Conflictos de intereses en nefrología / Conflicts of interest in nephrology

Since doctors disposed of effective tools to serve their patients, they had to worry about the proper management of available resources and how to deal with the relationship with the industry that provides such resources. In this relation­ship, health professionals may be involved in conflicts of interest that they need to acknowledge and learn how to handle. This article discusses the conflicts of interest in nephrology. Its objectives are to identify those areas where such conflicts could occur; to help to solve them, always considering the best interest of patients; and to help health workers to keep in mind that they have to preserve their autonomy and professional integrity. Conflicts of interest of professionals in the renal area and related scientific societies, with the industry producing equipment, supplies and drugs are reviewed. Dichotomy, payment for referral, self-referral of patients and incentives for cost control are analyzed. Finally, recommendations to help preserve a good practice in nephrology are made.

World Medical Association Guidelines on Promotional Mass Media Appearances by Physicians: Starting Campaigns for Ethics

No abstract available.

Safeguarding the Integrity of Science Communication by Restraining 'Rational Cheating' in Peer Review

Peer review is the pillar of the integrity of science communication. It is often beset with flaws as well as accusations of unreliability and lack of predictive validity. 'Rational cheating' by reviewers is a threat to the validity of peer review. It may diminish the value of good papers by unfavourable appraisals of the reviewers whose own works have lower scientific merits. This article analyzes the mechanics and defects of peer review and focuses on rational cheating in peer review, its implications, and options to restrain it.

Participações na organização e oficialização de novas sociedades componentes da IPA / Participaciones en la organización y formalización de nuevas sociedades componentes de la IPA / Participations in the organization and formalization of new components societies of IPA

No texto são descritas as participações da Sociedade Psicanalítica de Porto Alegre (SPPA), através do autor, nas tarefas de organização, avaliação e posterior oficialização, pela International Psychoanalytical Association (IPA), de quatro sociedades psicanalíticas latino-americanas. São sumariados os longos processos determinados pela IPA para a consecução de tais objetivos, bem como explicados os motivos de tais exigências. Finalmente, é acentuado o valor dos laços afetivos que derivam de tais trabalhos compartilhados

Based on the author’s experience, the text describes the participation of the Psychoanalytical Society of Porto Alegre (SPPA) in the tasks of organization, evaluation and later formalization by the International Psychoanalytical Association (IPA) of four Latin American psychoanalytic societies. The long processes determined by the IPA to achieve these goals are described and the reasons for these requirements are explained as well. Finally, the value of emotional ties that derive from such shared work is stressed

En el texto son descritas las participaciones de la Sociedad Psicoanalítica de Porto Alegre (SPPA), a través del autor, en las tareas de organización, evaluación y posterior formalización, por la Internatcional Psychoanalytical Association (IPA), de cuatro sociedades psicoanalíticas. Son resumidos los largos procesos determinados por la IPA para la consecución de tales objetivos, así como explicados los motivos de tales exigencias. Finalmente, es acentuado el valor de los lazos afectivos que derivan de tales trabajos compartidos

professional and social context of medical education

Medicine is no hard and thorny science like mathematics and metaphysics, so I soon made great progress [Avicenna =Ibn Sina, A.; 980-1037 A.D]. The social importance of the medical function and the limited number of people with the training to perform as physicians are not the only criteria explaining their professional dominance. A particularly important factor is the organization of the medical profession itself. Two basic characteristics are sociologically relevant in explaining professionalism: prolonged training in a body of specialized and abstract knowledge and an orientation toward providing a service [Rizk, 2000]. Moreover, once a professional group becomes established, it begins to further consolidate its power by formalizing social relationships that govern the interaction of the professionals with their clients, colleagues and other official agencies outside the profession. Recognition on the part of these bodies and the wider society of the profession's claim to competence as well as the profession's ability to control its own membership is necessary if professional decisions are not to be reviewed by outside authorities. Doctors, however, now work in a context in which the old verities about medicine and medical practice can no longer be taken for granted [Rizk, 2007]. The awareness of societal changes and the need to prepare health professionals to work in new roles are evident in the plethora of meetings and publications directed to [Medicine in the 21[st] Century]. Hence, the medicine and doctors are in a serious need of leadership if they are to adapt successfully to a different future. The doctor's role is evolving continuously in a process of negotiation between the medical profession and the society it serves [Rizk, 2000]. At different points in the history of the profession, the relative power of the profession and of society has varied. In the recent past, scientific and technological advances, the consequent growth of the tertiary care teaching hospital and specialist expertise have tended to place much of the power to define a doctor's role in the hands of the profession which was best able to understand the scientific aspects of that role. Some recent changes given [Tab. 1] have, however, influenced the way in which the health care and the doctor's role are viewed. The net effect of these changes is that the balance of power in the negotiation of doctors' role is changing to give a more equal share to the society and the profession. This negotiation of role has the implications for medical education. Medical education performs a service for society in training doctors to meet the need for medical care in society. It is necessary, therefore, for medical educational institutions to be able to recognize and interpret those needs and design appropriate educational programs. In many countries the social context of medicine has changed since the majority of medical teachers were students. Increased biomedical knowledge and technological development offers seemingly limitless potential for medical intervention aimed at the cure or life support. Simultaneously, the recognition that much disease has its origins in .lifestyle and preventable environmental factors has evolved. Governments must allocate finite health resources where they can, potentially, do the most good [Rizk and El Safty, 2006]. Other health professionals and patients themselves have an expanded role to play in meeting the emerging needs for illness prevention and maintenance of healthy populations. Most clinical education takes place within teaching hospitals where patient and doctor expectations and negotiations are at a different level from those in primary care setting. In light of these and other changes, expectations of the doctor's role have also changed. The majority of medical students are therefore unprepared for the nature of the expectations and demands they encounter later in their professional work. To fulfill this new role, future doctors will need skills not just in the clinical areas with which they are currently concerned but also in the ethical, social, political and economic aspects of medicine. Furthermore, the impact of sophisticated and often competing anthropologic and societal variables such as the ethnicity, race, culture, religion, spirituality, geopolitical orientation, indigenous psychology, personality and gender identity on individual's realization of health role, experience of health and illness and utilization of health services is not appreciated in the medical curricula. Medical education must thus provide learning experiences which reflect the reality of medical practice in an era of increasing technological possibilities but limited economic resources [Rizk, 2007]. Medical students must also have the opportunity to consider the ethical and practical aspects of decision-making which incorporates cost-effectiveness as one parameter [Rizk, 2008]