quinta-feira, 28 de fevereiro de 2008

Atenção Butantan e Fiocruz! Um novo sócio: Guantamano Tropical Medicine Institute.

Genial, a proposta de Peter Hotez defendida no Plos Medicine. Fecha-se a vexaminosa base naval de Guantámano. Alia-se conhecimento de Argentina, Brasil, Cuba e México aos dólares americanos e, combate-se o "verdadeiro inimigo" em um Instituto de Medicina Tropical.
Reinventing Guantanamo: From Detainee Facility to Center for Research on Neglected Diseases of Poverty in the Americas. Peter J. Hotez. PLoS Negl Trop Dis 2(2): e201. doi:10.1371/journal.pntd.0000201. Published: February 27, 2008 Copyright: © 2008 Peter J. Hotez.
Reports that the Bush administration has expressed an interest in closing the Guantanamo Bay detainee facility in Cuba, colloquially known in the US as “Gitmo,” could stimulate a new chapter in US foreign policy. By converting Gitmo into a biomedical research institute dedicated to combating the diseases of poverty in the Western Hemisphere, we can tap into a little known, but highly effective tradition of vaccine diplomacy that we first began 50 years ago at the height of the Cold War.
In the 1950s, polio epidemics were ravaging the major urban centers in the United States and in the Soviet Union. Children were the chief victims in both countries. The devastation wreaked by the polio outbreak spurred the establishment of new polio research laboratories in Moscow and in the US at Jonas Salk's laboratory in Pittsburgh, Pennsylvania and at Albert Sabin's lab in Cincinnati, Ohio.
Not long after the Sputnik launch in 1956, Washington put aside its ideological differences with the Soviets and permitted Mikhail Chumakov, the chief virologist at the Moscow laboratory, to collaborate with Dr. Sabin's laboratory to develop and test a live oral polio vaccine. Three years after Dr. Chumakov's historic visit, the Russians were vaccinating millions of children using an experimental vaccine developed in Dr. Sabin's lab. These initial Soviet trials provided the basis for the subsequent licensure of the oral polio vaccine throughout the US . As a result, almost every American inoculated against polio after 1963 and prior to 1996 received a vaccine that was developed and tested through Cold War diplomacy. Vaccine diplomacy could be similarly effective in reaching out to the poorest people in America's backyard.
In less than the time it takes to fly from Washington DC to the West Coast, I can walk through the public hospitals in Guatemala, Haiti, Honduras, and Nicaragua, and be guaranteed to see children suffering from protein malnutrition, parasitic worm infections, infectious diarrhea, Chagas disease, and tuberculosis meningitis. Data from the United Nations Children's Fund (UNICEF), World Health Organization, and the World Bank confirm this observation—some of the infant mortality rates and under-five child mortality rates in Bolivia, Guyana, and Haiti are as high as those in Botswana, Congo, Gabon, and Ghana . The rates of malnutrition (moderate and severe stunting) in Guatemala, Haiti, and Honduras rival those in Chad, Somalia, and Zambia. Indeed, five Latin American nations, namely Bolivia, Guyana, Haiti, Honduras, and Nicaragua, stand out for their low economic growth, low life expectancy, and high disease rates, presenting a bleak picture of poverty, malnutrition, and disease that compares with many regions of sub-Saharan Africa.
The poorest areas of Latin America and the Caribbean also stand out for their high rate of neglected tropical diseases, with millions or tens of millions of cases of hookworm and other intestinal worm infections , Chagas disease , schistosomiasis , and dengue, and almost one million cases of lymphatic filariasis and malaria in the region. In a previous article published in PLoS Neglected Tropical Diseases it was pointed out that many of the neglected tropical diseases that now occur in Latin America and the Caribbean were first brought there during the Middle Passage of the Atlantic slave trade . In this sense, the region's neglected tropical diseases represent a tragic living legacy of slavery .
America has an enormously impressive track record of developing and testing life-saving vaccines and drugs. It is therefore surprising that American leadership in biomedical sciences and its remarkable legacy for saving lives abroad has never been embraced as a meaningful component of American foreign policy. The US spends approximately $100 billion annually on health research and development, including $28 billion by the NIH and $57 billion by industry.
The neglected tropical diseases represent some of the most important poverty-promoting disease conditions. By establishing a center of excellence on the diseases of poor, at Guantanamo, the United States Government would directly address poverty and health disparities in the worst-off nations in Central and South America and the Caribbean. Such a center could conduct translational research to develop new drugs and vaccines for neglected diseases, possibly in collaboration with research institutes and public sector pharmaceutical manufacturers in some of Latin America's so-called innovative developing countries, such as Argentina, Brazil, Cuba, and Mexico. It could also promote clinical research and take on the control of some of the more pressing public health threats in the Caribbean region, including vector-borne diseases such as dengue. It would serve as a vital resource for training physicians, scientists, and public health experts, and meet an important demand for training in applying appropriate technology to global public health practice.
Through a focused initiative on lymphatic filariasis and schistosomiasis, a well-resourced biomedical institution located at Guantanamo could lead a path to eliminate these scourges from the Caribbean region and forever wipe out an important element of slavery's legacy. The facility could even take on some neglected tropical diseases that remain important yet often hidden public health problems among the economically disadvantaged and under-represented minorities living in the US, such as cysticercosis, dengue, leptospirosis, toxocariasis, and congenital cytomegalovirus infection and toxoplasmosis .
It is a moral outrage that a wealthy country like the United States allows its closest neighbors to suffer from some of the world's worst levels of disease, poverty, and malnutrition. Reinventing Gitmo to address our hemisphere's most pressing neglected health problems could help change America's reputation and legacy in the region. The US has previously supported covert military operations and encouraged military coups in the Americas , while the US Army continues to interrogate terrorist suspects at Gitmo (“We interrogate seven days a week, 24 hours a day,” a US general based at Gitmo told CBS news ). By transforming Gitmo from a detainee facility to a center for research on the diseases of poverty, the US would show that it sincerely wants to address the Millennium Development Goals in Latin America and the Caribbean , and ultimately make things better for the next generation of all Americans.

quarta-feira, 27 de fevereiro de 2008

A situação da autópsia nos EUA: uma homenagem a Maffei e Thales.

The New England Journal of Medicine apresenta texto excelente, onde os autores lamentam o declinio das autópsias sem finalidade legal,ou seja para permitir o progresso da ciência médica. Ao lado mostra-se o declínio dessa importante e fundamental modalidade de aprendizado, pesquisa e controle de qualidade. Aliás, não induzir autópsia é "empurrar o lixo para debaixo do tapete". O celebérrimo professor Walter Edgar Maffei (1905-1991) afirmava que em vários centros europeus, na sala de autópsia havia um dizer acima da mesa de exame: "aqui, se lava as mentiras!".
Voltado ao texto do NEJM, eles apontam abaixo, as vantagens da autópsia. Eu que fui discípulo de Thales de Britto, o professor mais sensacional que conheci na Faculdade de Medicina, a conclusão não é nenhuma novidade.
Education for practitioners and trainees (e.g., demonstration of pathological findings in advanced illness and uncommon conditions)
Identification and elucidation of emerging and re-emerging diseases (e.g., AIDS, legionnaires' disease, and West Nile virus)
Local quality assurance for all aspects of antemortem diagnosis (clinical evaluation, diagnostic imaging, laboratory testing, pathology), procedure performance, and functioning of medical devices
More accurate vital statistics
More accurate ascertainment of causes of death in research studies
Improved postmarketing surveillance for adverse effects of drugs, devices, and procedures
Identification (or exclusion) of conditions of interest to family members
PS: no site do Hospital Universitário há relato das sessões de autópsia lá realizada.

Big Pharma não quer mais ser Big

O IN VIVO Blog revela que dirigente da Glaxo Smith Kline (GSK) considera que o caminho da Big Pharma é se desintegrar em pequenas empresas e, alterar a forma de relacionamento com os investidores. Ou seja, o gigantismo tão criticado gerenciamento estatal, também não atende ao interesse do capital.
We have been ranting on about how Big Pharma should disaggregrate—split into smaller, biotech-like units that are perhaps even separately listed—for at least a year now. Refresh your memory here, or here, or here.So imagine our surprise—and delight—when Mike Owen, SVP of GlaxoSmithKline’s Biopharmaceuticals Center of Excellence for Drug Discovery, this morning put up a slide during The Economist’s Pharma 2020 conference in London calling for ‘separately listed therapy/technology areas’.

Tuberculose multi-resistente:alerta no Leste Europeu

A Organização Mundial da Saúde lançou hoje um relatório (versão completa em inglês) sobre a resistência do Micobacterium tuberculosis ao tratamento clásssico (na verdade resistente a rifampicina, hidrazida, quinolonas e aminoglicosídeos). Em outras palavras, os casos de tuberculose sem cura. Uma séria ameaça. Na África há somente seis países com informação confiável. Na América Latina, a situação não é problemática, exceto Guatemala. O Perú tinha incidência alta, mas está controlando. O grande problema está no leste europeu: Baku (Azerbaijão), 22.3% de casos de tuberculose "multi-resistentes". Moldávia, 19,4% in Moldova, Donetsk (Ucrânia) 16% e Tomsk Oblast (Rússia) 15% e Uzbesquistão, 14.8%.
No Estadão, o responsável pelo programa de tuberculose está surpreso com o relato que afirma que no Brasil houve ao menos um caso de tuberculose multi-resistente. Aiub Hijjar está corretíssimo quando minimiza o problema da resistência aqui e, se indigna com as quase cinco mil mortes por tuberculose causada por bactérias sensível aos medicamentos mais simples.

segunda-feira, 25 de fevereiro de 2008

Um pouco de humor na segunda-feira

De Álvaro Pereira Júnior, no Folhateen, Folha de S.Paulo, 25/02/08:
"cheguei à definição perfeita de blogueiro: é o sujeito que passa a manhã sem fazer nada e, à tarde escreve sobre o que fez de manhã".

domingo, 24 de fevereiro de 2008

Medicina do Viajante

Na coluna ao lado há onze textos escritos para o site "How Stuff Works" do Brasil sobre vários temas relacionados a viagem, tanto aéreas de longa duração, como de fins de semana na praia ou no campo. Há informação útil a todos. Em breve, texto sobre acidentes com aranhas, serpentes e com relâmpagos.

Instituto Butantan: sempre na vanguarda

Na sexta-feira, assisti ao simpósio Isais Raw no Instituto Butantan (sim, com "ene" no final, Butantã é o distrito administrativo e a subprefeitura) que comemorou 107 anos de existência. Criado pela pertinácia de Vital Brazil, administrado pela Secretaria de Estado da Saúde de São Paulo é responsável por soros e vacinas distribuídos para todo o país e exportados. Entre as várias proezas dos profissionais do Butantan encontra-se a identificação de taturanas que levaram mais de uma centena de brasileiros à morte. O Butantan identificou o veneno e, criou o soro. Leia mais clicando aqui.