Historical and epidemiological reflections about the epidemiologic foundations of contemporary Clinical Medicine / Reflexão histórico-epistemológica sobre os fundamentos epidemiológicos da Clínica Médica contemporânea

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

Since 1960 Clinical Medicine suffered a kind of inflection in its internal mechanisms of producing theoretical knowledge, as well as in the way that this knowledge is applied in practical life. The most important difference in relation to the past was that problems of clinical nature like, differential diagnosis, therapeutical decisions, and prognosis estimation, started to be predominantly processed by standardized analytical instruments, and most important, they were always previously submitted to an empirical-mathematical reasoning. Individual patients were no longer a being that reported signs and symptoms that were processed by a physician, they started to be a new entity in which these signs, previously established and validated by clinical studies have to be necessarily engrafted by the physicians in patients manifestations. At the same time that this process occurred, western world was living an important critical period, characterized by a very slow economic growth, and by a reevaluation of its ethical and moral values. After 1962, in the United States, it became obligatory to prove, through empirical scientific evidence that a new drug was effective, before marketing and sales authorization was issued to a company who wanted to launch the drug. The scientific method designed to prove efficacy of a drug was actually developed after this legal demand. This method is called generically Clinical Epidemiology. Several actors participated in the discussion of the rules of this method. Medical Schools, government representatives, pharmaceutical industry can be cited; the latter played a very special role, since it acted as a secretary of the whole process. The reason behind this was that, at those times, the two major pillars of the pharmaceutical business, innovation capacity and patent law, were being severely criticized, and proposals for changing the way this things were being conducted in American society were about to become a reality. We defend the position that the attitude of the pharmaceutical business representatives, were crucial for the establishment of the scientific rules that were considered consensual, and that these rules, for many reasons, started to be the paradigm of medical reasoning and individual decision in medical problems. Implementation, acceptance, and maintenance of this new clinical scientific method that was born after the legal demand for prove of efficacy of a new drug, particularly in medical community, occurred in a very particular way. We discuss the history of this process under two separate perspectives: the official history, as described by History Department of the Food and Drug Administration, and alternatively, through an analysis of the speeches of persons who actually participated directly in this discussion. Physicians, pharmacologists, lawyers, legislators, economists, pharmaceutical industry representatives, government members and politicians, all these groups, emitted their opinions and these were registered and published. This is the row material that was used to composite a new story of the whole process, and the result of this work is somehow different from the official history reported before. The scientific dimension of this story is mixed up with other important aspects like: legislative debates, private economical interests, the role of the State in regulating the economy, academic participation in decisions related to economic growth of a country, etcWe try to prove that the intersection of all these interests in a consensual framework built up a situation in which the previously referred technical-scientific dimension started to have a relatively bigger importance in relation to the other aspects as an instrument to legitimate what is truth (or what is false) in clinical medicine, to the whole body of the society. This fact brought two important practical consequences: a progressive reduction in other human aspects of clinical medicine apart from technology, and, the development of a system of barriers that jeopardize the possibility of a critical attitude towards the scientific method from those who practice medicine. Around the concept of humanism, studied particularly inside western philosophical tradition, we discuss how much this so called hypertrophy of the technical-scientific dimension and its practical consequences can be scrutinized and questioned in its epistemological foundations in order to rebuild a new medicine more human and critical.

ASSUNTO(S)

aplicação de novas drogas em teste humanismo investigational new drug application epidemiologia epidemiology história knowledge history conhecimento humanism

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