objeto'' y ''cuerpo como definición del yo''; 3) cuidado del cuerpo con tres subcategorías: ''importancia del autocuidado'', ''el cuerpo de los otros'' y ''prácticas de autocuidado''. Conclusión: la concepción organicista del cuerpo pone al descubierto cómo los estudiantes de Medicina comprenden al otro a partir de principios estrictamente biológicos; epistemológicamente se muestra que los estudiantes son vectores de tradiciones cartesianas carentes de una conciencia histórica en torno a las representaciones del cuerpo; política y socialmente las ideas del grupo se alinean con racionalidades neoliberales que vindican la mercantilización, tecnificación e individuación del cuerpo.

Introduction: Philosophical and socio-anthropological discourses about the body have not been of interest in medical formation. Objective: To understand the social representations of the body in medical students, Medellin, 2014. Methods: Ethnography with 11 students selected by theoretical sampling. Social representations were studied with the procedural approach. Methodological rigor criteria of credibility, auditability and transferability were applied. Results: Three analytical categories were analyzed: 1) conceptions of the body which included the subcategories ''biological'' and ''symbolic'' dimensions of the body''; 2) importance of the body described from the subcategories ''body as medium and object'' and ''body as definition of Ego''; 3) care of the body with three subcategories: ''importance of self-care'', ''the body of the other'', ''self-care practices''. Conclusion: The organismic conception of the body reveals how medical students understand the other from strictly biological principles; epistemologically it is evident that students are Cartesian vectors lacking historical awareness about the representations of the body; politically and socially the group is aligned with neoliberal rationalities that vindicate marketization, modernization and individuation of the body.

Introdução: os discursos filosóficos e sócio-antropológicos sobre o corpo não foram objeto de interesse na formação médica. Objetivo: caracterizar as representações sociais do corpo em estudantes de Medicina, Medellín, 2014. Métodos: etnografia com 11 estudantes selecionados mediante amostragem teórica. As representações sociais se estudaram desde o enfoque processual. Aplicaram- se os critérios de rigor metodológico de credibilidade, audibilidade e transferibilidade. Resultado: descrevem-se três categorias analíticas: 1) concepções do corpo que incluiu as subcategorias ''domínio material'' e ''domínio simbólico''; 2) importância do corpo descrito a partir das subcategorias ''corpo como meio e objeto'' e ''corpo como definição do eu''; 3) cuidado do corpo com três subcategorias: ''importância do autocuidado'', ''o corpo dos outros'' e ''práticas de autocuidado''. Conclusão: a concepção organicista do corpo põe ao descoberto como os estudantes de Medicina compreendem ao outro a partir de princípios estritamente biológicos; epistemologicamente se mostra que os estudantes são vectores de tradições cartesianas carentes de uma consciência histórica em torno das representações do corpo; política e socialmente as ideias do grupo se alinham com racionalidades neoliberais que vindicam a mercantilização, tecnificação e individuação do corpo.

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Tres cuestiones se analizan en el presente artículo. Primero, la formación del cuerpo-máquina del mundo moderno, es decir, el modelamiento de la existencia conforme a una racionalidadtecnológica agenciada y administrada por instituciones modernas como la familia, la escuela, el trabajo y la clínica. Segundo, la implantación en la vida del dualismo sujeto-objeto, cuestiónque será gestionada por la medicina y la razón técnico-científica, pilares primordiales de la época moderna. Culturalmente el hombre pasará a tener una relación antagónica con las cosasy con los otros. A partir de esto se establecerá una relación vertical con el “mundo de la vida”, donde lo importante es el control, la manipulación y el dominio de la naturaleza a través de la técnica. Por último, se evidencia el problema ético que surge ante el establecimiento de esta forma de racionalidad, poderosos dispositivos que encubren, ocultan y desvían el existir deese “mundo vital”...

Three things are analyzed in this text. First, the formation of the machine-body of the modern world, it means, the modeling of the existence according to a technologic rationality wangled andadministered by modern institutions like the family, the school, the job and the clinic. Second, the implantation in the life of subject-object dualism, matter which will be administered and initiated by medicine and scientific technical reason, main pillars of the modern age. Culturally the humankind will have an antagonistic relationship with the things, the nature and the others. With this, it will be established a vertical relationship with “world of life” where really important is the control, manipulation, the domain and the maintenance of order trough thetechnique. Finally, it becomes evident the ethic problem which comes out before the establishment of a way of rationality that covers up, hide and changes the existing of that “vital world”...

Três questões são analisadas no presente artigo. Primeiro, a formação do corpo-máquina do mundo moderno, isto é, a modelização da existência em conformidade com uma racionalidadetecnológica agenciada e administrada por instituições modernas como a família, a escola, o trabalho e a clínica. Segundo, a implantação na vida do dualismo sujeito-objeto, questão queserá gerida e controlada pela medicina e a razão técnico-científica, pilares primordiais da época moderna. Culturalmente o homem passará a ter uma relação antagônica com as coisas e com os outros. A partir disto se estabelecerá uma relação vertical com o “mundo da vida”, onde o importante é o controle, a manipulação e o domínio da natureza através da técnica. Por último,aborda-se o problema ético que surge diante do estabelecimento desta forma de racionalidade, poderosos dispositivos que encobrem, ocultam e desviam o existir desse “mundo vital”...

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