sexta-feira, 9 de fevereiro de 2007

Índia: poderio na área farmacêutica, fracasso na saúde pública.

A Índia é um país com uma indústria farmacêutica que está dominando o setor de genérico, por outro lado apresenta indicadores péssimos de saúde e nutrição. Abaixo, um despacho da Associated Press comentando pesquisa de saúde materno-infantil.
India Lags Behind West on Health Issues NEW DELHI -- Preliminary figures from the National Family Health Survey highlighted persistent gaps between the health of rural and urban India, and between health awareness among men and women, who in many parts of the country remain second class citizens. The most glaring problem in the 2005-2006 survey was the health of children. With about 46% of children malnourished -- a negligible improvement over the last survey, conducted in 1998-99 -- India is in the same league with nations like Burkina Faso and Cambodia. In China, Asia's other rising economic power and the country India often compares itself with, only 8% of children are underweight. The improved infant mortality rate -- down to 57 per 1,000 births from 68 in the previous survey -- remains dramatically lower in Western nations. In the U.S., for instance, it is seven per 1,000 births. Health in the countryside lagged far behind cities in every category where a comparison was offered. The rural infant mortality rate, for example, was 62 per 1,000 births, compared to 42 in urban areas. Nearly 51% of women made at least three visits to the doctor when they were pregnant, up from 44% in 1998-99. Some 41% had children in a hospital or clinic, up from about 34% in the last survey. The data also showed increased awareness about HIV. Some 57% of women who are or have been married knew about the virus -- a big jump from the 40% reported in 1998-99. But the figure is still likely to be criticized as far too low for a country with 5.7 million people infected with the disease, the most in the world. A much higher percentage of men in the same group -- 80% -- had heard about the disease. No comparison with the data from previous surveys was offered for men. The difference may have something to do with the fact that men are much more likely to be exposed to the country's media -- the survey found 80% of men had access to media, while only 65% of women did.

quinta-feira, 8 de fevereiro de 2007

Genéricos em alta nos EUA.

A prescrição e compra de medicamentos genéricos aumentou nos Estados Unidos, principalmente entre os idosos. Tudo isso apesar da propaganda intensa dos medicamentos de marca. Abaixo, reportagem do The Wall Street Journal.
Use of Generic Drugs Is Rising,Especially Among the Elderly By DEAN TREFTZFebruary 8, 2007; Page D3 WASHINGTON -- Government data to be released today show that almost two-thirds of prescriptions filled for Medicare beneficiaries are for generic, rather than brand-name, drugs, a proportion that is higher than in the under-65 age group and that is helping to lower the projected costs of the Medicare drug benefit. The Centers for Medicare and Medicaid Services, which runs the federal program for the elderly and disabled, found 61% of seniors' prescriptions were for generic medications in the third quarter, the third consecutive quarter of growth in using generics. The National Association of Chain Drug Stores also will announce today that the use of generic drugs rose to almost 53% of privately insured Americans, from 48% in 2005. Increased use of generics has been cited as one reason why growth in U.S. health-care spending has slowed from its earlier torrid rate. Generic alternatives to more expensive brand-name drugs allow seniors to delay reaching the drug benefit's coverage gap, also known as "the doughnut hole," or to avoid it altogether, Medicare officials said. The agency encourages the use of generic drugs.

quarta-feira, 7 de fevereiro de 2007

Racismo e Doença Cerebrovascular: uma hipótese

O professor Eduardo Faerstein do Instituto de Medicina Social da UERJ enviou carta apresentando o racismo com hipotético fator de risco para a doença cerebrovascular. A base foi editorial de minha autoria que pode ser acessado aqui ao lado: Stroke: a neglected disease in Brazil. Sao Paulo Med. J. vol.124 no.5 São Paulo 2006
Hypothesis: racism is a risk factor for cerebrovascular diseases Eduardo Faerstein I very much appreciated the editorial "Stroke in Brazil: a neglected disease",1 because it emphasized not only the high mortality rates due to cerebrovascular diseases in Brazil but also the surprising paucity of epidemiological studies that have so far investigated their determinants in our population. The editorial appropriately draws attention to the relevance of the social determinants of these conditions. I would like to suggest that the possible direct and indirect effects of racial discrimination in Brazil should be an issue for empirical investigation as potential determinants of cerebrovascular diseases. In fact, racism constitutes an additional axis of social inequalities that generate disease and deaths in our country, and has been the subject of growing academic interest.2 Recently, Chor and Lima3 reported that, differently from whites, black men and women aged 40-69 years have mortality rates from cerebrovascular diseases that are higher than from ischemic heart disease. In addition, our exploratory analyses among participants in the Pro-Saúde study in Rio de Janeiro suggested that perceived lifetime racial discrimination can increase the risk of hypertension (one major risk factor for cerebrovascular diseases), through the intervention of and/or interaction with socioeconomic adversity. These circumstances may act directly through chronic psychosocial stress and/or through more proximal etiological mechanisms in the causal chain (e.g. related to obesity).4 Research on cerebrovascular diseases in Brazil should take the possible effects of racism into account at the various stages of their natural history. In multiethnic societies such as ours this may shed light both on specific societal features of ethnicity-based discrimination – a historical, ever-changing phenomenon5 – and on its potentially wide-ranging health consequences. REFERENCES 1. Lotufo PA. Stroke in Brazil: a neglected disease. Sao Paulo Med J. 2005;123(1):3-4. 2. Faerstein E. Fórum: raça, racismo e saúde no Brasil. [Forum on race, racism, and health in Brazil]. Cad Saúde Pública. 2005;21(5):1584-5. 3. Chor D, Lima CRA. Aspectos epidemiológicos das desigualdades raciais em saúde no Brasil. [Epidemiologic aspects of racial inequalities in health in Brazil]. Cad Saúde Pública. 2005;21(5):1586-94. 4. Faerstein E, Chor D, Werneck G, Lopes CS, Lynch J, Kaplan G. Race and perceived racism, education, and hypertension among Brazilian civil servants (abstract). Am J Epidemiol. 2004;159(11):S35. 5. Fredrichson GM. Racism: a short history. New Jersey: Princeton University Press; 2003.

Patentes de medicamentos: uma revisão muito boa.

Não há necessidade de concordância com a conclusão dos autores, mas a revisão está muito boa. Acesso direto ao texto em
CHAVES, Gabriela Costa, OLIVEIRA, Maria Auxiliadora, HASENCLEVER, Lia et al. Evolution of the international intellectual property rights system: patent protection for the pharmaceutical industry and access to medicines. Cad. Saúde Pública, Feb. 2007, vol.23, no.2, p.257-267. ISSN 0102-311X. O artigo discute a evolução do sistema internacional de direitos de propriedade intelectual em três fases e as implicações para saúde pública, especialmente para a implementação de políticas de acesso a medicamentos. Durante a primeira fase, caracterizada pelas Convenções de Paris e de Berna, os países signatários determinavam os campos tecnológicos que seriam protegidos ou não. Na segunda fase, com a implementação do Acordo TRIPS pela OMC, os países são obrigados a garantir proteção patentária a todos os campos tecnológicos, inclusive para a indústria farmacêutica. Dentro das suas respectivas legislações nacionais, os países também têm a oportunidade de implementar o acesso às flexibilidades do TRIPS para medicamentos. Com a terceira fase, caracterizada pela negociação e assinatura de acordos comerciais bilaterais e regionais, os países terão que implementar medidas TRIPS-plus que podem ter implicações negativas para as flexibilidades do TRIPS e para políticas de acesso a medicamentos. Os autores concluem que a proposta atual de sistema internacional de direitos de propriedade intelectual favorece os direitos dos detentores de patentes, que deveriam estar em equilíbrio com os direitos à saúde para a população. Keywords: Medicamentos; Propriedade Intelectual de Produtos e Processos Farmacêuticos; Comercialização de Medicamentos.

terça-feira, 6 de fevereiro de 2007

Obesidade em mulheres pobres: estudo da USP.

Um estudo sobre obesidade identificou paridade e raça como fatores associados em mulheres de renda baixa na cidade de São Paulo. Esse estudo foi a tese de Alessandra Carvalho Goulart, orientado por Isabela Martins Bensenor na Faculdade de Medicina da USP. A publicação encontra-se no Nutrition Research do mês de janeiro de 2007, cujo resumo segue abaixo.
Maiores informações e o texto com Profa Isabela Bensenor em . O autor do blogue é co-autor do estudo.
Race and parity as risk factors for obesity among low-income women in Brazil Alessandra C. Goulart, Fernando M. Silvaa, Isac de Castro, Paulo A. Lotufo Marly A. Cardoso, Isabela M. Bensenor In recent years, several reports have indicated that obesity and associated chronic diseases presented a huge increase worldwide, especially in low-income women living in undeveloped countries. The aim of this study was to verify, in a cross-sectional way, the association among obesity, diet, lifestyle and socioeconomic factors among 116 low-income women (mean age, 42.6 F 13.4 years) living in a deprived neighborhood in the metropolitan area of Sao Paulo, the main city in Brazil. The sample was categorized in 3 strata according to body mass index (V25.0, 25-29.9, and z30.0 kg/m2). Anthropometric measurements and cardiovascular risk factors, as well as diet, lifestyle, and sociodemographic characteristics, were compared. Frequency of obesity was 28.4%—higher than the frequency of obesity observed in other Brazilian population samples. After multivariate adjustment, compared with women with less than 3 childbirths, women with 3 childbirths or more were more overweight (odds ratio [OR], 3.4; 95% confidence interval [95% CI], 1.2-9.6) and more obese (OR, 5.3; 95% CI, 1.3-17.5). Compared to black women, white women were also more obese (OR, 9.9; 95% CI, 1.5-64.6). In this sample of low-income women, parity and race were the most important factors associated with obesity.

A favor dos médicos estrangeiros

Um email bem educado insinuou ser corporativista e, defensor do controle de mercado de trabalho médico. Explico.
A vinda de médicos estrangeiros é benéfica a qualquer país porque traz novos conhecimentos e culturas. A questão é como se entra no mercado de trabalho médico.
O primeiro passo é que estar no Brasil com passaporte sem restrição para entrar e sair de seu país de origem, extensivo aos familiares e, sem qualquer restrição de pedido de naturalização. O segundo é passar no exame de revalidação do diploma médico. O terceiro é cursar residência médica. O quarto é ser aprovado em concurso público. O quinto é viver como brasileiro, pagando impostos, aluguel, escola, alimentação com o salário aqui recebido.
Pergunto: médicos cubanos sem enquandram nesses requisitos mínimos?

Corrida para a Casa Branca: saúde em primeiro lugar.

A postulação de candidato democrata para Casa Branca em 2008 está em três candidatos (Hillary Clinton, Barack Osama e John Edwards). Edwards lançou um plano corajoso para cobertura universal e, não teve medo em avisar que isso ocorreria com aumento de impostos dos mais ricos. Leia abaixo parte da reportagem do The Wall Street Journal de hoje.
Os republicanos também estão abordando o tema, como o Mitt Rommey, o ex-governador de Massachusetts. O tema será decisivo, porque o Iraque já dividi o eleitorado americano, mas a saúde pode atrair aos democratas votos tradicionalmente republicanos.
Edwards's Plan for Universal Coverage To Be Matched by Rivals By SARAH LUECK February 6, 2007; Page A4 WASHINGTON -- John Edwards's call for universal health care marks the opening volley in two debates facing Democrats running for president in 2008: How to provide health coverage to some 47 million uninsured people and what to do about President Bush's tax cuts. Many of the party's White House hopefuls, including Sens. Hillary Clinton (D., N.Y.) and Barack Obama (D., Ill.), say extending coverage to all the uninsured is a priority. Their focus on relatively sweeping health-care proposals matches escalating concern among voters and employers about medical costs and coverage. (See related articles on Medicare and the ways that plans to expand health coverage could impact the insured.) So far, Mr. Edwards has provided the most detail about how he would accomplish this, with the release yesterday of a plan requiring the government, employers and individuals to contribute to the cost of extending coverage to the uninsured. The former North Carolina senator and 2004 vice presidential nominee also has stated that tax increases for upper-income people would be needed to fund his plan, which aims to provide universal coverage by 2012. Specifically, he has proposed raising taxes for households with incomes of more than $200,000. That would essentially repeal some of the tax cuts shepherded by Mr. Bush. Mr. Edwards also would fund some of his health-care proposals by reducing the "tax gap," the amount of revenue the government is owed, but doesn't collect. "Yes, we'll have to raise taxes," Mr. Edwards said Sunday on NBC's "Meet the Press." He said it is "the only way you can pay for a health-care plan" estimated to cost the government $90 billion to $120 billion a year. It remains to be seen whether voters will accept Mr. Edwards's vision of "shared responsibility," in which employers would have to help fund their workers' coverage and individuals would be required to purchase insurance, often with the help of new tax credits aimed at low-income and middle-class people. Medicaid and the State Children's Health Insurance Program, or SCHIP, would be expanded to cover more children and low-income parents. New regional "health markets" would offer comprehensive health-insurance plans to anyone who doesn't get insurance through their jobs or a government program. Some Democrats expressed surprise at the bluntness of Mr. Edwards's remarks in favor of tax increases, but many health-policy experts believe higher taxes would be needed to fund any serious attempt at universal coverage.