CRITICAL REVIEW IRIDOLOGIA: REVISÃO SISTEMÁTICA IRIDOLOGÍA: REVISIÓN SISTÉMICA. Léia Fortes Salles 1, Maria Júlia Paes da Silva 2

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1 IRIDOLOGIA: REVISÃO SISTEMÁTICA CRITICAL REVIEW IRIDOLOGÍA: REVISIÓN SISTÉMICA Léia Fortes Salles, Maria Júlia Paes da Silva 2 ABSTRACT This study is a literature review about Iridology/Irisdiagose i the period from 970 to The objective was to idetify the worldwide scietific publicatios (articles) i this field ad the opiios about the method. Twety-five articles were foud, four of them from Brazilia authors. About the category, was literature review, 2 research studies ad 2 updates, historical reviews or editorials. The coutries that have cotributed more with the studies were Brazil ad Russia. Fiftee of those are i favor of the method ad 0 are agaist it. I coclusio, it is ecessary to develop more studies iside the methodological rigor, oce Iridology brigs hope to prevetive medicie. KEY WORDS Iridology. Alterative therapies. Nursig. RESUMO Este estudo é uma revisão de literatura (artigos) o período de 970 a 2005 sobre Iridologia/ Irisdiagose, com o objetivo de idetificar o úmero da produção cietífica mudial esta área e as opiiões sobre o método. Foram ecotrados 25 artigos, sedo quatro de autores brasileiros. Quato à categoria, era revisão bibliográfica, 2 pesquisas e 2 atualizações, históricos ou editoriais. Os países que mais cotribuíram com os estudos foram Brasil e Rússia. Posicioam-se a favor do método 5 artigos e 0 cotra. Coclui-se que é ecessário que sejam realizados estudos com pesquisas detro do rigor metodológico sobre essa prática, uma vez que a Iridologia traz esperaça a área prevetiva. DESCRITORES Iridologia. Terapias alterativas. Efermagem. RESUMEN Este estudio es ua revisió bibliográfica (artículos) durate el periodo de 970 al 2005 co relació a la Iridología/Iris-diagóstico, el objetivo fue idetificar la producció cietífica mudial e el área y coocer el parecer sobre el método. Fuero ecotrados 25 artículos, de los cuales cuatro de autores brasileños. E cuato a la categoría, fue de revisió bibliográfica, 2 producto de ivestigacioes y 2 sobre actualidad histórica y editorial. Los países que más cotribuyero co estudios fuero Brasil y Rusia. Co relació al parecer so favorables al método 5 artículos y 0 está e cotra. Cocluyese que es ecesario realizar estudios co rigor metodológico, pues la iridología brida esperazas detro del área prevetiva. DESCRIPTORES Iridología. Terapias alterativas. Efermería. Nurse. Master i Nursig at School of Nursig, Uiversity of São Paulo. Expert i Iridology ad Irisdiagose at the Faculdade de Ciêcias de São Paulo e Istituto Brasileiro de Estudos Homeopáticos. São Paulo, SP, Brazil. leia.salles@usp.br 2 Nurse. Full Professor at the Medical-Surgical Departmet at School of Nursig, Uiversity of São Paulo (EEUSP). São Paulo, SP, Brazil. juliaps@usp.br Portuguese / Eglish: Salles LF Silva MJP Received: 06/26/2006 Approved: 0/3/

2 INTRODUCTION The health paorama throughout the plaet is alarmig. Traditioal medicie ad healthcare systems have ot maaged to fulfill the eeds of the populatio. Healthcare systems i geeral are slow ad lack fiacial, huma ad material resources. The most moder exams ad the best drugs are difficult for most people to access. Nowadays, people are costatly searchig for alteratives to relieve their pai, without beig too expesive or causig too may side effects. They search for the holistic view, which traditioal medicie does ot provide aymore, sice it became too fragmeted due to its specializatio areas. The latter may be show due to the ever-icreasig search for professioals with specializatios i complemetary therapies. The mai reasos that motivate patiets to search for these therapies are: the search for health promotio ad disease prevetio; because it is beeficial both for the emotioal ad spiritual health; because the effectiveess of covetioal medicie is udetermied or geerally associated to side effects ad risks; ad whe the available traditioal resources for a certai pathological coditio have ot succeeded (). Several healthcare professioals are begiig to study some kid of complemetary therapy that may, together with their origial area, improve the care provided to their patiet. I order to meet this eed, several uiversities have started offerig courses i these areas. Oe of the greatest problems faced by the healthcare professioal who has a specializatio i some complemetary therapy is the resistace of his colleagues, who ofte forget that it is healthy to respect the differeces ad that the duality stads o ad, ot o or. Those who use complemetary therapies defed that these should be used alog with traditioal medicie, ot i substitutio to it. Nurses seem to be flexible regardig this issue. They look forward to learig about such therapies, they recommed them, ad eve use them i their ow healthcare (2). Most of the youg doctors ackowledge complemetary therapies, but they have ot agreed o whether to recommed them or ot, sice the Medicie Regioal Committee does ot ackowledge them. The oly exceptios i this case stad for homeopathy ad acupucture, which have also bee very criticized by the same doctors who are ow tryig to make it their oly expertise (3). I 994, the use of complemetary therapies by urses was studied. This study came to the coclusio that the umber of supporters was too small, which was related to the lack of a legislatio to authorize urses to Those who use complemetary therapies defed that these should be used alog with traditioal medicie, ot i substitutio to it. use them (4). I 997, COFEN ackowledges urses with expertise i complemetary health practices, through the Resolutio 97, sice they complied with the requiremets of the Natioal Educatio Departmet for specializatio courses (5). I 2004, the City Hall of São Paulo posted the implemetatio of Natural Therapies at the Muicipal Health Departmet, such as Irisdiagose, through the law o. 3.77, which reiforced the credibility of the method (6). Nevertheless, there are still few urses who dedicate themselves to these studies. This is a result of the type of traiig received durig udergraduatio, based o the biomedical healthcare model, as well as due to the fiacial resources ecessary for a solid qualificatio i these therapies (7). Irisdiagose is the sciece that reveals physical, emotioal ad metal aspects of a idividual through his iris. The higher the umber of ocoformities foud i the soft tissue of oe s iris, the shorter the vitality ad resistace, thus, the farther this perso will be from his welless. Irisdiagose allows the propaedeutic, prophylactic ad therapeutic approach ad aims maily at detectig disorders i progress ad at their early itervetio, so that such disorders may ot evolve ito a disease (8). The greatest advatage of Irisdiagose stads i the prevetio of diseases, sice eve before the patiet presets ay symptoms, the iridologist is able to detect sigals of ay disorder ad use the ecessary meas to keep the homeostasis of the orgaism, prevetig it from gettig ill (9). The Nursig practice offers healthcare services that are orieted i order to provide care aimed at promotig, protectig, recoverig ad reestablishig health. The urse searches for kowledge i several disciplies, ad absorbs the iformatio eeded for takig care of this patiet (0). For the urse who is a Iridisdiagose specialist, the iris observatio ad aalysis must be part of the cliical exam; I additio, its result must guide the ursig process, sice it costitutes oe more tool to get to kow the patiet/cliet (). There are Brazilia researchers who share this opiio (2). Despite of beig a multidiscipliary ad relatively ew sciece, Iridology does ot provide a diagosis, but cotributes to the holistic view of the Beig. We are still takig the first steps, but everythig idicates that, i associatio with the patiet s complaits ad the physical exam, Iridology will exceptioally help Nursig to guide the patiet approach more idividually, thus improvig the quality of care (2). Authors also state that prevetive medicie is a great opportuity for Ma to improve as a species, sice good 586 Salles LF Silva MJP

3 habits geerate health ad this gaied health will be trasmitted from geeratio to geeratio (3). Prevetio is the medicie of the future, ad the healthcare expeses will brig better results tha those made towards the disease. It is exactly i the prevetive medicie that lays the secret for good health, i all aspects, geeratig logevity ad better coditios ad quality of life (3). The mai purpose of Iridology is the prevetio. What happes is that the opiios about the method are divided. This article aims at gatherig what has bee writte about Iridology/Irisdiagose i scietific articles so far, ad at describig the opiios about the method. METHOD This is a descriptive, exploratory study with a quatitative approach. It was carried out through a literature review, usig the followig databases: EMBASE, PubMed/ MEDLINE, LILACS, PeriEf ad the Bibliographical Database of USP - DEDALUS. The descriptors used for fidig the refereces were Iridologia (DeCs), Iridology (MeSH). The iclusio criteria for this aalysis were: Publicatio type: articles i jourals. I ay laguage, but with the abstract i Eglish, Portuguese, Spaish or Frech. Publicatio year: period from 970 to Articles with a abstract. Exclusio criteria were: Articles without a abstract or with a abstract i ay laguage other tha Eglish, Portuguese, Spaish or Frech. Articles that approached several complemetary therapies, but ot Iridology specifically. This last item was cosidered a exclusio criterio because the authors believe that whe someoe decides to aalyze a subject, this perso must kow it well, ad articles citig all kids of complemetary therapies are certaily ot compatible with this thought. RESULTS AND DISCUSSION A total of 50 articles idexed with the words iridologia/ iridology were foud i the databases. After the evaluatio of the iclusio criteria - articles with a abstract ad specifically about iridology - the study had oly 25 articles, which will make up the results of this study. As Table illustrates, 25 publicatios were foud i jourals. Oly was a systematic review out of this total; 2 were research studies ad 2 were i editorial, updatig or historical text categories. The coutries that cotributed with publicatios were Brazil, Russia, Eglad, Frace, The Uited States of America, South Korea, Demark, Germay, Switzerlad, Australia, New Zealad, Ukraie, Chia ad Romaia. Regardig the opiios, 0 articles were foud to be agaist the method, ad 5 were favorable, as it is observed o Table 2. Table - Distributio of articles about Iridology, accordig to the origi coutry ad article category - São Paulo Study Category Scietific Research Literature Review Updatig/ Editorial/ Historical TOTAL Coutry Brazil Russia Eglad Frace U.S.A South Korea Demark Germay Switzerlad Australia New Zealad Ukraie Chia Romaia TOTAL Salles LF Silva MJP 587

4 Table 2 - Distributio of opiios (favorable/agaist) about the articles o Iridology, accordig to their category - São Paulo CATEGORY Research Review Updatig/historical/ editorial Total OPINION Agaist Favorable TOTAL The oly systematic review article about Iridology was writte i 999, by Erest E., from Eglad. It has bee the target of a discussio published by a Frech Ophthalmology joural, which teds to agree with the coclusios of the first article, eve though it is difficult to evaluate the situatio ad come to coclusio, sice there are few studies about the subject. It also highlights that Iridology has bee substatially growig ad that ew studies about the method are eeded. This review was based o oly 4 literatures, eve though the Frech article states that 67 articles about Iridology s reliability had already bee published by 998. Most of them are favorable to the method, but there is oe questioable methodology ad 4 articles agaist it, with a uobjectioable research i the methodological pla. A Russia article shows the growig use of Iridology by urses ad ophthalmologists ad the eed for updatig, i order to achieve a greater kowledge about the method. Most of the articles whose opiios about the method were egative, state that Iridology has ot bee cosidered capable of makig a diagosis. However, those who kow the method also kow that Iridology does ot provide diagoses, but shows which orgas are most weakeed ad more likely to fall ill. After this pre-diagosis, the patiet must still ru exams i order to come to the coclusio of the diagosis. A larger amout of publicatios was observed from 2000 o, as illustrated o Table 3. This statemet coicides with the world sceario of a icreasig search for complemetary therapies. Table 3 - Distributio of articles o Iridology accordig to the year they were published - São Paulo Opiio Agaist Favorable Total Year o. o. o TOTAL Amog the resources used, the Bibliographical Database at USP - DEDALUS ad the PeriEf database were the oes that mostly cotributed for the search i the atioal literature, sice atioal articles are ot idexed at PubMed/MEDLINE ad EMBASE. Out of these four Brazilia articles, three were writte by urses ad oe by a physicia. Three had bee published o the Nursig Magazie Brazilia editio, ad idexed i the LILACS database, uder the title Nursig (São Paulo); ad oe had bee published o the Homeopathy Magazie, as Table 4 idicates. Table 4 - Distributio of Brazilia articles o Iridology, accordig to the source ad publicatio period - São Paulo Period Total Source o. o. o. o. Nursig (São Paulo) Homeopathy Magazie TOTAL Salles LF Silva MJP

5 I Brazil, the oly specializatio course i Iridology ad Irisdiagose for healthcare professioals is provided by the Istitute of Homeopathic Studies, i associatio to the Uiversity of Scieces of São Paulo. It is evidet that the Brazilia Nursig service is observig ew tedecies, as lecturers are ivited to talk about Iridology i ursig uiversities ad techical schools, cofereces, joureys ad semiars, ot to metio the space offered recetly by atioal ursig jourals for the subject. CONCLUSION Therefore, this study evideces that the literature about the subject is scarce. Amog the studies that were foud, oly half of them were based o research studies, although ot always with a appropriate methodology. The oly review about the subject is based uiquely o four literatures. However, the subject is real, ad divides opiios. Iridology brigs hope for the curret healthcare sceery, ad prevetive medicie must be reiforced. Thus, ew studies about the subject are eeded serious studies, which show whether the method is efficiet or ot. It is ot acceptable for itolerace to prevail over the real eed to improve the care provided to patiets. Moreover, if this method is efficiet, it must be icluded as a tool to add up to traditioal medicie, like may other complemetary practices already do, ad do it well. REFERENCES. Eiseberg DM, Kessler RC, Foster C, Norlock FE, Calkis DR, Delbaco TL. Ucovetioal medicie i the Uited States: prevalece, costs, ad patters of use. N Egl J Med. 993; 328(4): Trovo MM, Silva MJP, Leão ER. Terapias alterativas/complemetares o esio público e privado: aálise do cohecimeto dos acadêmicos de Efermagem. Rev Lat Am Eferm. 2003;(4): Akiyema K. Práticas ão-covecioais em medicia o Muicípio de São Paulo [tese]. São Paulo: Faculdade de Medicia, Uiversidade de São Paulo; Barbosa MA. A utilização de terapias alterativas por efermeiros brasileiros [tese]. São Paulo: Escola de Efermagem, Uiversidade de São Paulo; Coselho Regioal de Efermagem de São Paulo (CORE- SP). Documetos básicos de efermagem. São Paulo; 200. p São Paulo (Cidade). Lei 3.77, de 08 de Jaeiro de Dispõe sobre a implatação das terapias aturais a Secretaria Muicipal de Saúde [legislação a Iteret]. São Paulo; [citado 2005 ago. 0]. Dispoível em: egocios_juridicos/cadlem/pesqumero.asp?t=l&=377 &a=&s=&var=0 7. Dobbro ERL. A música como terapia complemetar o cuidado de mulheres com fibromialgia [tese]. São Paulo: Escola de Efermagem, Uiversidade de São Paulo; Batello CF. Iridologia e Irisdiagose: o que os olhos podem revelar. São Paulo: Groud; Salles LF. Epidemiologia dos aéis de tesão [moografia]. São Paulo: Istituto Brasileiro de Estudos Homeopáticos - IBEHE; Fuerst EV, Wolff LV, Weitzel MH. Fudametos de efermagem. 5ª ed. Rio de Jaeiro: Iteramericaa; Salles LF, Silva MJP. A icidêcia dos aéis de tesão a íris de pessoas que vivem em São Paulo. Nursig (São Paulo). 2004;8(8): Regai EC. A Iridologia como istrumeto facilitador o processo de efermagem. Nursig (São Paulo). 999;2(2):8. 3. Berighs L. Vida saudável pela Iridologia. São Paulo: Robe; 997. Correspodece addressed to: Léia Fortes Salles A Rua systematic Tucua, review Apto Pompéia Salles CEP LF Silva MJP- São Paulo, SP, Brazil 589