Marilena Correa

Declaração de Helsinki: relativismo e vulnerabilidade

The Helsinki Declaration is a crucial ethical landmark for clinical research involving human beings. Since the Declaration was issued, a series of revisions and modifications have been introduced into the original text, but they have not altered its humanist approach or its international force for regulating clinical research. A proposal for an extensive revision of the Declarations underlying ethical principles has been debated for the past four years. If the proposal is approved, international clinical research involving human beings will be modified, further increasing the vulnerability of certain social groups. This article discusses the historical process involved in passing the Helsinki Declaration and the most recent debate on the new draft. The article analyzes the new texts social implications for underdeveloped countries, arguing for a political approach to the vulnerability concept.

Abortion: 20 years of Brazilian research

The aim of this paper is to discuss the main characteristics of the scientific literature on abortion in Brazil. Data were collected from 88 literature bases, and 2,109 documents from 1987 to 2008 were retrieved. Based on the findings, the field of abortion in Brazil is dominated by female researchers affiliated with public universities and nongovernmental organizations from the Southeast, with training in health sciences. There is no research on abortion in the North, while 14% of the studies were conducted in the Northeast and 4% in the Central-West. Abortion has been a constant theme in the scientific literature in Brazil, increasing in the mid-20th century.

Novas tecnologias reprodutivas: novas estratégias de reprodução?

A partir de entrevistas realizadas com um grupo de mulheres que tem, ou tiveram, dificuldade de engravidar, este estudo discute imagens da familia, da crianca e da paternidade / maternidade, apos o surgimento das novas tecnologias reprodutivas. A possibilidade de realizacao de bebes de proveta e ainda marcada por aspectos contraditorios, que colocam dificuldades para as pessoas e casais desejosos de reproducao, e que as utilizam ou pretendem utiliza-las. Quase totalmente instaladas no setor privado da medicina, a introducao e a difusao dessas tecnologias reproduzem a mesma logica excludente que vige no quadro da saude brasileira.

O discurso do risco e o aconselhamento genético pré-natal

A medicalizacao e um fenomeno social difuso nas sociedades ocidentais que se expressa segundo um diferencial de genero. A gravidez e um momento fortemente medicalizado, no qual as mulheres se veem cercadas de uma rede de vigilância de seu corpo, sendo responsabilizadas nao so pela propria saude, mas tambem pela producao de um feto saudavel. O controle dos riscos no pre-natal e proposto, entretanto, em um contexto no qual as possibilidades diagnosticas sao amplamente majoritarias comparativamente as possibilidades terapeuticas. Essa defasagem e agravada pelo fato de, no Brasil, o abortamento ser ilegal. Este artigo e fruto de pesquisa empirica realizada em um ambulatorio publico de genetica pre-natal, que constou de: observacao das praticas de atendimento, revisao de prontuarios e realizacao de entrevistas com profissionais de saude. Discutem-se o contexto fortemente medicalizado do aconselhamento genetico no Brasil e a percepcao dos medicos sobre suas praticas neste contexto. E discutido tambem o possivel impacto sobre a tomada de decisao das mulheres atendidas em relacao a riscos, tecnicas, exames e seus desdobramentos.A medicalizacao e um fenomeno social difuso nas sociedades ocidentais que se expressa segundo um diferencial de genero. A gravidez e um momento fortemente medicalizado, no qual as mulheres se veem cercadas de uma rede de vigilância de seu corpo, sendo responsabilizadas nao so pela propria saude, mas tambem pela producao de um feto saudavel. O controle dos riscos no pre-natal e proposto, entretanto, em um contexto no qual as possibilidades diagnosticas sao amplamente majoritarias comparativamente as possibilidades terapeuticas. Essa defasagem e agravada pelo fato de, no Brasil, o abortamento ser ilegal. Este artigo e fruto de pesquisa empirica realizada em um ambulatorio publico de genetica pre-natal, que constou de: observacao das praticas de atendimento, revisao de prontuarios e realizacao de entrevistas com profissionais de saude. Discutem-se o contexto fortemente medicalizado do aconselhamento genetico no Brasil e a percepcao dos medicos sobre suas praticas neste contexto. E discutido tambem o possivel impacto sobre a tomada de decisao das mulheres atendidas em relacao a riscos, tecnicas, exames e seus desdobramentos.

O admirável Projeto Genoma Humano

Este artigo apresenta um panorama das implicacoes sociais, eticas e legais do Projeto Genoma Humano. Os beneficios desse megaprojeto, traduzidos em promessas de uma revolucao terapeutica na medicina, nao se realizarao sem conflitos. O processo de inovacao tecnologica na genetica traz problemas de ordens diversas: por um lado, pesquisas em consorcio, patenteamento de genes e produtos da genomica apontam interesses comerciais e dificuldades de gerenciamento dos resultados dessas pesquisas. Esses problemas colocam desafios em termos de uma possivel desigualdade no acesso aos beneficios das pesquisas. Por outro lado, temos a questao da informacao genetica e da protecao de dados individuais sobre riscos e suscetibilidades a doencas e atributos humanos. O problema da definicao de homens e mulheres em funcao de tracos geneticos traz uma ameaca discriminatoria clara, e se torna agudo em funcao do reducionismo genetico que a midia ajuda a propagar. As respostas a esses problemas nao podem ser esperadas apenas da bioetica. A abordagem bioetica deve poder combinar-se a analises politicas da reproducao, da sexualidade, da saude e da medicina. Um vastissimo espectro de problemas como estes nao pode ser discutido em profundidade em um artigo. Optou-se por mapea-los no sentido de enfatizar em que medida, na reflexao sobre o projeto genoma, a genomica e a pos-genomica, enfrenta-se o desafio de articular aspectos tao diferenciados.

As novas tecnologias reprodutivas: uma revolução a ser assimilada

Este estudo discute as novas tecnologias reprodutivas, tambem conhecidas como reproducao assistida. Elas sao enfocadas como o cume do processo de medicalizacao da sexualidade e da reproducao, que historicamente forjou nocoes sobre o corpo, a sexualidade, o homem, a mulher, a gravidez, o parto, o aleitamento, a infância, assumindo um papel exemplar de normalizacao social. Mostra, particularmente, como os paradoxos da reproducao assistida sao ofuscados pelo investimento feito pela midia nesses novos fenomenos do campo medico, deixando na sombra seus efeitos duvidosos e a forma limitada como essas tecnologias sao avaliadas no campo cientifico.

Scaling Up and Reverse Engineering: Acquisition of Industrial Knowledge by Copying Drugs in Brazil

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Scaling up and reverse engineering Acquisition of industrial knowledge by copying drugs in Brazil Maurice Cassier, Marilena Correa

Aborto e misoprostol: usos médicos, práticas de saúde e controvérsia científica

This article puts into perspective the controversy between the association of the use of misoprostol for abortion and teratogenicity studies of the type found in a case report. The use of herbal medicinal drugs and the medical-obstetric and national and international norms governing the registration and circulation of pharmaceutical products were examined. Official documents of ANVISA, the Ministry of Health and the World Health Organization on the use of misoprostol, as well as 68 articles such as case reports published in national journals, linking abortion, misoprostol and teratogenicity were reviewed, systematically filed and analyzed using the monographic method. The legal prohibition of abortion prevents the proper prescription and use of a drug such as misoprostol that is both safe and effective. Thus, the danger for the health of women is linked not to the intrinsic characteristics of the drug, but to the moral arguments that constitute negligence and disregard for the fundamental rights of women.

Direitos reprodutivos das mulheres no sistema penitenciário: tensões e desafios na transformação da realidade

This article seeks to identify and discuss violations and challenges to the fulfillment of womens reproductive rights in situations of deprivation of liberty, with an emphasis on sexual and reproductive health. Regulatory parameters were considered as analytical frameworks that support these rights identified by the literature, and the discourses and practices linked to their effectiveness in the everyday life of prisons, collected in interviews with pregnant women and children in prisons, and the professionals whose practices interfere with the exercise of these rights. It was discovered that violations of these rights find support in speech that delegitimizes the motherhood of these women. We consider the use of rights as strategic in the struggle for the transformation of this situation.This article seeks to identify and discuss violations and challenges to the fulfillment of women’s reproductive rights in situations of deprivation of liberty, with an emphasis on sexual and reproductive health. Regulatory parameters were considered as analytical frameworks that support these rights identified by the literature, and the discourses and practices linked to their effectiveness in the everyday life of prisons, collected in interviews with pregnant women and children in prisons, and the professionals whose practices interfere with the exercise of these rights. It was discovered that violations of these rights find support in speech that delegitimizes the motherhood of these women. We consider the use of rights as strategic in the struggle for the transformation of this situation.

Tecnologias de reprodução assistida no Brasil: opções para ampliar o acesso

This article revisits the pattern of assimilation and dissemination of assisted reproductive technologies (ART) in Brazil, characterized by extreme concentration of this technology in the private medical sector and very low setting in the application of these techniques. This pattern has generated enormous difficulties and barriers to access to these techniques, basically for economic reasons. From the presentation of the overview of the history of ART, the article focuses on two cases that may propose solutions for excessive exclusion access, although it does not modify the same privatization logic that marks RT in the country, since the problem of infertility was not prioritized, so far, by the Unified Health System. The first, brought by the pharmaceutical industry, consists of a subsidized purchasing program of drug users by the so-called Programa Acesso. The second proposal, known as shared ovules donation, implies the exchange between two women, of biologically scarce reproductive materials (oocytes). This exchange occurs, in general, from a woman who has ovules and cannot afford treatment and another who has no ovules to reproduce, and pays for the treatment of the donor. Both proposals diffuse a legal framework rather poorly regulated in terms of the application of ART, but prohibit practices not authorized in the Constitution and criminalized in penal law such as the sale of human organs and tissues in general, as well as volunteers to payment tests for research. In terms of methodology, the article assumes monographic character and literary debate, but is also based on the collection of recent secondary data, as well as numerous empirical studies conducted over the last 25 years by the authors.