• Uma entrevista sobre Verdades e Solos
  • Resenha de “Céu Subterrâneo” no Jornal da USP
  • A verdade lançada ao solo, de Paulo Rosenbaum. Rio de Janeiro: Editora Record, 2010. Por Regina Igel / University of Maryland, College Park
  • Resenha de “Céu Subterrâneo” por Reuven Faingold (Estadão)
  • Escritor de deserto – Céu Subterrâneo (Estadão)
  • A inconcebível Jerusalém (Estadão)
  • O midrash brasileiro “Céu subterrâneo”[1], o sefer de “A Verdade ao Solo” e o reino das diáforas de “A Pele que nos Divide”.(Blog Estadão)

Paulo Rosenbaum

~ Escritor e Médico-Writer and physician

Paulo Rosenbaum

Arquivos de Categoria: Pesquisa médica

Episteme Issue – Blog Estadão

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Posted by Paulo Rosenbaum in Artigos, Na Mídia, Pesquisa médica, Prática clínica

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Episteme issue.

Paulo Rosenbaum, PhD.

Master in Preventive Medicine, Doctor of Science from USP

“Life is the set of factors that resist death”

Bichat, 1829

“The usual substantialist intuition is, in a
certain way, contradicted by the existence of homeopathy. In fact, in its formative, that is to say in its pure form, substantialist intuition claims that a substance acts proportionally to its mass, at least up to a certain limit. It is admitted that there are light doses, the excess of which produces disturbances. But it is not easy to admit the effectiveness of extreme dilutions administered by homeopaths. As long as the medical substance is considered as a quantitative reality, it is not easy to understand a substantial action that occurs, in some way, in inverse ratio of quantity.”

Gaston Bachelard – Dialectics of Duration

Homeopathy, and therefore all integrative medicines, has been ostensibly questioned. Would they be unscientific practices? Do they have a research program or not? Do they show empirical results from a clinical point of view? Are they plausible from a biological point of view?

For all this has been discussed in the media with a single catch: the monopoly of a shrill voice. For some years now, the microbiologist who heads the entity “Questão de Ciência” has been raising these and other questions. Some with some relevance. However, in his recent column in the newspaper “O Globo” he proved to be erratic and made a serious mistake. The bias of scientific prejudgment: it peremptorily answers all the questions it raises. Now, this is simply incompatible with reflection, especially for critical thinking, as one of the central characteristics of epistemology is well known.

Immersed in the anachronism of a typical dispute that goes back to the 19th century in the 21st century, it resurrects a polemic that we believed had overcome. Would it lack the fundamental intellectual opening: the possibility that its hypothesis is wrong? After all, as everyone should know, good scientific practice presents doubt and curiosity as essential. Science often has more questions than answers.

Dynamic processes of illness and healing

Life is inherent in vital processes. What defines the processes are some characteristics: every process is dynamic. Processes are made up of non-linear sequences of events. The process tends to produce normativity, but there is often a good deal of unpredictability until it comes to an end. If health is, as Aristotle wanted, an unstable equilibrium, it requires that the scientist or those who study biological processes dedicate themselves to the study of rhythms, also called the analysis of organic rhythm, and pay attention to vital phenomena.

This is what integrative medicines propose. Not only homeopathy with its supposedly enigmatic infinitesimal doses, but also the clinical interferences that are not limited exclusively by the field of biochemistry, but must be complemented by studies of biophysics, bioelectromagnetic fields, the information that subsists in ultra-molecular solutions ( Buck -balls or fullerenes ), and finally on the rapport effect resulting from the doctor-patient relationship. Here’s another excerpt from Gaston Bachelard:

“Moreover, there is nothing to prevent a homeopathic substance, having
taken the form of pure vibration, from being reconstituted in the form of substance. substances would perhaps quite simply trigger natural biological vibrations. It would also be explained that the ultra-diluted dose is preserved
more
fully than a massive dose because it can be restored.
it loses less easily than gross
and inert matter.”

Anyone who reduces homeopathy to minimal doses is wrong, it adopts another system of understanding and evaluating symptoms. Extends the healing criteria. It considers that each one has a personal way of convalescing and regaining lost health. So also concludes the Nobel Prize in medicine and discoverer of the AIDS virus, Luc Montaigner, who was surprised by the findings when he investigated the action of ultra-molecular drugs.

Ultra-molecular doses

If science still does not have the means to test such substances and elucidate them, this does not mean that they “are nothing” (sic) as the microbiologist and her team have categorically stated to resigned journalists, but only that the detection of these substances still requires a study that explains the phenomena induced in vivo (in living beings) and in vitro (in laboratory studies).

This means that there is evidence of the phenomenon even without a consensual and formal explanation that justifies it. Scientific skepticism is desirable and healthy, as long as the spirit of inquiry is not clouded by convictions that mimic dogmas. Axioms and prejudices that perniciously replace intellectual objectivity.

And it seems that the smartest response to suffering may not be just progressive doses of psychotropic drugs. It should be added that it is still not understood exactly how practices such as Yoga, psychotherapeutic techniques, meditation, massage therapy work, but they produce undeniably favorable results for many people who resort to them.

Drug experimenters in this pathogenic process (one of the elements of the hard core of the episteme), reveal their symptoms by anticipating – in modified physiological states – their nosological predispositions. So what happens? We anticipate our pathological potential. We organize our preconceived nosological potential more quickly and efficiently. We can observe these phenomena using one of the most consistent tools in the episteme that guides the methodology: the so-called pathogenesis (experimentation of ultra-diluted medicinal substances). Many are probably unaware of these elements when they are willing to judge what to make of homeopathic practice. It is surprising how many insist on not taking into account these phenomena that may have reproducibility. Here is an experiment, easy to demonstrate with double or triple blind crossover. And it remains accessible to anyone, from hardened skeptics to fanatical enthusiasts.

Let those who think with horror of experiments not be terrified, because the induction of symptoms can happen with any traditional medicine and with any non-iatrogenic vicissitudes. And it is essential to remember the empiricist origin of medicine. Not forgetting to mention that there are only 10 drugs with 1A certification (that is, with proof of very high efficacy) according to the most recent scientific papers.

Health and illness: a medicine situated between art and science

Situated between art and science, is the medicine of the subject – a medicine of the specifically human – a viable proposal as an effective clinical care?

It is from this perspective that the issues of health and illness should be addressed. As the epistemologist Karl Rothschuld explained, medicine is and always will be “operative science”, that is, it will always demand some artistic skill from the one who applies it – in the “artisanal” sense – because it cannot be reduced to pure science. Each integrative medicine adopts an interpretive system that is not limited to a special pharmacology.

If Hippocrates, the inventor of scientific medicine for having invented clinical history, a legacy that continues to this day – also known as the “Hippocratic school” – still has something to offer modern humans, it is that the health-disease binomial needs be understood within a context: the ananke physeos . Some epistemologists opt for the term translated “need of nature”. Now, why would illness be necessary? If pathology is a necessity of nature, it must serve something, that is to say, have a biological purpose. It has a meaning. It is not a matter of defending a teleology of diseases, but of verifying that it exists. Thus, we live in a battle between genomic and phenotypic patterns and the interference of the environment. All in almost random combinations that pressure us throughout our existences . Preserving health and preventing illness derive from these combinations.

At this point in contemporary history the main question should be: “ Is there a future for the medicine of the subject?” Probably the greatest contribution of medicine with a vitalist tradition to medicine.

Giving a new meaning to the tradition of integrative medicine, heir to a less mechanical conception of the subject, is to put it in contact with the main currents of contemporary thought, from epidemiology to philosophy, creating the opportunity for this medicine to be understood by current thinkers. . And have equal opportunity to be taught in health science schools with the same status as standard knowledge.

It could be summarized as follows: health — as Hans G. Gadamer thought is a mystery — pathology is not. In other words, the probabilistic chances of losing self-regulating homeostasis must be infinitely greater than maintaining health. There is an enigma whose elucidation is precisely the role of the researcher, who, in order to be successful, must be open to the counterintuitive, that is, to find proof of his hypothetical test (thesis) as well as unexpected and even contradictory answers to his initial assumptions.

Intuitive methods in nature and shock organ deviation

Organisms such as small rodents usually know they need artificial fever and bury themselves in hot sand when affected by infectious processes to better fight them. The inevitable question would be: how do they know they are sick and what do they need to overcome it? How do they know what they need to recover? In humans, other curious phenomena such as “pica”: the violent desire to ingest normally inedible products: earth in those suffering from iron deficiency anemia, hardened paint shell for those who have calcium deficiency, burnt wood or animal bones for other vitamin deficiencies or minerals.

Phenomena that can only be understood through the moment and clinical experience. An anguished subject with phobic neurosis migrates from the anxiety drive to a certain well-being when he becomes feverish, or while developing a sinus disease. Aspects that become more evident when an exonerative function, — one that aims to produce and eliminate secretions — is in progress. Clinicians can better understand and evaluate such processes than researchers for two reasons: because they are directly linked to the individual history of each patient and because they have a more systemic and integrated view of nature’s cycles.

The neuropathologist Prof. Walter E. Maffei stated that, in his vast clinical experience and in the autopsies he conducted, he had never seen a single chronic mental patient in a psychiatric hospital present a case of bronchial pneumonia as a cause of death . This is apparently counterintuitive, as he himself emphasized when he was the clinical director of Juqueri for more than five decades. Malnourished people usually have lung pathology as the end point of their existence, but this seemed not to be the case when it came to the chronically mentally ill. The pathologist relied on the old but very pertinent “shock organ bypass” theory. When a disease “migrates” from an anatomical region or organ system to a more superficial one, producing relief for the patient.

For this reason, even certain concepts and clinical approaches cannot be reduced to laboratory results or searched only by Magnetic Nuclear Resonance images. This does not mean that they are not verifiable clinical phenomena, only that we still do not have the tools to fully understand them. If only 1% of the funds earmarked for research could be made available to investigate the mechanism of action of infinitesimal drugs and other experimental drugs, we might have a different picture. And then we could decide the impact that the adoption or rejection of these therapies would have as a preventive policy and resources for health.

We must admit the complexity in order to reach a consensus on which field medicine should embrace to care and cure, especially when it comes to the aforementioned primary health care. The inevitable question: how can we still be deceived by evidence that is limited to the control of pathologies without taking into account the subjective and general substrate of sick patients? To use an expression from Edgar Morin, the complexity often hailed or evoked as a solution is much more – as I emphasized before – a problem concept than a solution concept.

The ethical rescue of the subject

The evidence must also be produced in the ontological turn of modernity, which is in the ethical rescue of the subject. That is, there are other conceptual dignities in science that are not limited to quantitative clinical trials. Studies such as quality of life health questionnaires, psychometric tests, assessment of people’s well-being are as relevant as the degree of efficiency of drugs on nosological entities.

This would be the relevant discussion, whether for advocates or critics of integrative practices. Without it, in fact, everything that escapes the mainstream of standard science , looks like nonsense or Manichean objection/praise. On the other hand, it is not up to those who practice these therapies to do the same with the reversed sign: surrender to the partisan defense, enunciate the therapeutic monopoly, crystallize the accumulated knowledge as a lifetime monument.

The return of the generalist and the resumption of primary health care

So what is the best way to evaluate the effectiveness of the clinic practiced by homeopathy and other forms of integrative medicine? Firstly, to identify the referential system that guides semiology, in this case aimed at justifying a medicine that must include the subject. To show that it makes sense to seek to capture the biological, affective and mental aspects of “being a sufferer”. Not only detecting characteristic and unique traits in each sick person, but capturing the context and circumstances that mutually elucidate mind-middle-body-drugs. This set would already show that it is a phenotechnic. Which only makes sense if the subject is reinserted into another system of medical notation, without competing and never dispensing with other approaches to contemporary medicine. Incorporate all available techno-scientific procedures with rationality, but at the same time refuse the arbitrary separation imposed by the excess of specialties.

Each disease follows a different course and presents itself differently in each person and there is already very concrete evidence in this regard. Medicine should not expunge the subjective state as a legitimate objective of its intervention, or delegate it to specialists. And at the height of scientism it was imagined that the status of pathology could be confined exclusively to somatic injury. But the clamor for more comprehensive care persisted. Experts are needed, but generalists need to be a priority. It was in spite of people’s needs that the division between mind and body split the medical art. And its reunification would be the regeneration and rescue of the general practitioner and the family doctor.

Thus, the subject from the perspective of medical anthropology will approach psychotherapeutic practices if it includes the figure of the doctor, that is, they are trained in a more generous anamnesis and understand the transference, in the expression and construction of language, narratives and their Meanings.

The suspicion that the pathology contains or is contained in a dysfunctional substrate with mental distress remains a challenge for even the most scientistic of clinicians. Substrate that needs to be embraced and not expunged as “pseudoscience” or “unscientific” (sic). This deserves the utmost attention for those who dedicate themselves to a serious investigation that goes beyond the stands of common sense. It can no longer be ignored by any attentive clinician. By anyone who understands science in a broader dimension than reductionism insists on extolling.

Illness, malaise, suffering, quality of life and beyond psychopharmacology

I quote the famous definition of the French physician, founders of histology, Xavier Bichat “life is the set of factors that resist death” (Bichat, 1829). But there is also the following possible development: life is born under the sign of mortality, a tension that remains active and accompanies us until our last days.

Getting sick is not just the existence of malaise, but also not recognizing the co-authorship of the symptoms; or simply to attribute the pathology to some exclusively exogenous agent. After all, being an agent of oneself means immediately recovering the horizon of self-care and increasing the acuity of attention to life. The health-disease process is, even in the opinion of some, a struggle. Struggle between health and illness and, therefore, between life and death and even resignation and ambition.

This means more or less the following: can we say that suffering is disease? We may or may not call this destructive ancestral force a miasma, a virus, a half-plague, or any other name. If suffering is inherent to gender, what are the limits for considering it a disease? What if we understand suffering not as a penitential state, but as a more or less important inability to dedicate oneself to self-care?

Pathologies are not, in Lain Entraldo’s understanding, “localized”, they are not limited to a single place. When well investigated, one can see how they permeate the entire economy of the subject. They are ingrained along with other symptoms that may be older or more recent. In other words, despite appearances, the disease is always systemic. First the illness (illness) and then the disease itself (disease) To dismantle it, therefore, it is necessary to see the complete map of the affected organism, as well as the environmental circumstances.

Anguish can be beneficial, as well as depression, as long as it is recreating or regenerating. It can be a melancholy trait to the point of being just another item in the vast existential load. But it can determine the course of pathology.

One of the central questions of medicine has been underestimated and seems purposefully absent from many contemporary epistemological discussions. The advance of technoscience in the production of pharmaceutical ingredients has brought impressive advances in the areas of immunizations, prostheses and orthoses, rehabilitation, associated with the growing – and welcome – sophistication of diagnostics. These advances, however, simultaneously produced a harmful side effect: overdiagnosis. Just as it wrongly displaced almost all issues related to mental suffering and the individualization of symptoms from medicine. Having said that, we ask how can medical practices re-incorporate and deal with the subjectivity of each patient?

As a rule, the solution has been to refer these patients to the systematic use of psychotropic drugs. But the solution may not lie in training general practitioners to administer psychiatric drugs. The reference to the euphemism called “re-humanization of medicine” may be in taking another approach, such as, for example, rescuing an anthropological perspective for medicine regardless of the medical method adopted.

Instead of therapeutic tournaments or media histrionics these would be the issues that really interest society.

I invite readers to this reflection: it is not an opinion, it is a question of episteme.

https://brasil.estadao.com.br/blogs/conto-de-noticia/a-insubstantialidade-eo-nada-questao-de-episteme/

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Mure, o visionário que nos trouxe a homeopatia – Blog Estadão (publicado originalmente no Jornal da Tarde)

21 domingo nov 2021

Posted by Paulo Rosenbaum in Artigos, Livros publicados, Na Mídia, O outro código da Medicina (e book) homeopatia, Pesquisa médica, Prática clínica

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Mure, o visionário que nos trouxe a homeopatia
Dr Paulo Rosenbaum

Em novembro de 1840 desembarcava no Rio de Janeiro o médico francês Benoît Mure, que se tornaria o introdutor da homeopatia no Brasil, chegando a dispor de sua fortuna pessoal para difundir a medicina e direcioná-la para o tratamento de escravos e de “excluídos pela sociedade”

Ao contrário do que muitos acreditam, a homeopatia tem uma longa história política e institucional neste país. Passou por várias fases de ascensão e queda e neste fim de século parece estar recobrando seu fôlego. A homeopatia foi oficialmente introduzida no Brasil por um discípulo direto de Samuel Hahnemann, o francês Benoît Jules Mure.

Benoît Mure (1809-1858) é um importante personagem na história da medicina brasileira especialmente no contexto da homeopatia. Deixou influências e as repercussões de seu trabalho continuam.

Mure chegou ao país depois de realizar uma peregrinação na Europa, aonde difundiu e divulgou os princípios da então nova arte médica. Palermo (na Sicília), Paris, Cairo e Malta estiveram em seu roteiro de propaganda homeopática.

Quando desembarcou no Rio de Janeiro a bordo da barca francesa Eole em novembro de 1840, Mure estava com 31 anos de idade e repleto de projetos visionários. Sua história repete a de muitos outros: recuperava-se de uma tuberculose pulmonar que o acometeu quando esteve sob o tratamento homeopático ministrado por Sebastião Des Guidi, discípulo de Hahnemann e introdutor da homeopatia na França. Filho de um rico burguês de Lyon, Mure formou-se em medicina em Montpellier (um reduto da medicina vitalista).

Este tratamento bem-sucedido, sucedeu outro sem êxito, levado adiante por um dos mais famosos médicos da França no início do século XIX, o clínico Magendie.

No entanto, vemos que os ímpetos científicos de Mure são intensos demais para serem apenas os frutos de uma gratidão pela medicina que o salvou de um quadro tuberculoso. Mure encontra a lógica – como o médico e naturalista alemão Constantine Hering já havia feito – e captura o método de Hahnemann, isto é o que particulariza sua preferência pela homeopatia.

O introdutor da homeopatia no Brasil, influenciado pelas idéias de Fourier e Jacotot, resolve fundar em Santa Catarina uma colônia societária falansteriana, na península formada pelo Rio São Francisco, denominada de Colônia do Sahy.

Um plano ao imperador

Conforme os registros coletados por Galhardo, sabe-se que em 18 de setembro de 1841 foram apresentados ao imperador os colonos societários franceses, juntamente com Mure. Esta colônia foi o propósito inicial da vinda de Mure, que era o representante oficial da Union Industrielle de Paris (Mure, 1999). Mure foi apresentado ao imperador para expor seu plano de ação:

“Venho, em nome de todas as classes sofredoras que aspiram em França a mudar de posição, pedir a vossa majestade os meios de gozar, debaixo de um governo tutelar, do fruto legítimo de seu trabalho.” (Mure apud. Galhardo, 1928: 280).

Compreende-se, a partir desta atitude militante de Mure, sua luta ulterior, quando incorporou a seu projeto de expansão da homeopatia o tratamento dos escravos e dos socialmente excluídos do Brasil imperial. Neste contexto compreendem-se também as mobilizações política mais recentes, quando homeopatas engajaram-se nas lutas políticas e sociais do país.

Segundo o homeopata e historiador da homeopatia Galhardo, coube a um deles, Antonio Ildefonso Gomes, a redação do primeiro documento brasileiro dirigido ao Congresso Nacional, solicitando, por escrito, a restrição da escravidão. Terá sido Benoît Mure quem funda a Escola de Homeopatia do Rio de Janeiro, em 1844, embrião do futuro Instituto Hahnemanniano do Brasil, oficialmente fundado em 1859.

O médico francês era um utopista, um incorformado, e sobretudo um sujeito dotado de uma invencível tenacidade. Trata-se daqueles que acreditam que o desenvolvimento científico só é de fato evolução quando há progresso ético simultâneo. Daí compreende-se porque ocupava um substancial espaço no contexto sócio-científico do Brasil de 1840.

Medicina social

Mure tenta devolver a vitalidade ao pensamento médico do recente império brasileiro. Faz preleções pelo futuro da arte médica, é prosélito de uma medicina social mais ativa, passa a defender significados e propósitos de sua particular concepção dos objetivos da saúde pública.

Contra uma prática exclusora ele inclui em seu projeto o tratamento dos escravos e das classes sociais sem acesso à medicina da Corte. De fato, a homeopatia foi, durante todo período de escravidão, a única medicina usada pelos escravos, uma vez que reunia duas qualidades indispensáveis: baixo custo e eficiência.

Há uma curiosa mistura nas propostas de Mure: o socialismo está sempre atrelado à passionalidade religiosa. Mas é precisamente esta característica que o coloca numa lista muito particular do gênero humano: trata-se daquele tipo de sujeito incansável. Ele era um ideólogo obstinado e perspicaz e sabia, como a socióloga e professora do Instituto de Medicina Social da UERJ Madel Luz mostrou, da necessidade de apoio político e aval acadêmico para conseguir bases mais estáveis para a homeopatia.

Então, Mure mobiliza-se para alcançar este apoio pressionando instituições, fazendo contatos políticos e buscando por vários meios um estatuto mais respeitável para o saber homeopático.

Seu objetivo era conseguir um parecer favorável da academia médica para a então nova escola médica. Consegue o reconhecimento, mas a um preço muito alto, já que o recurso midiático que usou como palanque para o apoio político também serviu de base para os ataques subsequentes. Uma verdadeira guerra se estabelece nos grandes jornais da época, especialmente no Diário do Comércio e a homeopatia vira uma polêmica nacional.

Coube ao médico brasileiro Duque Estrada ser o primeiro a aplicar, em alguns casos específicos, a homeopatia no Brasil. (Galhardo 1928, 275). Sob sua liderança, publica-se um panfleto popular para fixar nos postes do Rio de Janeiro e São Paulo com a finalidade de conter a pandemia de cólera.

Duque Estrada defende o tratamento homeopático para conter a epidemia de febre amarela e escreve para a Câmara dos Deputados propondo uma subvenção de 100 contos de reis destinada à criação de uma enfermaria para tratamento homeopático.

“O senador Vasconcelos votou na abolição da medicina oficial, toda a liberdade deve ser dada ao médico para curar pelo sistema de sua escolha” (Carvalho, 1857: 9).

A colônia societária do Sahy não vingou. Mas Mure vislumbra a difusão da homeopatia como uma perspectiva não menos nobre e a implementa em vários estados.

Ele e seus colaboradores, fazem verdadeiros planejamentos de marketing: pensam em expandir a propaganda a outros estados através de emissários, e em 1847 é instalada a Sociedade Homeopathica Bahiana, Filial do Instituto Homeopático do Brasil.

Fortuna pessoal

No final de 1847 também inaugura-se um Hospital Homeopático, sob a presidência de Duque Estrada. Vários consultórios populares eram abertos tanto no Rio de Janeiro como em Salvador. Os recursos para tudo isto, ao menos inicialmente, parecem ter vindo da fortuna pessoal que Mure trouxe para o País como herança.

Os consultórios gratuitos foram criados pelos homeopatas em 1843 e vendo seu sucesso junto à população e o aumento da adesão popular ao tratamento a Academia Imperial de Medicina, também resolve abri-los em 1848.

Já com a saúde abalada, ao que parece devido à reativação de sua tuberculose pulmonar, e tendo já pedido a exoneração do cargo de diretor que ocupava na Escola Homeopática do Brasil, Mure despede-se do Brasil, de onde parte em abril de 1848. Vicente Martins assumiu a Escola Homeopática e a reestruturou dando-lhe uma corpo curricular mais arrojado.

Depois da partida de Mure – que falece no Cairo, dez anos mais tarde, em 1858 –, observa-se o surgimento de novas organizações homeopáticas: “Sociedade Hahnemanniana”, “Academia Médico-Homeopática”, assim como cresce o número de publicações clássicas e originais. Impulsionados e subsidiados pelo Instituto Homeopático do Brasil, é a vez de outros estados receberem mais informações sobre a homeopatia;

No contexto sócio-histórico da primeira metade do século 19, o que os homeopatas pioneiros, incluindo Mure e seus colaboradores, fizeram pela difusão da homeopatia neste país, com seus erros e acertos, só pode ser definido, sem exageros apologéticos, como um trabalho excepcional. Por isto seu trabalho teórico é de uma importância insubstituível, tanto no entendimento da situação político-institucional atual e pregressa da homeopatia brasileira, assim como da própria prática clínica de hoje.

Mas é através de sua obra empírica/experimental que seu projeto adquiriu dimensão mundial. Mure, em seu “Patogenesia Brasileira e Doutrina da Escola Médica do Rio de Janeiro”, dirige e compila uma série de 39 patogenesias (experimentos metódicos de substâncias medicamentosas) com substâncias obtidas, selecionadas e preparadas segundo a farmacotécnica homeopática, em um período histórico cujas dificuldades científicas eram literalmente descomunais. Edições de seu livro aparecem em 1853 (Estados Unidos) e 1859 (Espanha).

Uma opção natural para a medicina

O mundo científico já havia reconhecido de forma especialmente generosa os trabalhos dos viajantes e naturalistas que catalogaram (científica e iconograficamente) a exuberante flora e fauna deste país. É o caso dos médicos holandeses Piso e Marcgrave (integrantes da comitiva de Maurício de Nassau), de Saint-Hilaire, dos botânicos Spix e Martius e de pesquisadores menos famosos do século XIX como Freire Alemão, Velloso, Almeida Pinto, Caminhoá e Peckolt.

Agora que nos aproximamos dos 500 anos do descobrimento, seria importante promover resgates e rever ícones. Faltou reconhecer ao trabalho de Mure, especialmente pelo estudo da fauna e da flora do País. Além disto o autor vai muito além de uma catalogação farmacodinâmica/farmacognósica. Não se detém em fazer uma mera recompilação dos efeitos medicinais ou de indicações terapêuticas das substâncias obtidas das fontes da medicina indígena e popular, muito comuns nos tratados dos botanistas. Ele conduz, dirige e coordena a apresentação de medicamentos, muitos inéditos, acreditando na prodigalidade de uma natureza generosa que oferece meios curativos geograficamente próximos dos povos que deles os necessitam.

Apresenta listagens de sintomas obtidos através da experiência metódica. Faz isto usando as recomendações hahnemanianas quando adota os critérios de uma Higantropharmacologia (estudo dos efeitos das substâncias medicinais sobre o homem) quando são registradas as observações dos efeitos – objetivos e subjetivos — sobre a totalidade.

O trabalho experimental organizado por Mure não é somente ainda apropriado para subsídios de pesquisa histórica, e mesmo instrumento terapêutico, como de fato representou um incomum marco na preservação da biodiversidade. Isto em uma época na qual tais preocupações eram virtualmente inexistentes. Diríamos então que o trabalho deste idealista é provocador, original e acima de tudo dos mais modernos se considerarmos que há um boom de pesquisas atuais buscando novas substâncias medicinais nas florestas tropicais, investigação que o Instituto Homeopático do Brasil já conduzia desde 1843.

Pode-se observar em “Patogenesia Brasileira”, o esforço do trabalho experimental de Mure e João Vicente Martins (assim como outros colaboradores), o esforço de uma geração comprometida com a busca criativa de novas visibilidades para a medicina, os sujeitos e até para o próprio modelo social. Visionários que, como eles, dispuseram-se a achar as substâncias medicinais, a ir à pesquisa de campo e organizar uma matéria médica brasileira com elementos obtidos dos reinos da natureza, muitos deles ignorados (ou apenas catalogados) por outros ilustres viajantes

Paulo Rosenbaum, especial para o JT

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Hahnemann, 266 years later (Published in the Newspaper “O Estado de São Paulo”)

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Posted by Paulo Rosenbaum in Artigos, Pesquisa médica, Prática clínica

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Samuel Hahnemann

Paulo Rosenbaum

Hahnemann, 266 years later

Born on April 10, 1755

“Man, considered as an animal, was created more helpless than all other animals. It has no congenital weapons for its defense like the bull, no speed to make it able to escape from its enemies like the deer, it has no wings, it has no feet with interdigital membrane, it does not have fins – it does not have impenetrable armor against violence like the land and freshwater turtle, nowhere to take refuge provided by nature because it is dominated by thousands of insects and worms for your safety .. Man is subject to a very large numbergreater disease than animals, which are born with a secret knowledge of healing methods for these invisible enemies of life, instinct, which man does not possess. The man alone painfully escapes his mother’s womb, smooth, soft, naked, helpless, helpless and deprived of everything that can make his existence bearable, deprived of everything that nature richly contemplates the earth’s worm to make his life happy.”

Samuel Hahnemann in “The Medicine of Experience”

The researcher and the thinker.  

First of all, I think it would be fair to explain what will not be prioritized in this work. We will not be concerned with the famous paragraphs of the “ Organon ”, or with the topics of “ Chronic Diseases ”, nor do the conventional revision of its tumultuous biography. We try to take the facts created by Hahnemann as ideas and from these search — using the bio-bibliographic parallels — the clues that led us to the process of creating his theories. Our character played at least two simultaneous and interdependent roles in the sphere of knowledge: researcher on the nature of health phenomena and thinker.

Due to a careful and intentional methodological option, we will not consider your works as finished and definitive pieces. There is never an end to real scientific constructions. On the contrary, we see in its corpus (frequently and naively exalted by its irreplaceable coherence) theoretical gaps, methodological gaps and operational contradictions . We will try to show that all these “inconsistencies” can lead us to interesting logical developments of the original propositions. Correctly assessed, contradictions allow for rediscoveries. Searched gaps and gaps favor the end the progress of clarifications, not the only one, but the last end of scientific knowledge. In this way, we, the descendants and legatees of this medical philosophy, will be able to penetrate each historical segment of their arguments.

We used authors like Koyre, Canguilhem and Khun to better situate Hahnemann’s attack against the normal science of his time, like that of a spirit that is mobilized to undertake and change the medicine of its time. We will weigh the socio-historical influences of the 18th and 19th centuries and seek to show that scientific changes often occur not only through empirical reforms, but mainly, through philosophical movements that redefine scientific horizons and make such reforms possible. In our case, we will see that both the romantic movement and natural philosophy are part of the theoretical trenches that expanded and built the support for transformations.

Backed by historical epistemology, we conclude, quoting Prof. Roberto Machado, that chronological anteriority is not always a logical inferiority. It is possible to apply such a concept in any science, including Hahnemannian work. I explain with an example familiar to our topic. We must consider the hypothesis that perhaps the sixth edition of Organon is not – although the author himself considers it the closest to perfection – the point of greatest evolution of the method. It is also possible to consider that the homeopathy that we do today is not necessarily a progress in relation to the practice of the pioneers. We can even suppose that many of the discussions that we have today, under the illusion of originality, are only faint echoes of what has already been exhaustively and creatively debated and practiced. 

From this perspective, we do not consider it any discredit, but proof of vitality to examine issues that have been surprisingly active for over two and a half centuries. This persistence denotes the tenacity of the Hahnemannian records. Studies that privilege critical bias are the only ones that honor the script of science, for if Hahnemann entered the historical debate it was precisely because of his ability to let himself be affected by the surprising phenomena that he was unveiling. Only in this way will we understand the historical-philosophical flow that underpinned it, with the multiple perspectives that its challenges have been launching in these two centuries of permanence.

The inaugural doubt can then be presented: once Hahnemann updates and incorporates scientific modernity in its inductive perspective, including the search for experimental validation , what would be its distinguishing mark in the investigation of medical phenomena? Just beyond that, what will be the point of your exhaustive research? It seems clear that by subscribing to the therapeutic reform originated in the objections of island (Sydenham, Hunter) and French (Bichat, Fodera) clinicians regarding the use of medical material and its therapeutic manipulation, our author puts himself in line with the empirical reform that was taking place. sketching.

Only afterwards did he subvert the order installed in the medical sciences and turn the traditional clinic into an uproar by proposing a very unique and original modernity, especially in relation to the use of drugs in their practical application.

Let’s go back to the end of the 18th century. The thick curtain of the methodological monopoly reigned in the era of the great medical systems. Hahnemann is engaged in what was considered the best medicine of his time. In the end, he did not envision any regeneration for the serious and recurring mistakes found. Let us understand his situation at once: he is a desperate doctor who can no longer act with what he had been trained (that is, treat patients) without serious damage to his conscience. It then restricts itself to adopting a relatively innovative hygienism. He begins to loathe the therapies he witnesses. He prefers to give up clinical practice. Fortunately, his intuition was refractory to his skepticism. He argued his intellectual distrust under the avalanche of uncertainties that obsessed him. He considered it better and admitted that there might be something to be done, notions that deserved to be revisited. Initially it imposes an induction, apparently inspired by the prerogatives of an author who, strangely, never mentioned: Francis Bacon.

We must see the enormous effort of his rescue. It seems clear that the traces left by the medical history for which it was based as a starting point have become its main epistemological guidelines. Hahnemann captures ideas that have not been preserved from the medical tradition, with a view to reincorporating them. When it is finally defined by a method it tests it. But it is certain that the usual methodological losses will not be condemned by the aphorisms of the Novum Organum . It also denies the very common acquisition of knowledge through the application of drugs to the sick (ab usage in morbis ). His interest moves to another research matrix. But where is she? Apparently in the study of the effects of poisoning and accidental poisoning on the healthy.

The year 1796 was decisive in its trajectory. After several smaller essays, published in the same Hufeland newspaper , H. writes a work that will carry a very ambitious title. There he claimed to have discovered nothing less than “a new principle for ascertaining the medicinal power of drugs”. However, how could he announce a novelty when much earlier, as he and even evoked from medical historiography, the principle of similars had already been seen and applied? Analogy and sympathies were marked as common grounds for similarity’s discursive constructions.[1] These were ancient resources, old acquaintances of the healing art. How then does he claim that he induced the birth of a new system of medical understanding when the medieval physician Rhazes and another famous scholar of illustration, Von Haller, already admitted the need to bring the experiment on the healthy to medicine?

What abuse of self-referential sources was he promoting when he claimed to be both an agent and a witness, that is to say, the main protagonist of an announced revolution?

There is perhaps one of those logics of scientific discoveries which, as Khun admits, are motivational, psychological, and therefore crucial. At the end of the 18th century, we would find Hahnemann extremely unhappy. He fueled a deep skepticism in the face of the inefficiency he contemplated. He distrusts his practice by denying the therapeutic successes enacted by his peers. It does not seem to admit that the scientific revolution had really installed itself in therapeutics. It also rebels against the comfort of the repetitions of the chairs. Randomly rummages through the pandora box of medicine. His curiosity generated a significant breakdown in his medical certainties. With intellectual boldness and determined intuition, she puts everything into perspective. Hahnemann is no longer a skeptic: he is already an iconoclast.

The Meissen guy dares to think. It is a true obsessive metaphor, the leit motiv that plagues certain subjects in certain temporal units. His rupture stems from a rational inspiration, fueled by a scientific curiosity that confirms his purpose of methodically reexperiencing and the assumption that he must expose his hypotheses to empirical tests. Tests that, to their own astonishment, are provisionally sanctioned.

The problem of identities and influences: hip ochratisms, animisms and vitalisms.

Much has been discussed about the Hahnemannian sources and it is true that thanks to this we have advanced in the understanding of the bases on which he ends up configuring the homeopathic method. There is still a lot to study. We chose to reduce our approach to the influences that, in our opinion, were the most consistent and original. The first to be highlighted is that of the Hippocratic work. There is no doubt that this influence is notable in addition to many times explained by Hahnemann. [two]

It is impossible to doubt the fascination that genuine Hippocratic writings had on him. The sobriety in describing the phenomena, his ability to peer and reveal without trying to explain what he did not know was among his main virtues. As you know, the Hippocratic doctor should be, first of all, a physiologist , that is, someone who is able to speak correctly about nature. In fact, the supreme virtue of Greek doctors was the establishment of accurate prognostic observations. Or, in this impossibility, say nothing about them.[3]

Many authors pointed to the coincidences between the medical positions of Hahnemann and Hippocrates, calculating that this was yet another reactivation of Greek wisdom.[4] As we know, clubbing simply bases medical history on medicine. Each case must be seen in its particularity and each individuality must be examined in the multiplicity of possible responses.[5] Hahnemann recognizes in the Kos tradition a less invasive, natural and rational, therefore better, medical rationality. He knows the therapeutic limits of hippocratism, so he recognizes the prognostic and diagnostic virtues , after all Hippocrates was the one who introduced the case study by comparison through anamneses.

For Hippocratic medicine that applied the Aristotelian concept of individualization, the important thing was to discern the various pathologies within the variability of individual profiles. Its purposes: to diagnose and predict better. For Hahnemann, foreshadowing the germ of his subsequent ruptures, the particularities of the subject’s biographical / pathographic events also begin to stand out , with eminently therapeutic purposes.

More than one author tried to establish a parallel between Hahnemann and the works of authors from different eras and trends such as, for example, Paracelsus, Von Haller, Claude Bernard, Pavlov and Freud. There is a possibility to justify all these influences and inspirations, but in this study we will take another direction. Other halos of influence need to be exposed.

Chronologically, it is worth mentioning some great previous adventures that have left their mark on the history of medicine. We will start with the Vesalius coverings founding the modern anatomy and establishing the correlation between anatomical form and function. Of course, the break created by Paracelsus and its developments in therapy cannot be neglected in any serious homeopathic study. Nor is Sydenham’s systematic empiricism, of evident hypocratic inspiration. Or even the perspectives of an animated anatomy introduced by Von Haller when he induces the first consistent physiological studies towards overcoming humoral-based pathology , a prolonged inheritance of Galenism. Not to mention the enormous repercussions on all medicine in the 18th century of Morgagni’s research when it correlated experimentally – in systematic autopsies – clinical history and anatomical lesion demonstrating the almost linear correspondence between the complaints and the morphological substrate of the pathology. 

Hahnemann studies and cites each of these authors, so it is impossible to doubt his option for empirical validation. The authorities he evoked are mostly clinicians and researchers of eminently experimental ballast. It is a phase in which Hahnemann is particularly interested in the study of chemistry, venereal diseases, and, of course, poisonings 

Despite renouncing the idea[6] , our author presents many similar traits to the founder of medical animism, Stahl.[7] Both excellent chemists. They are among the best of their generations, formed under the influence of the schools of Sylvius and Van Helmont[8] (iatrochemistry). Both are among the most reputable medical researchers in their respective periods. They share the same indignation at the irrational interventionism they witness. They test their hypotheses and redefine their activity: from chemistry to the investigation of the vital phenomenon. That was a moment of effervescence in the century of enlightenment: the emergence of empirical physiology was witnessed, Lavoisier founded a chemical revolution , Kant renewed continental philosophy, a romantic reaction to Cartesian mechanics was outlined. Given the proper proportions, it is not only in our time that the world changes rapidly. 

Hahnemann, like Stahl, notes that the priority was in the analysis of the vital phenomenon, too important to occupy an insignificant place. Vitalism’s identity had always been in danger of disappearing. However, it always reappeared when the clinic resumed empirical research. Animism and vitalism are progressively increasing in their scientific programs. Despite the agreement, the paths take different destinations. While Stahl takes up Aristotelian metaphysics in a very personal way, that is, shaped by the pietism with which he was involved, Hahn emann privileges Aristotelian logic as a method to solidify the constructs that are to give him the theoretical and experimental support necessary for the progress of the project .[9]

Nevertheless, Stahl mobilized the same themes in the 18th century as Hahnemann in the 19th. It fights the mechanism of the man-machine. He rebels against systematic medicine, starts to doubt the peremptory certainties of therapy, and gives an empirical tone to his treatments. In most of its therapeutic orientations , it adopts expectation as a technique.[10] He does this with great awareness because he considers it a less pernicious method than the available resources. An entire school will imitate him, after all, in the “first place, do no harm” ratifies a resumption of Hippocratic naturalism and, consequently, a return of confidence in the natural medicine . resurrecting the idea of ​​the regenerating power of the hypocratic medicinal nature, when physis would provide for the recovery of the sick. The first Hahnemann did not escape this trend. 

Roughly speaking, the Stahlian method, which also adheres to the principle of similarity, ends up in operational difficulties that are not negligible. There is no systematic treatment of the question of anima or how and under what circumstances the drug should be applied. Stahl intimately doubts the therapy, but has nothing better to offer. You only have the option of the expectant clinic. In its therapy, for the first time since the failure of Paracelsus’ psychiatry, we found a primitive psychotherapy – the fundamental disorders are rooted in the anima – which seemed to value the patient’s psycho-mental state, as well as the use of the always useful dietary resources. . Here it successfully imitates Barthez’s experimental tentamen , in any case therapeutically as not very operative as his, because they both had no medical instruments except those inherited from a tradition they had performed and tried to distance themselves from.

Hahnemann, on the other hand, creates a new path. He pursues the epistemological maturity that he slowly incorporates into his instrumental guide – Organon . This incorporation decisively affects its practice. He quickly moves from initial research, the embryo of his scientific program , to application in the sick. Again, he submits his hypothesis to the tests, increasing his casuistry with the traditional difficulties already familiar to everyone who knows his biography.

But what he gets goes far beyond what he initially assumed. He observes tangible results between the event (drug introduction) and the effects observed within a plausible time gradient. This intervention, he thinks, changes the natural evolution of the disease. This is the first step, he calculates. Careful, that r map your findings with caution. It is necessary to understand that originally he was prioritizing – until now he had not expressed his criticism of the inconjugability of nosologies – the pathological entity itself, the disease, as an object of study. Po ssivelmente was worried about a quick comparison of results.

Thus his pragmatism is reinforced by the verification that, with adjustments, he is even before a new path. It is not, strictly speaking, a new principle, but it is definitely one in our path here. Rota, which for many reasons will be terribly arid for the innovative doctor: the empirical school was undermined by the great medical systems (especially those of Hoffmann and Boerhaave), the study of the totality was being sacrificed by the principle of localization [11]

The symptoms (and with this the clinical history) were no longer so important because they had been restricted to “lesion slaves”[12] . Similitude was in disuse and was practically ignored by major medical schools. Nobody valued it, much less operationalized the tenuous medicines of Hippocratic medicine.[13] The romantic movement (as well as natural philosophy, Schelling’s “nathurphilososophie” ) that decisively influenced our author, did not exactly produce a scientific endorsement for the new researchers. Let us add to this panel the difficulties to challenge the hegemony of Newtonian physiology and its convincing mechanics applied to biology.

Furthermore, and most importantly, Montpellier’s vitalism was isolated and discredited by the advancement of the medical schools of Paris and of island medicine . In the medical field, the elision of vitalism was a fact. In this way, the environment – despite the fact that famous analysts saw the opposite – was inhospitable to what was about to unfold, to the theses that were about to be enunciated. Hahnemann, just as Galileo really acts against everything and everyone, or as Hilton Japiassú wants, referring to the famous stronome “despite everything and everyone”. Finally, it organizes a counter-thought and makes an epistemological cut in medical knowledge.

Again our inconoclast dares. He is not exactly concerned with “scientific coherence”, or “political articulations”, moreover, on the contrary, he is extremely unskilled in this sphere. He wears himself out excessively in the fight against rivals, he is defeated internally in his intention to keep homeopathy on the idealized route, he sees himself facing the constant threats of interdiction of the movement. All because he had well-defined priorities. He is stubborn with the idea of ​​the “new way”, which allows to progressively refine the theory. References to vitalism, up to the fourth edition of Organon , were quite incipient . It is developed by crossing information and refining medical knowledge with ideas arising from practice, that is: the totality-purpose, interactions between mind / body-medicines-environment. He begins to borrow concepts and ideas from the vitalist tradition, voluntarily or not, starting to resort to them to explain the phenomena he witnesses.   

Only during this period did he introduce the expression ” lebenskraft “, a vital force. Expression that will take on different characteristics in each school and that composes only one of the items of the conceptual structure of vitalist philosophy. However, what is most dear to the Hahnemannian corpus is not the “vital energy”, but the very concept of vitality “lato sensu”, as if defining a way in which the living organism operates. What started to matter, primarily, were the modes of operation of these organisms as non- mechanical, non-inertial totalities , especially analyzed in their operational functions: form / function / purpose. Hahnemann, like Stahl and Barthez, realizes the insufficiency of mechanistic principles to account for pathological and therapeutic phenomena.

With effect, vitalism can be placed more a consequence of these investigations and that the cause of these. It is also very important to show that the mechanism-vitalism polarity was never its starting point. It emerges as a natural result of research, which only increases its epistemological weight. Interpreting the results of the events, investing all his intellectual and deductive efforts, he ends up giving his newly conceived theory the status of method. Hahnemann reexplores a theory in which he can couple his findings. It is about reactivating an empirical vitalism replacing “wild” empiricism. Of course, as you realize how important and operative these assertions are, more positivity is added to the method. His research is becoming more and more oriented. He is increasingly determined to seek support for the enormous variety of hypotheses he raises.

Epistemological plans: from the induction of similarity to the deduction of singularity. 

Break with primitive similarity . Susceptibility, or the exalted peculiarity. The infinitesimal is nothing. The vitalist research program. An evil worse than the original: suppression. 

Thus, before trying to define the basic traits of his personality, or trace an outline of his historical costume, it is necessary to redefine the various traits of his work in the construction of his methodology.

In the first place, our thinker emerges as a doctor formed from conventional schools, whose main theoretical matrix was iatroquímica (Vienna, Leip zig, Erlarngen). His therapeutic vision is therefore centered on medical chemistry in the 18th century. Despite numerous proofs of his intellectual precocity and his refined intuitive ability, Hahnemann was unlikely to change his praxis in such a radical way. It would be less expected, given the absolute dominance and hegemony of that trend, that he would found a new medical school.

What takes you to your destination will probably remain ignored in the recesses of your most intimate metaphors, which I fear, we will never have satisfactorily clarifying access. It remained for us to follow the lead of their arguments. His primitive dissatisfaction with systematic medicine and his courage to denounce the lack of effectiveness of the medical systems to which he was exposed denote his first phase. Hermeneuts would call this their first application. But our problem remains the same. We have not yet been able to efficiently diagnose how and under what conditions he conceived his “new principle”.

By isolating himself and claiming to have abandoned medical art, as he confided: “I thought that art was doomed to nothing”, he sentenced himself to the search for something better. Once it has discarded the practice of its time, its next company will be to detect the failures of the great medical systems . These ended up becoming the great epistemic breach to objectify your doubt: there is something to be rethought, quickly and radically.

His research originates in the sphere of theoretical review, and between libraries and translations, among incunabula and folio s lost medical history records his rescue: Hippocratic similarity and model experimentation of the old empirical schools. Nowadays it would be equivalent to depreciating the genomic tendency and to resume, with extra-historiographic purposes, the recommendations of Hellenic medicine. He elaborates his own synthesis and sees the need to experiment on human bodies. [14] But it will not do so in the face of pathologies, it will be necessary “not sick” to obtain more reliable reports. At the same time, it is concerned with distinguishing its new formulation from Paracelsus’ correspondences and refutes, in advance, the possible attacks against what would come to disqualify it as naive empiricism. For the first, he recommends severe criticism, confronting the tradition of the markings , for the second, systematic studies against the “empirical accidents” recorded in historiography.

But, confirming what Canguilhem noticed, the sources matter less and the treatment given to them is much more important, and in this case , H. does this work in a very original way. It goes beyond medical texts and advances its research focus on works of natural history, of travelers and explorers who visited other peoples and cultures collecting therapeutic jobs and registering, almost journalistically, the medicinal habits and customs of the colonies of European countries. He is much more interested in clinical records than in books on doctrine and therapeutics. It was relatively common in the seventeenth and eighteenth centuries for medical authors to transcribe their clinical cases, as if to publish their daily experiences, to write down their therapeutic successes (even those that Hahnemann will later demonstrate as suppressions), so that others could know what their behaviors were like in prá ethics.  

  1. it ingeniously takes advantage of this immense source of therapeutic imbroglios, contesting the axiom that the masters are always right. Gumpert was happy to refer to him as a hard-core rebel. It uses the authorities, in a legitimate movement of co- thought, to disallow them. Take advantage of only the symptoms that emerge from “wild” treatments and the intoxications that you identified in these records .[15]

Although Hahnemann recognized the enormous value of applied chemistry and that many substances were useful in palliating certain pathological states, he refused to admit that we would need to restrict their knowledge to their proximity to the “natural system”, or to their taxonomic kinship. He admits that there may be, in fact, analogies between the external, physical-morphological evidence of the substances and the medicinal effects. But he does not accept them – as the doctrine of signatures predicted – as a given reality. He wants a research program to prove it or refute it. In this sense, Hahnemann undermines the epistemology of “signatures”. However, as Foucault had detected, those who work with similarities also necessarily have to deal with the signs.  [16]

The difference is that the signatures (or markings) that interested Hahnemann were of a different nature, they could not be botanical because they were also subjective, they were experiences [17] , making it impossible for these to be correlated to organs, physiological systems or pathologies. He begins to look for methodical observation and experiment in the possibility of registering the manifestations of the human totality. 

He states that “botanical affinity” would never allow conclusive inferences about the similarity of the action since the “external similarities” were superficial and insufficient to know possible medicinal effects. Here his critique of primitive similarity and the doctrine of Paracelsian signatures, as well as the whole system of medical matter, appears again, and in a much more evident way.[18]

Hahnemann had a double influence: one of them was the great medical systems of his time, iatro-chemistry, and on the other hand he was deeply impressed by the empirical propositions. It is precisely in this mid-term between the tensions of a rational and empirical nature that he forges his proposals. For this reason, it is not possible to present only one facet of its concerns, since it is committed from the beginning to divisions that will permeate the entire project. It is the contradictions generated by them that move the history of their propositions.

It uses the concept of similarity, but adheres in this field to a new epistemic , modern, therefore analogical. In other words, during the experimentation process, it seeks to detect, from the point of view of the subjectivity and subjectivity of the subject, which expresses symptoms and the changes that the substance has inflicted on him.

These revisions give him the pejorative title of “book physician” from his enemies and the other scientists and historians of his time, the diagnosis of the founder of a ” pure metaphysical system “.[19] A little unfair to anyone who published a libel sanctioning the medicine of experience. Thus, the central role of all the controversy that Hahnemann is about to create only at this stage outlines more defined features. He is about to reach his next target: the “botanization” of diseases, or better, his taxonomization. In one of these passages, one asks: “Should we happen to trust a botanist who is restricted to dividing plants between herbs and shrubs?”. 

It should be noted that Hahnemann was not only concerned with the visible, potentially triggerable signs of medicinal substances. He begins to occupy himself with the totality of manifestations, such as experiences, dreams, sensations and all sorts of subjective symptoms , obtained from the medication. Its semiology is, to borrow an expression of propaedeutics, “in the open”. For this very reason it obtains for my medical matter a myriad of new symptoms: objective, constitutional and especially mental symptoms . It incorporates all sorts of subjective symptoms, usually overlooked by semiology.[20] Found a new model of clinical history.

It attacks the episteme that placed nosos as the main object of therapy. What it means to say: it shakes the building that had, and still has, the central role of all therapeutics, the framework even of Western typifying medicine. Here we come to something truly revolutionary. Here is the embryo of one of its epistemological ruptures. What he says to us means “no to typifications” and at the same time “to look for unpredictable symptoms”. It is worth asking why you do this?

Did he perceive the little scope of the symptoms taken only as confirmations of the anatomo-clinical pictures ? Or do you suspect the efficiency of the therapy under the semiological direction undertaken until then? All of these hypotheses are plausible, however, what Hahnemann foreshadows is the concept of nonspecific susceptibility, only officially formulated almost a century later. In other words, it discovers the semiological-therapeutic importance of modalized symptoms. It gives primacy to the rarity of the clinic. Unveils the manifestations that express the disturbances in an imprecise way. In other words, it discovers the value of the unexpected , of the unpredictable phenomena in natural illness.

Redundant to say the degree of innovation of this proposal. It starts to incorporate this orientation as an inseparable part of the method. From this guideline, it is natural to deduce that it is no longer possible to prescribe based semiologically on the predictable syndromic conditions. That is, following the Hahnemanian reasoning, the pathognomonic symptoms of diseases can no longer be taken as the only semiological guides for therapy. Unless these symptoms have a personal note, it is worth mentioning those that have idiosyncratic characteristics.[21]

Now, if your review can rescue similarity and experimentation, why not go further and do the complete job by demolishing the whole system of classifying nosologies? Here we will have to sharpen our discriminatory capacity: its primary target was not this. What he wanted to do was to anticipate the enormous insufficiency of that classifying system for the establishment of therapy . Knowing what it is, that is to say, knowing the name of the disease, does not necessarily give the diagnostician the predicate of prescribers, the notion of knowing how to treat.

But you cannot avoid the logic: why, if the experiences reveal susceptibilities and “sensitive fibers” of different qualities that respond to different amounts and stimuli, why consider only specific remedies? In fact, if the medication actions are diversified and affect the entire economy, why then the privilege of a diaphoretic, a revulsive, an astringent, emenagogues or sweat? If the illnesses are inconjugable why are the drug correspondences chosen by local affinities? Why not be suspicious of organotropisms that do not take into account the totality of manifestations in the subject? =

In addition, another rescue was imminent. After concluding that it is impossible to establish a therapy under the banner of pathology, Hahnemann is visibly concerned with the paths that these can take, when they are suppressed / modified in their natural path. His conclusions again coincide punctually with what he finds registered in medical historiography: he starts to check for substitutive pathologies. It promotes yet another resurrection, this time it is the turn of the old doctrine of “morbid metastases”. It finds that in the course of any therapeutic action, pathological versions worse than the original ones may appear. It implies that the expectation may be a lesser evil (since here the suppression would be in charge of the vis medicatrix ) of what is the therapy. At the same time, it finds that the analysis of the totality and the application of mild medications are more rational means to protect the subject, or at least minimize the risks of a possible harmful path, such as the one mentioned above.

Finally, the most indestructible epistemological question. What do you look for in attenuations: to optimize the action of the drug through a lesser medicinal effect? Get the subtle alchemical body of substances? Deviate from aggravations? Coercing the vital energy? It is possible for all questions to obtain affirmative answers simultaneously and successively. But let us judge by the beginning. Hahnemann, for familiarity or opportunity, begins his work with poisons: heleborism, arsenicals, mercurials, sulfur, zinc and other toxics fill his repertoire. Check the rules that lead toxics to produce their effects under strong and low doses. It notes that qualitatively those susceptible respond to doses well below the toxic threshold. That the action of drugs on subjects is extremely heterogeneous. Now, if the clinical and mental conditions reappear under different intoxications, the minimum amounts to awaken the symptoms can be different for each subject and much smaller than expected. What laws and clinical-pharmacological criteria do these phenomena obey? None satisfactorily known. There must be individual variability that induces subjects to non-homogeneous responses. How do you proceed? Dilute and try it, only in a second stage it dynamizes the drug, after all the simal infinite is nothing. 

The ethical imperative. =

“There are circumstances in which neither the like nor the opposite heal; it is what should heal ”

Hippocrates

In the years that followed his greatest research, Hahnemann now finds himself immersed in his experience, immersed in his work of caring for patients. They have been sketching and building an ethical corpus . He does all his work looking for a system that includes an action compatible with the delicacy that semiological and therapeutic work requires from the homeopathic project. And already knowing this, he fuses his expectation of curative purpose with a pedagogical-philosophical action that would also induce the subject to a more articulated action between nature and destiny, between spirit and body, between environment and work.

However, our author pears the creative with prudence in the statement of these propositions. He fears for the worst – rightly so – when he gives homeopathy a character of univocal universal philosophy, because if, on the one hand, he knows that the sectarians will always be pre-called to defend it at all odds , on the other, he realizes the danger of a fallacious aura that this double meaning can provide for a method that was intended to be articulated as a scientific practice.

At no time, however, does it state or denote that among the particularities of the drug’s action are an action in the spirit per se . The references to an immaterial action of the medications only match the idea of ​​”quasi-spirit” in a specific context: like us, he, despite noting the positive effects, ignored the mechanism of action of ultramolecular doses. Indeed, he sees that the medicine conveys generic, imprecise, “quasi-spirit” possibilities that are assumed as information by the set of organic systems (mind-body-environment complex) of the subject[22] can change your most intimate perspectives, but who can know for sure?

Thus, in parallel with the scientist Hahnemann, we have a thinker of completeness who stands in favor of ethics. So what would be the Hahnemanni ana ethics then ? Here we leave aside, at least for now, the methodological constructions and the induction that our author proposes. We will try to understand what is convenient for him for curative action.

First, Hahnemann does not judge, he only listens carefully to the subject in his narrative, which, as we know, presupposes unusual details in clinical histories. These are the usually negligible symptomatic “wastes” that contemporary clinic has renamed as “neuro-vegetative disorders” or, at best , subjective symptoms. What mattered to a clinic based on the names of the illnesses if vertigo made the subject recline to the right with cold, if perspiration produces ecstasy, if along with the headache a desperate desire for lemon arose or even if the crises of anxiety to break out at 17 o’clock on time? These ended up – here it is not possible to analyze why – because they turn into mere parasitic symptoms of the medical occupation. No previous clinician valued or transcribed the patients ‘ symptoms with such obsessive care. H. had learned how to apply them in practice. The truth is that even the best doctors from other periods, including those who recorded very complete medical histories like, for example, Sydenham, did not know how to treat material from detailed anamnesis.

Second, the analysis of the cases attended by Hahnemann shows the commitment to all symptoms. No pre-valuation. No anticipated hierarchical criteria. No schemes chosen beforehand. Just a motto: any peculiarity will be exalted . Whether in the “Archives of Stapf”, in the “Notebooks of patients” or in the various records such as, for example, those pointed out in the rescue of Genneper, these guidelines overlap, apparently not very methodological. What you can see in all your records is the meticulousness of the record: the original words, the type of music, the details in the dreams, the empirical verification of clairvoyance, the altered perceptions, the dream recesses, the perverted functions and the body in anguish.

So when he proposes to put sculapio on the scale he weighs his positivism against his metaphysics. He realizes that he cannot, even with the deepest personal effort, hide his polarity as Masi-Elizalde has so well shown. Ass ume that, if on the one hand he will give the scientific aspect of his propositions a logical-formal tone, on the other hand he will continue to affirm what he believes in, enunciating his deep philosophical-religious concern, focusing on the very meaning of existence. Hahnemann induces and deduces all the time. After all, he shows himself to be a researcher who cannot hide his motivations. In this case, at the same time that he uses ontological substantialism to define the properties of being, he rejects part of these characteristics a pr iori , which will be the object of further control, during the experiments.

Another important methodological criterion introduced by Hahnemann is found in the explicit and repeated recommendations that each drug should be used exclusively. The idea of non-mixing is yet another field of spistemological maturity in your medical system as it seeks to control the intervening variables with the most understandable of the arguments: two drugs together cause a third and unknown element that makes the analysis of the effects uncontrollable and very little need.

The use of inert substances should also be mentioned. It should be noted that this use is recommended in a strictly ethical context: the commitment to the other also involves the controversial act of apprehension of “not medicating”, namely, the use of the compliant medication. It is precisely because he understands that imprecision is inherent in the homeopathic method and its operational difficulties that Hahnemann allows and encourages the use of non-medicinal “something” when the need and / or indication of the verum is not clear. How impressive was his ability to perceive the need and importance of a therapeutic artifact, however pseudo-medicinal, as a step in the work that allows for a better research of the improvements, the worsens and the stability in a homeopathic treatment. 

The Hahnemannian version of “creative leisure” – as in the famous letter to the workaholic tailor “[23] – is one of the most auspicious and denotes the recognition that there is, after all, a scale of values, criteria and priorities. Work, it is clear, cannot be harmful. It should not be counted as a sacrifice to health. Faced with the epidemic front classified under the CID of RSI “injury by repetitive efforts”, once again our author foresees the worrying fate of organisms reduced to “bodies that produce”. To the perplexity of neo-pragmatism, Hahnemann’s complex axiological system never separates the construction of homeopathic science from its ethical commitments. Of these, a certain teleologism of the human statute that identifies the vital phenomenon with the inclusion of certain perspectives of refinement: cultural, affective, spiritual cannot be underestimated.  

Whether we like it or not, Hahnemann has no quibbles about spirituality, which he sees with a practical focus, that is, it is not in the sphere of alienation or in the turmoil of a contemplative asceticism. Nor is it a dogmatic metaphysics and still less the contemporary neo-esotericism freely associated with homeopathic doctrine. According to him, man has an internal system that allows him to detect the transcendent nature of his spirit, as well as his ability to recognize Gd. Even this certainty did not make him hostage to the Salvationist theses.

There is a sophisticated mix in our author: on the one hand, it adheres to a kind of personal synthesis of naturalist philosophy[24] which tends to a vitalism of a spiritualistic nature (Luz, 1988) with the perception that it must always be united to “being here”. On the other, it assumes scientific positivism as an incorruptible duty to the medical object. Perhaps, for this very reason, on purpose, he never intended to assemble a set of medical knowledge under a metaphysical safeguard of a mystical or religious nature. It is an insurrection against this prerogative. Waiving any form of sectarianism to put your hypotheses under question.

After recognizing the transcendent nature of man, the founder pleads for the scientific and conceptual clarity of homeopathy as a logical, pragmatic, scientific choice. First, the methodological choice. Then he admits a metaphysical-based ontology – warning that “all are kings” there – that he must undergo the tests of empirical evidence.

In other words, it admits an empirical metaphysics. Its accurate scale no longer weighs just sculápio. It weighs values, supports the search for a broader medical approach, emphasizes hygiene, the role of the environment, the need and finding references in existence. Hence his option – this is particularly interesting in his epistolary – for an existential religious spirit not linked or subordinate to schools or hermetic doctrines. Hahnemann prefers to subordinate this acquisition to the subject’s achievements, case by case. He deduces that there is a kind of tribute to the singular of each subject, as there is an unmistakable merit in personal discoveries: they are non-transferable and configure subjectivity.

If in this way each subject can obtain pedagogical, philosophical and homeopathic help, so much the better, since the high ends do not know the dimensions and the quality of existence cannot be measured, except by very peculiar measures: exactly from references of the very nature treated / cared for.

Hahnemann understood that it was exactly this nature that would allow man to refer any health project to a reconsideration of the importance of the status of mental status in therapy. The mood starts to be considered[25] not only as a semiological-therapeutic reference but, and mainly, as a kind of “marker” for the improvement of the subject’s general state. However, in order to refer this improvement to more sophisticated projects, Hahnemann recommends, in addition to the dynamized drug, a continuous personal effort that can be enhanced or not by a pedagogical-philosophical action through what he called “auxiliary mental regime”.

The posterity of the inheritance: in addition to the contradictory and simibilus principles, which is appropriate.

When we see the immense responsibility that homeopathy has as perhaps the last medical rationality that is truly divergent from hegemonic thinking, we are apprehensive and concerned about its future. The internal disagreements of the movement , the difficulty of the various schools in assuming their identity and the radicalizations about each of the Hahnemanian phases started to hinder the development as well as the goals of the homeopathic movement.

Many critics of homeopathy substantiate their criticisms of the lack of scientific curiosity of homeopaths who did not update the method in the light of a review of medical theories after Hahnemann. Despite the exaggeration and ideological bias embedded in it, there is a basis for these criticisms. We need to recognize the exaggerations, the flaws and the important elisions in his work. After all, it is not a revealed text. We have to admit that a certain programmed ingenuity permeates the homeopathic environment that expects nothing less than the perfection of a scientific construction. But here we also see the opposite bias: adapting uncritically to current research norms and standards can mean the rise of a pragmatic version of similarity and the ruin of a resistance that fought to preserve a set of knowledge and medical procedures that characterize a particular iatrophilosophy.

Hahnemann’s merits were many: preparing an immense terrain still unfinished, not only leaving faithful followers but contaminating critical passers-by , not having defined rigid strategies and living immersed in a fruitful resistance whose deep traces reach all the medicine of our time, marks epistemological issues that are making themselves felt even in other disciplines. However, it is no longer enough that we repeat the content architected by the Hahnemannian code to exhaustion. This has already served us, now it brings a scientific suspicion. The accusation of cult of personality is rekindled. It exposes us to the fragility of sameness. Stoic restatements embarrass us in the fragile era of immobility as warned us in different ways and in different historian-author versions like Dudgeon, Bradford, Haehl and Marcy and Fortier-Bernorville. The repetitions, the mere reaffirmation of our resistance, do not deserve to be taken by a positive heuristic .

Homeopathy does not have any special attribute that credits it as a different knowledge from the others. There are no innate or acquired invulnerabilities, there is no guarantee for anything. It is part of the game to submit to the refutations, to face the internal contradictions and to bow to the criteria of knowledge criticism required to be able to continue to be validated and thus remain as a practice. Homeopathic ideas need to circulate in order to be preserved. Their logic was challenged and put under question. We restrict ourselves to cheering only for increasingly clear evidence and for the expansion of the investigation.

Paradoxically to his strong doctrinal sense, Hahnemann positions himself as one of the first revisionists of homeopathy. Let us remember that his conversion from iatroquímica to a cosmic-synthetic vitalism, where he incorporates similarity as a method, was a direct consequence of a spirit willing to be affected by research. Only afterwards, seeing the insufficiency (or “excessive” sufficiency ) of the analogue as therapeutic reasoning, does it incorporate infinitezimalization as in order to obtain modified, subtle, but convenient responses.

And, in the end, when he did not need to risk his prestige, he resolved to bear the turbulent consequences by enunciating a sketch of medical anthropology, seeking a hidden malaise, a meta-meaning underlying the empirical-phenomenological of the symptoms. It is the phase that enunciates the psoric theory. In other words, there is everything in Hahneman’s reasoning, including contempt for a straight and cumulative coherence that exhaustively demands adherents and enemies.

Stick to the medical object to meet the demand for a more efficient clinic, namely, with the specific purpose of curing or controlling defined pathologies is an ancient problem of medicine. Here, too, our inventor imposes changes. In his ethics, the radical commitment to the other does not mean only being attentive to changes of a pathological character as the primacy of medical care. The originality here was to have pretended to be defined by an ethical-synthetic humanism, whose main attributes must be the solidarity and understanding of the suffering subject. Sufferings manifest through imaginary or real idiosyncrasies that the sick subject tells the doctor, seeking relief and support. Homeopathic help does not come (or could not come) only against the morphology of sick bodies, it will always come as an answer to the incomprehensible sensations, metaphors and allusions that invade and plague the subject.

Hahnemann finally builds a methodology in which it will always be necessary to ask “what ails you?” and “what do you suffer from?” to find out, in the end “who is it”? This dissolves, once and for all, the contemporary illusion of a future in which machines that detect vital qualities would replace medical action using electrodes that trigger the simile. At least for the Hahnemannian subject, the original perspective remains: the essence of the clinical spirit is the procedure of one man in front of another.

It is necessary to show that homeo patia conveys a therapeutic possibility of order and dimensions completely foreign to those of the fields of action defined by the causalist model of biomedicine as the only ones specific to the medical act. This distinction brings us directly to the scope that we see in homeopathy as an original proposal that must finally be taken as a way of making medicine. Homeopathy then needs to be identified as an iatrophilosophy. A subject medicine, an interactive medicine beyond the specifics of diseases. We build a healing art that is much broader than the application of similarity. Its fundamental distinction, which even highlights it from other medical rationalities, lodges itself elsewhere: it is in its “what to do”, when it understands man in his aspiration to be understood by the totality of manifestations.

Homeopathy already needed and had its martyrs, already experienced the taste of exile, the ban, banishment. Homeopaths fought (and fought) with doctors from other traditions and between themselves endless disputes , both long and useless. Whether we are going to prolong this strife or finally dedicate ourselves to what matters is an option exclusively under our yoke.

So, let’s talk about the impropriety of the always mistaken question “what would Hahnemann say”? Impossible to know how he would behave. The inferences of his scientific testament show that we should foresee doses of rationality and moderation. We are pleased to note that the influences of romanticism were not, in the end, negligible items in the analyzed influence hall. since, as is known, this movement was extremely important in the subject’s rescue route. Therefore, after these prolonged disputes, we would expect a relaxation of doctrinal inflexibility so that everyone really interested in the renewal of medicine could adhere to the third Hippocratic principle. No prior hegemony. No methodological monopoly. Only intellectual openness as a premise, doubt as a compass. In view of the current immensity of modern medical possibilities, neither the opposite nor the similar as univocal concepts, just what suits each patient.

Finally, what we recognize as genius in Hahnemann is spread throughout the corpus . Notable as an original thinker , revolutionary as an epistemologist of medicine, generous as a doctor. He sealed his contribution to knowledge as an inducer, deductor and inventor. Challenges that will still occupy several generations and that should produce developments that will expand to have access to those more complex traits of the human spirit and its sufferings. However, all these efforts will be recognized as a single duration and as long as we are able to recycle the notion of progress we want. They will remain true and efficient as long as we are able to recap – which necessarily means selecting and maturing – the contents of this great cornerstone of knowledge that we call medicine, and one of its therapeutic arms that we call homeopathy.  

Grades

[1] Cf. Foucault, M. “The four similarities” in “The words and the things” 1966.

[2] “We have never been closer to the discovery of the science of medicine than in the time of Hippocrates. This thoughtful unsophisticated observer sought nature in nature. He saw and described diseases before he precisely, without addition, without coloring, without speculation. ” Hahnemann, Lesser Writtings, 1852.

[3] “In the faculty of pure observation he was not surpassed by any other doctor who came after him. Only an important part of medical art was this favored son of nature deprived: – besides that he was a complete teacher in his art – in the knowledge of the rivers and their application. But he did not simulate such knowledge – he recognized his disability by the fact that he gave almost no medicine (because he knew them very imperfectly) and relied almost entirely on the diet. ” Hahnemann, S Lesser Writti ngs, 1852

[4] We know the aphorism that has guided many generations of medical historians: “the natural history of medicine is a successive sequence of returns to Hippocrates”

[5] This conception of the medical school in Kos was briefly taken up by the dream of merging horizons represented by the legendary school in Salerno with its aegretidines diagnosis . Cf. Homeopathy and Vitalism. 1996

[6] Critically criticizes Stahl’s idea of ​​”animal soul”. He does the same with the supposed influences of paracelcism on his work.

[7] Cf. Coulter, HL Divided legacy. op. cit. Vol II.

[8] Jean Baptista Van Helmont , a systematic physician and Belgian chemist, was the first to distinguish gases from air (he invented the word gas) he and Silvius are the first to recommend, based on the idea of fermentatio fermentation) use of acidifying and alkalizing to improve abnormal digestive performance.

[9] The sparks of Kant’s critical philosophy can be seen here.

[10] According to Entralgo, his therapy was basically restricted to the use of tonics and purgatives. Cf. Entralgo, PL Historia de la Medicina, Modern and Contemporary Medicine. Los Grandes Sistemáticos. 1954. p. 245  

[11] Subsequently explained by Virchow.

[12] As Morgagni pointed out in his “De Sedibus”

[13] Even when attempting to reissue it in the low doses of Van Helmont.

[14] For Koyré, scientific revolutions are due more to the mutation of philosophical ideas than to empirical discoveries. Cf. Koyre, A. Pensar La Ciência. p. 27. 

[15] This is basically the spirit of his first medical subject: Fragmenta, from 1805.

[16] Here is what Hahnemann points out: “Due to the fact that the cinchona cortex has a bitter and astringent taste, therefore the bitter and astringent cortexes of ash, horse chestnut, willow, etc., were considered to have the same action. that the cinchona cortex, – as if the taste could determine the action! Due to the fact that some plants have a bitter taste, especially gentiana centaureum, called fel terrae, for this reason only professionals were convinced that they could not act as substitutes for the bile! Since the arenaria carex root has an external resemblance to the sarsaparilla root, it was deduced that the former must have the same properties as the latter ”Hahnemann, S. Lesser Writtings, 1856

[17] Cf. Rosenbaum. P. Homeopathy: interactive medicine. Imago Editora. Rio de Janeiro, 2000 (Publication of the Master ‘s dissertation in the Department of Preventive Medicine – FMUSP “Homeopathy as Medicine of the subject, historical roots, epistemological frontiers”)  

[18] “Therapists attributed to star anise the same expectant qualities that are possessed by anise seeds, merely because the latter have a similarity in taste and odor to the seed capsules of the former and even some parts of the tree (iliceum anisatum ) that produces these capsules is used in the Philippine Islands as a poison for suicidal purposes. – This is what I call the philosophical and experimental origin of medical matter! ” Hahnemann, S. Lesser Writtings. 1852

[19] More contemporaneously Entralgo came to classify homeopathy as “free medicine” .Cf. Entralgo, PL Historia de La Medicina. Modern and Contemporary Medicine. Madrid, 1954

[20] With the exception of substances classically producing changes in the psyche, such as opiates , alcohol and other medicines of plant origin such as cannabis indica, cannabis sativa and others – in the compilations that he scrutinized. 

[21] For example: in the case of mental illnesses, pathognomonic psychic symptoms must be excluded from the scrutiny since they are expected in a framework, the main characteristic of which is precisely the disturbances of the mental sphere. Ditto for the expected symptoms of any pathology.   

[22] For the Hahnemanian man a substantial compound is inseparable.

[23] This is advice that Hahnemann sends to a patient, a tailor, in which he warns him about the risks of overwork and the need to put other priorities in his life.

[24] Since it criticizes nathurphilosophie

[25] This was one of the important differences between Stahl’s and Barthez’s projects. Cf Homeopathy, Interactive Medicine . op. cit.

https://brasil.estadao.com.br/blogs/conto-de-noticia/hahnemann-sera-atual-266-anos-depois/

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Haverá outro código para a Medicina?(Estadão)

13 sábado abr 2019

Posted by Paulo Rosenbaum in Amazon, Artigos, Imprensa, Na Mídia, O outro código da Medicina (e book) homeopatia, Pesquisa médica

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medicina integrativa, Outro código da Medicina, Samuel Hahnemann

Haverá outro código para a Medicina ?*

10 de abril – data de nascimento de Samuel Hahnemann

O que é um código? Pode ser uma coleção metódica e sistemática de leis, uma coleção de regras sistemáticas de procedimento e conduta, ou um sistema de sinais secretos ou convencionais usados no comércio e na literatura. O título deste livro insinua que pode haver mais de uma compreensão para a medicina, pode haver mais de um código de procedimento e conduta para compreeender saúde e enfermidade. E um não exclue necessariamente o outro. Vários códigos podem conviver e ser simultâneamente usados, sem que um tenha supremacia sobre o outro.

O público que consome livros científicos conhece pouco de medicina preventiva e tem noções muito vagas sobre as medicinas integrativas.  O conceito popular é de que a prevenção não é solução e de que uma medicina menos invasiva como as técnicas das medicinas integrativas pairam aspectos polêmicos. A verdade é que a grande maioria deste público as conhecem apenas superficialmente. Poucos a conhecem como uma medicina que cuida de sujeitos. Outros, não têm a menor idéia de sua abrangente capacidade de atuação que vai dos doentes com patologias severas às pessoas com problemas clínicos sem diagnóstico definido. Enfim que a prevenção pode atuar no indefinível estado chamado de “mal estar”. Este “mal estar” (illness) indevidamente pouco valorizado, também é muito importante na medicina pois aparece muito antes de que a patologia (disease), a doença propriamente dita se organize e apareça na forma de sinais e sintomas. O que menos gente sabe ainda é que a homeopatia interfere em todas estas áreas levando em consideração também o estado de saúde.

E por que o grande público sabe tão pouco sobre ela ou a conhece de forma tão estereotipada?

A homeopatia por exemplo é uma medicina sobrevivente. As provas são sua longa permanência na adversidade e sua lenta, porém sustentada expansão. As referências são escassas em todo tipo de mídia, especialmente quanto aos seus aspectos efetivamente mais interessantes. A omissão crônica do verdadeiro alcance da homeopatia também explica e justifica sua baixa visibilidade.

A homeopatia pode ser definida como um sistema terapêutico de interferência médica baseada em similitude e observação clínica que usa a individualização dos sintomas como sua principal fonte de conhecimento. Trata-se de uma prática médica que ouve estórias, acolhe narrativas e interpreta biografias.Não é fortuito que estejam nascendo movimentos como “Medicina Baseada em Narrativas”, “Medicina sem Pressa”, “Medicina Baseada em Empatia”, “Hermenêutica Médica”

Em “Céu Subterrâneo”,  (romance publicado em 2016 pela editora Perspectiva) trago uma referencia da “História dos Animais” de Aristóteles. Numa determinada passagem ele escreve sobre a memória. Por um erro de interpretação conhecemos a famosa versão de que o homem seria racional em oposição aos animais que estariam descritos como irracionais. Para o filósofo no entanto, a verdadeira distinção seria outra, e está em outra passagem deste mesmo livro: o que nos diferencia dos outros animais não seria a possibilidade de raciocinar pois é evidente que os animais também o fazem. Para o pensador, a grande distinção estaria na capacidade humana para evocar a memória conforme sua vontade. E narra-la.

Cito isso para lembrar que Prof. Walter E. Maffei, importante pesquisador e neuropatologista brasileiro e um dos meus principais mestres. Maffei ilustrava uma de suas aulas na Faculdade de Medicina projetando imagens de gatos. Por que? Afirmava, com razão, que aqueles que tinham as predisposições alérgicas despertada por alguma idiossincrasia, poderiam apresenta-las apenas com a “lembrança” desta experiência. Não seria necessária a presença física de um gato, poderia bastar imaginar à exposição a algum alergeno que não estivesse presente para “excitar” instantaneamente um quadro alérgico. A lembrança de alguém que apresenta sensibilidade ao pelo deste animal poderia desencadear um início de manifestação alérgica. Esse exemplo evidencia pelos menos duas coisas, a incrível sensibilidade do psiquismo e o papel da memoria em nossa saúde.

Muitos aspectos permanecem misteriosos na clínica. Não é incomum que os pacientes desenvolvam estranhas e desconhecidas sensibilidades aos produtos farmaceuticos e alimentícios mais comuns. Ou sujeitos que sentem súbito mal estar quando terremotos estavam para ocorrer a milhares de quilometros dali. Sabemos que muitas pessoas tem perturbações cardio-circulatórias e respiratórias antes e durante os fenomenos climáticos. Existem vários relatos de pressentimentos e sintomas inexplicáveis que normalmente não seriam relevantes para uma aplicação da técnica de tratamento, mas extremamente importantes para compreensão da história clínica de alguns individuos.

Não se trata de um fenomeno religioso ou de uma mistificação. Temos que recordar que, para a genuína investigação científica sempre existirão mais perguntas do que respostas.

O homem não é mero contemplador, de seu habitat ou de seu sistema de tratamento médico. Como todo ser vivo pertence ao ecosistema. O tempo todo age sobre ele e ao mesmo tempo sofre múltiplas influências do meio no qual habita. A meteorobiologia, uma disciplina, nos ensina o poder das meiopragias sobre os seres. Quando aumentam as manchas solares ocorrem ciclos epidemicos de doenças na Terra, as influências climáticas, barométricas e da poluição atmosférica sobre os estados de saúde são clinicamente evidentes.

Também não é infrequente que médicos sejam pegos de surpresa com o que aprendem das experiencias pessoais dos pacientes, de suas sensibilidades e caracteristicas individuais. Estar atento a estes aspectos não se limita a quem pratica qualquer modalidade de terapeutica integrativa, mas a todos que se dedicam a tarefa de cuidar da saúde dos seres humanos e dos animais.

Costumamos dizer que não há mentira em clínica. O que um paciente sente não pode ser julgado no campo estrito da verdade ou da mentira. Para atestar se um sintoma é falso ou verdadeiro não basta fazer uma investigação clínica que confirme ou não a patologia. Todos os sintomas são, de uma forma ou de outra, verdadeiros, pois mesmo as fantasias, delírios e as interpretações fazem parte integrante dos problemas dos sujeitos enfermos.

Médicos, ou qualquer profissional das práticas de saúde precisam ser treinados para acolher o que cada pessoa percebe de anomalo ou estranho no funcionamento de seus órgãos e em sua própria vida. Tudo que o paciente informa deveria ser relevante para o medico cuidador, independentemente da correlação que este estabeleça com alguma enfermidade específica. Isso vale para o generalista e o especialista, para o clinico e o cirurgião.

No mundo todo cresce uma tendência cientifica: passa a ser cada vez mais importante individualizar as doenças. Como toda uma tradição médica vitalista pensava, includindo o próprio Samuel Hahnemann é preciso saber como cada doença impacta a saúde de cada pessoa, pois cada um tem uma forma particular de desenvolve-la e de voltar a ficar saudável. Esta diretriz, preocupação constante de muitos medicos vitalistas na história da medicina, pode fazer toda a diferença.

E não só nos resultados diretos, mas em todo processo de adoecimento, convalescença e recuperação. Como lidar com o desconforto? As vezes, um tratamento pode ser dolorido e provocar sofrimento. Para a pessoa enferma é muito importante a assistência, o suporte e a presença de quem cuida. Portanto um aspecto vital de qualquer tratamento é a qualidade do cuidado que o profissional dispensa ao enfermo.

Pode-se encontrar referencias bibliograficas sobre todas as reflexões e informações. Estas reflexões são fruto de décadas de observação e testemunhos da clínica médica nos últimos 30 anos. O presente texto que o leitor tem nas mãos, ou na tela, é uma condensação de um livro, hoje esgotado, que transformei em e-book sob o título “O outro código da medicina”.

As vezes as pessoas perguntam por que diante de sua eficácia e abrangência clinica — especialmente na atenção primária à saúde e na prevenção e tratamento das moléstias crônicas — como se explica que a homeopatia nunca tenha se universalizado como forma de atendimento? Há anos a Organização Mundial de Saúde recomenda as medicinas tradicionais. Uma publicação recente da Escola de Saúde Pública da Universidade de Harvard[1] recomendou o uso de homeopatia nos sistemas de atenção primária à saúde. No Brasil, o SUS teve várias tentativas de ampliar o uso de práticas integrativas. Recentemente, a Suiça organizou uma consulta popular e a homeopatia finalmente entrou como opção terapeutica no sistema público de saúde. Sabe-se que ela já foi reintroduzida no curriculo de escolas de medicina nos EUA. Na Alemanha, além de popular, a homeopatia e as medicinas integrativas tem larga aceitação pelos medicos e também é usada por grande porcentagem de clínicos e especialistas como tratamento complementar. Entretanto o fato persiste: por que nunca conseguiram se universalizar como práticas médicas. Importante tentar responder por que.

São muitos fatores concorrendo simultâneamente. O primeiro e mais importante é a dificuldade para estabelecer núcleos de pesquisa que sejam financiados pelo Estado e independentes da pressão dos poderosos lobbies que comandam a indústria farmaceutica. Sem prover estes centros autonomos de pesquisa com recursos e capacidade política para determinar a prioridade das pesquisas todo avanço farmacotécnico em medicina fica sujeito à lógica dos dividendos das fábricas e sob o controle de oligopolios farmaco-industriais conforme sugeriu ainda no início do século XX o historiador da medicina Henri Sigerist. Não há nenhuma tese conspiratória ou anti-capitalista nesta observação, apenas elementar constatação de fatos. É importante reconhecer os muitos avanços das tecnologias médicas e o papel da indústria farmacêutica, ainda que isso não a transforme em um símbolo de benemerência. E é também justo que se pergunte: por que a indústria não investiria em um ramo tão promissor e potencialmente lucrativo como a de medicamentos homeopáticos que conta com centenas de milhões de consumidores?

Um dos problemas para os interesses mercantis na produção de medicamentos está no fato de que, por exemplo, as substâncias medicinais homeopáticas não têm patente, isso é, constituem um bem público. Trata-se portanto de um conjunto de medicamentos que foram incorporados ao patrimonio da humanidade, já que nenhuma indústria ou indivíduo detém os direitos de propriedade dessas substâncias. Isso significa que sobre estes fármacos não incidem royalties. Exatamente isso que você acaba de ler: nenhuma substância usada nos fármacos empregados na homeopatia possui domínio de patente. Isso explica seu relativo baixo custo. E também explica a quantidade desproporcional de ataques dirigidos contra ela e sua relativa incapacidade de responder a eles com pesquisas subsidiadas.

Evidentemente existem outras dificuldades: a natureza sectária de parte do establishment das medicinas integrativas. Numa compreensível atitude defensiva que emergiu contra as décadas de acusações de ineficácia das doses ultradiluídas, existe neste meio relutancia em fazer a autocrítica necessária para se antecipar e apontar suas próprias deficiências, lacunas e limites de atuação.

Existem praticantes que insistem numa lógica autosuficiente que clama para a medicina integrativa uma emancipação total das demais racionalidades. E também existem aqueles que aceitam abrir mão da teoria que organiza e confere alguma consistência teórica para o método. Porém para qualquer medicina de inspiração vitalista não se pode resumir os benefícios apenas ao “resultado clinico pontual”, e sim ao conunto de potenciais benefícios para a totalidade da pessoa enferma.

O dilema é compreensível: se por um lado ela se apresenta como uma outra lógica médica, por outro, ela precisa em parte assimilar-se à cultura científica corrente se quiser ser levada a sério. Isso significa que a medicina integrativa acaba falhando em se estabelecer, tanto na prática privada como no setor publico, pois não consegue nem evidenciar claramente sua performance clínica, nem se fazer entender pela linguagem contemporânea. Um impasse, que no caso específico da homeopatia, dura quase dois séculos.

O erro fundamental está numa certa recusa inconsciente destas correntes em aceitar que de uma forma ou de outra a única saída para que uma tese seja aceita nas sociedades contemporâneas é sua penetração na cultura através das pesquisas academicas e da discussão com a sociedade. Somente esse pertencimento à cultura garantiria a permanência de uma formulação sofisticada como é a proposta de uma terapeutica pautada no uso dos semelhantes.

Sofisticada, porque pretende, inclusive, retomar um assunto dos mais importantes, e, ao mesmo tempo uma das questões científicas mais negligenciadas da medicina: ainda são raras e escassas pesquisas sobre o como as pessoas se curam.

Notem que hoje já existem núcleos de pesquisa médica que discutem criticamente a validade dos protocolos padrões. O cálculo de risco para alguns procedimentos terapêuticos tem sofrido questionamentos. E uma boa parcela dos pesquisadores já leva cada vez mais a sério o fenomeno chamado superdiagnóstico[2].

As medicinas integrativas devem ser apresentadas não só como alternativas – com todas as suas conotações contra-culturais — mas como um processo que dialoga ao mesmo tempo com a ciências naturais como com as várias áreas das humanidades como a antropologia, filosofia e psicologia. Ao mesmo tempo, precisa ser mais enfática em sua proposta: estabelecer bases teóricas próprias para uma medicina do sujeito emancipada, por exemplo, das teorias psicanalíticas e das mistificações. Portanto, ela deveria ocupar o centro da discussão das ciências humanas com as ciências biológicas.

Temos tempo. Sejamos todos pacientes, a discussão está apenas começando.

[1]A Escola de Saúde Pública de Harvard e o Hospital Beth Israel, afiliado à Faculdade de Medicina de Harvard publicaram recentemente os resultados de um estudo conduzido por Michelle Dossett, MD, PhD e colaboradores incluindo o expert em placebo  Ted Kaptchuk, OMD onde concluem que os estudos conduzidos usando a homeopatia “sugerem potencial beneficio para a saúde publica como redução de uso desnecessário de antibioticoterapia, redução de custos para tratar de algumas doenças do trato respiratório melhora nas depressões relacionadas ao período do pós menopausa, melhora os resultados na saúde de indivíduos com moléstias crônicas e controle de doenças epidêmicas como por exemplo a epidemia de leptospirose em Cuba”

Homeopathy Use by US Adults: Results of a National Survey. Dossett ML, Davis RB, Kaptchuk TJ, Yeh GY. Homeopathy Use by US Adults: Results of a National Survey. Am J Public Health. 2016 Apr; 106(4):743-5.

*O outro Código da Medicina (e-book kindle)

[2] Overdiagnosed – cuja tradução poderia se aproximar de “superdiagnósticado”. Caracteriza-se em valorizar excessivamente os exames subsidiarios e atribuir importância exagerada aos disturbios clínicos que talvez não mercessem tratamento, pois seriam patologias inofensivas ou “amigáveis”. O custo orgânico e psiquico de determinados procedimentos terapêuticos são simplesmente elevados demais para os pacientes.

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O SUS e as fronteiras epistemológicas (Blog Estadão)

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Posted by Paulo Rosenbaum in Artigos, Na Mídia, O outro código da Medicina (e book) homeopatia, Pesquisa médica, Prática clínica

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O Sus e as Fronteiras epistemológicas

“Avistar uma fronteira, é, já, ultrapassa-la”

Gaston Bachelard

Paulo Rosenbaum, PhD. Doutor em Ciências (USP) Mestre e Pós doutor em Medicina Preventiva pela FMUSP

Em resposta ao artigo “O SUS contra a ciência” dia 17/07/18 publicado na seção “Espaço aberto” de autoria de Natalia Pasternak Taschner e Alicia Kowaltowski.

O artigo de hoje das duas autoras acima trata de um tema importante, mas é de tal forma reducionista e desinformador que pode ser ele mesmo considerado como duvidoso em termos de acurácia científica. A contradição começa com o título escolhido: “O Sus contra a ciência”. Ele evoca o que há de pior em termos de maniqueísmo científico e epistemológico e trata uma questão cara à saúde pública com desleixo e uma perturbadora despreocupação com a ética. O grande mérito do artigo poderia ser trazer para a discussão os graves problemas de saúde pública, mas adotou uma abordagem confrontadora, e infelizmente o mérito potencial do nobre espaço acabou desperdiçado como um grande equivoco. Superando os problemas deste libelo anacrônico, teço, a seguir alguns comentários baseados em um dos trabalhos que desenvolvi no trabalho academico na FMUSP.

A história da medicina tem sido contada apenas parcialmente, sempre privilegiando as concepções e práticas hegemonicamente sancionadas na atualidade. Existe mais de uma outra forma racional de responder aos desafios colocados à medicina em sua trajetória histórica. O resgate da tradição empírico-vitalista, da qual a homeopatia é a principal herdeira, redimensiona essa trajetória. Esta outra versão da história nos fala do fato homeopático e das suas possibilidades para viabilizar projetos de intervenção não restritos à funcionalidade mecânica do organismo.

Se isto vem ocorrendo na práxis da biomedicina, deve-se à consciência instintiva de seus protagonistas, uma vez que a formação acadêmica não capacita os médicos para esta modalidade de intervenção. Compreende-se, então, que seus protagonistas experimentem enormes dificuldades em readaptar essa visão não mecânica a seus curricula práticos, uma vez que a pedagogia dispensada ao médico ainda centra-se substancialmente nesta única dimensão. Ou seja, há, sim, um despertar para outras dimensões do adoecer, a percepção de que este não está circunscrito ao problema biológico. No entanto, este outro modo método de enxergar e avaliar a doença e seu tratamento ainda encontra poucas condições de viabilizar-se pela carência de agentes no campo operacional.

As medicinas tradicionais entre os quais encontram-se a homeopatia, a medicina oriental, a auryveda,já foram demasiadamente castigadas e perseguidas por ideologias médicas e sistemas racionais onipotentes, cujas repercussões fizeram-se sentir na maturação de seus programas. Não se trata, porém, de uma condição especial da homeopatia e da medicina oriental. Este é um problema inerente à competição, anteriormente referida, entre programas científicos. Numa época em que a pluralidade metodológica parece arrefecer a competição entre paradigmas, algo inusitado pode estar ocorrendo: as práticas integrativas correm o risco de tornarem-se algozes de si mesmas, caso não saibam trabalhar com suas próprias contradições e reorganizar a teoria a partir do que dela emana como produto. Fica clara a completa impossibilidade de continuar a esquivar-se de interagir com as outras disciplinas e repartir este legado, herdado dos sucessivos conflitos que as caracterizaram em suas órbitas históricas.

Para tanto não basta que uma epistemologia “emprestada” de outros saberes possa corrigir as insuficiências metodológico-conceituais, mesmo que seja baseada naquilo que emerge da prática ou através das discussões teóricas. Assim, não serão os os químicos, físicos, psicanalistas, historiadores da ciência ou a tradição biomédica aqueles que trarão a luz que falta. Essa luz deverá surgir do próprio incômodo e inquietude salutar que impõe-se aos que sentem a necessidade de produzir suas evidências: os médicos que praticam outras formas de medicina. Nota-se que isto já está acontecendo e ocupando certos nichos do conhecimento, ainda que de forma tímida e pouco produtiva.

Devemos insistir na interlocução, que será difícil, assimétrica, tortuosa. Mas não é mesmo a tensão que instiga e excita o ânimo do pesquisador? Com a mesma obstinação, contudo, deve-se cuidar para que o produto inicial da interlocução venha a partir do interior, neste caso, a partir do conjunto de vivências produzidas pela própria homeopatia.

Segundo Henri Bergson (1936: 15), a “pesquisa científica é um diálogo entre a mente e os fatos”, portanto, uma construção científica é, por excelência, um diálogo referido a uma interlocução entre uma realidade eleita e uma mente disposta a percebê-la.

As práticas integrativas (recomendadas pela OMS e a OPAS como uma forma inteligente de assistência médica na atenção primária) constituem-se como um saber com aplicatio, mas são bem mais do que isto. Por acaso as autoras se deram ao trabalho de pesquisar e informar isso aos leitores deste jornal? Decerto não. O fato é que as medicinas integrativas construiram um método, um acordo intersubjetivo que vigia sua própria execução. Trata-se de uma filosofia médica (uma iatrofilosofia particular) com tradição suficientemente forte para reivindicar que suas formas de conhecer o sujeito, seu adoencimento, cuidado e cura sejam recolocadas como uma das possibilidades de teoria do conhecimento em medicina.

Se o que hoje se discute dentro dos distintos modelos científicos, tais como a teoria da complexidade e a teoria do caos, obtém status epistemológico em biologia, comparáveis mesmo ao que a teoria da relatividade ou a teoria quântica obtiveram na física, existem percepções que compõem o saber integrativo que devem perceber o valor e fecundidade de sua efetiva e positiva colaboração.

A rigor a medicina não é ciência, segundo Canguilhén a medicina já foi classificada epistemologicamente como “ciencia operativa” pois nela repousa uma quantidade incomensurável de processos complexos que não terminam quando se confecciona a prescrição, ainda idealizada como o ato derradeiro da atividade médica. A rigor, a discussão está apenas começando, uma vez que deve-se considerar a imprevisibilidade das comunicações e a imensa variabilidade de resposta dos sujeitos em suas distintas reações e respectivas idiossincrasias. Isto vale especialmente para a medicina em sua dimensão arte, quando a cada nova consulta estas comunicações se processam de um sujeito ao outro.

As medicinas integrativas precisam começar a reaprender com sua própria construção teórica, que deverá emergir de uma prática cuidadosa, que saiba, como bem diz o aforismo hipocrático, considerar que “a arte é longa, a ocasião fugidia e a experiência enganadora, o juízo difícil” (Hipócrates, 1838).

A arte é longa, porquanto tanto os comentaristas ocidentais como Hahnemann, ao invés de facilitar o trabalho e montar um sistema no qual se poderia usar o antigo sistema das nosologias para prescrever, afirmaram o valor do particular sobre o geral. “Criaram”, assim, um desafio hermenêutico nas reduções propostas pelas generalizações a partir das classificações de doenças. O cogito hahnemanniano sugere, então, que deve existir também uma nosologia do particular, do incomum, forçosamente também do impreciso. Cria uma inversão de valores, um contrapensamento, que contém em si mesmo uma das peças-chave do seu método, um problema digno de investigação para qualquer epistemólogo contemporâneo. O fato adquire aqui estatuto de idéia fecunda. Isso hoje se reflete no crescimento de medicina baseada em narrativas, a slowmedecine, a rejeição aos hiperdiagnósticos e uma orientação cada vez mais cuidadosa para o desenvolvimento de uma medicina mais individualizada.

A ocasião é fugidia já que para aprender não basta uma série de experiências mesmo que metodologizadas e organizadas. Escapa, no domínio da subjetividade do paciente, uma série de elementos fundamentais, o que automaticamente transforma em quase quimera a busca de uma inapreensível essência do sujeito. Os pacientes, assim como as substâncias medicinais, “escapam-nos” por entre os dedos, porque não somos suficientemente aparelhados para detectar o que há ali de curável e de curativo, respectivamente. O sujeito que sofre procura ajuda, alívio para seu sofrimento, qualquer ajuda pode lhe dar um suporte positivo. Muitas vezes isto pode resultar em processos transferenciais adequados, medicamentos criteriosamente escolhidos a partir de diagnósticos individuais, mas deve-se admitir que nem sempre eles são suficientes.

Os médicos debruçam-se sobre representações de fragmentos (sintomas) para cuja interpretação buscam analogias em outros (experimentações) para capturar a natureza da afecção de tipos singulares. A unidade no indivíduo é fato, mas o que muitas vezes capturamos são apenas as intermitências (sintomas e queixas) desta unidade. Quando se vê um medicamento bem escolhido agir, enxerga-se ali somente uma maior coerência entre estas intermitências. Podemos passar a perceber uma retomada da ritmicidade do conjunto. E então, na evolução clínica, pode-se observar como, para que e para onde este sujeito em reconstrução está indo. Por isso trata-se de um disparate a defesa da tese de que há uma e somente única forma correta de exercer a medicina.

A experiência é enganadora porque jamais poderemos traduzir completamente uma vivência subjetiva, como é o caso da anamnese e relação médico-pacienite, de acordo com uma assepsia metodológica. Mas de fato, como professa o primeiro aforismo hipocrático, aquilo que se conhecia até experimentar torna-se uma retradução de fragmentos de vivências que obriga o médico a comparar com aqueles que se colhe em cada consulta. E em cada nova consulta de um mesmo paciente, enxerga-se outros fragmentos, com os quais muitas vezes, entre transferências e contratransferências, se misturam médico e paciente.

O juízo é difícil porque é necessário possuir potencial e instrumental éticos suficientemente amadurecidos. Assim, pode ser preciso retroceder diante de um juízo já feito. Devemos, como um magistrado diante de um caso de múltiplas possibilidades, instruir o processo, deixando o mínimo de vestígio de nossas mãos sobre a decisão, mas sabendo que sempre restará uma margem de interpretação, de liberdade no ato de julgar. O juízo é difícil porque nossa capacidade de perceber o “sujeito-tema” resvala nas nossas próprias metáforas.

“Mas é completamente diferente com o tratamento de objetivos, cuja natureza essencial consiste de operações vitais – o tratamento, a saber, da estrutura humana viva para levá-la de uma condição não saudável para uma saudável (que é a terapêutica) e a disciplina da mente humana para desenvolver e exaltá-la (que é a educação). Em ambos os casos, o tema sobre o qual trabalhamos não deve ser considerado e tratado de acordo com as leis físicas e químicas como os metais do metalúrgico, a madeira do lenhador ou o tecido e as cores do tintureiro. É impossível, portanto, que ambos, médico e professor, quando cuidando da mente ou do corpo, devam necessitar de um conhecimento antecipado de seu sujeito-tema, que possa conduzi-lo pela mão até o término do seu trabalho, assim como obter, talvez, um conhecimento das propriedades físicas e químicas dos materiais que ajude e conduza o metalúrgico, o curtidor e outros artesões até a perfeição dos seus. A vocação de ambos demanda outro tipo de conhecimento, assim como seu objeto, um indivíduo vivo, é completamente diferente.”

(Hahnemann, sobre o valor dos sistemas especulativos em medicina, 1984: 491-492).

É verdade que nem todas as praticas integrativas são válidas e que pode haver, entre elas, práticas pseudocientíficas. Algumas, sem o olhar atento de quem deve ter formação médica, podem ser, de fato, lesivas ao paciente. Destarte as medicnas integrativas exercidas com rigor e ética tem nas mãos, em síntese, uma possibilidade concreta de intervir no sujeito, desenvolveu uma semiologia generosa, podendo interferir na maior parte das enfermidades crônicas. É claro que encontram-se algumas lacunas: insuficiência teórica, já que uma reformulação de alguns pressupostos se faz necessária; restrições do arsenal terapêutico frente à diversidade humana e a assunção das atuais limitações e dificuldades para demonstrar a ação de sua eficácia terapêutica.

Na presente ausência de estruturas hospitalares adequadas (ou serviços que ao menos aceitem-na como uma possibilidade), como viabilizar todas as opções possíveis nos casos agudos e nas emergências? Como agir coerentemente e com responsabilidade clínica frente àquelas enfermidades que requerem suporte adicional, como reabilitação, cirurgias eletivas e até mesmo drogas convencionais? Estas todas são questões que, apesar de estarem aparentemente no âmbito da prática, merecem um melhor acolhimento nas futuras discussões epistemológicas.

Outro aspecto importante é o espaço e o tempo ocupados durante uma consulta. Este “tempo” pode ser visto como um obstáculo, quando se dimensiona em que tipo de sociedade vivemos. Ao mesmo tempo, representa um positivo resgate solidário no trato entre pessoas. Trata-se de um tempo absolutamente necessário para que o terapeuta possa reconstruir a história patográfica e biográfica do paciente. Tempo também precioso para que um “outro” possa ser traduzido por si mesmo para o terapeuta. Tempo para praticar a auto-observação, consiga ele se fazer entender ou não por nós, terapeutas, seus interlocutores. Suponhamos que possamos ensinar aos médicos que se deve equiparar a destreza com o cuidado, a perícia com a suavidade, e que tanto a acurácia como a efetividade devem ser pensadas, também, prospectivamente. Por que não ensinar aos médicos que se deve, sim, atender às doenças, mas ouvindo-se simultaneamente as metáforas daqueles que as apresentam que, de maneira uníssona, reclamam cuidados e escuta.

Este pode ser um sensível “termômetro” da potencial capacidade ética e compassiva do ato de cuidar. Também representa uma enorme economia aos contribuintes já que os procedimentos são em sua maioria ambulatoriais, portanto muito menos dispendiosos e o atendimento mais pessoal e artesanal possui enorme potencial para evitar intervenções desncessárias. Além de, quando for o caso, encaminhar e triar melhor os casos que precisam de atenção mais especializada e/ou hospitalar.

Talvez, aparentemente, as medicinas integrativas como medicina do sujeito não sejam a terapêutica mais adequada à lógica das sociedades atuais onde tempo representa apenas dinheiro e poder.

Mas, talvez, isso mesmo é que faça dela uma alternativa assistencial fundamental.

https://brasil.estadao.com.br/blogs/conto-de-noticia/o-sus-e-as-fronteiras-epistemologicas/

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A Mentalidade Preventivista (blog Estadão)

06 segunda-feira fev 2017

Posted by Paulo Rosenbaum in Artigos, Imprensa, Na Mídia, Pesquisa médica

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blog conto de noticia, boite kiss e a justiça, conto de notícia, filosofia, holocausto, Literatura, Mark Twain, medicina e acaso, mentalidade preventivista, tarda justiça

Era para ser um texto em homenagem ao aniversário desta cidade. Não deu. Pois lá se vão quatro anos do incêndio da boate Kiss e a tarda justiça ainda continua fazendo vítimas em série. Em homenagem às famílias, aos que não podem mais se defender da inépcia do Estado e para que — em algum futuro tremendamente remoto — tragédias anunciadas, disfarçadas de fatalidade, não voltem a ocorrer republico no blog, excepcionalmente, o texto “A Dor merece nosso Constrangimento”. Decerto que o imponderável, o imprognosticável,  a  incerteza e o absurdo são tanto perturbadores, como onipresentes na condição humana. Porém, isso não tem nada a ver com pane seca, falta de extintores, erros de cálculos em pontes e viadutos, falha na inteligência, justiça leniente, leis anacrônicas, cárceres inimagináveis, descaso com áreas de risco, e, finalmente, déficit de vigilância para cuidar que as instituições não sejam escravas das corporações.

Que a mentalidade preventivista se infiltre em quem governa. E, se não, — que as consequências desta falta crônica desabem sobre os omissos, mostrando que quem quer gozar do Poder, quem precisa do Poder, quem está obcecado por ele, tem a obrigação, moral ou criminal, pouco importa, de planejar e, sobretudo, a responsabilidade de antecipar acontecimentos.

 

A dor merece nosso constrangimento

 

Devo estar cultivando a insensibilidade, já que não me comoveu o choro nem a circunspeção dos políticos nos funerais. Além disso, temos que suportar o horroroso espetáculo dos apresentadores explorando a biografia das vítimas ou especialistas explicando como os alvéolos são destroçados pela inalação de fumaça. Nesse campo de batalha, só cabem urros, uivos, ritos de contrição. A dor merece nosso constrangimento.

São poucas ou muitas as palavras que podem descrever acuradamente o absurdo. Absurdo é pouco, estultilóquio, limitado, dislate, distante. Precisava de um vocábulo sem precedentes. Pois “galimatias” revela um glossário analógico apropriado para o desastre gaúcho: um acervo de heresias e incoerências disparatadas, coxia de desconchavos, parvoíce chapada, um amontoado de cacaborradas, aranzel, inépcia, chocarrice. Para contornar registros menos recomendáveis ao grande público, cada um deles pode indicar o repertório que se passa pelas nossas cabeças quando tragédias completamente evitáveis parecem inevitáveis.

A falta de decência não é só fazer as coisas sem pensar que outros podem se ferir ou sair lesados. Paira no ar um senso de desproporção, tocado pelo culto ao único mito invicto de nossa era: grana.

Há uma máxima que deveria vir instantaneamente à cabeça de qualquer um: “Tratarei todo filho como se fosse meu”. Passa longe do sentimento predominante. Que dizer dos donos do lugar e dos homens da segurança? Inicialmente, sem perceber a eminente tragédia, impediram pessoas de sair do inferno. Quais as regras a serem seguidas e quais merecem desobediência civil já?

Não sei quantos mais poderiam ter sido salvos da asfixia, da carbonização. Uma vida poupada teria feito toda diferença. Mas havia a barreira do execrável pedágio, a pirotecnia fora de lugar, o entupimento das salas, as formigas espremidas na armadilha.

Não vem ao caso apontar para a banda ou para os proprietários como alvos óbvios de punição e responsabilização criminal. Já que pais e mães tiveram seus futuros cassados, e as vítimas ardem na sombra, seria preferível acompanhar o que o poder público tem a dizer.

Em geral, fiscais são bons burocratas e, raramente, têm consciência de seu papel vital na prevenção dos desastres. Prevenção, lugar-comum, baixa visibilidade, antipopular, mas a única palavra-chave para não termos que ouvir a esfarrapada desculpa “fatalidade”. Isso não é um se, está acontecendo agora. Nas enchentes, na calamidade absoluta que é a segurança pública do país, na incapacidade organizacional para gerir o dia a dia das cidades. A verdade é que, se ainda vivemos ilesos, é por sorte e apesar do Estado. E não se trata de apontar para um único partido. Todos comungam deste mínimo múltiplo comum, a incapacidade de enxergar que toda matéria política caberia numa sentença: governo é para o povo. Submergidos no populismo ignorante, cosmético e estelionatário, quanto dinheiro ainda será arrecadado nas miríades de impostos pagos para fiscalizar e manter as bocas de lobo, as escolas, o passeio publico, a segurança, a defesa civil? E como isso será gasto? Não sabemos e ninguém sabe.

Mark Twain escreveu: “O governo é meramente um servo, meramente um servo temporário: não pode ser sua prerrogativa determinar o que está certo e o que está errado, e decidir quem é um patriota e quem não é. Sua função é obedecer a ordens, não originá-las”.

Só quando os administradores forem imputáveis e sentirem nos bolsos e na privação de liberdade que, se falharem em prevenir o prevenivel sofrerão consequências pesadas, talvez tenham mudanças efetivas no dislate que é o planejamento público no Brasil. Só quando a opinião pública exigir que as apurações não se limitem a dois ou três bodes expiatórios, mas, a quem, de fato, permitiu a vigência do absurdo. Talvez ai, calçados na educação solidária, o respeito aos cidadãos conquistará status de lei.

Na hora dos massacres, a solidariedade autêntica vem das pessoas desvinculadas do poder. Emerge pura da nossa emoção, premida pelo nada, esvaziada de sentido, e lapidada pela voz rouca do abandono. Um sobrevivente do incêndio descreveu “Vi o monte de corpos empilhados uns em cima dos outros, como os judeus no Holocausto”. Ainda que o cenário justifique a analogia, a outra semelhança é a gratuidade com que essas vidas foram incineradas.

Todos nós, civilizados desde o berço, podemos enxergar tragédias como inerentes à condição humana. Rachaduras na placa continental, asteroides, furacões e terremotos são eventos inevitáveis, às vezes inexoráveis. Crematórios, não. A dor merece nosso constrangimento, assim ao menos sofreremos todos juntos. Não entendo bem por que, mas parece que precisamos nos derreter para nos unirem.

Paulo Rosenbaum é médico e escritor. É autor de “A Verdade Lançada ao Solo” (Ed. Record) e “Céu Subterrâneo” (Ed. Perspectiva)

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Novo e-livro disponível no Kindle – O outro código da Medicina-agradeço Divulgação-Comentários-Reviews)

01 sábado ago 2015

Posted by Paulo Rosenbaum in Amazon, O outro código da Medicina (e book) homeopatia, Pesquisa médica, Prática clínica

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O outro código da medicina: homeopatia [eBook Kindle]

paulo Rosenbaum (Autor)

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Descrições do Produto

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No livro “O outro código da Medicina” o médico, mestre em medicina preventiva e pós doutor em ciências, Paulo Rosenbaum, coloca sua experiência clínica e capacidade de pesquisa a disposição do leitor para elucidar aspectos pouco conhecidos da arte de cuidar. Se a saúde é um enigma, a homeopatia pode ser definida como um sistema terapêutico de interferência médica baseada em similitude e observação clínica que usa a individualização dos sintomas como sua principal fonte de conhecimento. Trata-se de uma prática médica que ouve histórias, acolhe narrativas e interpreta biografias: uma medicina do sujeito.
Apresentamos aqui este outro código da medicina, a homeopatia, em linguagem acessível, tocando nos principais tópicos de sua história, filosofia e técnica. Adicionamos também as reflexões sobre saúde e enfermidade que emergiram de anos de pesquisa e prática clínica.


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  • Formato: eBook Kindle
  • Tamanho do arquivo: 876 KB
  • Vendido por: Amazon Servicos de Varejo do Brasil Ltda
  • Idioma: Português
  • ASIN: B01323DJWM
  • Dicas de vocabulário: Não habilitado
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