Associação Médica Americana reconhece racismo e pede desculpa.

AMA Apologizes for Discrimination Against Black Doctors
Posted by Jacob Goldstein
“For more than 100 years, many state and local medical societies openly discriminated against black physicians, barring them from membership and from professional support and advancement. The American Medical Association was early and persistent in countenancing this racial segregation.”
Those are the conclusions of a panel convened by the AMA to look into the “historical roots of the black-white divide in U.S. medicine.” The panel’s report was published online by JAMA yesterday, as the AMA issued a formal apology for “its past history of racial inequality toward African-American physicians.”
The report doesn’t offer any revelations; it was no secret that black physicians were largely barred from the AMA as late as the 1960s. Nor will the apology change the past. “In offering an apology, the AMA recognizes that contrition cannot remove the stain left by a legacy of discrimination,” Ronald Davis, the association’s immediate past president, wrote in a JAMA commentary that was published in conjunction with the report.
But the National Medical Association, which was founded in the 19th century by black physicians who were barred from the AMA, welcomed the apology. “We commend the AMA for taking this courageous step and coming to grips with a litany of discriminatory practices that have had a devastating effect on the health of African Americans,” the group’s president said in a statement.

Novamente, a questão do porte de armas.

Editorial do The New England Journal of Medicine aponta o risco da Suprema Corte estar permintido um "quasi experimento" ao afrouxar a regulamentação do controle de armas, no caso específico de uma ação no Distrito de Colúmbia. O experimento será verificar o número de ferimentos e mortes após a redução do controle de armas.

Guns and Health
Jeffrey M. Drazen, M.D., Stephen Morrissey, Ph.D., and Gregory D. Curfman, M.D.
the country on a risky epidemiologic experiment. The announcement by the Court last month of its decision in District of Columbia v. Heller,1 which struck down a ban on handgun ownership in the nation's capital, has set the stage for legal challenges to gun regulation in other major American cities. Such challenges have already been introduced in Chicago and San Francisco. If there is a widespread loosening of gun regulations, we will learn over the next few years — in a before-and-after experiment — whether the laws we had in place had a significant impact in mitigating death and injury from handguns. In our opinion, there is little reason to expect an optimistic result; research has shown and logic would dictate that fewer restrictions on handguns will result in a substantial increase in injury and death.
The Supreme Court's 5-to-4 decision reflects the sharp division among the justices and a very narrow victory for the majority. Still, all the justices agreed that American society has a legitimate interest in regulating firearms. The disagreement lay in the extent of regulation that they found acceptable within the framework of the Constitution. The majority indicated that regulation must be limited to specific circumstances, such as gun ownership by felons and the mentally ill and the carrying of firearms in schools and public buildings, whereas the minority believed that more far-ranging regulation, including laws such as the District of Columbia's handgun ban, meets a constitutional standard.
We believe that closer regulation promotes the public health. In April, just after the oral arguments in District of Columbia v. Heller, we wrote that "health care professionals, whose responsibility it is to treat the wounded and the dying, have special reason to be concerned."2 In light of the Court's decision in the case, that concern has been magnified.
The Centers for Disease Control and Prevention, in concert with health authorities across the country, keeps careful records on the number of injuries and deaths that result from handgun use. In 2005, the last year with complete data, there were more than 30,000 deaths and 70,000 nonfatal injuries from firearms.3 About one quarter of the nonfatal injuries and a tenth of the deaths were in children and adolescents. To place these numbers in perspective, 10 times as many Americans die each year from firearms as have died in the Iraq war during the past 5 years. Firearm injuries represent a major public health problem that seems certain to be exacerbated with less handgun regulation.
It is well documented in the medical literature that regulation of guns benefits the public health. For example, a careful study4 demonstrated that the 1976 restrictive handgun law in the District of Columbia, which was the focus of the Heller case, resulted in an immediate decline of approximately 25% in homicides and suicides by firearms, but there was no such decline in adjacent areas that did not have restrictive laws.
With the weakening of handgun regulations, we are very concerned about the health of the public, especially young people, whose safety is disproportionately affected by firearms. We have a heightened concern about suicide, in which impulsivity may have an important role; ready access to a gun may significantly increase the risk of completion.5,6 We believe that a sensible level of regulation is essential. There is no language in the Constitution that would limit regulation. Indeed, the preamble to the Second Amendment includes the phrase "well-regulated" in reference to the use of firearms by militias. Given the diversity of geography and population in the United States, lawmakers throughout the country need the freedom and flexibility to apply gun regulations that are appropriate to their jurisdictions. The Court's decision in District of Columbia v. Heller may greatly reduce the latitude that legislators have had in setting firearm regulations for their localities.
With the Supreme Court's decision and the expectation of a substantial reduction in gun regulation, we are poised to witness another epidemiologic study of the effect of regulation on gun violence. With this experiment, which may play out in many American cities, we will know in the coming years whether the overturned laws reduced death and injury from handguns. The Court has heard the arguments and made its decision; we will now learn the human ramifications of this landmark case.

Repercussões de uma asneira: tratar colesterol elevado em crianças

A Big Pharma é terrível! O seu canto da sereia muda rapidamente de audiência. Cardiologistas, endocrinologistas, psiquiatras e, agora pediatras. A Academia de Pediatria Americana propõe que haja rastreamento e tratamento de colesterol elevado em crianças, devido ao aumento da obesidade e diabetes na infância. Que tal tratar as causas da obesidade? Abaixo, transcrevo o resumo do diário do DIA repercutindo a asneira acadêmica. Entendam bem dos dois até mais tardar os dez anos....A próxima proposta será no cordão umbelical. Bem, agora vamos aguardar os "coleguinhas brasileiros especialistas em dislipidemia na infância" começar a tagarelar. Com certeza haverá em algum congresso nacional uma mesa-redonda sobre o tema.

New recommendation for treating high cholesterol in children raises controversy.
NBC Nightly News (7/7, lead story, 2:40, Williams) reported that "[w]hen the pediatricians in this country start talking about cholesterol-lowering medications for children,...it may be one indicator of a very big problem." ABC World News (7/7, lead story, 2:40, Gibson) added that U.S. pediatricians have put forth "a new and quite controversial proposal,...calling for an early approach and aggressive approach toward high cholesterol" in children.
The Washington Post (7/8, HE2, Kritz) reports that the "American Academy of Pediatrics (AAP) Committee on Nutrition has updated its 10-year-old cholesterol screening and treatment guidelines." The new guidelines were published in the July issue of Pediatrics. Previously, the "recommendations called for testing only kids two and older whose parents have heart disease or high cholesterol levels, or whose disease and cholesterol information is not known." But, the committee now urges "testing [for] all kids with risk factors for heart disease...starting at age two, and no later than age 10."
In the New York Times's (7/8, F5) Well column, Tara Parker-Pope writes, "This aggressive new recommendation for warding off heart disease in some children has stirred a furious debate among pediatricians since the American Academy of Pediatrics issued it on Monday." Although "some doctors applauded the idea, others were incredulous. In particular, these doctors called attention to a lack of evidence that the use of the cholesterol-lowering drugs, called statins, in children would prevent heart attacks later in life."
AAP member, Stephen R. Daniels, M.D., Ph.D., of Cincinnati Children's Hospital, said that the recommendation "stems from recent research showing that cholesterol-fighting drugs are generally safe for children," the AP (7/7, Tanner) explained. In fact, "[s]everal of these drugs are approved for use in children, and data show that increasing numbers are using them."
According to the academy, its recommendation "takes on a new urgency, given the current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus hypertension, and cardiovascular disease in older children and adults," Bloomberg (7/8, Alesci) adds. But, Peter Belamarich, M.D., of the Children's Hospital at Montefiore in New York, said that only "[a]bout one percent of children meet the criteria for drug treatment under the new guidelines." Therefore, he, will "avoid prescribing drugs for his patients until there is more long-term safety data on cholesterol lowering medicines in children."
The Wall Street Journal's (7/7, Goldstein) Health Blog, Minnesota's Star Tribune (7/8), the Baltimore Sun (7/7, Lhee), AHN (7/7, Hernandez), HealthDay (7/7, Reinberg), MedPage Today (7/7, Peck), WebMD (7/7, DeNoon), and Medscape (7/7, O'Riordan) also covered the story, as did U.S. News & World Report (7/7, Shute) in its On Parenting blog.

Jaleco branco semelhante ao macacão de piloto de corrida

The New Yorker apresenta reportagem da relação médicos e indústria farmacêutica com um cartoon semelhante ao reproduzido acima. (clique aqui).

Ao lado é outra caricatura publicada no Health Blog do WSJ de autoria de Jeff Darcy há dois anos. Apesar da discussão se há plágio ou não, o que interessa é o quanto essa questão está sendo cada vez mais criticada.

PNDS: repercussão baixa

Os resultados da Pesquisa Nacional de Demografia e Saúde divulgados nessa quinta-feira foram surpreendentes e, de grande importância para compreender a dinâmica social e, consequentemente de indicadores epidemiológicos. No entanto, a repercussão na mídia impressa foi baixíssima. Somente, Carta Capital lançou na capa a pesquisa. Os jornais paulistas quase ignoraram os resultados. Gostaria de entender o fato: efeito Ingrid? efeito Speed?

Por outro lado, de forma impressionante e exemplar, o Ministério da Saúde está fornecendo as tabelas em formato .sav (do software estatístico SPSS) para quem quiser começar a analisar a quantidade imensa de dados. Obviamente, de acordo com as regras do Consórcio de Informações em Saúde.

Finalmente, parabéns a essa "mulherada"....Elza, Tânia, Sandra, Suzanne, ao CEBRAP, USP, UNICAMP e, claro ao DECIT e, à comunidade "demográfica brasileira" cada vez mais conceituada e madura.

'Lei Seca" é papo de otário ou de lobista das cervejeiras

Já expressei várias vezes aqui argumentos e expus fatos sobre o risco de se dirigir sob efeito de bebida alcóolica. A lei atual é moderna e adequada aos padrões exigentes da civilidade. Chamá-la de lei seca é desonestidade. Não há proibição à venda ou ingestão de bebida alcóolica, simplesmente, não se admite que se mate ou morra ao volante. José Arthur Giannotti em artigo lamentável na Folha de S.Paulo (06/07/08) não consegue entender porque o Brasil baixou tanto o limiar do nível alcóolico, próximo ao dos paíse nórdicos. O nosso filósofo não "realizou" que a carga de mortalidade por acidentes de trânsito no Brasil é maior do que em outros países.

Os argumentos contra a lei são equivalentes àqueles contra o cinto de segurança e o de fumar em ambientes fechados. Os exemplos dos bombons licorosos ou do sagú lembram as asneiras de que o uso do cinto de segurança seria perigososo, porque sua utilização aumentaria o risco de ficar preso dentro do carro em caso de afogamento ou de incêndio.

A Associação dos Bares, ao invés de pagar caros advogados, poderiam criar um novo e lucrativo negócio junto com as cooperativas de taxistas. Cada bar ou restaurante, ou um conjunto de deles faria convênio com uma cooperativa de confiança. O cliente pediria um carro e indicaria o destino. O restaurante cobraria na própria conta a viagem e, anotaria o nome do motorista. Todos ganhariam, menos os valets. Eles poderiam se transformar em taxistas, aliás uma atividade mais digna porque permite trabalho autônomo. Pais ficariam mais tranquilos se soubessem que seus filhos voltariam para casa com motorista conhecido.

Outro aspecto importante será a redução de estacionamentos em bairros como Vila Madalena, cujos terrenos poderiam ter utilidade maior como residência ou comércio. Isso também reduzia o barulho causado pelo tráfego de carros e estacionamentos de carros nas ruas pelos valets.

Novo visual

O blogue está de cara nova. Estive fora duas semanas nos Estados Unidos. Enquanto isso alguns temas surgiram sem que pudesse comentar, como a lei que coibe a direção de veículos por pessoas alcoolizadas, as pressões pela saída do Ministro da Saúde, a divulgação da Pesquisa Nacional de Demografia e Saúde.

Mas, ficam aqui impressões sobre a questão da saúde nos Estados Unidos:

1. propaganda de medicamentos de forma insuportável, agressiva, de forma nunca visto antes tanto na televisão como no rádio e na imprensa escrita.

2. o número de livros criticando o complexo médico-industrial-midiático aumentou muito, ao mesmo tempo que há uma quantidade muito grande de ensaios sobre a importância de se restabelecer a relação médico-paciente.