Bioethics – ABC CARDIOL

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Editorial

A Reflection on Conflicts of Interest in Medical Guidelines

Prescribing a drug directly to the patient, recruiting a volunteer for a clinical research, lecturing at a specialty congress, participating in a committee that elaborates clinical guidelines, supervising a clinical visit with residents, giving your opinion for colleagues over coffee.

All of these situations are characterized by human interaction, greater or lesser asymmetry of knowledge, and multiple interests, where the possible privilege of one may cause damage to another.

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Editorial

COVID-19 and Uncertainty: Lessons from the Frontline for Promoting Shared Decision Making

José Augusto Soares Barreto-Filho et al. André Veiga Luis Claudio Correia

COVID-19 has already become the largest and deadliest epidemic of the past hundred years. On a daily basis, healthcare professionals in the frontline are called upon to give answers and make decisions that directly affect the lives of infected patients, and scientists are summoned to the Herculean task of providing “effective medications” in record time for a recently discovered virus with devastating potential mortality. With a hitherto unseen avalanche of information, the debate on how to treat patients with COVID-19 has gone beyond the limits of the technical arena, taking on ideological and political aspects as well.

Science is based on facts. The fact is that we do not currently have an etiological treatment with proven efficacy and safety to combat SARS-CoV-2. At the moment, there are only promises in the pipeline. To exemplify, the most emblematic case of lack of rationality and scientific thinking is the polemic regarding chloroquine/hydroxychloroquine (CQ/HCQ) for treatment of COVID-19. CQ/HCQ is a drug that has been widely and successfully used in patients with malaria and systemic lupus erythematosus. Against COVID-19, the drug inhibits replication of SARS-CoV-2 in vitro , and it modulates the inflammatory cascade triggered by the virus. In vitro data demonstrate biological plausibility, but plausibility does not mean likelihood that a hypothesis is true. CQ/HCQ was, nevertheless, promoted to the category of “magic bullet” by a publication from France, whose methodology was characterized by high risk of bias and random error, meaning that it could not be defined as “scientific evidence.” This notwithstanding, the publication was overestimated, in an ideological manner, by the individuals who were least faithful to the precepts of the liturgy of science. Contaminated by this fallacy, feeling obligated to solve the pandemic magically, even presidents took on the role of drug advertisers, thus helping to viralize pseudoscience and amplify the false information problem.

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Viewpoint

Bioethics Cardioteam Useful for Bedside Crisis Management

Max Grinberg

Preamble

Bedside crisis (BSC) is a high-stress incident in Medicine. Predicting the outcomes is difficult and short-term worsening probability is high ^– .

Whether connected or not to malpractice, it usually represents frustrated hopes. It involves the health professional, patient, family, institution and the health system, in varying combinations.

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Viewpoint

Valvular Heart Team

Max Grinberg

“An idealist is a person who helps other people to be prosperous.”

Henry Ford (1863 – 1947)

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Letter to the Editor

Patients' use of the Internet

George Barreto Miranda et al. João Ricardo Cordeiro Max Grinberg

Dear Editor,

In Brazil, a country where digital inclusion at home is growing, there is a lack of data on the patients’ use of the Internet for health information. A survey conducted among 118 patient in the Heart Valve Diseases Outpatient Clinic of InCor, resulted in the findings shown in .

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A Reflection on Conflicts of Interest in Medical Guidelines

COVID-19 and Uncertainty: Lessons from the Frontline for Promoting Shared Decision Making

Bioethics Cardioteam Useful for Bedside Crisis Management

Preamble

Valvular Heart Team

Patients' use of the Internet

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