Practice guidelines that may kill

The mission of our Journal and our movement is to privilege the patient over the disease. We hold that the patient represents the ever changing reality facing the provider. The disease is a theoretical construction that allows the provider to categorize and approach different illnesses [1]in the ever changing patient landscape. To pursue our mission, we face an uphill battle as we defy the trend of a time enamored with technology. This ‘‘high tech, low touch’’ society aims to bypass the pain of the human interactions, to ignore the discomfort of confronting a mystery in every human encounter. We do hold that life is a mystery in its original sense. The Latin Mysterium indicated a rite that allowed humankind to achieve an immediate (without mediators) experience of the deity, that is of the reality in its entirety. By saying that human life is a mystery we state that it is a living reality, self-evident, that cannot be circumscribed by words, cannot be conceptualized but only can be lived. The hallmark of this living experience is a kaleidoscope of sentiments moving and interacting on a background of intertwined joy and suffering. That includes the pain of growing, of delivering a continuously renewed human being and the joy that follows a parturition and any other difficult accomplishment. Human cloning is perhaps the ultimate aspiration and ambition of a ‘‘High Tech’’ culture. With human cloning, the high tech society hopes to eliminate suffering by creating the healthiest, most handsome, most intelligent and most successful human beings in the delusion that these produces of technology may defeat disappointments, diseases, and death, that thanks to genetic manipulations human growth may be made painless. Has anybody ever mentioned to clone Jesus Christ, or Francis of Assisi, or Luther, or Gandhi, or any world leader who has offered to carry other people’s pain, as ‘‘a lamb led to the slaughter’’, to offer his/her suffering or death for the salvation of many? High tech society’s final hope is to dispense with sacrifice, that is to dispose of love. Sacrifice means to make oneself ‘‘sacred’’ that is reserved to the service of another person. As such it is the basic ingredient of love. Human cloning may represent a fictional manifestation of an all too real goal: to eliminate the disconcert of dealing with the individual mystery of each person, of facing a reality that cannot be predicted by a mathematical model and crystallized on a computer screen. Nowadays both patient and physician share this aspiration and the result is a very expensive medical practice in which 99 % of the time is spent in obtaining imaging and laboratory tests. In this issue of JMP Ricci and collaborators denounce the lack of reliability of an instrument enshrined in modern medical practice: the practice guidelines [2, 3]. The authors review the guidelines issued by different organizations toward the management of the same disease and reveal their inconsistency. In most cases, they also reveal the absence of any scientific evidence in support of these guidelines. This is a type of study that we would like to report more often in our journal, because it is germane to our mission. In general, we would like for more authors to ask to what extent medical technology is at the service of the person, or has assumed a life on its own that may work against the person. Few years ago in Asuncion, I attended a meeting of the Sociedad Sur Americana de Medicina Interna. A Brazilian epidemiologist described very effectively the scourge of cervical cancer that is the number one killer of women in developing countries. She emphasized several prevention modalities that included vaccination against HPV, L. Balducci (&) Moffitt Cancer Center, Tampa, FL, USA e-mail: lodovico.balducci@moffitt.org