Uma homenagem a Leonardo Lotufo

Leonardo Lotufo, meu tio-avô foi dirigente várias vezes do então Palestra Itália e, depois do Palmeiras. Dirigiu o Conselho do clube quando houve a mudança de nome. Ao contrário do que ocorre hoje, pessoas com posse - ele era proprietário da NeoBrasil, empresa de luminosos - junto com outro palestrino compraram o passe de Jair Rosa Pinto para o time do Palmeiras, agora reconhecido como Campeão Mundial. Como meu tio disse uma vez, a Copa Rio foi a redenção brasileira, não somente paulista ou palmeirense depois do fracasso da Copa do Mundo de 1950

Turistas, não o filme, mas a realidade dos transplantes no Paquistão, India e Filipinas

Estarrecedora essa mensagem da Reuters mostrando o aumento do turismo de transplante. O relato é da Organização Mundial da Saúde. No Paquistão há local onde há uma proporção considerável de habitantes somente com um rim. O preço é 2500 dólares, mas pouco fica com o doador.

Já tinha ouvido muito a respeito, mas essa informação é das mais documentadas.

Interessante o nosso mundo atual: O Paquistão gasta dinheiro formando médicos (e, dos bons), a Filipinas gasta outro tanto com enfermeiras. Ambos profissionais não ficam em seu país e, vão para os Estados Unidos, Canadá e Europa. Em troca, pacientes americanos e europeus recebem rins de paquistaneses e filipinos. Bem, os cubanos não têm nada a ver com a história.

Transplant tourism" on rise due to donor shortages
Fri Mar 30, 2007 1:50pm ET By Laura MacInnis GENEVA (Reuters) - "Transplant tourism" is on the rise because organ donations are not keeping up with growing demand, especially for kidneys, the World Health Organization (WHO) said on Friday. The United Nations agency said it was concerned about a rise in cases where people in countries such as Pakistan, Egypt and the Philippines were persuaded to sell their body parts to outsiders, mostly through a broker. The practice has increased over the past decade, said Luc Noel of the WHO's health technology and pharmaceuticals unit. We believe 5 to 10 percent of all kidneys transplanted were in 2005 transplanted in this setting," he told a news conference in Geneva, home to the WHO's headquarters. Transplantation is increasingly regarded as the best solution to end-stage organ failure, according to the WHO. Jeremy Chapman, a physician at Westmead Hospital in Sydney, Australia, said medical advances in transplantation surgery have resulted in surging demand from those needing new kidneys, livers, hearts, corneas and bone marrow. Long waiting lists for organs from cadavers have caused frustrated patients to look overseas for new sources, he said. The wealthy, in search of their own survival, will sometimes seek organs from the poor," Chapman said after experts convened by the WHO recommended stricter organ donation and transplantation rules to confront the practice. Farhat Moazam of the Sindh Institute of Urology and Transplantation in Karachi, Pakistan, said increasing numbers were traveling to her country to buy kidneys. "There are villages that are in the poorer parts of Pakistan where as many as 40 to 50 percent of the population of the village we know only has one kidney," Moazam told the briefing. She said donors are often promised as much as 150,000 rupees ($2,500) for an organ but may only get a fraction of that after brokers' fees and associated medical costs are paid. It is possible for healthy individuals to donate organs and tissues which they can live without, such as a kidney, part of the liver, blood or bone marrow. Living donations regularly take place in developed countries, most often between relatives. Noel said many of those who sell their organs and tissues do not receive adequate follow-up medical care, increasing their health risks.

Enfermeiros estrangeiros nos EUA: bom para quem recebe, mal para quem envia.

The American Journal of Public Health publica artigo original onde verifica a tendência e qualidade do enfermeiro vindo de outro país. Em uma década, aumentaram de 8,8% para 15,2%. Na maioria com formação muito boa e adequada.

Sempre tive dúvidas porque as escolas de enfermagem, quando existem e, não meros departamentos da escola médicas, são relativamente fracas. Descobri há dez anos que eles não precisam gastar com a formação de enfermeiros, compram fora. Essa tendência está aumentando e, nós precisamos ter o cuidado para não sermos também um celeiro de enfermeiros para os EUA. E, depois importarmos enfermeiros cubanos semi-escravos.

Trends in Skills and Country of Origin Among Foreign-Trained Nurses in the United States, 1990 and 2000
Daniel Polsky , Sara J. Ross , Barbara L. Brush Julie Sochalski
Objectives. We describe long-term trends in the characteristics of foreign-trained new entrants to the registered nurse (RN) workforce in the United States. Methods. Using the 1990 and 2000 US Census 5% Public Use Microdata Sample files, we compared trends in characteristics of US- and foreign-trained new entrants to the RN labor force (n=40827) and identified trends in the country of origin of the foreign-trained new entrants. Results. Foreign-trained RNs grew as a percentage of new entrants to the RN workforce, from 8.8% in 1990 to 15.2% in 2000. Compared with US-trained RNs, foreign-trained RNs were 3 times as likely to work in nursing homes and were more likely to have earned a bachelor’s degree. In 2000, 21% of foreign-trained RNs originated from low-income countries, a doubling of the rate since 1990. Conclusions. Foreign-trained RNs now account for a substantial and growing proportion of the US RN workforce. Our findings suggest foreign-trained RNs entering the United States are not of lower quality than US-trained RNs. However, growth in the proportion of RNs from low-income countries may have negative consequences in those countries

The Lancet: compra a briga com Blair por causa do Iraque.

Richard Horton, editor do The Lancet, não aguentou os ataques aos artigos publicados sobre a guerra do Iraque vindos do governo britânico. Whitehall não gostou do número: 650 mil civis mortos no Iraque. Ontem, no The Guardian, ele respondeu em texto reproduzido na íntegra. Fez uma associação com o fim dos 200 anos da abolição da escravatura e tráfico pelos ingleses.
Our collective failure has been to take our political leaders at their word. This week the BBC reported that the government's own scientists advised ministers that the Johns Hopkins study on Iraq civilian mortality was accurate and reliable, following a freedom of information request by the reporter Owen Bennett-Jones. This paper was published in the Lancet last October. It estimated that 650,000 Iraqi civilians had died since the American and British led invasion in March 2003.
Immediately after publication, the prime minister's official spokesman said that the Lancet's study "was not one we believe to be anywhere near accurate". The foreign secretary, Margaret Beckett, said that the Lancet figures were "extrapolated" and a "leap". President Bush said: "I don't consider it a credible report".
Scientists at the UK's Department for International Development thought differently. They concluded that the study's methods were "tried and tested". Indeed, the Johns Hopkins approach would likely lead to an "underestimation of mortality".
The Ministry of Defence's chief scientific adviser said the research was "robust", close to "best practice", and "balanced". He recommended "caution in publicly criticising the study".
When these recommendations went to the prime minister's advisers, they were horrified. One person briefing Tony Blair wrote: "Are we really sure that the report is likely to be right? That is certainly what the brief implies?" A Foreign and Commonwealth Office official was forced to conclude that the government "should not be rubbishing the Lancet".
The prime minister's adviser finally gave in. He wrote: "The survey methodology used here cannot be rubbished, it is a tried and tested way of measuring mortality in conflict zones".
How would the government respond? Would it welcome the Johns Hopkins study as an important contribution to understanding the military threat to Iraqi civilians? Would it ask for urgent independent verification? Would it invite the Iraqi government to upgrade civilian security?
Of course, our government did none of these things. Tony Blair was advised to say: "The overriding message is that there are no accurate or reliable figures of deaths in Iraq".
His official spokesman went further and rejected the Johns Hopkins report entirely. It was a shameful and cowardly dissembling by a Labour - yes, by a Labour - prime minister.
Indeed, it was even contrary to the US's own Iraq Study Group report, which concluded last year that "there is significant underreporting of the violence in Iraq".
This Labour government, which includes Gordon Brown as much as it does Tony Blair, is party to a war crime of monstrous proportions. Yet our political consensus prevents any judicial or civil society response. Britain is paralysed by its own indifference.
At a time when we are celebrating our enlightened abolition of slavery 200 years ago, we are continuing to commit one of the worst international abuses of human rights of the past half-century. It is inexplicable how we allowed this to happen. It is inexplicable why we are not demanding this government's mass resignation.
Two hundred years from now, the Iraq war will be mourned as the moment when Britain violated its delicate democratic constitution and joined the ranks of nations that use extreme pre-emptive killing as a tactic of foreign policy. Some anniversary that will be.
· Richard Horton is a doctor and the editor of the Lancet

Ministra Matilde: uma proposta

Prezada Ministra, acho que você já recebeu muitas pedradas pelo que disse, não disse e, que acharam que dissera. Agora, passada a tempestade, recomendo em prol da redução das desigualdades de cor, raça e etnia que solicite três audiências:

(1) ao ministro Paulo Bernardo (Planejamento), solicitando que pare de implicar com a área da saúde e retire os entraves á regulamentação da emenda constitucional número 29 e, repor o valor devido à Saúde com o novo cálculo do PIB;

(2) ao ministro Tarso Genro (Justiça), explicando que a repressão à violência interessa muito mais ao pobres e negros do que ao ricos e brancos, como muitos no governo federal adoram falar;

(3) ao seu chefe, sua Excelência, o Presidente da República para que entre para a história reduzindo a diferença de mortalidade entre negros, pardos e pretos. Para tanto, basta ordenar aos seus dois colegas de cima que parem com essas estultícies em relação à saúde e à segurança pública.

Veja, então o exemplo americano que a senhora tanto gosta. Afinal, a senhora adota o "one drop rule", (que eu particularmente abomino, mas respeito sua opinião). Esse foi o mote de um post editado nesse blogue na semana passada: JAMA publica estudo mostrando a evolução da mortalidade entre brancos e negros. Há uma redução na diferença de mortalidade entre os homens devido a redução da mortalidade por aids, traumas em geral e homicídios entre o negros. Entre as mulheres por causa das doenças cardiovasculares entre as negras.

Coragem para contestar os stents e sua indústria.

Na sessão da American College of Cardiology, que se encerra hoje, houve a apresentação de vários estudos novos, um deles chamado COURAGE. Esse estudo avaliou 2287 pacientes com angina do peito para comparar se angioplastia com stent não farmacológicos é superior ao tratamento convencional com medicamentos. Houve uma leve vantagem para o tratamento clínico, ou seja não há porque indicar angioplastia nessa situação. O texto completo está em http://www.nejm.org Abaixo segue um reportagem muito esclarecedora do The New York Times com a repercussão do estudo. Um pouco antes, a Boston Scientific que produz o Taxus - stent farmacológico - aproveitou-se da situação para lançar a idéia que o problema do estudo foi que somente 3% dos participantes teriam usado o seu produto.

By BARNABY J. FEDER Published: March 28, 2007 NEW ORLEANS, March 27 — Is today the first in a new era for angioplasty and stenting, the artery-clearing technology that enchanted doctors while giving birth to a multibillion-dollar industry? Many heart specialists at the annual scientific meeting here of the American College of Cardiology said it ought to be, based on a report Monday that found little additional value in giving stents to most heart patients as long as they received the right medicines. “We were amazed at how well people did with medical therapy,” said Dr. William Weintraub, chief of cardiology at the Christiana Care Health System in Newark, Del., who is leading the analysis of the economic and quality of life data from the trial. The trial focused on patients with severe constrictions in their arteries that were causing angina chest pains or other symptoms but were not immediately life-threatening. Device makers and some doctors, however, doubted that the trial would have broad impact. They noted several reasons to question the results, starting with the fact that only 3 percent of the stented patients in the trial received the latest drug-coated models. Those models were just reaching the market when enrollment in the study ended in 2004.
Whether the trial results lead to a change in the use of stents depends on how the doctors and patients react. In any event, the research comes as sales have already been dropping because of safety concerns.
Estimates from doctors and analysts of the number of stent patients whose conditions resembled those in the trial ranged from 20 percent to as much as 80 percent. Marshall Gordon, who follows device makers for Credit Suisse Securities in New York, said that in conversations with cardiologists, 30 percent to 40 percent of them said they would recommend less angioplasty. But, he cautioned, it was too soon to know how the practice would unfold. Dr. Salim Yusuf, a Canadian cardiologist who has argued that stents are overused, questioned how much impact the study would have. “We’re going to have a hell of a time putting the genie back in the bottle,” Dr. Yusuf said to the researchers gathered Tuesday. “It’s a $15 billion to $20 billion industry. You have huge vested interests that are going to push you back.” Dr. Yusuf was referring not just to device makers but also to interventional cardiologists, the specialists who do angioplasty and stenting. The technology was born 30 years ago when Dr. Andreas Gruentzig first used a catheter threaded into a coronary artery to inflate a tiny balloon inside a developing blockage. The arrival of a minimally invasive alternative to bypass surgery for restoring blood flow to ailing hearts led to a rush of investment in device companies. Small fortunes were made in the mid-1990s when stents were invented in response to angioplasty’s biggest shortcoming — the tendency of arteries to quickly reclose. Those fortunes became giant ones when drug-coated stents were introduced in the United States in 2003, sending the number of patients returning for repeat procedures below 10 percent. The Taxus stent from Boston Scientific, which arrived in 2004, achieved more sales in its first year than any health care product in history. By last year, more than 60 percent of the patients getting stents had more complex blockages than those the drug-coated stents had been tested on in clinical trials, according to federal regulatory officials. Then reports began emerging that deadly clots could form in the drug-coated stents long after implantation. Sales began dropping on uncertainty about the stents’ safety even though the data showed that the problem affected only a handful of patients out of every thousand. The available data, which some doctors say is inadequate, suggests that the clotting is not frequent enough to make the new stents less safe than the older bare-metal devices they have largely supplanted. A decline in sales last year reflected some switching to the cheaper bare-metal stents, but by the end of the year, the total number of procedures was falling for the first time. Now the question is whether the new trial data will accelerate the decline and make it harder for the companies to reverse with new products that might be safer. Medical therapy — which to cardiologists means a combination of modern drugs, exercise, healthy diets and almost anything else that does not break the patient’s skin — was so successful at relieving angina that Dr. Weintraub and others said angioplasty should be used as a fallback, after the drug treatments failed in patients like those in the trial. In common practice, many such patients get angioplasty and stents because they are sent to interventional cardiologists for angiograms — X-rays of the blood vessels sustaining the heart muscle. The angiogram requires inserting a thin catheter to deliver a dye to the arteries being pictured. Because the same system is used to deploy the tiny angioplasty balloons that create channels through blockages and then to implant stents to prop the vessel open, interventional cardiologists often do such procedures immediately after a major blockage is identified. “It’s very difficult to turn your back on the angiogram and not fix what’s there,” Dr. William Boden, a lead investigator in the trial, said. Yet that is exactly what the trial results suggest that doctors could safely do in patients like those studied. Two-thirds ended up not needing angioplasty and stents. The one-third whose symptoms worsened to the point that they underwent stenting or bypass surgery did not suffer higher rates of death, heart attacks or hospitalization if stenting was delayed to try aggressive medical therapy first, the trial found. In the trial, patients who received angioplasty and stents got quicker and more complete relief initially. By the end of five years, 74 percent of that group and 72 percent of the patients assigned to the medical therapy group had no symptoms of the chest pains — in essence, statistically speaking, an identical outcome. Dr. Weintraub said on Monday that the trial data suggested that the cost of gaining an additional year of improved quality of life from stenting came out to $217,000 a patient, because so many patients gained nothing. That data, however, covered such a broad range of individual outcomes that he cautioned against relying too much on it. More notably, he said, the data suggested that 1 percent of stenting patients gained an additional year of improved quality of life for less than $50,000, a commonly used standard for whether medical resources were being used wisely. But all of the researchers stressed that angioplasty with stenting was still the preferred therapy for many less-stable patients. Some doctors said they were worried that patients reading about Courage, as the new study is called, might get the wrong impression. “If someone comes in with a heart attack, you could lose vital time having to convince a patient or family member it’s appropriate,” Dr. Ralph Brindis, a cardiologist in San Francisco, said

O boicote à vacina contra a pólio na Nigéria.

Na Plos Medicine desse mês há um relato muito interessante sobre o boicote à vacinação contra a poliomielite em cinco estados da região norte da Nigéria. O tema é interessante para verificar que não bastam recursos financeiros, mas sim uma rede mínima - social, política, cultural - para permitir políticas de saúde pública.

O texto completo está em http://medicine.plos.org. Abaixo, um resumo.

Community Prevent Further Boycotts?
The vaccine boycott in Nigeria was influenced by a complex interplay of factors. These factors included lack of trust in modern medicine, political and religious motives, a history of perceived betrayal by the federal government, the medical establishment, and big business, and a conceivably genuine—albeit misplaced and ineffective—attempt by the local leadership to protect its people. A recent editorial in The Lancet argued that “few data exist on the best way to stop the spread of false information” . One lesson from the Kano boycott is that research is needed to investigate why people have concerns and fears about vaccination, and what steps should be taken to avoid boycotts in the future. Other lessons are discussed below.
Governments should be sensitive to local politics, especially as they affect health-care delivery
Immunization campaign programs should be a participatory event involving state and local governments, community leaders, and parents. There are three types of community leaders in northern Nigeria—traditional rulers, political leaders, and religious leaders. Traditional rulers acquire their status through succession and their authority is rooted in traditions and customs [40–42]. Political leaders acquire their status through the political process and religious leaders do so on a religious basis. Among the three, the traditional ruler is best placed to represent the interests of children. Community leaders may contribute to the success or failure of health research and delivery .
Public awareness campaigns about vaccination are crucial.
These should stress the value of immunization and involve the media. Reaching the community requires radio, television, and folk media (such as local music, theatre, and festivals). Immunization messages can be packaged into songs by local musicians and can be communicated through drama in the language that local people understand.
Research ethics committees should be established in each local government.
These committees would examine and approve or reject health research in its sphere of influence. Members of these community-based ethics committees should include volunteers who are ready to undergo basic ethics training relevant to their duties. The committees should be under the supervision of, and funded by, the local government's councils, and the committees should work with local medical associations. They should choose their own chairperson and determine their own agenda in line with the national ethics code. Barriers to the formation of local ethics committees include inadequate capacity, funding, and communication.

A decisão do STJ: vitória ou derrota do consumidor de planos de saúde?

A decisão do Supremo Tribunal de Justiça que cabe somente ao médico e, não ao plano de saúde decidir medidas diagnósticas e terapêuticas é um entendimento que poderá ser tornar jurisprudência. Assim interpretam a decisão, as entidades de defesa do consumidor. A Agência Nacional de Saúde Suplementar minimizou o caso, considerando com um problema restrito aos planos antigos.

Minha opinião é que a participação dos planos de saúde e seguros-saúde deve ser novamente discutida dentro da lógica do Sistema Único de Saúde, onde o nome já diz tudo, representam um setor "suplementar". Continuo defensor ardoroso que esses planos deveriam atuar somente nos setores de atenção básica e secundária (consultas, cirurgias simples, gravidez e parto) e, o tratamento do câncer, transplantes e terapia intensiva ficaria em hospitais públicos ou então em hospitais particulares, para que a "minoria branca de Claudio Lembo" possa se tratar. Qual a vantagem da minha proposta? Haveria aumento real e, não fictício da cobertura à assistência médica porque esses planos poderiam oferecer propostas acessíveis ao orçamento familiar e, principalmente das empresas que manteriam como benefício trabalhista. Com isso haveria um desafogo do pronto-socorros e hospitais públicos que poderiam se dedicar aos procedimentos que exigem maior implementação tecnológica. A pergunta do título vem da possibilidade de que premido cada vez mais pelo alto custo, as seguradoras deixem o mercado de saúde.

Casa Branca 2008: cobertura universal à assistência médica

A disputa presidencial americana no próximo ano terá como tema, assistência médica, mais especificamente a ampliação da cobertura restrita atual para o atendimento universal. Essa questão candente foi discutida com os candidatos potenciais à Casa Branca, mas somente os democratas compareceram. Todos concordam que é um imperativo do momento atual americano, mas poucos explicitam que haverá aumento de impostos. Essa questão é tão importante, que governos estaduais estão se adiantando à legislação federal. Hillary Clinton é que mais pode falar, afinal foi destroçada há doze anos quando no governo de seu marido tentou abordar o tema. Abaixo, trecho da reportagem do The New York Times.

LAS VEGAS, March 24 — Seven Democratic candidates for president promised Saturday to guarantee health insurance for all, but they disagreed over how to pay for it and how fast it could be achieved.
Senator Barack Obama of Illinois said Saturday that he would develop a plan that would provide health care insurance for all by January 2013. Senator Hillary Rodham Clinton of New York assailed the health insurance industry and said she would prohibit insurers from denying coverage or charging much higher premiums to people with medical problems. John Edwards, the former senator from North Carolina, offered the most detailed plan for universal coverage, saying he would raise taxes to help pay the cost, which he estimated at $90 billion to $120 billion a year. Senator Barack Obama of Illinois appeared less conversant with the details of health policy and sometimes found himself on the defensive, trying to explain why he had yet to offer a detailed plan to cover all Americans. “The most important challenge is to build a political consensus around the need to solve this problem,” Mr. Obama said. Gov. Bill Richardson of New Mexico offered a potpourri of ideas to achieve universal coverage, including tax credits to help people buy insurance and an option to let people ages 55 to 64 buy coverage through Medicare. To help pay for his proposals, Mr. Richardson said, he would “get out of Iraq” and redirect money from the military to health care. The candidates spoke at a forum on health care at the University of Nevada, Las Vegas, sponsored by the Service Employees International Union and the Center for American Progress Action Fund, a liberal advocacy group. Sponsors of the forum said they had also invited Republican candidates, but none attended. Health care is emerging as a top issue in the 2008 presidential race, as businesses join consumers in demanding action to curb costs and cover the uninsured.
Nevada has gained new prominence in the political calendar. It will provide an early test of voter sentiment in a Sunbelt state with a large Hispanic population, and the results here could help create momentum for a Democratic candidate going into New Hampshire. Nevada Democrats are scheduled to hold presidential caucuses on Jan. 19 next year, five days after the Iowa caucuses and three days before the first-in-the-nation primary in New Hampshire.
Mrs. Clinton said she hoped to make health care “the No. 1 voting issue in the 2008 election.” Her remarks were reminiscent of a speech she gave to the service employees union in May 1993, when she attacked “price gouging, cost shifting and unconscionable profiteering” in health care and the insurance industry. On Saturday, she said that the failure of her proposal for universal coverage in 1994 made her more determined to achieve the goal now. “It also makes me understand what we are up against,” Mrs. Clinton said. “We have to modernize and reform the way we deliver health care. But we have to change the way we finance it. That’s going to mean taking money away from people who make out really well right now.” Mrs. Clinton complained that “insurance companies make money by spending a lot of money, and employing a lot of people, to avoid insuring you, and then if you’re insured, they try to avoid paying for the health care you receive.”
To deal with such problems, Mrs. Clinton said, “we could require that every insurance company had to insure everybody, with no exclusion for pre-existing conditions.”

Diferença de mortalidade entre negros e brancos nos EUA

JAMA publica estudo mostrando a evolução da mortalidade por gênero e raça. Há uma redução na mortalidade entre os homens devido a redução da mortalidade por aids, traumas em geral e homicídios. Entre as mulheres por causa das doenças cardiovasculares.

Queda na prescrição de stents farmacológicos nos EUA

Confesso que não consegui avançar na leitura de seis artigos no The New England Journal of Medicine sobre a controvérsia dos stents farmacológicos. Era tarefa para o Carnaval. Hoje, The Wall Street Journal mostra que houve queda na prescrição dos stents farmacológicos porque os médicos passaram a temer trombose tardia. Esse problema pode ser contornado com o uso de Plavix por um ano, mas o preço alto e, sempre a possibilidade de adesão baixa ao tratamento está empurrando médicos a indicar o stent simples. Vamos ver o que está acontecendo por aqui, mas meu palpite é que não haverá modificação. A seguir, trecho da matéria, onde mostra que há médicos pensado com a cabeça e com o bolso do paciente. Coisa rara!.

Compared with bare stents, drug-coated stents reduce the need for repeat stentings, but they come with a small risk of blood clots years after a stent is implanted. To reduce that risk, patients are now urged to take the blood-thinning drug Plavix for a year after implantation. The drug-coated stents cost about $2,300 each and are highly profitable for the two companies that sell them in the U.S. -- Boston Scientific and Johnson & Johnson. Several companies sell bare stents, including Abbott Laboratories and Medtronic Inc., for roughly $800 each. Some doctors say they are now more hesitant to use drug-coated stents on poorer patients who are unlikely to be able to afford the $1,500-a-year cost of Plavix. "We've been burned by patients who don't take their Plavix," said Gary L. Schaer, director of the cardiac-catheterization laboratory at Rush hospital in Chicago, describing one patient who balked at the cost and "literally wiped out her whole heart" with a blood clot. Now, "if we suspect that patients have a history of noncompliance, or we're concerned that they won't follow directions or they just can't afford it," Dr. Schaer said he typically uses a bare-metal stent instead.

Nem "Burat" conseguiu descrever a aids no Cazaquistão

O texto do The New York Times segue na íntrega porque revela a catástrofe vinda de pagar mal aos médicos e não ter controle da prescrição e comércio de sangue. Uma centena de crianças portadoras do HIV adquirido em transfusões de sangue desnecessárias foram diagnosticadas em localidade no Cazaquistão. Diz a reportagem que há um "racha" do valor da transfusão entre quem prescreve e o banco de sangue. Por enquanto, a caça são contra as bruxas locais. Como aquele país, é uma ditadura petrolífera tal como a Líbia, talvez eles arrangem o equivalente às enfermeiras búlgaras e o médico palestino para serem os culpados, tal como a ditadura líbia encontrou, encarcerou e condenou.

Eu faço parte da minoria que detestou "Burat", o "segundo melhor repórter do Cazaquistão". Mas, não pude deixar de associar o filme ao fato.

Doctors, and a Medical Procedure, on Trial in Kazakhstan
Justyna Mielnikiewicz for The New York Times
By ILAN GREENBERG
Published: March 20, 2007
SHYMKENT, Kazakhstan — For weeks now, Kanat Alseidov has been sitting only a few feet from the doctor on trial for prescribing a blood transfusion for Mr. Alseidov’s 2-year-old son, who had pneumonia.
Justyna Mielnikiewicz for The New York Times
In Shymkent, Kazakhstan, 100 children tested positive for H.I.V.
Two months after receiving the transfusion, the boy, a ruddy, playful toddler named Baurzhan, who tangles constantly with his twin sister, tested positive for H.I.V., the virus that causes AIDS.
“I couldn’t understand why the doctor said my son needed a blood transfusion or he would get worse,” Mr. Alseidov said. Baurzhan’s exposure to H.I.V. was only the beginning of an epidemic that has engulfed Shymkent, an industrial, car-choked city near the Uzbekistan border. Since the summer of 2006, 100 children who were treated at the children’s hospital here have tested positive for H.I.V. Twenty-one doctors are accused of medical malpractice for allowing the H.I.V. outbreak. And as the trial has progressed, it has become increasingly clear why the doctor who treated Mr. Alseidov’s son had prescribed a blood transfusion to treat pneumonia: the parents of the infected children here in Shymkent say that doctors charged patients $20 for 14 ounces of blood, splitting the proceeds with the local blood bank. A profit of up to $10 on every transfusion may not sound like much, but it is a considerable amount in a country where doctors’ salaries begin at $175 a month. While pervasive corruption encourages many unnecessary transfusions, patients frequently demand transfusions. Doctors and patients in Russia and Eastern Europe, Central Asia and parts of China and India truly believe that fresh infusions of blood can fortify a healthy body and remedy diseases that are not blood-related, say Western doctors with extensive experience in the region.
One result, Western health experts say, is that throughout Central Asia and much of the developing world, local doctors prescribe tens of millions of unnecessary transfusions, putting people at heightened risk of contracting AIDS or other diseases transmitted by blood. “It’s dumb medicine,” said Dr. Max Essex, chairman of the Harvard AIDS Institute and a professor at the Harvard School of Public Health, in a telephone interview. “One of the reactions that the medical establishment took in this country in the late ’80s, even after H.I.V. blood tests were available, was to drastically cut down the number of blood transfusions given.” All of those factors seem to have converged on the children of Shymkent. One 8-month-old boy received 25 unnecessary blood transfusions, according to court documents. The boy’s transfusion regimen was halted only in summer 2006 when he was found to have H.I.V. “It’s insane,” said Dr. Michael O. Favorov, an epidemiologist and Central Asia program director for the Centers for Disease Control and Prevention, based in Atlanta. Dr. Favorov headed an extensive medical investigation by the agency that identified the transfusions of tainted blood as the source of the Shymkent outbreak. “This kid needed no blood,” he said. Mr. Alseidov said doctors told him that no family member could provide the blood, so he went to a private blood bank. He says he was told at the blood bank that the doctor would receive half the $20 price for the blood. “Our hospitals are like a factory line,” Mr. Alseidov said. “The doctors sometimes take not even $10, but they make their money from volume.” Doctors say their low wages force them to search for ways to generate additional revenue. “Salaries are very low, and even increases don’t make a difference because of inflation,” said Dr. Amangeldy Shopaer, deputy chief physician at the Shymkent Infectious Diseases Hospital, where all 100 infected children have received treatment.
The children’s families say government neglect has compounded their predicament.
“It’s not popular to blame the government, but the evidence is clear,” Mr. Alseidov said. “Veins are not garbage bins.” Compounding their problems, families of infected children are often forced to move to seek anonymity after they are ostracized by friends and neighbors. More than half the fathers of the H.I.V.-positive children have left their families, according to family members of victims attending the trial here.
Despite the detailed American study, Dr. Shopaer maintained that the cause for the outbreak remained “not concretely known” and defended the practice of ordering blood transfusions for non-blood-related illnesses, including treatment for pneumonia. “In some cases it is required,” he said. “It depends on what kind of pneumonia.” The biggest H.I.V. epidemic in the region is in neighboring Uzbekistan, which straddles major drug-trafficking routes and where the number of reported cases has more than doubled since 2001 to 31,000, according to the World Health Organization.
Kazakhstan’s government has responded to the outbreak by firing the health minister and breaking ground on a planned pediatric AIDS facility in downtown Shymkent. Government health officials have also hired a Russian-speaking pediatric AIDS specialist from Israel to oversee treatment of Shymkent’s infected children and have completed the testing of 8,800 children throughout the country who are on record for recently receiving new blood. No new cases were found. Small outbreaks continue to haunt the developing world, however, especially the former Soviet Union, where corruption in the medical system is rampant and belief in the remedial powers of new blood runs deep. Russia alone has reported more than 200 outbreaks of H.I.V. associated with unnecessary blood transfusions. “We have been screaming and yelling since 2002, but there is limited funding to address the problems,” Dr. Favorov of the Centers for Disease Control and Prevention said. “Unfortunately before you see the thunderstorm, nobody wants to open an umbrella

Medicamento falha, Wall Street Journal noticia.

Uma proposta revolucionária para as doenças cardíacas, o AGI-1067 (quem quiser assistir um filme fantástico sobre aterosclerose e a ação desse fármaco, acesse http://www.atherogenics.com) não teve sucesso na sua tentativa de reduzir morte e reinfarto do miocárdio. Uma pena. Esse fato ocorre a todo momento na pesquisa farmacêutica, mas cada vez mais a notícia chega pela imprensa econômica. O estudo deverá ser apresentado daqui há 8 dias em Nova Orleans, no congresso do colégio americano de cardiologia, mas hoje já sabemos do resultado pelo The Wall Street Journal.(abaixo a notícia) Talvez, esteja respondendo a uma pergunta de um amigo que questiona porque assino o WSJ e, compareço a poucos congressos. Esse é um dos motivos, a notícia chega antes, outro é que as transmissões à distância pela internet estão cada vez melhores e, a baixíssimo custo.

AtheroGenics Says Heart DrugMisses Primary Trial Target
By RON WINSLOWMarch 19, 2007 7:56 a.m.
AtheroGenics Inc. said its heart drug AGI-1067 failed to reach its primary goal in a 6,127-patient clinical trial, but that it did reduce a combination of cardiovascular death, heart attack and stroke.
The Alpharetta, Ga.-based company announced the preliminary findings this morning just eight days before scientists are scheduled to present more complete data at next week's meeting of the American College of Cardiology in New Orleans. Under the college's embargo rules, the company is forbidden from disclosing further details of the study until then.
"We're obviously disappointed we didn't meet the primary endpoint," said Russell Medford, president and chief executive officer of AtheroGenics, "but we are optimistic about the results of the trial and we do look forward to continuing development of what we think is an important drug with the goal of improving patient care."
AGI-1067 is a drug with both anti-inflammatory and antioxidant activity that the company is developing to prevent serious cardiovascular events in people at risk of heart disease.
Analysts have generally been skeptical that the drug would achieve its primary target, though many viewed it as a potential blockbuster if it did. The drug's fate likely depends on further details from the study, including the statistical strength of the possible benefits the company described.
The primary endpoint, as the main goal of a clinical trial is called, included cardiovascular death, resuscitated cardiac arrest, nonfatal heart attacks, need for bypass surgery or angioplasty to clear blocked arteries, and urgent hospitalization for acute chest pain. Patients in the trial all had a history of heart disease and all were being treated with a variety of other heart drugs, including cholesterol-lowering drugs called statins.
"We have a wealth of information that we're going through," Dr. Medford said in an interview this morning. "What we've seen is encouraging and we have determined that further development of the drug is important."
Whether that will require additional clinical studies isn't clear. Decisions will involve AstraZeneca PLC, which has a joint venture with AtheroGenics, and which will have 45 days once analysis of the data is complete, to determine whether to continue the relationship. The company also plans to hold discussions with the Food and Drug Administration.

Headhunter ou Pockethunter??

Abaixo, exemplo de email que recebo há mais de um ano de empresas de consultorias. O email nunca é endereçado a mim, mas ao pesquisador (a), ou seja é uma circular na área acadêmica. No caso abaixo, já há menção aos honorários do emissor do email, o autodenominado headhunter. Outras mensagens anteriores eram mais capciosas, nada indicavam de honorários, mas segundo uma boa fonte do mercado de recursos humanos, o honorário inicial é de R$5.000,00. Em negrito, meus comentários. Colega, se você recebeu um desse email, a única solução é apertar a tecla "delete". Jornalista, leitor do blogue: uma pauta das boas, não?

Boa Tarde,Sou Headhunter e trabalho com negociações junto às áreas de Pesquisa & Desenvolvimento, Palestras, E-learning, Negociação de Projetos junto ao mercado privado, recebemos uma indicação (indicação de quem, do currículo Lattes??) de seu perfil profissional relacionado as suas linhas de pesquisa: Clínica Médica, Cardiologia, Endocrinologia, Educação Médica, Morfologia, Hipertensão, Enfermagem, Saúde Reprodutiva, Epidemiologia, Tocoginecologia, Medicina Fetal, Saúde Coletiva, Geriatria,(não sei de onde saíram Morfologia, Enfermagem, Medicina Fetal) entre outros. Seu perfil do profissional e seu contato foram localizados através (sic) de artigos publicados nas principais revistas nacionais e internacionais relacionadas à doença ou ainda, através (sic) de titulações (Mestrado, Doutorado, PHD ou Livre Docência). Desenvolvemos o trabalho de gerenciamento e gestão de carreira e coaching, especializada na área da saúde, com o intuito de intermediação entre o meio acadêmico e o privado, realizando prospecções junto às empresas nacionais e internacionais interessadas em investir no mercado brasileiro envolvendo todas as fases de Pesquisa (Básica, Clínica, entre outras, nos mais diversos níveis). As áreas de prospecção & mercado são: - Assessoria Científica (Pesquisa Básica, Clínica, Investigação); - Pesquisa e Desenvolvimento de Novos Produtos; - Controle de Qualidade e Produção, bem como Assuntos Regulatórios; - E-learning e cursos em assuntos médicos para (Comunidade Científica e Qualidade de Vida); - Auditoria para Seguradoras, Convênios e Bancos; - Gestão de Projetos e Captação de recursos para pesquisas; Os projetos em sua maioria part-time (carga flexível), remuneração compatível com o perfil curricular, sendo que profissionais com DE (Dedicação Exclusiva), poderão prestar serviços como Consultor, onde não prejudicará o mesmo dentro de sua Instituição de Ensino. (fantástico, não é? O melhor dos mundos!) Precisamos agendar uma entrevista para a próxima semana em meu escritório em XXXX, para discutirmos maiores detalhes sobre os projetos, e também sobre os honorários (somente isso, que mais você quer?) do Headhunter (Pré e Pós Contratação profissional), e ainda sobre Gestão de Carreira e Coaching que são ferramentas de suma importância dentro do mercado privado, bem como para maior aproveitamento e absorção o profissional dentro do mercado de trabalho, novas áreas e novos desafios.Saliento também que estes projetos são estritamente confidenciais (tão confidenciais que circulam por email sem destinatário) e nenhum tipo de indicação de profissionais que trabalhem dentro dos segmentos acima citados, não serão aceitos. Queira por gentileza responder-me respectivo e-mail, com formas de contato, para que sejam sanadas quaisquer dúvidas quanto ao conteúdo deste. É o presente, para apresentar informações preliminares, já que eu, Headhunter, trabalho com confidencialidade de informações em todos os sentidos. A entrevista durará em torno de 2:00 horas.

Lá, como cá, mal poetas (e, planos de saúde) há

Aqui, no Brasil há uma grande estupidez dos planos de saúde ao não cobrir a contracepção. Por exemplo, a vasectomia, cirurgia simples e barata não é paga por todos os seguros-saúde. O mesmo para a esterilização tubárea. Explicação: preconceito contra o sexo, nada mais do que isso. Qual seria a lógica econômica: "pago um procedimento de R$500, 00 e, tenho um segurado que não terá filhos com parto de R$10.000, 00 e, uma nova vida acrescida ao meu plano" . Se eu administrasse um plano de saúde, ofereceria de graça a contracepção. Agora, leio no The New York Times, notícia semelhante (e, agora com respaldo da justiça): há planos de saúde que não cobrem o contraceptivo hormonal ora - a pílula - mas paga Viagra e o Rogaina para calvície. Ou seja, preconceito contra a mulher e a reprodução. Vejam parte da notícia que ressalta a decisão judicial a favor do plano que não paga a "pílula".

Court Says Health Coverage May Bar Birth-Control Pills
By TAMAR LEWIN
Published: March 17, 2007
The Union Pacific Railroad Company did not discriminate against its female employees by excluding birth-control pills from its health insurance coverage, according to a federal appellate panel in St. Louis.
In the first federal appellate ruling on the issue, the United States Court of Appeals for the Eighth Circuit ruled 2 to 1 on Thursday that because the railroad’s health insurance plans did not cover any types of contraception, for men or women, it did not violate the Pregnancy Discrimination Act, part of the federal law forbidding discrimination in employment.
“Union Pacific’s health plans do not cover any contraception used by women such as birth control, sponges, diaphragms, intrauterine devices or tubal ligations or any contraception used by men such as condoms and vasectomies,” the opinion said. “Therefore, the coverage provided to women is not less favorable than that provided to men.”
Thursday’s ruling grew out of several sex-discrimination lawsuits by female Union Pacific employees who used prescription contraception, including two railroad engineers, Brandi Standridge of Idaho and Kenya Phillips of Missouri. The suits were consolidated into a class-action suit on behalf of all the railroad’s females employees who used prescription contraception without insurance reimbursement

Discutindo a Educação no Brasil: blog do Alon

Abaixo transcrevo a provocação vinda do blog do Alon (http://blogdoalon.blogspot.com) a respeito da educação no Brasil. É uma síntese excelente de propostas para a educação. Concordo quase 100%. Pena, que o lobby dos computadores e das ONGs avaliadoras irá persistir. Impondo a idéia que uma máquininha e um gente que nunca ministra aula, ganhando por hora/consultoria (por baixo R$ 100,00) e escrevendo relatórios inintelígiveis que consertarão o atraso na educação. Além, claro do sindicalismo, da turma do livro didático que continuarão a tirar a sua lasquinha.

Desvincular os reajustes dos professores da ativa e dos aposentados.-

Pagar mais aos professores que dão mais aulas.-

Pagar mais aos professores cujos alunos consigam melhor desempenho num sistema nacional de avaliação, feito para checar, anualmente e de maneira objetiva, os conhecimentos de todos os estudantes.

- Afastar imediatamente, para reciclagem, os professores cujos alunos não atinjam notas mínimas nesse sistema nacional de avaliação. Ao final da reciclagem, esses professores deverão ser submetidos a um exame nacional de conhecimentos. Se não atingirem uma certa nota, ficarão proibidos de dar aulas até novo exame. Se forem reprovados em dois exames, serão demitidos.

- Periodicamente, os professores terão que fazer cursos de atualização, ao final dos quais serão avaliados e terão seu salário ajustado, para cima ou para baixo, de acordo com o desempenho na prova.

- Será estabelecida uma tabela nacional de salários de professores. Estará garantida a correção automática dos salários pela inflação anual. Aumentos reais dependerão do sistema de desempenho descrito nos itens anteriores.-

Será pago um adicional de salário a professores que dêem aula em regiões de população mais pobre.- Professores estarão proibidos de fazer greve.-

Serão demitidos professores que faltarem além de um limite, apertado, estabelecido em lei.

- Uma parte das vagas na universidades públicas estará reservada aos estudantes com bom desempenho, ao longo de todo o seu histórico escolar, no sistema nacional de avaliação.

- Haverá cotas sociais e raciais na rede pública, mas de modo declinante no tempo.

Haverá escolas, vagas e professores na rede pública em número suficiente para atender, em período integral, a todas as crianças desde a pré-escola até o final da 8a série.

- A maior parte dos recursos para bolsas universitárias de pesquisa e pós-graduação será destinada para as ciências ditas exatas e ditas biológicas.

- Eliminar-se-á o sistema da progressão continuada.E você, tem propostas?

Vamos ao debate.

Vigitel: longa vida!

Ontem, o Ministério da Saúde liberou na sua página (http://saude.gov.br) os resultados de 2006 do Vigitel, ou Vigilância de Fatores de Risco e de Proteção das Doenças Crônicas por Inquérito Telefônico. A imprensa divulgou amplamente, sempre enfatizando a diferença entre as capitais.

Esqueceram -os jornais - do principal. Esse belo estudo (que tive a oportunidade de ver nascer) da equipe do NUPENS da Faculdade de Saúde Pública da USP coordenado pelo Professor Carlos Augusto Monteiro com recurso do Ministério da Saúde também avaliou a distribuição desses fatores por nível de escolaridade. E, quase que invariavelmente, aqueles com menor escolaridade apresentam prevalência maior de fatores de risco e menor de fatores de proteção. No caso do tabagismo é incrível: aqueles com educação formal até 8 anos, a prevalência é de 24,2%, mas para quem estudou 12 anos ou mais, esse valor se reduz a 14,4%.

Alguns comentários sobre esse método:

(1) é muito, mas muito mais barato do que as pesquisas de porta em porta com amostragem e, a comparação com os estudos de prevalência de porta em porta são semelhantes;

(2) permite realizar estudos seriados anuais mostrando tendências de cada um dos fatores de risco e proteção;

(3) se por um lado deixa de diagnosticar os casos assintomáticos de hipertensão e diabetes, por outro consegue identificar o acesso a esse diagnóstico.

Aproveito o momento para cumprimentar o novo Ministro da Saúde e, solicitar a manutenção do Vigitel.

Aids na India

Nada preocupa mais do que o avanço da aids na China e na India, os dois países mais populosos. The New England Journal of Medicine dedica um texto elucidativo sobre a situação indiana. O acesso é livre em http://www.nejm.org. Abaixo, trecho inicial do artigo

The epidemiologic data for India (estimates of the number of infected persons range from 3.4 million to 9.4 million) are far less precise than for South Africa (4.9 million to 6.1 million). The estimate for India is based primarily on anonymous testing data from public clinics for prenatal care and for patients in high-risk groups or with sexually transmitted infections. Although the number of surveillance sites is expanding, the data may still be skewed and inadequate.2,3 In 2005, no data were available for many of India's more than 600 districts. The estimated HIV prevalence among people 15 to 49 years old in India is 0.5 to 1.5%, whereas in South Africa it is 16.8 to 20.7%. Moreover, HIV prevalence among 15-to-24-year-old women attending prenatal clinics in 4 southern Indian states decreased by 35% between 2000 and 2004; it was unchanged among women 25 to 34 years old in these states and in 14 northern states. These data suggest a slowing of any overall increase in prevalence.
Nevertheless, the 2006 estimates have served as a wake-up call. In January 2007, Sujatha Rao, director general of India's National AIDS Control Organization, said at a Mumbai conference on HIV–AIDS therapy, "We have come a long way from complete denial of the HIV epidemic when it was first discovered in 1986 to a complete acceptance of the fact that we have a problem."
India is a nation of contrasts. The economy is modernizing, but the culture is largely traditional. There are multiple religions and languages and long-standing patterns of behavior in relationships between the sexes. Violence against women is common and is "the most important structural issue" for HIV prevention, according to Ashok Alexander, director of Avahan, the India AIDS initiative of the Bill and Melinda Gates Foundation. Discrimination by health care professionals against people with HIV also remains "a big problem," according to Soumya Swaminathan, deputy director of the Tuberculosis Research Center in Chennai. And many adults still say they have never heard of AIDS.).

Wall Street e o preço dos medicamentos

Não se origina de ninguém do governo, de ONGs, de partidos políticos, mas sim do próprio centro financeiro americano o questionamento do preço elevado dos medicamentos novos para tratamento para o câncer. Ruim, para os negócios concluiu o analista da Morgan Stanley.

From Wall Street, a WarningAbout Cancer-Drug Prices
Morgan Stanley AnalystCreates Stir in IndustryAs He Sees a Backlash
By GEETA ANANDMarch 15, 2007; Page A1
Two years ago, Steven Harr urged Genentech Inc. to lower the price of a key drug that was helping buoy its stock price. He was an unlikely messenger because of his job: a Wall Street research analyst whose investing clients crave profits.
In a conference room with 30 senior managers from the biotech company, Dr. Harr said he feared patients wouldn't be able to afford the drug Avastin, which costs about $47,000 for the average 10-month course of treatment for colorectal cancer. He warned that Congress "will get involved when its constituents can't get drugs." Genentech later capped Avastin's price, acknowledging the influence of Dr. Harr, among many others.
From his perch at Morgan Stanley, the 36-year-old Dr. Harr has become an important gadfly on the most controversial issue in the biotech industry: drug pricing. A burst of expensive new drugs -- routinely costing tens of thousands of dollars a year -- is boosting the fortunes of biotech companies, which say the prices reward investors, reflect the difficulty of developing these medicines and fuel vital research. But the costs are setting off a growing outcry from patient advocates, doctors and Congress, which is considering two bills aiming to bring prices down. Wall Street analysts rarely speak out for fear of alienating the companies they cover. But as Dr. Harr sees it, the high costs are bad for business. He has repeatedly argued that rising drug prices could trigger government controls, hurting the industry long term. He says soaring cancer-drug prices, generating fat profit margins, aren't sustainable.
"I do not favor government setting prices on drugs because it will stymie innovation," he says, "but it is my fear that this will happen."
Advances in research are changing cancer from a death sentence to a chronic disease for many people. That is also bringing huge new costs: In 2002, cancer drugs accounted for 13% of the nation's drug spending, according to Morgan Stanley; this year it says such spending is projected to almost double, to 22%. For now, the high prices of cancer drugs are continuing to boost the stocks of companies that make them. Indeed, investors who followed Dr. Harr's advice on Genentech stock would have missed out on a 25% surge in the two years he urged caution on the shares.
Propelled by sales of expensive new drugs, Genentech, based in South San Francisco, Calif., is one of the world's fastest-growing companies. It reported revenue of $9.3 billion in 2006, a 40% increase from 2005. Net income rose 64% in 2006 to $2.1 billion.
But a pushback on drug prices is gathering steam in the Democrat-controlled Congress. And already, the two biggest biotechs, Genentech and Amgen Inc., have taken initiatives to cap prices of certain cancer drugs.
Dr. Harr "pointed out a potential risk that wasn't completely understood by everyone," says Jay Markowitz, a surgeon and now a biotechnology analyst at mutual-fund company T. Rowe Price Group.
"What he said was relevant and it was necessary, but it was not a popular thought," adds Bill Slattery, a partner at Deerfield Partners, a New York health-care investment fund that has invested in Genentech.
Dr. Harr grew up in Omaha, Neb., the second of four children of an attorney and a journalist. Conversations at the family dinner table were often debates on issues of the day; because of his strong opinions, his father sarcastically dubbed him "the diplomat."
After graduating from Johns Hopkins School of Medicine, Dr. Harr was finishing his residency at the University of California, San Francisco, when he grew interested in biotechnology. In 2000, instead of beginning a cardiology fellowship, he headed to Wall Street. He followed a friend to the former boutique investment bank Robertson Stephens, which hired him as a junior analyst. Two years later, he moved to Morgan Stanley.
Cancer-drug prices moved to a new level of the stratosphere in 2004, when two products came to market at huge premiums over others in the field. Erbitux, made by ImClone Systems Inc. and partner Bristol-Myers Squibb Co., was introduced at $10,000 a month. That was about $40,000 for the course of treatment for the average late-stage colorectal-cancer patient for whom it was marketed.
The price shocked Dr. Harr. Biotech drugs, which are produced by live cells, were generally more expensive than pills that are a mixture of chemicals. But this was twice the price of other new cancer drugs on the market, and many times the cost of older drugs.

Genérico, não necessariamente o mais barato.

Como os consumidores brasileiros já aprenderam, em vários momentos o preço do genérico se aproxima ou mesmo supera o do equivalente de marca. Agora, esse fenômeno foi detectado nos EUA, onde a venda de genéricos está crescendo muito nos últimos dois anos. Abaixo, trecho de reportagem do The Wall Street Journal.

Why Generic Doesn't Always Mean Cheap
Zocor Case Shows DrugstoresMay Offer Only Small SavingsOver Brand-Name Drug Prices
By SARAH RUBENSTEINMarch 13, 2007; Page D1
The great promise of cheap generic drugs is taking a bumpy road to arrival.
Case in point: Zocor, one of the most commonly prescribed pills in the U.S., which lost patent protection last June. Multitudes of patients have switched to generic versions of the cholesterol-lowering drug, lured by lower insurance co-payments or the promise of a significant price drop for those who pay out-of-pocket.
As predicted, the price that many insurers pay for generic Zocor has dropped dramatically. But the price that pharmacies charge patients who pay cash remains high in many locations, with wide variations by vendor. At online pharmacy walgreens.com, for instance, the price for 30 tablets of a 20-milligram dose of Merck & Co.'s Zocor is $149.99, compared with $89.99 for simvastatin, the generic version. And last week, the same dose of simvastatin cost $108.99 at CVS's Web site, compared with $154.99 for Zocor. After a call from a reporter, CVS said it would drop its simvastatin price to $79.99, as part of an "ongoing price analysis."
At a time when policy makers are searching for ways to cut health-care costs, generic drugs are often viewed as one of the most straightforward solutions. But as the situation with generic Zocor illustrates, prices can vary wildly, and may not be nearly as cheap as expected. Generics of a number of other notable drugs that came off patent recently -- including the antidepressant Zoloft, the antibiotic Zithromax and allergy drug Flonase -- have also so far failed to deliver big savings in many cases.
"We're not seeing that sharp a drop-off" in price among generic drugs that have come out in the past couple of years, says Jim Yocum, executive vice president of DestinationRx Inc., a Los Angeles pharmacy data and software company. "We're just not seeing it."
To be sure, even for the uninsured, generics still typically cost less than their branded counterparts. And at big clubs such as Costco Wholesale and Sam's Club, out-of-pocket prices for generics do generally plummet. Simvastatin costs $6.97 for 30 pills of the 20-milligram dose at a Sam's Club for which the company provided price information.
But just how far -- and how fast -- generic prices fall depends on a number of factors. Among them: how many generics makers sell the drug; how much competitive pressure pharmacies feel; whether there is another alternative, such as a different generic in the same class of drugs; and whether a particular generics maker gets an initial exclusivity period. By law, the first generics maker to challenge a patent on a branded drug and prevail wins six months of exclusive sales.
For the more than 46 million Americans without health insurance -- plus perhaps millions more whose insurance plans don't cover drugs -- the lesson is to shop carefully. Some pharmacies list prices online, and certain Web sites will compare prices from a number of competitors. If your pharmacy doesn't list prices, a few phone calls to some competitors can mean big savings. If you're willing to travel, try pharmacies that aren't very close to each other and are less likely to react directly to each other's prices.
The growing variety of outlets for prescription drugs -- with wholesalers and online vendors joining the chains and mom-and-pops -- brings a range of business models that affect how generics are priced. At sellers where drugs are a significant driver of revenues, prices may remain high. Sometimes, as with generic Zocor, prices stay high even after a six-month exclusivity period ends, when additional generics makers start fueling supply.
Stores say they regularly review prices. At drugstore.com, generic simvastatin until recently had been at $125 for the common 30-tablet dose, compared with $135.99 for Zocor, even after the six-month exclusivity period ended in late December. After a reporter called to inquire about the price, drugstore.com on Friday dropped simvastatin to $27.99, which the company said was part of a regular review. Zocor now costs $139.99. On walgreens.com, simvastatin's price hadn't fallen after the six-month period's end. After a reporter inquired about it in late February, it dropped to $89.99 from $129.99. A spokeswoman said the price had already been under review.

63a turma da FMUSP 1975-80: felizes e realizados

Inauguração do mural da 63a turma da FMUSP com quase três décadas de atraso.

De baixo para cima: (primeira fila) Paulo Sérgio, Virgínia, Wilmar e Chen: (segunda fila) Jussara, Regeane, Sônia, Rosa e Regina; (terceira fila) César, Valim, Vassalo, Arnaldo, e Alex: (quarta fila) Victor, o blogueiro, Nacile, Oswaldo e Felipe: (quinta fila) Luis Carlos, Anisio, Jorge e Marcelo; (fundão) Mário César, João. Em pé, Mário e Milton. Depois da foto chegaram Heloísa, Elisa, Brunetti, Haydée, Vilma e Ibraim.

Ocorreu no dia 10 de março de 2007, no prédio quase inteiramente restaurado da Faculdade de Medicina.

Racialismo e aids: mais um exagero da nova política racial.

Peter Fry, em O Estado de S. Paulo apresenta a sua argumentação contra o fato cada vez mais espalhado e, menos comprovado do aumento da aids em negros no Brasil. Os dados são frágeis e, contraditoriamente a argumentação está na contra-mão em não se associar raça/cor da pele com a aids. A luta nos anos 80 foi para não se ligar automaticamente o homossexualismo ou a origem africana ou haitiana com a doença. Agora, a política racial oficial re-introduz tudo aquilo que se queria evitar: o preconceito de raça e cor por motivo de doença.

Quem ama,não mata!

Assassinatos de Mulheres eram comuns até os anos 70, quando a imprensa e o movimento feminista que então surgia passaram a denunciar esses assassinatos, onde o criminoso era quase sempre absolvido. Para jornalistas esse tema tornou-se particularmente problemático depois que um cardeal da imprensa assassinou uma colega e, eles corporativamente se calaram. As feministas preferiram utilizar o Dia Internacional das Mulheres para atacar o presidente eleito de um país onde a agressão à mulher é condenada na maioria dos Estados com rigor muito maior do que aqui no país.
Por isso, estou lançando um censo prospectivo dos assassinatos divulgados na grande imprensa, não só de mulheres, mas todos os decorrentes da passionalidade.
Folha de S. Paulo 10/03/07: Suzani Pereira da Rocha, 23, foi morta pelo ex-namorado Haroldo Moreira da Silva, 56, na segunda feira em Curitiba, PR.
Folha de S. Paulo 09/03/07: : Maria Cristina Tabano Pires, 40, morreu anteontem, após passar seis dias internada com queimaduras de 2º e 3º graus em 95% do corpo. O crime aconteceu no dia 2, quando seu marido, o advogado Sérgio Luiz Pires, 45, jogou um litro de álcool no corpo dela e ateou fogo.

Aos mais novos: o título desse post é decorrente do lema do movimento feminista dos anos 70, depois da morte de mulheres em Minas Gerais, quando um(a) autor(a) anônimo(a) escreveu em muros, o lema acima. Anos depois, a Rede Globo fez uma mini-série excelente sobre o tema com esse título.

A Câmara de Especialização Médica

Somente no Brasil, entre as economias respeitáveis, ocorre a liberalização da especialização médica. Na pátria do liberalismo, os Estados Unidos, há controle do número de especialistas. Por isso, a proposta do MEC e Ministério da Saúde merece toda consideração. O ideal é a criação de uma Câmara de Especialização Médica que defina as prioridades de formação a partir da realidade demográfica e epidemiológica e, não motivada pela força política de sociedades especializadas e de professores universitários.

O ideal seria uma Câmara montada no tripé: governo, formadores de pessoal e entidades de classe. Participariam: MEC, Ministério da Saúde, CONASS, CONASEMS pelas três esferas de governo; ABRAHUE e representantes de universidades e, também a ABRAMGE, AMB, CFM e Federação Nacional dos Médicos.

Genéricos em alta no Brasil, mas a indústria faturou bem em 2006.

A indústria farmacêutica não pode reclamar: aumentou o faturamento em reais que quase 10% em 2006 quando comparado a 2005. Os genéricos tiveram aumento de faturamento bem maior:26,3%. Apesar do aumento no último ano, a participação dos genéricos no mercado total foi de 9,4%

STF bate de frente com a Máfia das liminares de remédios de alto custo.

A Ministra Ellie Gracie do Supremo Tribunal Federal concedeu liminar há 10 dias que vai impedir a cristalização da jurisprudência sobre medicamentos de alto custo no país. Quem solicitou e recebeu essa determinação foi o Estado de Alagoas. Há Estados endividados devido ao abuso da indústria de liminares para garantir o recebimento de medicamentos de alto custo. Segundo a Ministra "está se reduzindo a possibilidade de oferecer à comunidade a atenção básica". Como funciona o esquema:

(1) a indústria percebe logo que o custo do medicamento não pode ser pago por pessoa física e nem coberto por plano de saúde. De início, tenta junto ao Ministério o seu cadastramento em algum tipo de programa.Mas, na maioria das vezes, não obtém sucesso.

(2) com a negativa oficial, a indústria financia agências de publicidade, assessorias de imprensa, médicos e ONGs de pacientes para atuar na corrente favorável ao medicamento. Capas de revistas, seminários e artigos do tipo você pode ter______, pergunte ao seu médico são estimulados ao máximo;

(3) em hospitais e clínicas particulares, o médico é estimulado a prescrever o medicamento de alto custo. Na porta, o propagandista informa que a única solução é com ação judicial e, indica advogado .....até conseguir a liminar. (Na praça Oswaldo Cruz em São Paulo, havia uma faixa entre dois postes com os dizeres: "Interferon peguilado: sentença judicial rápida. Fone:9xxx.xxxx.)

(4) quando secretários de saúde vão a público reclamar do abuso das liminares, a assessoria de imprensa lança em jornal artigo assinado por médico subvencionado pela empresa jurando que aquele medicamento é tão revolucionário quanto a penicilina ou a anestesia. Ou então publica carta lacrimosa de um pai afirmando que o secretário é um sujeito pérfido etc etc e, que se fosse o filho do secretário as coisas seriam diferentes.

Enquanto isso, quem está fora do esquema fica sem penicilina e anestésicos.

Mudança na bula do eritropoiéticos: FDA acorda

O sonolento FDA parece que está um pouco mais atento, depois da mudança no Congresso americano, onde é votado o orçamento do órgão. Hoje, lançou uma advertência sobre os medicamentos que aumentam a produção de glóbulos vermelhos em pacientes renais crônicos. O resultado foi a queda das ações das farmacêuticas. Abaixo, a declaração oficial.

The U.S. Food and Drug Administration (FDA) today issued a public health advisory outlining new safety information, including revised product labeling about erythropoiesis-stimulating agents (ESAs), widely-used drugs for the treatment of anemia. The drugs affected by the safety update are darbepoetin alfa (Aranesp) and epoetin alfa (Epogen and Procrit). (ESAs are genetically engineered forms of the naturally occurring human protein, erythropoietin. Natural erythropoietin is made by the kidney and increases the number of red blood cells).
FDA and the manufacturer of these products have agreed on revised product labeling that includes updated warnings, a new boxed warning, and modifications to the dosing instructions. The new boxed warning advises physicians to monitor red blood cell levels (hemoglobin) and to adjust the ESA dose to maintain the lowest hemoglobin level needed to avoid the need for blood transfusions. Physicians and patients should carefully weigh the risks of ESAs against transfusion risks.
Recently completed studies describe an increased risk of death, blood clots, strokes, and heart attacks in patients with chronic kidney failure when ESAs were given at higher than recommended doses. In other studies, more rapid tumor growth occurred in patients with head and neck cancer who received these higher doses.
In studies where ESAs were given at recommended doses, an increased risk of death was reported in patients with cancer who were not receiving chemotherapy and an increased risk of blood clots was observed in patients following orthopedic surgery. "The agency is in the process of re-evaluating the safety of Aranesp, Epogen, and Procrit on the basis of the results of recent clinical studies," said Steven Galson, MD, MPH, director of FDA's Center for Drug Evaluation and Research. "The new studies provide significant new information for both prescribers and patients, and the new information applies to all ESAs, which share the same mechanism of action. The safety of these products will be discussed when the Oncologic Drugs Advisory Committee (ODAC) meets in May and further revisions to the labeling may occur after that meeting." Safety concerns from earlier ESA studies were discussed during a 2004 meeting of the ODAC. Product labeling was previously revised in 1997, 2004, and 2005 to reflect new safety information. The three drugs are approved to treat anemia in patients with chronic kidney failure and in patients with cancer whose anemia is caused by chemotherapy. Epogen and Procrit are approved for patients scheduled for major surgery to reduce potential blood transfusions and for the treatment of anemia due to zidovudine therapy in HIV patients. ESAs are not approved to treat the symptoms of anemia – including fatigue – in cancer patients, surgical patients, or those with HIV. All three drugs are manufactured by Amgen Inc. of Thousand Oaks, California. Procrit is marketed and distributed by Ortho Biotech LP, a subsidiary of Johnson & Johnson

No Dia Internacional da Mulher: Lula, Serra,Cabral e O Estado de S.Paulo

Li o Estadão hoje e, fiquei surpreendido positivamente com o:

(1) posicionamento de Sua Excia, o Presidente da República afirmando que sexo é secular.... e, pau na hipocrisia em relação ao sexo. Finalmente, um Presidente que reafirma "1889" com a separação do Estado e da Igreja. Disponibilizar camisinha não estimula ninguém ao sexo (aliás, inibe), mas é obrigação sanitária do Estado dar todas as condições para o sexo seguro.

(2) anúncio do Governador de São Paulo liberando mais verbas para programas relacionados à saúde reprodutiva;

(3) jornal mostrando que a taxa de fecundidade está diminuindo em São Paulo, mas que o planejamento familiar é um direito do cidadão e, não um política de redução de "pobres-bandido-faminto- desocupado" como os neomaltusianos adoram propagar.

(4) declaração do Governador do Rio de Janeiro, afirmando que privilegiará a realização de vasectomias nos hospitais estaduais.

Circulation destaca a América Latina

Circulation, a principal revista de cardiologia, pertencente à American Heart Association lançou uma edição com a data de 06 de março de 2007 com assuntos referentes à Ámerica Latina e ao Brasil, a maioria com autores brasileiros.

A Doença de Chagas está presente, mas o melhor artigo é de Wady Hueb, do estudo MASS realizado no InCor-HCFMUSP que comentarei em breve.

O acesso restrito permite a leitura dos resumos está em http://www.ahajournals.org. Quem necessitar dos textos completos pode requisitar ao autor correspondente cujo email está no final do resumo. Ou então, pedir a esse blogueiro.

Tekturna, algo novo da Big Pharma para hipertensão

Finallmente, algo novo da Big Pharma para hipertensão - o aliskiren - da Novartis,nome comercial Tekturna, aprovado nos Estados Unidos. Trata-se de um inibidor da renina, o primeiro produto desse grupo. Agora, é verificar o quanto adicionará ao tratamento atual e, evidentemente o custo. Abaixo uma descrição do produto.

Tekturna(R) - The First New Type of High Blood Pressure Medicine In More Than a Decade - Receives Its First Approval in the US
Mar 5 2007, 8:20 PM EST PRNEWSWIRE
EAST HANOVER, N.J., March 6 /PRNewswire/ -- Novartis announced today that the United States has become the first country in the world to approve Tekturna(R) (aliskiren) tablets, the first new type of medicine in more than a decade for treating high blood pressure -- a condition estimated to affect nearly one billion people worldwide and remains uncontrolled in nearly 70% of patients.
The Food and Drug Administration (FDA) issued the approval for Tekturna as the first in a new class of drugs called direct renin inhibitors. A once-daily oral therapy, Tekturna acts by targeting renin -- an enzyme responsible for triggering a process that can contribute to high blood pressure. This condition is a leading contributor to cardiovascular disease, considered the world's leading cause of death. Tekturna received FDA approval for treatment of high blood pressure as monotherapy or in combination with other high blood pressure medications. The use of Tekturna with maximal doses of ACE inhibitors has not been adequately studied. Tekturna is expected to be available in March in pharmacies as 150 mg and 300 mg tablets. "Renin angiotensin system activity contributes to many of the complications associated with high blood pressure," said Marc A. Pfeffer, M.D., PhD, Professor of Medicine, Harvard Medical School and Cardiologist, at Brigham & Women's Hospital. "By inhibiting this important system at its origin, renin production, a direct renin inhibitor, such as Tekturna, offers an exciting therapeutic option for treating hypertension." In an extensive clinical trial program involving more than 6,400 patients, Tekturna provided significant blood pressure reductions for a full 24 hours. Furthermore, Tekturna provided added efficacy when used in combination with other commonly used blood pressure medications. In clinical trials, the approved doses of Tekturna were generally well tolerated and the most common side effect experienced by more patients taking Tekturna than patients taking a sugar pill was diarrhea. Other less common reactions to Tekturna include cough and rash. Tekturna should be discontinued as soon as pregnancy is detected as it may harm an unborn baby, causing injury and even death. Women who plan to become pregnant should talk to their doctor about other treatment options before taking Tekturna. Angioedema has been rarely reported in patients taking Tekturna. "Many patients require two or more medicines to control their blood pressure. As a new treatment approach, Tekturna has the potential to help these patients manage their disease," said James Shannon, MD, Global Head of Development at Novartis Pharma AG. "Tekturna demonstrates our commitment to developing innovative medicines to help the millions of patients suffering from high blood pressure." Novartis is committed to conducting a large outcome trial program to evaluate the long-term effects of Tekturna and direct renin inhibition. Tekturna was developed in collaboration with Speedel

Tortura não precisa de adjetivos: física ou psicológica, o dano é o mesmo.

O estudo abaixo sugere que estressores psicológios não podem ser facilmente distinguidos da tortura física. Embora alguns considerem que a tortura física causa mais dano do que atitudes como execuções falsas, ameaças de estupro, ameaça contra familiares, testemunha tortura a outros prisioneiros, deprivação da micção/evacuação e do sono (ufa, chega....) o impacto é semelhante. Uma advertência metodológica: esse é um estudo transversal (ou uma survey), do momento, não tem seguimento ainda que permita conclusão mais forte. Novos resultados poderão surgir em nova avaliação em 12 ou 24 meses.

Torture vs Other Cruel, Inhuman, and Degrading Treatment
Is the Distinction Real or Apparent?
Metin Baolu, MD, PhD; Maria Livanou, PhD; Cvetana Crnobari , MD
Arch Gen Psychiatry. 2007; 64:277-285.
Context After the reports of human rights abuses by the US military in Guantanamo Bay, Iraq, and Afghanistan, questions have been raised as to whether certain detention and interrogation procedures amount to torture.
Objective To examine the distinction between various forms of ill treatment and torture during captivity in terms of their relative psychological impact.
Design and Setting A cross-sectional survey was conducted with a population-based sample of survivors of torture from Sarajevo in Bosnia and Herzegovina, Banja Luka in Republica Srpska, Rijeka in Croatia, and Belgrade in Serbia.
Participants A total of 279 survivors of torture accessed through linkage sampling in the community (Banja Luka, Sarajevo, and Rijeka) and among the members of 2 associations for war veterans and prisoners of war (Belgrade).
Main Outcome Measures Scores on the Semi-structured Interview for Survivors of War, Exposure to Torture Scale, Structured Clinical Interview for DSM-IV, and Clinician-Administered PTSD (posttraumatic stress disorder) Scale for DSM-IV.
Results Psychological manipulations, humiliating treatment, exposure to aversive environmental conditions, and forced stress positions showed considerable overlap with physical torture stressors in terms of associated distress and uncontrollability. In regression analyses, physical torture did not significantly relate to posttraumatic stress disorder (odds ratio, 1.41, 95% confidence interval, 0.89-2.25) or depression (odds ratio, 1.41, 95% confidence interval, 0.71-2.78). The traumatic stress impact of torture (physical or nonphysical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors.
Conclusions Ill treatment during captivity, such as psychological manipulations, humiliating treatment, and forced stress positions, does not seem to be substantially different from physical torture in terms of the severity of mental suffering they cause, the underlying mechanism of traumatic stress, and their long-term psychological outcome. Thus, these procedures do amount to torture, thereby lending support to their prohibition by international law.
Author Affiliations: Section of Trauma Studies, Institute of Psychiatry, King's College, University of London, London, England (Drs Baolu and Livanou); and Department of Psychiatry, Clinical Hospital Zvezdara, Belgrade, Serbia (Dr Crnobari ).

Redução dos homicídios em São Paulo: aumento do investimento em segurança e o efeito adverso.

Na Folha de S.Paulo, mais explicações sobre a queda dos homicídios em São Paulo, pelo sociólogo Cláudio Beato da UFMG. Finalmente, discutir a redução do homicídio deixou de ser tabu para a imprensa paulista. Concordo com ele, sobre a pouca importância, para não dizer da imprecisão metodológica do já famoso "Mapa da Violência". Mas, Cláudio cometa um erro ao afirmar que as regiões metropolitanas de Rio e São Paulo representam 40% dos homicídios, essa proporção foi menor em 2004: 12523/4874 ou 26%. Outro aspecto importante da entrevista foi afirmar que não sabe o que acontece em várias áreas, principalmente em Pernambuco. Bom, muito bom mesmo, um intelectual afirmar que não sabe explicar um fato. Sem qualquer ironia. Abaixo, trecho da entrevista onde valoriza a política de Covas, mas ressalta um efeito adverso, a organização prisional decorrente do número elevado de prisões.
FOLHA - Por que São Paulo diminuiu algumas taxas em proporções maiores que as de Bogotá? BEATO - No caso de São Paulo, o importante foi o investimento feito em segurança pública desde a época de Mário Covas [1995-2001]. Covas fez cortes em quase todas as áreas, menos em segurança. Hoje o sistema de segurança de São Paulo é um dos mais bem montados do país. Apareceram outros problemas. Tiraram criminosos das ruas, mas permitiram que se organizassem nas prisões.
FOLHA - E as políticas sociais? BEATO - Eu ia falar disso. Ao lado do investimento em segurança, em prisões, você teve um sem número de atividades de sociedade civil, de programas em escolas, no Jardim Ângela. A gente não sabe o impacto desses programas. Houve uma reação da sociedade contra a violência. Algumas prefeituras, tal como a de Diadema, começaram a se envolver no combate à violência. Os governos também desenvolveram um grande número de projetos sociais. Você não reduz crime com uma medida só, é sempre uma somatória de ações.