Una pandemia de salud: Hay que creer para ver
DOI:
https://doi.org/10.56050/01205498.1624Palabras clave:
asistencia sanitaria, pandemia de salud, Dr. Alejandro R. JadadResumen
¿Qué tienen en común los siguientes escenarios?• Después de reinar como uno de los tratamientos médicos más utilizados desde hace más de 3.000 años, la sangría sólo empezó a declinar en el siglo 20 (1), a pesar de que era ineficaz, y responsable de muchas muertes, incluyendo las de George Washington y Carlos II (2).
• A pesar de ser una práctica sencilla, altamente eficaz y bien entendida, menos de la mitad de los profesionales de la salud se lavan las manos al entrar en contacto con los pacientes (3), y menos del 20% de las personas en todo el mundo lo hacen, después de defecar (4). La resistencia al cambio fue tan feroz inicialmente, que Ignaz Semmelweis, quien proporcionó la primera evidencia clara de su beneficio en el siglo 19, fue ridiculizado, acosado e incluso obligado a exiliarse por la comunidad médica de Viena, muriendo sin el reconocimiento que merecía, ya que tomaría 50 años más para que sus ideas fueran aceptadas (5).
• Durante miles de años, los machos dominantes han excluído a las mujeres, niños y enemigos de la categoría de seres humanos completos, para justificar el sometimiento y terribles actos de violencia. A lo largo de los siglos, los médicos han tolerado y apoyado la creencia de que ciertos grupos de personas son “menos que humanos”, jugando un papel clave en la evaluación del valor de los esclavos, garantizando que la tortura no sea letal, realizando experimentos o manteniendo su aptitud para el trabajo forzado (6-9).
• En la asistencia sanitaria del siglo 21, además de algunos ejemplos flagrantes de guías de práctica clínica racistas (9,10), la deshumanización es endémica en relación con las interacciones con los pacientes y los participantes en estudios de investigación, ya que con frecuencia son tratados como máquinas homogeneizadas, seres insensibles, con trozos de órganos enfermos, o como seres incivilizados, irracionales o carentes de sentimientos (11-13).
Biografía del autor/a
Alejandro R. Jadad Bechara, Centro para la Innovación Global en eSalud, Toronto
Fundador del Centro para la Innovación Global en eSalud, Toronto, Canadá.
Referencias bibliográficas
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3. Melville NA. WHO Hand-Hygiene Initiative Largely Ignored [Internet]. Medscape. 2011 [cited 2017 Oct 15]. Available from:
https://www.medscape.com/viewarticle/743111?pa=fLKsA6rB%2BJdPT5uxPCijbG0BOAo- 7viI0Eq7td56wUV8 PrtENi2RTpiAXhwjc12VALCEJNCr bkqLWYvqLrhntWA%3D%3D
4. Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JPT, Wolf J, et al. Systematic review: Hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Trop Med Int Health. 2014 Aug 1;19(8):906–16.
5. Daniels IR. Historical perspectives on health: Semmelweis: a lesson to relearn? J Roy Soc Health. 1998;118:367–70.
6. Smith DL. Less Than Human: Why We Demean, Enslave, and Exterminate Others. St. Martin’s Press; 2011. 336 p.
7. Kenny S. How black slaves were routinely sold as “specimens” to ambitious white doctors [Internet]. The Conversation. 2015 [cited 2017 Oct 15]. Available from:
http://theconversation.com/how-black-slaves-were-routinely- sold-as-specimens-to-ambitious-white-doctors-43074
8. Hogarth RA. Medicalizing Blackness: Making Racial Difference in the Atlantic World, 1780-1840. UNC Press Books; 2017. 290 p.
9. Shaban H. How Racism Creeps Into Medicine. The Atlan- tic [Internet]. 2014 Aug 29 [cited 2017 Oct 15]; Available from:
http://www.theatlantic.com/health/archive/2014/08/how-racism-creeps-into-medicine/378618/
10. Braun L, Wolfgang M, Dickersin K. Defining race/ethnicity and explaining difference in research studies on lung function. Eur Respir J. 2013 Jun;41(6):1362–70.
11. Haque OS, Waytz A. Dehumanization in Medicine: Causes, Solutions, and Functions. Perspect Psychol Sci. 2012 Mar;7(2):176–86.
12. Gambrill E. The Diagnostic and Statistical Manual of Mental Disorders as a Major Form of Dehumanization in the Modern World. Res Soc Work Pract. 2013 Sep 8;24(1):13–36.
13. Timmermans S, Almeling R. Objectification, standardization, and commodification in health care: a conceptual readjustment. Soc Sci Med. 2009 Jul;69(1):21–7.
14. Kahneman D. Thinking, Fast and Slow. Doubleday Canada; 2011. 512 p.
15. Pandemic [Internet]. Online Etymology Dictionary. [cited 2017 Oct 15]. Available from: http://www.etymonline.com/word/pandemic
16. Honigsbaum M. Historical keyword: Pandemic. Lancet. 2009;373:1939.
17. Morens DM, Folkers GK, Fauci AS. What is a pandemic? J Infect Dis. 2009 Oct 1;200(7):1018–21.
18. Dicker RC, Coronado F, Koo D, Parrish RG. Principles of Epidemiology in Public Health Practice. US Centers for Disease Control and Prevention; 2006.
19. Anonymous. The WHO pandemic phases. World Health Organization; 2009.
20. World Health Survey [Internet]. World Health Organization. World Health Organization; 2016 [cited 2017 Oct 15]. Available from: http://www.who.int/healthinfo/survey/en/
21. Jadad AR, Cabrera A, Gatov J, Hakem Zadeh F, Mohapatra A, Pace N, et al. The Health of Humanity Project [Internet]. Institute for Global Health Equity and Innovation. 2017 [cited 2017 Oct 15]. Available from: http://www.dlsph.utoronto.ca/initiative/the-health-of-humanity-project/
22. Antonovsky A. Unraveling the mystery of health: How people manage stress and stay well. 1st ed. San Francisco: Jossey-Bass; 1987. 218 p.
23. Ryff CD, Singer B. The Contours of Positive Human Health. Psychol Inq. 1998 Jan 1;9(1):1–28.
24. Seligman MEP. Positive Health. Appl Psychol. 2008 Jul 1;57:3–18.
25. Benedictow OJ. The Black Death, 1346-1353: The Complete History. Boydell Press; 2004. 433 p.
26. Nelson JC. Historical Atlas of the Eight Billion: World Population History 3000 BCE to 2020. Create Space Independent Publishing Platform; 2014. 106 p.
27. Johnson NPAS, Mueller J. Updating the accounts: global mortality of the 1918-1920 “Spanish” influenza pandemic. Bull Hist Med. 2002 Spring;76(1):105–15.
28. Oral health [Internet]. World Health Organization. World Health Organization; 2016 [cited 2017 Oct 16]. Available from: http://www.who.int/mediacentre/fac tsheets/fs318/en/
29. Allen L. Are we facing a noncommunicable disease pandemic? J Epidemiol Glob Health. 2017 Mar;7(1):5–9.
30. Obesity and overweight [Internet]. World Health Organization. World Health Organization; 2017 [cited 2017 Oct 15]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/
31. Klayman J. Varieties of Confirmation Bias. In: Busemeyer J, Hastie R, Medin DL, editors. Psychology of Learning and Motivation. Academic Press; 1995. p. 385–418.
32. York EP, Brown T. The price they paid. J Community Hosp Intern Med Perspect. 2015 Feb 3;5(1):26436.
33. everidge WIB. The Art of Scientific Investigation. Create Space Independent Publishing Platform; 2015. 196 p.
34. Decision Making from a Cognitive Perspective: Advances in Research and Theory. Academic Press; 1995. 426 p.
35. Definition of definition [Internet]. Oxford Dictionaries. Oxford
36. Dictionaries; [cited 2017 Oct 16]. Available from: https://en.oxforddictionaries.com/definition/definition
37. Polanyi M. The Tacit Dimension. University of Chicago Press. 2009.
38. United Nations. Constitution of the World Health Organiza- tion [Internet]. 1948. Available from: http://www.who.int/governance/eb/who-constitution-en.pdf
39. Gurnani MV, Agarwal A. Healthy Lives for All, Until the Last Breath: An Interview with Dr. Alex Jadad. Univ Toronto Med J. 2014;92:20–4.
40. Jadad AR, O’Grady L. How should health be defined?BMJ. 2008 Dec 10;337:a2900.
41. Blalock HM. Conceptualization and Measurement in the Social Sciences. First Edition. SAGE Publications, Inc; 1982.
42. Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ. 2011 Jul 26;343:d4163.
43. Schulkin J. Allostasis, Homeostasis, and the Costs of Physiological Adaptation. Cambridge University Press; 2004. 372 p.
44. Carel H. Phenomenology and its application in medicine. Theor Med Bioeth. 2011 Feb;32(1):33–46.
45. Svenaeus F. Naturalistic and Phenomenological Theories of Health: Distinctions and Connections.
46. Royal Institute of Philosophy Supplements. 2013;72(Supplement - 1):221–38.
47. WHO. Global Reference List of 100 Core Health Indicators, 2015 [Internet]. Health statistics and information systems. World Health Organization; 2016 [cited 2017 Apr 17]. Available from:
http://www.who.int/healthinfo/indicators/2015/en/
48. Bombak A. Self-Rated Health and Public Health: A critical Perspective. Frontiers in Public Health. 2013;1:15.
49. Jürges H, Avendano M, Mackenbach JP. Are different measures of self- rated health comparable? An assess- ment in five European countries. Eur J Epidemiol. 2008 Sep 24;23(12):773–81.
50. Ferraro KF, Wilkinson LR. Alternative Measures of Self- Rated Health for Predicting Mortality among Older People: is past or future orientation more important? Gerontologist. 2015 Oct;55(5):836– 44.
51. Huohvanainen E, Strandberg AY, Stenholm S, Pitkälä KH, Tilvis RS, Strandberg TE. Association of Self- Rated Health in Midlife With Mortality and Old Age Frailty: A 26- Year Follow-Up of Initially Healthy Men. J Gerontol A Biol Sci Med Sci. 2016 Jul;71(7):923–8.
52. Gasull M, Pallarès N, Salcedo N, Pumarega J, Alonso J, Porta M. Self- rated health and chronic conditions are associated with blood concentrations of persistent organic pollutants in the general population of Catalonia, Spain. Environ Res. 2015 Nov;143 (Pt A):211–20.
53. Falk H, Skoog I, Johansson L, Guerchet M, Mayston R, Hörder H, et al. Self-rated health and its association with mortality in older adults in China, India and Latin America- a 10/66 Dementia Research Group study. Age Ageing. 2017 Jul 18;1–8.
54. DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. J Gen Intern Med. 2006;21(3):267–75.
55. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997 Mar;38(1):21–37.
56. Jylhä M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med. 2009 Aug;69(3):307–16.
57. Lee HY, Kim J, Merighi JR. Physical Activity and Self-Rated Health Status among older adult Cancer Survivors: Does Intensity of Activity Play a Role? Oncol Nurs Forum. 2015 Nov;42(6):614–24.
58. Lee Y. The predictive value of self assessed general, physical, and mental health on functional decline and mortality in older adults. Journal of Epidemiology & Community Health. 2000;54(2):123–9.
59. Johar M, Jones G, Savage E. The effect of lifestyle choices on emergency department use in Australia. Health Policy. 2013 May;110(2-3):280–90.
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Cómo citar
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Jadad Bechara, A.R. 2021. Una pandemia de salud: Hay que creer para ver. Medicina. 43, 3 (oct. 2021), 414–425. DOI:https://doi.org/10.56050/01205498.1624.
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