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

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

The epistemological aspects in the historical works of Don Bates.

The object of this paper is to systematize an epistemological framework of analysis derived from Don Bates's extended essay "Medicine and The Soul of Science," and apply that framework to a number of problems connected to medical knowledge, addressed in previous research by the author. The paper also draws from Bates's earlier work, especially the two-part "Closing the Circle" on William Harvey and the reception of his ideas by his contemporaries, and from contrasting and comparing it to the work of philosophers and historians of science who tackled similar problems, most notably Ludwik Fleck, Thomas Kuhn, and Ian Hacking. The resulting framework is based on three main concepts: constructed coherencing, the unproblematic background knowledge (UBK), and the mechanical mind. The paper closes with an application of that framework to the discussion of knowledge in medicine and the definition of diseases.

Hybrid forum or network? The social and political construction of an international 'technical consultation': male circumcision and HIV prevention.

The technical consultation in Montreux, organised by World Health Organization and UNAIDS in 2007, recommended male circumcision as a method for preventing HIV transmission. This consultation came out of a long process of releasing reports and holding international and regional conferences, a process steered by an informal network. This network's relations with other parties is analysed along with its way of working and the exchanges during the technical consultation that led up to the formal adoption of a recommendation. Conducted in relation to the concepts of a 'hybrid forum' and 'network', this article shows that the decision was based on the formation and consolidation of a network of persons. They were active in all phases of this process, ranging from studies of the recommendation's efficacy, feasibility and acceptability to its adoption and implementation. In this sense, this consultation cannot be described as the constitution of a 'hybrid forum', which is characterised by its openness to a debate as well as a plurality of issues formulated by the actors and of resources used by them. On the contrary, little room was allowed for contradictory discussions, as if the decision had already been made before the Montreux consultation.

Male circumcision and HIV: a controversy study on facts and values.

We present a controversy study on the association between male circumcision (MC) and HIV. Our general goal is to shed light on the issue, unravelling and comparing different conceptions of scientific evidence and their respective world views. We seek to reconstruct, based on an analysis of the literature on the topic, key moments in the history of the controversy about the association between MC and HIV prevention, analysing more closely three recent randomised studies, given their relevance to the argumentative strategy employed by those who defend circumcision as a prevention method. Following this, we present a synthesis of the main arguments against the three referred studies. In conclusion, it seems that reasonable arguments for a more cautious approach are not being adequately considered.

How to identify science being bent: the tobacco industry's fight to deny second-hand smoking health hazards as an example.

Social studies of science have produced a critical description of science that challenges traditional ideas about "objectivity" and "neutrality". Given evidence that scientific tools have been used to undermine solid science against the interests of the general public as opposed to protecting society from findings prematurely declared to be facts, this article asks: how can one differentiate between the usual proceedings of scientists and deliberate attempts to distort science? In order to respond to this question, the author presents systematic studies of the distortion (or "bending") of science, with special attention to the role of public relation firms in the process. Drawing on examples from the tobacco industry, the article concludes that there are two key features of the tobacco industry case that indicate that distortions in science may have taken place: the fact that controversies surrounding tobacco has been centered in public forums, and legal or regulatory arenas more than scientific domains; and the presence of conflicts of interest in authorship and funding.

[Interobserver reliability of the international classification of primary care at a primary health care unit]. / Confiabilidade interobservador da classificação internacional de atenção primária em uma unidade de atenção básica à saúde.

We evaluated the International Classification of Primary Care interobserver reliability for coding the complaints reported at a primary public health unit. The study sample consisted of 300 appointments. Reasons for appointment were registered by physicians on the medical record and coding was performed by two investigators. Reliability among the classifiers as to the number of coded reasons was calculated by weighted kappa. Crude kappa coefficients were used for the remaining analyses (chapter codes and full codes). A total of 634 reasons were coded by the first classifier and 699 by the second one. Crude reliability of numbers of reasons was moderate, with a 0.71 weighted kappa (95% Confidence Interval [95%CI]: 0.68-0.73). Regarding chapter codes and full codes, reliability was substantial (kappa = 0.89; 95%CI: 0.87-0.91) and moderate (kappa = 0.72; 95% CI: 0.68-0.76), respectively. Our results suggest a good performance of the Classification for coding reasons for visit in primary care, even when data are obtained from physician consultation notes.

[Brazilian live birth information system: a review study]. / Sistema de informações sobre nascidos vivos: um estudo de revisão.

The aim of this study was to perform a systematic review of the use of the Live Birth Information System (Sistema de Informações de Nascidos Vivos--SINASC) in health research. MEDLINE, LILACS and SciELO databases were searched from 1994 to 2005 using the following combination of descriptors: "SINASC", "live birth", "Brazil". We identified 157 abstracts within the reference period, among which 44 were selected and classified according to specific criteria. The number of articles published per year increased during the period studied. The majority of the studies was carried out in the Southeast region and used the municipality as the geographic unity of analysis. A varied range of subjects were assessed including descriptions of live births profiles, health service and programs evaluations and risk factors for infant outcomes. In conclusion, although the SINASC represents an important data source for maternal-infant health research, the system's coverage and the reliability of its data need to be better evaluated.

[The protocols and the medical decision: evidences based in experience or existence?]. / Os protocolos e a decisão médica: medicina baseada em vivências e ou evidências?

The main purpose of this study is to understand the concepts and interests concerning the transformation of the practical quotidian knowledge produced by experience into probabilistic epistemological models. The object is the argumentation and practices surrounding consensus-forming which knowledge criteria are valid for diagnostic and therapeutic decisions. Our starting point is Ludwik Fleck's work, which states that facts are not objectively given but collectively and contingently created so as to adjust themselves to a style of thought. Our research strategy was an ethnographic observation of medical rounds and clinical meetings in a cardiology ICU in Rio de Janeiro. The analysis was based on the works of Knorr-Cetina (transepistemic arenas) and Perelman's argumentation theory. It revealed the consolidation of a tendency to incorporate explicit cost-benefit criteria and the interests of different agents such as doctors, government and the medical-industrial complex in the introduction of protocols. The observation demonstrated an ambivalent use: protocols/scientific studies and clinical experience as well. A certain skepticism of the clinicians and their relative inability in the usage of the analytic tools of the epidemiological thought style were particularly remarkable.

[The relevance of qualitative techniques in biomedical research]. / A relevância do uso de técnicas qualitativas em pesquisas sobre a biomedicina.

On observing how qualitative and quantitative studies are reported in the biomedical literature it becomes evident that, besides the virtual absence of the former, they are presented in different ways. Authors of qualitative studies seem to need almost invariably to explain why they choose a qualitative approach whereas that does not occur in quantitative studies. This paper takes Ludwik Fleck's comparative epistemology as a means of exploring those differences empirically, illustrating on the basis of two studies dealing with different aspects of biomedical practices how qualitative methods can elucidate a variety of questions pertaining to this field. The paper concludes presenting some structural characteristics of the biomedical field which on one hand, would not be explored properly without employing qualitative methods and, on the other hand, can help understanding the little value given to qualitative techniques in this area.