Bioethics, medicines, interests conflict and quality controlThe article analyzes the problems of pharmaceutical advertising that distorts, exaggerates or hides certain information (side effects of drugs), as well as the work of pharmaceutical sales  representatives, the problem of drugs’ risk, marketing authorization, access to drugs, therapeutic practice, conflicts of interest, and quality control in medicine. These issues have a greater importance in public health; since the lack of respect for the fundamental principles of bioethics (benefit, not harm, autonomy and consent) has a direct impact on the health of the population. / El artículo analiza la problemática de la publicidad farmacéutica que deforma, exagera o esconde ciertas informaciones (efectos secundarios de los medicamentos), así como la labor de los visitadores médicos, el problema del riesgo medicamentoso, la autorización de comercialización, el acceso a los medicamentos, la practica terapéutica, los conflictos de intereses y el control de calidad en medicina. Estos temas tienen una importancia mayor en salud pública, ya que el no respetar los principios fundamentales de bioética (beneficencia, no maleficencia, autonomía y consentimiento) incide directamente sobre el estado de salud de la población

L’étude d’un centre de soins énergétiques montréalais offrant un rituel de guérison révèle le besoin de composantes symboliques dans l’expérience de guérison. À partir de l’expérience rituelle et de la subjectivité des participants, mes objectifs seront de comprendre les raisons et les besoins d’une telle quête thérapeutique dans le contexte de la société québécoise. Dans cette perspective, je m’interroge sur la production de sens qui émane de représentations symboliques étrangères à la culture québécoise (chamanisme et alchimie) et ses répercussions sur l’expérience de guérison. Ces formes de subjectivités et d’actions thérapeutiques affirment une quête de sens face à la maladie que la communauté médicale ne peut soutenir. Dans cette quête de sens face à la maladie, le rituel du cercle de guérison s’impose comme une activité symbolique où le sujet, individuel ou collectif, met en scène son image, son identité et ses valeurs. Cet espace thérapeutique fournit une forme d’agentivité et un lieu pour remettre en question l’autorité médicale. J’examinerai donc le contexte et les raisons pour lesquels les gens se tournent vers ce type de soins, le symbolisme de la guérison et la place du rituel dans l’imaginaire des participants. En élucidant le contexte culturel et le sens que prend le rituel dans la vie des participants, je pourrai illustrer les opérations symboliques menant à la construction des expériences de guérison. / The study of an energetic cares center who is offering a healing ritual in Montreal reveals the need of symbolic components in the healing experience. Starting with ritual experiences as well as subjectivities of individuals, the aim of this presentation is to understand the needs and the meanings of such therapeutic itineraries in the context of contemporary Quebec. The growing popularity of alternative medicine such as neo-shamanic healing circle reveals the needs of symbolic components in the experience of healing. From this perspective, I’m questioning how these individuals can make sense of symbolic representations coming from different cultures (shamanism, alchemy). What are the meanings of the symbolic dialogue and his repercussion in the healing experiences? These forms of subjectivities and transformative actions affirm a meaning quest of illness that the biomedical community cannot provide. The ritual of healing circle is imposing himself has a symbolic activity allowing the subject to affirm his image, his identity and his values within an embodied transformative experience. This type of cares also provides a form of agentivity and a space to question the biomedical authority. I am going to examine the context in which people are turning to such care, the mechanism of transformation at work, as well as the role of the ritual in the imaginary of the participants. By shedding light on the cultural context and the meanings of the ritual for the participants, I will illustrate the symbolic operations leading to healing experiences.

Traditional Birth Attendants (TBAs) are the primary health care providers for women at the time of childbirth in many parts of the world. In India, particularly in remote areas such as Garhwal, these women play a key role in maternal health. Training programmes for TBAs can lead to dramatic reductions in neonatal mortality as well as in maternal morbidity and mortality, due to improved hygienic practices at the time of delivery. Yet training programmes for TBAs often lack sociocultural relevance, and fail to incorporate an understanding of the TBAs' perceptions of the process of pregnancy and delivery. Understanding more about the role of the TBA as a diagnostician and a decision-maker within a given sociocultural context can make such training programmes more culturally congruent. This research report describes the way in which TBAs (dais) in Garhwal interpret obstetrical complications, and how they make decisions regarding the need for cosmopolitan medical care. TBAs in Garhwal interpret obstetrical complications using a variety of explanatory models, arising from an understanding of health and illness which shows influences of Vedic, Ayurvedic, folk and cosmopolitan medical models. These explanatory models often led to a perception of "danger” and the "dangerous case" which is widely divergent from the cosmopolitan medical model. Specific areas are identified where the dais' interpretation of "danger" was particularly divergent from the cosmopolitan medical model. These areas of conceptual conflict result in diagnoses and treatment procedures which can lead to significant delays in the woman receiving needed cosmopolitan medical care. The third stage of action-research process is the development of a participatory training programme, in which the TBA is an active participant. The aim of the training programme is to move towards a shared perception of risk regarding major obstetrical complications. / Thesis / Master of Arts (MA)