Disputed expertise and chaotic disinformation: COVID-19 and denialist physicians in Brazil.

This article aims to show how incorrect ideas about COVID-19 were promoted by physicians in Brazil, contributing to a catastrophic response at the cost of hundreds of thousands of lives, and to examine the implications of this episode for the social studies of science, technology and medicine. The literature on the relationship between science and society takes two broad approaches, which are sometimes at odds with each other: (i) there is a traditional critique of science that points to unsupported claims of certainty and thus undue interference in general human affairs; (ii) there are many examples of attempts to undermine reasonable scientific claims, when they clash with economic and/or political interests of certain groups. Navigating those extremes is particularly critical in situations in which accurate knowledge is necessary for intervening in people's lives, as is the case in health-related issues. Determining who has actual epistemic expertise is a key factor in solving this conundrum. This became painfully clear during the unfolding of the COVID-19 pandemic, which highlighted the uncertainties of science in guiding decisions being made in real time, and provided opportunities for many forms of disinformation and conspiracy theories that hampered public health measures and promoted useless or even dangerous "treatments". This article discusses an instructive example of such developments in the chaotic response to the pandemic challenge in Brazil, which saw, among other unfortunate situations, physicians aligned with the denialist federal government advocating for unproven - or proven as ineffective - treatments and disseminating unfounded doubts about vaccines. Presumed expertise on the basis of professional training clearly did not translate into actual expertise in the necessary domains to ascertain the validity of such claims and scientific advice was overridden by ideology.

[From psychosomatic medicine to medical psychology: the theoretical and institutional trajectory of Julio de Mello Filho]. / Da medicina psicossomática à psicologia médica: a trajetória teórica e institucional de Julio de Mello Filho.

Studies on the causality of pathologies and the doctor/patient relationship based on psychoanalytic formulations received two denominations in Brazil: psychosomatic medicine and medical psychology. The physician and psychoanalyst Julio de Mello Filho took a leading role in this movement after the psychiatrist and psychoanalyst Danillo Perestrello was incapacitated by illness. This study investigates how the theoretical concepts of the psychosomatic movement were structured and the institutional strategies used to establish this discipline in Brazil. From an epistemological and historical point of view, the initial notion of transforming the hegemonic medical model was seen to lose force, followed by a shift in medical psychology as a field of health psychology.

Os estudos sobre as causalidades das patologias e da relação médico/paciente a partir de formulações psicanalíticas receberam duas denominações no Brasil: medicina psicossomática e psicologia médica. O médico e psicanalista Julio de Mello Filho assumiu o protagonismo dessa proposta a partir da doença incapacitante do psiquiatra e psicanalista Danillo Perestrello. A estruturação da concepção teórica do movimento psicossomático e as estratégias institucionais utilizadas para a consolidação desse campo disciplinar no cenário brasileiro são o objeto deste estudo. Por meio de um referencial epistemológico e histórico, conclui-se que a proposta inicial de transformação do modelo médico hegemônico perde força e observa-se um deslocamento da psicologia médica como um campo da psicologia da saúde.

Baby food industry interference with infant feeding international regulation-A case study on the standard for follow-up formula.

Introduction: Globally, first-food systems have changed and breastfeeding has decreased due to the increased growth in commercial breast milk substitute (BMS) consumption, which includes both follow-up and toddler formulas. These products are manufactured by a small number of corporate leaders in international BMS sales. Discussions for global regulation of these products take place in the Codex Alimentarius and are permeated by the strong participation of these corporations in the Codex committees. Objective: In the present study, the participation of the baby food industry in the review of the follow-up formula standard in the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU) was analyzed. Methods: The analysis of the CCNFSDU documents was based on the period from 2009 to 2019 and used quantitative and qualitative approaches. Compositional and participation data from country delegations and observer organizations on the representative profiles of the involved institutions and the baby food industry's involvement in this process were established systematically. Results: In total, 134 out of the 189 Codex Alimentarius member countries engaged in the standard review process, of which 28% were involved in the entire process. The private sector was present in 81% of the most assiduous member state delegations to the meetings. Furthermore, ~60% of the observer organizations involved in the review process were business associations representing industry interests. Moreover, the International Special Dietary Foods Industries was the only business association with observer status in the CCNFSDU that was specifically dedicated to representing the baby food industryduring the review process. Conclusion: These research results expand the body of evidence confirming the expressive and disproportionate participation of baby food industries and their representatives in the discussion processes within the scope of the CCNFSDU. However, studies investigating the Codex and the public documents of its respective committees are limited. Thus, this was the first study to analyze the influence of the baby food industry on BMS global regulatory compliance.

Science, health, and human rights.

A solid knowledge base is one of the necessary conditions to assure health as a human right. The contemporary source of such knowledge are the sciences at large, which however presents a problem, since the scientific enterprise can - and has been - a source of human rights violations as well. The field of social studies of science (STS) takes an iconoclast approach to the science, providing much needed criticism of its claims of authority. Recently, however, when attacks from multiple sources attempt to undermine perfectly reasonable scientific developments, the STS approach may not provide the adequate tools to deal with such challenge, especially with regard to health issues. This essay explores, with examples, ways in which the critical stance of STS may be compatible with a defense of proper scientific knowledge - in fact, helping to define what that actually means - without falling in the trap of scientism.

[Danilo Perestrello and the psychosomatic medicine movement in Brazil: from theory to institutional acceptance]. / O movimento da medicina psicossomática no Brasil: a trajetória teórica e institucional de Danilo Perestrello.

In the 1950s, the psychosomatic medicine movement emerged in Brazil, led by psychiatrist and psychoanalyst Danilo Perestrello. This article analyzes the strategies developed to configure this proposal and establish this field of study. From the beginning, this movement was characterized by a plan to reformulate medicine based on psychoanalytic theory and obtain favorable reception in institutions. During his career, Perestrello published articles and books with the intention of establishing a new way of thinking among physicians and worked at strategic institutions. His withdrawal from professional work due to a serious illness in 1976 was a factor contributing to the fragmentation of the psychosomatic movement in Brazil.

Na década de 1950, surgia o movimento da medicina psicossomática no Brasil, tendo como protagonista o psiquiatra e psicanalista Danilo Perestrello. A configuração dessa proposta e a análise das estratégias construídas para a formação desse campo disciplinar são o objeto deste estudo. Desde o início, esse movimento foi marcado por um projeto teórico-institucional de refundação da medicina sobre bases psicanalíticas e de institucionalização. Em sua trajetória, Perestrello publicou artigos e livros que tinham como intuito formar um novo estilo de pensamento entre os médicos, bem como a ocupação de instituições estratégicas. Seu afastamento profissional, devido a uma grave doença em 1976, representou um fator desagregador do movimento psicossomático no contexto brasileiro.

Here we go again: the reemergence of anti-vaccine activism on the Internet.

This essay discusses the resurgence of anti-vaccine activism in recent years, based on relevant literature and the author's own experiences. After presenting possible reasons for the reemergence of such movements and their consequences, the author analyses the role of Internet-mediated communication in amplifying this discourse and making it less amenable to criticism, presenting some of the main arguments deployed by the anti-vaccine agents in their discussions. The text concludes with a draft of possible responses to this increasingly worrying phenomenon.

Analysis of the application of a deterministic routine for identifying multiple pregnancies on SINASC, Brazil. / Análise da aplicação de uma rotina determinística para a identificação de gestações múltiplas no Sistema de Informações sobre Nascidos Vivos.

OBJECTIVE: to evaluate the application of a deterministic routine for identifying multiple pregnancies on the Brazilian Live Birth Information System (SINASC). METHODS: SINASC data deduplication and linkage with the mortality database (fetal deaths) for Rio de Janeiro state for the period 2007-2008; we used a deterministic routine, using a key based on SINASC maternal and birth information, complemented by manual review. RESULTS: of the 433,874 SINASC records, 9,036 (2.1%) were classified as multiple pregnancy newborns; after implementing the routine, we reclassified 385 records as twins, and 286 as singletons; accuracy of multiple pregnancy information on the SINASC database was high (sensitivity=95.8%; specificity=99.9%); applying the routine without the manual review process increased sensitivity by 4.2%, with no significant change of specificity. CONCLUSION: despite the accuracy of information regarding multiple pregnancy held on SINASC, we suggest the use of this routine as an option for improving classification of twins.

Trying to make sense out of chaos: science, politics and the COVID-19 pandemic.

This essay discusses the proliferation of discourses about the COVID-19 pandemic, presenting the challenges both to science and public policies that such an information overload present, having Collins' sociology of expertise as a theoretical framework.

On health needs: the concept labyrinth.

This study aims to reflect on the intertwining of certain key ideas about what we call "health" within the hegemonic biomedical paradigm: health, disease, health needs, medicalization and medical-industrial complex. This reflection is based on the philosophical contributions of Heller and Wiggins on needs; on the discussion of some authors, especially Canguilhem, about health and illness; and Collins' sociology of expertise. After pointing out some of the conundrums that arise from the conceptual fluidity of the topics abovementioned, we present a path forward, based on Collins' proposals about the role of experts in political arguments, to resituate the discussion on health needs.

Maternal education and age: inequalities in neonatal death.

OBJECTIVE: Evaluate the interaction between maternal age and education level in neonatal mortality, as well as investigate the temporal evolution of neonatal mortality in each stratum formed by the combination of these two risk factors. METHODS: A nonconcurrent cohort study, resulting from a probabilistic relationship between the Mortality Information System and the Live Birth Information System. To investigate the risk of neonatal death we performed a logistic regression, with an odds ratio estimate for the combined variable of maternal education and age, as well as the evaluation of additive and multiplicative interaction. The neonatal mortality rate time series, according to maternal education and age, was estimated by the Joinpoint Regression program. RESULTS: The neonatal mortality rate in the period was 8.09‰ and it was higher in newborns of mothers with low education levels: 12.7‰ (adolescent mothers) and 12.4‰ (mother 35 years old or older). Low level of education, without the age effect, increased the chance of neonatal death by 25% (OR = 1.25, 95%CI 1.14-1.36). The isolated effect of age on neonatal death was higher for adolescent mothers (OR = 1.39, 95%CI 1.33-1.46) than for mothers aged ≥ 35 years (OR = 1.16, 95%CI 1.09-1.23). In the time-trend analysis, no age group of women with low education levels presented a reduction in the neonatal mortality rate for the period, as opposed to women with intermediate or high levels of education, where the reduction was significant, around 4% annually. CONCLUSIONS: Two more vulnerable groups - adolescents with low levels of education and older women with low levels of education - were identified in relation to the risk of neonatal death and inequality in reducing the mortality rate.

The Zika Virus Outbreak in Brazil: Knowledge Gaps and Challenges for Risk Reduction.

We analyzed uncertainties and complexities of the Zika virus outbreak in Brazil, and we discuss risk reduction for future emergencies. We present the public health situation in Brazil and concurrent determinants of the epidemic and the knowledge gaps that persist despite building evidence from research, making public health decisions difficult. Brazil has adopted active measures, but producing desired outcomes may be uncertain because of partial or unavailable information. Reducing population group vulnerabilities and acting on environmental issues are medium- to long-term measures. Simultaneously dealing with information gaps, uncontrolled disease spread, and vulnerabilities is a new risk scenario and must be approached decisively to face emerging biothreats.

Accuracy of probabilistic and deterministic record linkage: the case of tuberculosis.

OBJECTIVE: To analyze the accuracy of deterministic and probabilistic record linkage to identify TB duplicate records, as well as the characteristics of discordant pairs. METHODS: The study analyzed all TB records from 2009 to 2011 in the state of Rio de Janeiro. A deterministic record linkage algorithm was developed using a set of 70 rules, based on the combination of fragments of the key variables with or without modification (Soundex or substring). Each rule was formed by three or more fragments. The probabilistic approach required a cutoff point for the score, above which the links would be automatically classified as belonging to the same individual. The cutoff point was obtained by linkage of the Notifiable Diseases Information System - Tuberculosis database with itself, subsequent manual review and ROC curves and precision-recall. Sensitivity and specificity for accurate analysis were calculated. RESULTS: Accuracy ranged from 87.2% to 95.2% for sensitivity and 99.8% to 99.9% for specificity for probabilistic and deterministic record linkage, respectively. The occurrence of missing values for the key variables and the low percentage of similarity measure for name and date of birth were mainly responsible for the failure to identify records of the same individual with the techniques used. CONCLUSIONS: The two techniques showed a high level of correlation for pair classification. Although deterministic linkage identified more duplicate records than probabilistic linkage, the latter retrieved records not identified by the former. User need and experience should be considered when choosing the best technique to be used. OBJETIVO: Analisar a acurácia das técnicas determinística e probabilística para identificação de registros duplicados de tuberculose, assim como as características dos pares discordantes. MÉTODOS: Foram analisados todos os registros de tuberculose no período de 2009 a 2011 do estado do Rio de Janeiro. Foi desenvolvido algoritmo para relacionamento determinístico, usando conjunto de 70 regras, a partir da combinação de fragmentos das variáveis-chave com ou sem modificações (Soundex ou substring). Cada regra era formada por três ou mais fragmentos. Para a abordagem probabilística, foi necessário estabelecer ponto de corte para o escore, acima do qual os links seriam classificados automaticamente como pertencentes ao mesmo indivíduo. O ponto de corte foi obtido por meio do relacionamento da base de dados Sistema de Informação de Agravos de Notificação - Tuberculose com ela mesma, posterior revisão manual e curvas ROC e precision-recall. Foram calculadas a sensibilidade e especificidade para análise de acurácia. RESULTADOS: A acurácia variou de 87,2% a 95,2% para sensibilidade e 99,8% a 99,9% para especificidade para as técnicas probabilística e determinística, respectivamente. A presença de valores faltantes para as variáveis-chave e o baixo percentual da medida de similaridade para o nome e data de nascimento foram os principais responsáveis pela não identificação dos registros do mesmo indivíduo pelas técnicas utilizadas. CONCLUSÕES: As duas técnicas apresentam alta concordância para a classificação como par. Apesar de a técnica determinística ter identificado mais registros duplicados que a probabilística, a segunda recuperou registros não identificados pela primeira. A necessidade e a experiência do usuário devem ser consideradas para a escolha da técnica a ser utilizada.

[Where Descartes got it right: the implications for science, biomedicine, and public health]. / Os acertos de Descartes: implicações para a ciência, biomedicina e saúde coletiva.

The "received view" of Descartes has shaped the image of a dualist thinker who radically separated mind and body and thus laid the foundations for a "divided modernity". Numerous epithets have been applied to Cartesian thinking, all of which now sound depreciative: mechanicism, determinism, and reductionism, among others. This article contends that Descartes was not the type of dualist that is normally assumed. Based on a rereading of two essential works (Discourse on Method and Metaphysical Meditations) and a dialogue with the new literature on the theme, we contend that overcoming the "received view" of Descartes can shed new light on discussions in (and of) the collective health field and highlight the so-called expanded health paradigm (including aspects beyond the biological or physiological, such as the psychological, social, economic, cultural, and political).

Rapid Repeat Pregnancy in Brazilian Adolescents: Interaction between Maternal Schooling and Age.

STUDY OBJECTIVE: An association between rapid repeat pregnancy (RRP; occurring within a birth interval of up to 24 months) and undesirable obstetric and perinatal outcomes has been shown, especially among adolescents and women without adequate schooling. The objective of this study was to evaluate the effect of the interaction between maternal schooling and age on the incidence of RRP. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A nonconcurrent cohort study was carried out using probabilistic record linkage techniques. The 59,400 linked records of singleton live-born infants delivered in 2002 whose mothers were up to 29 years old and lived in Rio de Janeiro City were evaluated. RESULTS: Compared with young adults with adequate schooling, the adjusted risk ratio for RRP for adolescents with inadequate schooling was 2.1 (95% confidence interval, 1.8-2.4). The attributable proportion was 0.16 (95% confidence interval, 0.02-0.29). CONCLUSION: Young maternal age and inadequate schooling interact, increasing RRP.