segunda-feira, 10 de março de 2008

Medicamentos na água potável: ?!?!

Medicamentos encontrados na água. O texto completo é um despacho da Associated Press (clique aqui) . Abaixo, o comentário do blogueiro do WSJ
It’s not so expensive to get pharmaceuticals after all: Just drink water.
An
investigation by the Associated Press found trace amounts of scads of drugs in drinking-water supplies around the country. For a list of what was found in the watersheds of 28 metro areas, click here. Among the water’s offerings were antibiotics, anti-convulsants, mood stabilizers and sex hormones. There were traces of sedatives in water serving the city that never sleeps.
While eyebrow-raising, there’s debate about what this actually means for human health. A microbiologist for PhRMA, the drug industry’s trade group, told the AP there’s little to no risk to humans. But at a conference last summer, Mary Buzby, director of environmental technology for Merck, said: “There’s no doubt about it, pharmaceuticals are being detected in the environment and there is genuine concern that these compounds, in the small concentrations that they’re at, could be causing impacts to human health or to acquatic organisms.”
Recent research found the small amounts of drugs affected human embryonic kidney cells, human blood cells and human breast cancer cells, the AP says, causing cancer cells to proliferate too quickly, for instance. (See
this AP story for more on the research.) Wildlife are also being affected: Male fish are being feminized, creating egg yolk proteins. But some scientists caution the research is extremely limited, and there are lots of unknowns. Water providers rarely inform the public about the phenomenon, in part because they fear the fear factor. The head of a group representing major California suppliers told the AP that the public “doesn’t know how to interpret the information” and might be unduly alarmed. How do the drugs get in the water, anyway? Through our own waste, the AP explains. When people take drugs, their bodies absorb some, but not all, of the medication, and the rest goes down the toilet. Wastewater, of course, is treated before it’s discharged into reservoirs, rivers or lakes, and then it’s cleansed before it makes its way to the tap or into bottles. But trace amounts of drug residue remain.

sexta-feira, 7 de março de 2008

Vacinação para hipertensão (resumo do artigo original)

Publicado hoje, no The Lancet. No site, há um vídeo discutindo o tema. Depois, comento.
Effect of immunisation against angiotensin II with CYT006-AngQb on ambulatory blood pressure: a double-blind, randomised, placebo-controlled phase IIa study
Background : Hypertension can be controlled adequately with existing drugs such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Nevertheless, treatment success is often restricted by patients not adhering to treatment. Immunisation against angiotensin II could solve this problem. We investigated the safety and efficacy of CYT006-AngQb—a vaccine based on a virus-like particle—that targets angiotensin II to reduce ambulatory blood pressure.
Methods :In this multicentre, double-blind, randomised, placebo-controlled phase IIa trial, 72 patients with mild-to-moderate hypertension were randomly assigned with a computer-generated randomisation list to receive subcutaneous injections of either 100 μg CYT006-AngQb (n=24), 300 μg CYT006-AngQb (24), or placebo (24), at weeks 0, 4, and 12. 24-h ambulatory blood pressure was measured before treatment and at week 14. The primary outcomes were safety and tolerability. Analyses were done by intention to treat. This study is registered with
ClinicalTrials.gov, number NCT00500786.
Findings :Two patients in the 100 μg group, three in the 300 μg group, and none in the placebo group discontinued study treatment. All patients were included in safety analyses; efficacy analyses did not include the five dropouts, for whom no data were available at week 14. Five serious adverse events were reported (two in the 100 μg group, two in the 300 μg group, and one in the placebo group); none were deemed to be treatment related. Most side-effects were mild, transient reactions at the injection site. Mild, transient influenza-like symptoms were seen in three patients in the 100 μg group, seven in the 300 μg group, and none in the placebo group. In the 300 μg group, there was a reduction from baseline in mean ambulatory daytime blood pressure at week 14 by −9·0/−4·0 mm Hg compared with placebo (p=0·015 for systolic and 0·064 for diastolic). The 300 μg dose reduced the early morning blood-pressure surge compared with placebo (change at 0800 h −25/−13 mmHg; p<0·0001 for systolic, p=0·0035 for diastolic).
Interpretation : Immunisation with CYT006-AngQb was associated with no serious adverse events; most observed adverse events were consistent with local or systemic responses similar to those seen with other vaccines. The 300 μg dose reduced blood pressure in patients with mild-to-moderate hypertension during the daytime, especially in the early morning.
Funding Cytos Biotechnology AG.

terça-feira, 4 de março de 2008

Big Pharma está criativa: o ENHANCE trial

Passou despercebido por mim, durante as férias, um fato inédito: uma empresa, a Schering-Plough lançou no seu site e na imprensa leiga a suspensão de um ensaio clínico Effect of Ezetimibe Plus Simvastatin Versus Simvastatin Alone on Atherosclerosis in the Carotid Artery (ENHANCE) trial. Procurei o artigo original e, não achei. Descobri, agora que houve uma forma heterodoxa de comunicação científica: somente conclusões. O trial terminou em junho de 2006! JAMA apresentou comentário ácido sobre o ocorrido. (clique aqui)

O tráfico de droga com receita médica

Há muito discuto aqui, o uso e abuso de medicamentos que criam dependência que são comprados com receita médica. Felizmente, médicos estão diminuindo a má-prática de atender ao assédio de amigos, familiares e vizinhos e, já há falsários vendendo receitas devido à dificuldade em conseguir com médico. Nos Estados Unidos, onde o controle de prescrição é muito maior, a situação é muito complicada: 4,4% utilizam medicamentos controlados por razões não médicas. Vejam, o resumo do trabalhos publicado no Archives of Pediatrics and Adolescent Medicine. (março 2008)
Screening for Drug Abuse Among Medical and Nonmedical Users of Prescription Drugs in a Probability Sample of College Students. Sean Esteban McCabe, PhD, MSW Arch Pediatr Adolesc Med. 2008;162(3):225-231.
Objectives To determine the prevalence of medical and nonmedical use of 4 classes of prescription drugs (opioid, stimulant, sleeping, and sedative or anxiety) and to assess probable drug abuse among 4 mutually exclusive groups of medical and nonmedical use of prescription drugs.
Design In 2005, a Web survey was self-administered by a probability sample of 3639 college students (68% response rate).
Setting A large, midwestern 4-year university.
Participants The sample had a mean age of 19.9 years, and respondents were 53.6% female, 67.4% white, 12.1% Asian, 6.0% African American, 4.2% Hispanic, and 10.2% other racial categories.
Main Outcome Measures Medical and nonmedical use of prescription drugs was measured. Probable drug abuse was assessed using a modified version of the Drug Abuse Screening Test, Short Form.
Results A total of 40.1% of respondents reported no lifetime use of at least 1 of 4 classes of prescription drugs, 39.7% reported medical use only, 15.8% reported both medical and nonmedical use, and 4.4% reported nonmedical use only. The odds of a positive screening result for drug abuse were greater among medical and nonmedical users (adjusted odds ratio, 5.5; 95% confidence interval, 3.4-7.3) and nonmedical users only (adjusted odds ratio, 6.5; 95% confidence interval, 4.0-10.6) compared with nonusers. The odds of a positive screening result for drug abuse did not differ between medical users only and nonusers. Conclusions Nonmedical users of prescription drugs are at heightened risk for drug abuse, whereas medical users without a history of nonmedical use are generally not at increased risk. Drug abuse screening should be routine for college students, especially among individuals with any history of nonmedical use of prescription drugs

sábado, 1 de março de 2008

Um ataque à autonomia universitária: processos contra autores

Notícia do blog White Coats que traz noticias da área médica de Boston. Um exemplo de atentado à autonomia universitária iniciar processos contra autores de artigos que vão contra o interesse de empresas ou de grupos. Aqui, assistimos a campanha contra uma pesquisa patrocinada pela FAPESP sobre uso de drogas e, outra pior, vinda de abaixo-assinado contra um projeto de pesquisa da UFRGS.
Autonomia universitária é a liberdade de pesquisar utilizando o que de melhor existir em termos de metodologia científica. Quem não gostar do resultado que mostre em outro momento como cartas, revisões e, novos estudos, o equívoco apresentado. Se autor e revistas forem levianos ao publicar "artigos difamatórios" perderão o único patrimônio acadêmico: a respeitabilidade.
Em tempo, autonomia universitário não deve ser confundida com o "direito" em não respeitar as leis do país ou não prestar contas do dinheiro gasto.
Posted by Elizabeth Cooney February 28, 2008 06:05 PM
A Harvard physician has been sued by a manufacturer claiming its product was unfairly disparaged in a paper he wrote in a scientific journal, an unusual development in the world of scholarly publishing. Dr. Douglas P. Kiel, a gerontologist at Harvard Medical School and Hebrew Senior Life, wrote an article published in the
Journal of the American Medical Association that said hip-protectors did not prevent fractures in nursing home patients. HipSaver Inc. of Canton, which makes hip protectors, filed a suit in Norfolk Superior Court Feb. 15 alleging that Kiel knowingly tested an inferior product and produced results that placed its version in a poor light. A story on the suit appeared in yesterday's Harvard Crimson. “It would have been more appropriate and scientifically accurate for Dr. Kiel to limit his conclusions to the specific hip protector that he studied,” HipSaver president Edward L. Goodwin said in a statement. “As it stands, his JAMA-published conclusions have wrongfully damaged the entire field of hip protection, including the HipSaver brand.” JAMA editors are not commenting on the suit, but stand by the study as published, a spokesman said. Kiel did not return a call from the Globe seeking comment, but Hebrew Senior Life is looking carefully at the charge before responding, spokeswoman Jennifer Davis said in an interview. “The research was published in one of the most prestigious and carefully vetted peer-reviewed journal published in the country,” she said. “Dr. Kiel is a very well respected and accomplished geriatric physician as well as researcher. So we certainly at this point feel we would do nothing other than support him completely in face of the complaint.”

Leitura de domingo: o iluminismo termina no bezerro de ouro.

O professor Leonardo Maurício Diniz, da Universidade Federal de Minas Gerais enviou-me esse texto excelente, com inúmeras referências desde a Bíblia até David Sackett, passando por Goethe e Swift. Uma boa leitura para o fim de semana para compreender a medicina antiga e a atual. "The Era of Enlightenment Ends With the Golden Calf" . Lecture given during The Škrabanek Foundation Colloquium "Medical Utopianism: A Threat to Health" held at the Royal College of Physicians, London, on April 25, 2002. Author: Michael Berger, Clique aqui para ver o texto completo.

Estatísticas de saúde implica imprensa livre e autonomia universitária.

Abaixo, segue reportagem do Estadão sobre a mortalidade por dengue questionando os númeroso do Ministério da Saúde.
Passou despercebido, em pleno Carnaval, mas a Folha de S.Paulo questionou os dados de mortes violentas não especificadas. Não vou entrar na discussão, que não cabe a um blog. Talvez, um texto em "Clínica & Epidemiologia".
Utilizei esse exemplo, mas mostrar que comparar estatísticas entre países implica identificar a existência de liberdade de imprensa, autonomia universitária e ministério público atuante. O restante pode ser, e com grande chance, manipulação de dados. Vide o horror da saúde pública na ex-URSS.
Em 2 anos, dengue matou 45% mais do que o divulgado
Por Fabiane Leite, no Estadão:A dengue no Brasil tem matado muito mais do que mostram os relatórios divulgados pelo Ministério da Saúde e governos estaduais e municipais. O número real de mortes pela doença em 2006 e 2007 - 326 óbitos - é 45% maior do que os 225 óbitos informados nos últimos dois anos em boletins sobre situação epidemiológica da dengue, revelam novos dados da pasta.O ministério, assim como governos estaduais e municipais, só inclui nos relatórios divulgados para o público as mortes por dengue hemorrágica e não informa os óbitos pelas outras formas de manifestação da doença, que também podem matar: a dengue clássica e a dengue com complicações, classificações definidas pela Organização Mundial da Saúde (OMS).Segundo a pasta, a própria OMS trabalha apenas com a divulgação das mortes hemorrágicas, para facilitar a comparação entre os países. A adição dos dados de mortes por outras formas da doença é o que eleva as já significativas estatísticas da dengue no País - no ano passado, o Brasil registrou epidemias em cinco Estados, com mais de 500 mil casos suspeitos e aumento do número de mortes por dengue hemorrágica. Em 2008, já houve diminuição da incidência da doença em 40%, informou o ministério.