Novidades na cardiologia: ACC 2008

Hoje, continua a sessão científica do American College of Cardiology, momento onde há novas revelações importantes. Há alguns anos, as revistas se acertam com os organizadores para lançarem na internet, o artigo referente a uma apresentação de importância.

Estão no The New England Journal of Medicine com acesso livre:

1. comparação dos bloqueadores do receptor de angiotensina com os inibidores de enzima de conversão isolados e, em conjunto (resultado esperado): estudo ONTARGET.

2. tratamento de hipertensão acima de 80 anos (resultado sensacional!!): estudo HYVET.

No JAMA também com acesso livre:

3. comparação da pioglitazona com glimepiride na redução da luz da artéria coronária (há muita água, ou sangue para passar por essa placa aterosclerótica ainda): estudo PERISCOPE.

Se tiver paciência, leia sobre um momento infeliz da Big Pharma.

O caso ENHANCE já foi tratado aqui como mais um "fanfarronice" em Big Pharma cada vez mais criativa. Duas empresas patrocinam um estudo com medicação combinada para reduzir o colesterol, não conseguem atingir o alvo pretendido e, publicam um comunicado na internet. Hoje, na reunião científica do American College of Cardiology houve apresentação do ensaio clínico. Clique aqui para entender o ocorrido com a reportagem da HeartWire. Ao mesmo tempo, The New England Journal of Medicine publicou o artigo "original". (acesso livre)

Heparina:19 mortes

Já discuti o problema da heparina vinda da China nos Estados Unidos. Agora, o The New York Times apresenta novos dados sobre o caso que se associa a 19 mortes no país. Na foto ao lado, o tratamento que os intestinos de porcos são submetidos na China. Moyses Nin, editor de Foreign Affairs comenta que houve somente estimulo ao aumento da quantidade de comércia, com pouca ou nenhuma preocupação com a qualidade e segurança dos produtos comercializados.

A ética do bazar de órgãos: debate na Harvard School of Public Health

The Ethics of the Organ Bazaar
The event, entitled "Markets for Kidneys? The Ethics of the Organ Bazaar," was held on February 8 in Snyder Auditorium. Speakers presented the often harsh realities of the international organ trade. Ethicists, economists, and audience members struggled to define the compelling issues and circumstances that could make selling organs palatable. The event was organized by HSPH Professor Daniel Wikler.
The latest headlines showcase some of the problems with the international organ trade. In India, for example, there appears to be an illicit organ market, despite being outlawed, that includes the participation of some doctors. Some donors appear to be abducted or conned, and many of their organs are sold to people from other countries.
Demand for organs vastly outpaces the supply, said Luc Noël, coordinator of the Clinical Ethics Team for the World Health Organization. The total number of annual kidney transplants, for example, estimated at 66,000 worldwide, far from meets the needs of the 1 million people suffering from end-stage renal disease, even if only one-half of them meet surgical criteria.
The critical shortage of organs has led to "transplant tourism," a term that describes patients, donors, or physicians who travel to other countries to obtain organs through commercial transactions, typically from the poor and vulnerable.
"We must have a global consensus of objection to commercialization of transplantation," said Francis Delmonico, a surgery professor at Massachusetts General Hospital and Harvard Medical School and director of medical affairs for the Transplantation Society.
In the 1990s, the WHO drafted guiding principles on human organ transplantation that prohibited giving or receiving payments for organs. Taking it further, a 2004 World Health Assembly adopted a resolution where delegates agreed to "take measures to protect the poorest and vulnerable groups from ‘transplant tourism' and the sale or trafficking of tissues and organs."
Even with global censure of a commercial organ market, the ultimate solution lies in the willingness and ability of each country to become self-sufficient in organ transplants, providing a fair system within its borders to satisfy the medical demand there, several speakers said.

Uma vez mais, a doação de órgãos

Hoje,um despacho Associated Press. Novamente, a venda de rins.

Philippine Health Chief Orders Eradication of Kidney Black Market
Associated PressMarch 26, 2008 9:55 a.m.
MANILA, Philippines -- A new order aimed at eradicating a thriving black market in kidney sales by desperately poor Filipinos would restrict foreigners traveling to the Philippines in search of donors, the health secretary said Wednesday. Health Secretary Francisco Duque said the order, which he signed Monday, called for the creation of a government board to oversee kidney donations and transplants, ensure proper care of donors and make more transparent and ethical a disturbing practice that has flourished in secrecy.
Kidney trading in the Philippines, involving poor people and prisoners who sell their organs for paltry sums to syndicates catering mostly to foreign clients, has been reported by the local media and reflects the depth of the Southeast Asian nation's poverty. A TV network once featured a Manila slum in which dozens of men sported abdominal scars after giving up their kidneys. The order seeks to provide a more benevolent image to kidney donations by prohibiting the payment of money as a precondition. It says donations must be done "out of selflessness and philanthropy" to save and ensure the quality of life of the beneficiary. "We want to remove this black market," Mr. Duque said. "We want to protect our already poor countrymen from abuse." Health Undersecretary Alexander Padilla said the order, which took more than two years to craft, was sought specifically because of numerous reports of foreign patients traveling to the Philippines in search of kidney donors. "We don't want to be known as the kidney capital of the world," Mr. Padilla said. A 1991 law only regulated transplants of kidneys and other organs from brain-dead donors. One contentious issue was whether to ban foreigners from securing kidneys from local donors -- a move backed by private advocacy groups to prevent the exploitation of the poor in Third World countries, Mr. Padilla said. Authorities eventually decided against such a ban but made it difficult under the new order for foreign patients to obtain kidneys, he said. The order prioritizes Filipino patients in the allocation of donated kidneys and prohibits their export to any other country. About 10,000 to 12,500 Filipinos develop serious renal diseases each year and about half could be saved by kidney transplants, according to the health department. Only about a tenth of those who could have transplants actually do so because kidneys are in short supply and the procedures cost so much. There are no existing statistics on the number of foreigners seeking local kidney donors.

Como o mundo está ficando sem graça: teste de paternidade nas drogarias

Clique aqui ou leia o resumo abaixo em inglês. Machado de Assis não teria mais vez. Bentinho passaria o cotonete na bochecha de Ezequiel ,de Capitolina e dele próprio. O problema estaria resolvido em 3-5 dias úteis por 200 reais....

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