de Almeida Filho N. La clínica, la epidemiología y la epidemiología clínica. [Clinical medicine, epidemiology, and clinical epidemiology.] Cuadernos Médico Sociales [Medico-social Notebooks] (Rosario,Argentina) 1994 March; 67:33-45.

Objectives:To analyze critically so-called “clinical epidemiology” from the theoretical, methodological, and practical perspectives (including its struggles with centers of epidemiology).

Methodology:Analytical and interpretive.

Results:The author develops the thesis that the way epidemiology constructs its object of knowledge, which is equivalent to its mode of knowledge production, is inadequate if it is utilized without mediations for the construction of clinical discourse. He considers clinical epidemiology as the most important scientific ideology in the area of health since the appearance of “preventive medicine.” De Almeida Filho suggests that manuals of “clinical epidemiology” present this proposition as an integrated discipline with the following characteristics: a) a certain theory of clinical diagnosis, based on an evaluation of validity and reliability of the processes of case identification; b) a methodology for the construction of etiological knowledge through observational strategies of research in small groups; c) an adequate methodology for the study of efficiency and effectiveness of therapeutic procedures; and d) the proposal of a “clinical metrics,” structured with the use of probabilistic models of decision making establishing a clinical prognosis. The author shows that, with the exception of the designated clinical metrics, apparently there is nothing new in terms of the application of current epidemiological methodology to clinical problems. In practical terms, clinical epidemiology groups (he mentions Yale and McMaster as pioneers) have been organized in competition with the centers of epidemiological research, adopting antagonistic positions in almost all levels of institutional praxis. If for the moment in these struggles “clinical epidemiology” is allied with clinical medicine against epidemiology, in the long run this situation will also imply the destruction of clinical practice as we know it. The article discusses in a systematic manner the multiple links, both empirical and theoretical, between clinical medicine and epidemiology, and their conceptual and methodological differences. Later the article evaluates the degree of epidemiological legitimacy in the proposition of characteristic hybridization in “clinical epidemiology,” particularly in relation to its tendencies to treat as technical the process of diagnostic and therapeutic decision making in clinical medicine.

Conclusions:The author suggests in his conclusions that the movements which advocate for “clinical epidemiology” are narrowly articulated with the tendency to treat medical practice as a technical exercise. This practice comes to reduce even more the application of technologies for the recognition and management of pathological conditions. In this sense, clinical practice is ruled almost exclusively by an individualistic and biological focus, with little emphasis on the conceptual development of medicine and its basic sciences. Clinical practice is treated as an ahistorical and uncritical project.

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