Rates and implications of caesarean sections in Latin America: ecological studyCommentary: all women should have a choiceCommentary: increase in caesarean sections may reflect medical control not women's choiceCommentary: “health has become secondary to a sexually attractive body”
The implications of the rates of cesarian sections being done in
Latin America are more alarming than Belizan reports (1). At the surface
is the statistics that in 81% of the 12 counties studied over 850,000
cesarian sections done
could be designated as medically unnecessary. He felt that this could be
because of an increase in the number of private hospitals and a
(?marginal) increase in the GNP. Latin America, which includes 18
different countries and which has a population of 456 million in 1995 is
projected to have a population of over 499 million by next year, averaging
an annual growth rate of 1.8% and a population density of 25/sq km.
With the mechanics of its poipulation dynamics Belizan's report is
fascinating. Interestingly, in the 1980's Latin America's economic
problems threatened global economy with massive debts and corrupt despotic
regimes which were unwilling to make changes. Subsequently the coming of
more democratic rule instituting economic reforms has transformed the
situation and many economies are growing rapidly. The rapid growth in
population, the widening gap between the rich elite and the poor and the
baleful influence of the narcotic "industry" have threatened economic
stability. The narcoptic empires are so powerful that they can openly
challenge national and local governments. This problem is particularly
acute in Columbia, Peru and Panama. Under these circumstances one cannot
really vouch and say that the high rates of cesarian sections are because
of an increasing GNP.
This statistics of cesarian sections in Latin America is more
alarming when one considers the fact that this part of the world has over
85% literacy and with 27 major cities that account for an urbanisation of
over 71%. So far as religious beliefs are concerned over 93% are
Christian, of which over 70% are Roman Catholic. Racially there is more
class consciousness than colour consciousness in most of the Latin
American countries, with Amerindians (the original inhabitants of the
Hignland nations and the Lowland tribes), Euroamericans, Afroamericans,
Asians (mainly Japanese, Koreans and Chinese) and the mixed races
(Mulattos and Mestizos).
Belizan's results are unlikely to be a reflection of the social,
cultural or ethnic variations, literacy or GNP. It is more likely to be an
honest reflection of the conduct and misconduct of the medical profession.
Goodstein comments that outright fraud in the medical profession is a
special kind of transgression, different from civil fraud (3). When it
does occur, it is almost always found in the biomedical sciences. Many
government agencies have mistakenly tried to obscure the important
distinction between real fraud and lesser forms of scientific misconduct.
Fraud means serious misconduct with the intent to deceive. Intent to
deceive is the very antithesis of ethical behaviour in science.
The high number of cesarian sections done may be a reflection of
career pressure, case holding for simple monetory gains or an
unwillingness to follow scientifically acceptable practices and norms of
professionally ethical conduct. All these factors are synonymous with
scientific fraud in practice. At the turn of the millenium the profession
has made a flight from science and reason, replacing it with pragmatism
and logic. Such practices are a result of continued and wilful ignorance
(or negligence) rather than of natural or straight ignorance. The former
kind of ignorance is unavoidable and its admission mandatory. By contrast
wilful ignorance is the delibrate refusal to learn items relevant to one's
interests. This is the only intolerable kind of ignorance, for it is a
form of dishonesty. And yet this is long peddled in many areas of the
medical profession.
Therefore the only rational implication of the high incidence of
cesarian sections in Latin America (and even in India) is that the medical
profession must review the medical conduct and misconduct in science.
References:
1. Belizan J et al. Rates and implications of cesarian sections in
Latin America. BMJ 1999; 319: 1397-1402
2. Johnstone P. Operation World. Zoe Publications, Nigeria; pp 62-67
3. Goodstein D. Conduct and misconduct. Ann. New York Acad. Sci.
1996; 775: 31-38
Rapid Response:
Conduct and misconduct in Science
The implications of the rates of cesarian sections being done in
Latin America are more alarming than Belizan reports (1). At the surface
is the statistics that in 81% of the 12 counties studied over 850,000
cesarian sections done
could be designated as medically unnecessary. He felt that this could be
because of an increase in the number of private hospitals and a
(?marginal) increase in the GNP. Latin America, which includes 18
different countries and which has a population of 456 million in 1995 is
projected to have a population of over 499 million by next year, averaging
an annual growth rate of 1.8% and a population density of 25/sq km.
With the mechanics of its poipulation dynamics Belizan's report is
fascinating. Interestingly, in the 1980's Latin America's economic
problems threatened global economy with massive debts and corrupt despotic
regimes which were unwilling to make changes. Subsequently the coming of
more democratic rule instituting economic reforms has transformed the
situation and many economies are growing rapidly. The rapid growth in
population, the widening gap between the rich elite and the poor and the
baleful influence of the narcotic "industry" have threatened economic
stability. The narcoptic empires are so powerful that they can openly
challenge national and local governments. This problem is particularly
acute in Columbia, Peru and Panama. Under these circumstances one cannot
really vouch and say that the high rates of cesarian sections are because
of an increasing GNP.
This statistics of cesarian sections in Latin America is more
alarming when one considers the fact that this part of the world has over
85% literacy and with 27 major cities that account for an urbanisation of
over 71%. So far as religious beliefs are concerned over 93% are
Christian, of which over 70% are Roman Catholic. Racially there is more
class consciousness than colour consciousness in most of the Latin
American countries, with Amerindians (the original inhabitants of the
Hignland nations and the Lowland tribes), Euroamericans, Afroamericans,
Asians (mainly Japanese, Koreans and Chinese) and the mixed races
(Mulattos and Mestizos).
Belizan's results are unlikely to be a reflection of the social,
cultural or ethnic variations, literacy or GNP. It is more likely to be an
honest reflection of the conduct and misconduct of the medical profession.
Goodstein comments that outright fraud in the medical profession is a
special kind of transgression, different from civil fraud (3). When it
does occur, it is almost always found in the biomedical sciences. Many
government agencies have mistakenly tried to obscure the important
distinction between real fraud and lesser forms of scientific misconduct.
Fraud means serious misconduct with the intent to deceive. Intent to
deceive is the very antithesis of ethical behaviour in science.
The high number of cesarian sections done may be a reflection of
career pressure, case holding for simple monetory gains or an
unwillingness to follow scientifically acceptable practices and norms of
professionally ethical conduct. All these factors are synonymous with
scientific fraud in practice. At the turn of the millenium the profession
has made a flight from science and reason, replacing it with pragmatism
and logic. Such practices are a result of continued and wilful ignorance
(or negligence) rather than of natural or straight ignorance. The former
kind of ignorance is unavoidable and its admission mandatory. By contrast
wilful ignorance is the delibrate refusal to learn items relevant to one's
interests. This is the only intolerable kind of ignorance, for it is a
form of dishonesty. And yet this is long peddled in many areas of the
medical profession.
Therefore the only rational implication of the high incidence of
cesarian sections in Latin America (and even in India) is that the medical
profession must review the medical conduct and misconduct in science.
References:
1. Belizan J et al. Rates and implications of cesarian sections in
Latin America. BMJ 1999; 319: 1397-1402
2. Johnstone P. Operation World. Zoe Publications, Nigeria; pp 62-67
3. Goodstein D. Conduct and misconduct. Ann. New York Acad. Sci.
1996; 775: 31-38
Competing interests: No competing interests