Journal Information
Vol. 17. Issue 5.
Pages 422-429 (September - October 2003)
Vol. 17. Issue 5.
Pages 422-429 (September - October 2003)
Open Access
Procedimiento experimental, innovador y establecido. Ética y ciencia en la introducción de la tecnología médica
Experimental, innovative and standard procedures. Ethics and sciencie in the introduction of medical technology
Visits
5560
J.M.V. Pons
Corresponding author
jpons@aatrm.catsalut.net

Correspondencia: Esteve Terradas, 30. Recinte Parc Sanitari Pere Virgili. Edifici Mestral, 1.a planta. 08023 Barcelona. España.
Agència d'Avaluació de Tecnologia i Recerca Mèdiques. Barcelona. España
This item has received

Under a Creative Commons license
Article information
Resumen

La frontera que delimita un procedimiento como experimental, innovador o establecido, dentro del proceso médico asistencial, suele ser imprecisa en gran parte de los casos. Aún lo es más en el campo quirúrgico y de los productos implantables que difieren sustancialmente de las intervenciones terapéuticas farmacológicas, que están mucho más reguladas.

Sin embargo, tanto ética como científicamente, conviene delimitar al máximo el carácter de las distintas intervenciones médicas que se aplican en sujetos humanos, sin dejar a criterio individual el margen de discreción existente hoy en día, especialmente en la innovación quirúrgica.

El examen de forma externa e independiente del cociente beneficio/riesgo de la innovación propuesta ha de permitir transparentar, en la relación médico-paciente, el carácter particular de la técnica, así como los requerimientos éticos y científicos para su evaluación más apropiada.

Palabras clave:
Investigación
Innovación
Cirugía
Productos sanitarios
Ética
Abstract

The dividing lines between experimental, innovative and standard medical procedures are frequently blurred in current clinical practice. This is even more true in the fields of surgery and implantable devices. These differ substantially from pharmacological interventions, which are better regulated.

However, the character of the various medical interventions applied in human subjects should be ethically and scientifically delimited as clearly as possible. This task cannot be abandoned to personal discretion and criteria, which are currently used, especially in the field of surgical innovation.

External and independent review of the risk-benefit ratio of proposed innovations should enable specification of the particular features of a technique in the patient-doctor relationship, as well as the ethical and scientific requirements for more appropriate evaluation.

Key words:
Investigation
Innovation
Surgery
Health devices
Ethics
Full text is only aviable in PDF
Bibliografía
[1.]
Organisation for Economic Co-operation and Development (OCDE).
Main definitions and conventions for the measurement of research and experimental development (R&D).
A summary of the frascati manual 1993. OCDE/GD(94)84, Head of Publications Service OECD, (1994),
[2.]
J.B. Dossetor.
Innovative treatment versus clinical research: an ethics issue in transplantation.
Transplant Proc, 22 (1990), pp. 966-968
[3.]
S.J. Reiser.
Criteria for standard versus experimental therapy.
Health Aff (Millwood), 13 (1994), pp. 127-136
[4.]
B. Freedman, A. Fuks, C. Weijer.
Demarcating research and treatment: a systematic approach for the analysis of the ethics of clinical research.
Clin Res, 40 (1992), pp. 653-660
[5.]
F.G. Miller, D.L. Rosenstein.
The therapeutic orientation to clinical trials.
N Engl J Med, 348 (2003), pp. 1383-1386
[6.]
A.J. Jovell, M.D. Navarro-Rubio.
Evaluación de la evidencia científica.
Med Clin (Barc), 105 (1995), pp. 740-743
[7.]
D.J. Cook, G.H. Guyatt, A. Laupacis, D.L. Sackett, R.J. Goldberg.
Clinical recommendations using levels of evidence for antithrombotic agents.
Chest, 108 (1995), pp. 227-230
[8.]
C.E. Margo.
When is surgery research? Towards an operational definition of human research.
J Med Ethics, 27 (2001), pp. 40-43
[9.]
P. McCulloch, I. Taylor, M. Sasako, B. Lovett, D. Griffin.
Randomised trials in surgery: problems and possible solutions.
BMJ, 324 (2002), pp. 1448-1451
[10.]
C.M. Ward.
Surgical research, experimentation and innovation.
Br J Plast Surg, 47 (1994), pp. 90-94
[11.]
M.F. McKneally.
Ethical problems in surgery: innovation leading to unforeseen complications.
World J Surg, 23 (1999), pp. 786-788
[12.]
R. Hoffenberg.
Christiaan Barnard: his first transplants and their impact on concepts of death.
BMJ, 323 (2001), pp. 1478-1480
[13.]
L.I. Bonchek.
Sounding board. Are randomized trials appropriate for evaluating new operations?.
N Engl J Med, 301 (1979), pp. 44-45
[14.]
I. Singer, S. Nisam.
There should never be another antiarrhythmics versus implantable defibrillator (AVID) trial.
Am J Cardiol, 80 (1997), pp. 766-768
[15.]
Are implantable cardioverter-defibrillators or drugs more effective in prolonging life? The Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial Executive Committee.
Am J Cardiol, 79 (1997), pp. 661-663
[16.]
D. Bonn.
UK patients with hip implants to be reviewed.
[17.]
FDA Food and Drug Administration.
Information Sheets; Guidance for Institutional Review Boards and Clinical Investigators Update.
Ref Type: Data File [consultado 29/01/2001], (1998),
[18.]
Declaració de Hèlsinki (2000) Associació Mèdica Mundial.
Principis ètics per a la recerca mèdica amb subjectes humans.
Bioètica & Debat, 6 (2001), pp. 1-16
[19.]
H. Jonas.
Técnica, medicina y ética. Sobre la práctica del principio de responsabilidad, Paidós Ibérica, (2001),
[20.]
H.K. Beecher.
Ethics and clinical research.
N Engl J Med, 274 (1966), pp. 1354-1360
[21.]
Human Experimentation: When Research Is Evil (Ideas in Conflict Series), G E M/McCuen Publications Incorporated, (1998),
[22.]
M. Ruiz-Canela, J. Irala-Estévez, M.A. Martínez-González, E. Gómez-Gracia, J. Fernández-Crehuet.
Methodological quality and reporting of ethical requirements in clinical trials.
J Med Ethics, 27 (2001), pp. 172-176
[23.]
T. Smith.
Ethics in medical research: a handbook of good practice, 2nd, Press Syndicate of the University of Cambridge, (2001),
[24.]
Guia de recomanacions sobre el consentiment informat, Departament de Sanitat i Seguretat Social. Generalitat de Catalunya, (1997),
[25.]
R.D. Truog, W. Robinson, A. Randolph, A. Morris.
Is informed consent always necessary for randomized, controlled trials?.
N Engl J Med, 340 (1999), pp. 804-807
[26.]
F.G. Miller, D.L. Rosenstein, E.G. DeRenzo.
Professional integrity in clinical research.
JAMA, 280 (1998), pp. 1449-1454
[27.]
R. Wheeler.
One person's innovation is another's experiment.
BMJ, 320 (2000), pp. 1548
[28.]
D.H. Spodick.
Numerators without denominators. There is no FDA for the surgeon.
JAMA, 232 (1975), pp. 35-36
[29.]
J.W. Love.
Drugs and operations. Some important differences.
JAMA, 232 (1975), pp. 37-38
Copyright © 2003. Sociedad Española de Salud Pública y Administración Sanitaria
Download PDF
Idiomas
Gaceta Sanitaria
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?