Política de saúde (aids ) e política industrial (medicamentos)

Uma pausa no caso Avandia. Agora, voltando ao caso efavirenz que motivou uma reportagem de Valor Econômico (25/05/07) que conseguiu ir no âmago da questão: a contradição do progama da aids. Excelente na assistência, deficiente na sustentação econômica. O Estado brasileiro está correto em desenvolver sua política de saúde pública com autonomia para reduzir dano a sua população. Fez isso de forma no caso da aids. Por outro lado, o Estado brasileiro foi incorreto ao não desenvolver a política industrial na área de medicamentos. Com isso, o "Estado brasileiro que está correto" foi penalizado pelo "Estado brasileiro que foi incorreto". Aí entram, os pescadores de águas turvas com soluções para hoje que foram as causas do erro do passado. Qual erro? Considerar três nuncas: (1) nunca poderíamos competir com a Big Pharma. (2) nunca desenvolveríamos um programa de genéricos. (3) nunca teríamos um programa de saúde pública competente. Essa inapetência pelo poder global (e, claro conflito imenso de interesse com a Big Pharma) fez com a Índia passasse na nossa frente e, conseguisse dar muita dor de cabeça à Big Pharma. Por outro lado, a política indiana para aids é pífia.

A solução agora, não é comprar remédios de indianos, não é xingar a indústria farmacêutica multinacional (nem adulá-la) mas sim desenvolver a rede de incorporação de tecnologia na área de medicamentos, oferecendo muitas vantagens para entrada no Brasil do capital da........Big Pharma acoplado a incentivos a indústria local desde que tenha perspectiva do mercado mundial. Insisto muito, que o Brasil pode ser a plataforma da Big Pharma na área não só de genéricos como de química fina.

China: mudança na assistência à aids e ao portador do HIV.

Depois de negar a existência da aids no país, permitir transfusões sem controles e de perseguir ativistas hemofílicos e pesquisadores da área, o governo chinês assumiu a responsabilidade pelo diagnóstico e tratamento da aids. Em seis anos houve aumento de verbas e política própria de prevenção e tratamento. A distribuição geográfica é bem diferenciada como mostrado na figura. Abaixo, extrato do texto do The New England Journal of Medicine que pode ser acessado na íntegra clicando o título desse post. A prevalência da aids/HIV no Brasil é de aproximadamente 0,7%, ou seja quase 15 vezes o identificado na China.

Although China's first AIDS cases were discovered in 1989, the government did not publicly acknowledge the existence of a major epidemic until 2001. Two years later, as international attention mounted after the outbreak of severe acute respiratory syndrome (SARS), the government abruptly changed course, launching aggressive measures against AIDS. An interagency committee was created to coordinate a government-wide response, and a national AIDS treatment program was established. The national budget for HIV–AIDS grew from approximately $12.5 million in 2002 to about $100 million in 2005 and about $185 million in 2006.1 In January 2006, the Chinese Cabinet issued regulations for HIV–AIDS prevention and control, outlining the responsibilities of the central and local governments and stipulating the rights and responsibilities of infected persons. The government estimates that 650,000 Chinese people are infected with HIV and hopes to limit the total to 1.5 million by 2010. The current estimate represents an HIV prevalence of approximately 0.05%.

Tráfico de meninas e a aids

O tráfico de seres humanos - principalmente na Ásia tem sido objeto de estudo de Jay Silverman da Harvard School of Public Health. Aproximadamente 600.000 a 800, 000 pessoas são comercializadas (termo horrível!!!) por ano, sendo 80% de mulheres e crianças. Dois dos principais países são Nepal eBangladesh. De acordo com Silverman, a idade média do tráfico é 15 anos e, pasmem 25% contraem o HIV!! Reportagem completa clicando o título do post.

Tratamento da aids: Abbott se acerta com a Tailândia.

The Wall Street Journal noticia acerto entre a Abbott e o governo da Tailândia nos preço do Kaletra, para tratamento da aids. Tudo isso depois da represália da empresa em registrar e vender nos medicamentos àquele país, por causa da possibilidade de entrada de genéricos para aids. O novo preço é inferior ao dos genéricos. Abaixo, trecho da matéria, onde destaco em negrito que os países emergentes são fundamentais para manter a lucratividade da Big Pharma, cujas vendas estão em queda nas economias centrais.

Abbott's Thai Pact May Augur Pricing Shift
By NICHOLAS ZAMISKA in Hong Kong and JAMES HOOKWAY in BangkokApril 23, 2007
Abbott Laboratories has backed away from a confrontation with the Thai government over patent protection for a popular AIDS treatment, a concession that could embolden other developing countries pushing big drug makers to lower the price of their products.
Abbott is offering to sell the latest version of its AIDS drug Kaletra in Thailand at a discounted rate, according to Miles D. White, Abbott's chief executive. The move reverses Abbott's decision in February to withhold the new form of Kaletra, called Aluvia in some countries, from Thailand following a Thai government announcement it would allow sales of generic versions of the drug and other branded medicines to cut patients' costs. "In this particular case, in the name of access for patients, we offered to resubmit Aluvia at our new price, which is lower than any generic, provided they wouldn't issue a compulsory license," Mr. White said. He said the initial decision was driven by "concern that compulsory licensing would be abused ever-more widely, using HIV as an excuse." Jennifer Smoter, a spokeswoman for Abbott, said Thailand's health ministry has expressed interest in the offer, but a resolution hasn't been reached. Abbott's move doesn't affect its decision to withhold six other drugs from Thailand. Abbott Laboratories in February withheld an AIDS drug from sale in Thailand after the government said it would allow sale of generic versions of drugs. • What's New: Backing down, Abbott is offering to sell the drug in Thailand at a discounted rate. • The Significance: Other developing nations may push for lower drug prices.
• The Background:Abbott's turnabout could crimp growth of global drug makers, which rely on emerging markets to compensate for slowing growth in home markets. Gustav Ando, an analyst for Global Insight, an economic-forecasting firm in Waltham, Mass., said, "If one country does it...any country can do it.... It's not going to stop there." Abbott, of Abbott Park, Ill., in February, refused to sell the country seven of its newest drugs. The move appeared to backfire, prompting consumer boycotts in Thailand, bringing human-rights advocates out in support of Thailand's policy and provoking protests from some Abbott shareholders, who argued Abbott should sell its latest drugs in Thailand. Thailand generated about $30 million a year in sales for Abbott, said a person familiar with the company's sales.
In backing down, Abbott is joining Merck & Co. and Sanofi-Aventis SA, which already have cut the prices of their AIDS and heart-disease drugs in the hope of dissuading Thailand from switching to less-expensive alternatives. Thailand still could choose to import generic drugs to replace Abbott's, however, just as it is now using generic versions of Merck's AIDS drug Efavirenz, despite Merck's own move to lower prices. Big drug companies have been pushing sales in emerging markets like Thailand, in part, because of a backlash against expensive brand-name drugs in the U.S. and other Western markets. Merck expects revenue in emerging markets to double by 2010 to more than $2 billion a year. Abbott's international pharmaceutical sales totaled $1.68 billion in the first quarter of this year -- nearly as much as its $1.69 billion in U.S. sales. In 2006, Abbott's total sales in the U.S. dropped 7.5% to $11.5 billion, while the company's international revenue rose nearly 11% to $10.9 billion.

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

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.).

Aids na Rússia e Brasil: uma comparação excelente.

Se você se aproxima ou já passou dos 50 anos, a leitura do texto abaixo deve começar há 30 anos: as doenças infecciosas estavam quase eliminadas segundo o Surgeon General dos EUA, sendo um resquício de países pobres; a Rússia era a principal república da "pátria do socialismo" e, o Brasil, bem o Brasil era apenas uma ditadura militar.

Responda se foi na Rússia ou no Brasil que ocorreram as seguintes situações em relação ao HIV/aids: o povo sem preconceito abordou questões relacionadas à sexualidade, com pouco moralismo e muito pragmatismo; a Igreja não auxiliou, mas não conseguiu impor sua moral; o governo criou e manteve um programa efetivo de alcance amplo para prevenção e tratamento que atingiu todas as classes sociais. Como resultado, a epidemia de aids refluiu e a incidência de portadores de HIV caiu.

Se você respondeu Rússia, parabéns você comprovou que ideologia cega. Leia então The Politics of Government response to HIV/AIDS in Russia and Brazil de Eduardo J. Gómez do Department of Population and International Health da Harvard University.

Acesso livre em

http://www.globalhealth.harvard.edu/documents/
“……This paper presents a cross-regional analysis of the politics of government response to HIV/AIDS in Russia and Brazil. It elaborates on an alternative interdisciplinary approach to understanding the politics of government response, emphasizing a combination of historical institutionalism, cultural analysis, and state bureaucratic capacity for implementing AIDS prevention and treatment programs……”