Flávio Dantas

Ensino da deontologia, ética médica e bioética nas escolas médicas Brasileiras: uma revisão sistemática

The relevance of teaching medical ethics to undergraduate medical students is recognized worldwide. Since 1969 all Brazilian medical schools must teach ethics to the undergraduate students. To assess the evolution of the teaching of deontology, medical ethics or bioethics over the last thirty years, a systematic review of Brazilian publications on this subject was performed. Three studies published in three different decades were identified, showing little progress in the number of disciplines exclusively dedicated to the teaching of medical ethics as well as in the number of teaching hours and faculty staff directly involved with medical ethics, most of them in connection with forensic medicine. Professional accountancy and confidentiality were the issues most explored in the courses, mainly by means of oral expositions and case discussions. Given the importance of educating future medical doctors in ethics, this matter should be taught during the entire course by skilled and clinically experienced medical doctors with additional knowledge in humanities. It should be taught in line with other ethical subjects in the academic institutions in order to prepare ethically competent doctors for practicing the art and science of medicine.

How can we get more reliable information from homoeopathic pathogenetic trials?: A critique of provings

Indeed, a medicine must first of all be essayed in a healthy body, without any foreign admixture;when the odour and taste have been examined, a small dose must be taken, and attention must be paid to every change that occurs, to the pulse, the temperature, respiration and excretions. Then, having examined the symptoms encountered in the healthy person, one may proceed to trials in the body of a sick person.

The safety of homeopathic products

It is regrettable that Professor Kirbys editorial (May 2002 JRSM1) did not mention a review of this topic conducted and published by us2. This was a formal systematic review using prospectively defined inclusion and exclusion criteria and data extraction procedures. It comprised a review of English-language publications and enquiries with manufacturers and regulatory agencies. Table 1 shows a sample of the data: in therapeutic clinical trials (as opposed to healthy-volunteer homeopathic pathogenetic trials) the incidence of reported adverse effects (AEs) is higher in the verum group than in the placebo group (mean incidence 9.4/6.1). Table 1 Adverse effects (AEs) of homeopathy reported in therapeutic clinical trials The conclusions were based on these data and reports of apparent AEs from homeopathic pathogenetic trials (provings) and case reports. The main conclusions were: Homeopathic medicines may provoke AEs, but these are generally mild and transient There is under-reporting There are cases of ‘mistaken identity’, where herbal and other medicines were described as homeopathic The main risks associated with homeopathy are indirect, relating to the prescriber rather than the medicine. Although strictly speaking outside the remit of the editorial, the last point is particularly important. Not only is it the main risk of homeopathy, but it is a topical issue. Medical practice in the UK is currently essentially unregulated; anybody, irrespective of training or registration, can describe themselves as a homeopath. This is the main preventable source of risk. In their evidence to the House of Lords Select Committee on Complementary and Alternative Medicine3, bodies representing non medically qualified acupuncturists and herbalists stated that their professions wished to become statutorily regulated, the Select Committees report endorsed this view, and the process towards statutory regulation of these professions is now underway. The non-medical homeopaths, however, indicated that they did not currently wish statutory regulation, despite the view of the Faculty of Homeopathy (doctors and other health professionals practising homeopathy) that homeopathy should be practised only by statutorily registered professionals, and that a new profession should be created if necessary.