Mais dinheiro ou melhor gasto? que tal os dois...

Abaixo, transcrevo parte de artigo excelente (assinante da Folha, clique aqui) de Lígia Bahia e Mário Scheffer sobre a administração dos serviços públicos de saúde. Eles defendem o aumento do orçamento da saúde, mas não deixam de reconhecer sérios problemas gerenciais, cujas origens se encontram no idealismo dos sanitaristas com o "controle social" via os conselhos e conferências e, a manipulação sindical dos funcionalismo da área da saúde. Em suma, há necessidade de mais dinheiro, mas sem uma reforma administrativa radical, o dinheiro continuará ser mal gasto.

As necessidades de saúde dos usuários do SUS nem sempre coincidiram com as hierarquias estabelecidas pelos gestores, intelectuais e movimento sindical da saúde. Talvez seja o momento de os interesses corporativos darem ouvidos a quem mais entende dos problemas intrincados de financiamento e de gestão: a população que depende do SUS, que não agüenta mais ver o acesso negado, a rede pública em penúria, a peregrinação em filas, os prontos-socorros lotados, a precarização do trabalho dos profissionais que atuam nos serviços.

Médicos e Tortura: The Lancet

Biko to Guantanamo: 30 years of medical involvement in torture David J Nicholl a, Trefor Jenkins b, Steven H Miles c, William Hopkins d, Adnan Siddiqui e and Frank Boulton f, on behalf of 260 other signatories This week marks the 30th anniversary of the death of anti-apartheid activist Steve Biko while being detained by South African security police. Initially, the Minister of Justice suggested Biko had died of a hunger strike; however, the inquest revealed that he had died of the consequences of head injuries sustained during police interrogation, and identified gross inadequacies in the medical treatment from the two doctors responsible for his care, including the falsification of records. The regulatory authorities failed to take firm action, and it was only grass-roots efforts by doctors that led, almost 8 years later, to Benjamin Tucker being found guilty of improper and disgraceful conduct and being struck off the medical register; Ivor Lang was found guilty of improper conduct and was given a caution and a reprimand.

There are strong parallels between the Biko case and the ongoing role of US military doctors in Guantanamo Bay and the War on Terror. Last year, we suggested that the physicians in Guantanamo force-feeding hunger strikers should be referred to their professional bodies for breaching internationally accepted ethical guidelines. One of us (DJN) lodged formal complaints with the medical boards for Georgia and California as well as pointing out to the American Medical Association (AMA) that the former hospital commander at Guantanamo, John Edmondson, was a member. After 18 months, there had been no reply from the AMA, the Californian authorities stated that they “do not have the jurisdiction to investigate incidents that occurred on a federal facility/military base”, and the authorities in Georgia stated that the “complaint was thoroughly investigated” but “the Board concluded that there was not sufficient evidence to support prosecution”. Yet an analysis of the same affidavit by the Royal College of Physicians concluded that “in England, this would be a criminal act”. The UK government has refused a request from the British Medical Association for a group of independent doctors to assess the detainees and, to date, there has been no formal report on the three alleged suicides in Guantanamo that took place in June, 2006. The resolution of the Biko case was instrumental in the rehabilitation of the South African Medical and Dental Council and the Medical Association of South Africa, which had been subject to boycotts during the apartheid years. The failure of the US regulatory authorities to act is damaging the reputation of US military medicine. No health-care worker in the War on Terror has been charged or convicted of any significant offence despite numerous instances documented including fraudulent record keeping on detainees who have died as a result of failed interrogations. We suspect that the doctors in Guantanamo and elsewhere have made the same mistake as Tucker who, in 1991, in expressing remorse and seeking reinstatement, said “I had gradually lost the fearless independence…and become too closely identified with the organs of the State, especially the Police force…I have come to realise that a medical practitioner's first responsibility is the wellbeing of his patient, and that a medical practitioner cannot subordinate his patient's interest to extraneous considerations.” The attitude of the US medical establishment appears to be one of “See no evil, hear no evil, speak no evil”.

Os stents farmacológicos, mais uma vez evidência de risco.

Novamente os stents farmacológicos para o tratamento da doença coronariana. Sempre no mesmo palco, o Congresso Europeu de Cardiologia. Nas próximas semanas choverão desmentidos dos estudos abaixos. Vamos ver como se comportarão as ações da Boston Scientific e da Johnson & Johnson. Aqui no Brasil, a "solução" foi e continuará simples: stents farmacológico para todos e clopidogrel (Plavix) para todos para evitar estenose tardia. Afinal, dinheiro aqui não é problema, é solução. Depende para quem.....

Drug-Coated Stents Are Questioned A WSJ NEWS ROUNDUPSeptember 5, 2007; Page D7 VIENNA -- Patients given drug-coated stents after an acute heart attack are nearly five times as likely to die six months to two years later as those with bare metal forms of the arterial scaffolding, new research showed. The finding, from a two-year analysis of 2,300 patients in 14 countries, fuels the debate over the safety of so-called drug-eluting stents, made by companies such as Boston Scientific and Johnson & Johnson. Doctors at the European Society of Cardiology meeting said the finding showed the need to be very selective about giving drug stents to the right patients. At the same time, experts emphasized that there were differences among the patients in the study that could have affected the outcome, and that these findings aren't the final word on the safety of drug-coated stents for heart-attack patients. Gabriel Steg of the Hospital Bichat-Claude Bernard in Paris followed the fate of patients who were given stents -- tiny wire-mesh tubes used to prop open clogged heart arteries -- following the most deadly kind of heart attack. For the first six months, those on drug stents did as well as those on bare ones. But after 180 days, the drug-stent patients were 4.7 times as likely to die, with a mortality rate of 8.6%. Dr. Steg said the trend probably reflected the high thrombosis risk in this group of patients. Drug stents are known to carry a small risk of blood clots after the first year, known as "late stent thrombosis." This occurs in less than 1% of patients but kills nearly half of those affected. Dr. Steg said many heart patients with less acute conditions could still benefit from drug stents, which help prevent arteries narrowing again. "I still believe there is room" for drug-eluting stents "in many patients and I disagree with the concept of banning" drug-eluting stents altogether, Dr. Steg said. Drug stents remain controversial in the cardiology community and fears about late stent thrombosis have led to a slump in sales in the past year. Eckhart Fleck, director of cardiology at the German Heart Institute in Berlin and a spokesman for the European Society of Cardiology, said the findings were serious and showed that doctors shouldn't be indiscriminate in use of drug stents. "This study will make doctors less enthusiastic about using drug-eluting stents," said Spencer King, a cardiologist at Fuqua Heart Center in Atlanta and spokesman for the American College of Cardiology. "The concerns about safety may make doctors shy away." Johnson & Johnson said in a statement the results were inconsistent with the findings of other analyses of patient records and with all currently available randomized controlled trials. Boston Scientific, separately, said the lower mortality seen in patients one year after receiving bare-metal stents was atypical when compared with earlier data on the company's Taxus stent. It said a study, which has just completed enrolling 3,000 heart attack patients, is now under way comparing Taxus with bare-metal stents. A Swedish study presented Sunday, involving 35,000 patients, found no overall increased risk for heart patients between drug and bare stents after four years of follow-up -- a reversal of the same researchers' earlier three-year findings that patients with coated stents were more at risk

"Estado deve superar dogmas da esquerda"

Essa é a manchete do Valor Econômico referente à entrevista do governador de Pernambuco, Eduardo Campos, do PSB e neto de Miguel Arraes. Os comentários do governador são perfeitos e, muito semelhantes aos de Cristóvão Buarque há dez anos quando dirigia o Distrito Federal. Destaco somente uma frase: " a esquerda precisa saber que premiar o profissional que mostra resultado é uma necessidade da gestão pública".

O governo Campos já tinha sido destaque aqui por não escamotear a violência em Pernambuco. (alô, governador Aécio, tudo calmo em BeAgá??), agora ele não nega que o estado que dirige é campeão negativo (o termo é do governador) em educação básica e segurança púbica e, detem o vice-campeonato negativo em saúde.

Socialista adora privilégio, neoliberal não sabe quanto custa o almoço

A revista Época dessa semana traz reportagem sobre a assim chamada "crise da saúde'. Hoje, a página eletrônica publica entrevista do Ministro Temporão onde ressalta a necessidade de mudar a gestão hospitalar.(clique aqui). Nessa reportagem há uma intervenção minha, a de que "nenhum país oferece acesso universal à saúde. A sociedade precisa saber o que quer. O sistema público faz de vacinação a transplantes". A reportagem concluiu a seguir: Talvez o Brasil precise de - e esteja disposto a pagar por - tudo isso. Talvez não.

Já vi intelectual de esquerda escrever artigo criticando a pseudo democracia racial e social e, depois solicitar atendimento hospitalar diferenciado (afinal, ficar esperando ao lado de negros e pobres....).Vi também outros que criticam a fúria fiscal, em particular a CPMF, mas exigem que o hospital público supra atenda as necessidades de sua família. Em suma, temos o socialista que ama um privilégio e o neoliberal que não se importa quanto custa o almoço...

Se ao menos "nossa direita" e "nossa esquerda" fossem coerentes....

O aleitamento materno: ainda uma questão nos EUA.

Na semana anterior, houve mais um "acontecimento" na zona leste de São Paulo a favor do aleitamento materno. Confesso que assustei vendo a motoniveladora passando por cima de mamadeiras e latas de leite em pó. Mas, vale pela boa causa que representa. Hoje, The Washington Post noticia a campanha pelo aleitamento materno nos Estados Unidos. A situação lá é pior do que a brasileira, principalmente pela menor cobertura trabalhista no pós-parto.

Abaixo, o comentário de Jacob Goldstein, blogueiro do The Wall Street Journal.

To persuade more women to breastfeed, federal health officials planned an ad campaign featuring stark images and warning that babies who aren’t breastfed are more likely on average to have certain health problems. The baby formula industry hired big-time lobbyists to object, and cold and prickly images .C ongress is investigating the shifting ad campaign as part of its broader look into claims by former surgeon general Richard Carmona that he was sometimes muzzled by the Bush administration. One of the department of Health and Human Services’ stated goals for the decade is to increase the percentage of women who breastfeed their babies; a CDC report earlier this year found that rates are indeed increasing, but are still short of targets set by HHS. The president of the American Academy of Pediatrics, Carden Johnston, was among those approached by industry representatives, who argued that the campaign would needlessly frighten women and make those who were unable to breastfeed feel guilty. Johnston, apparently persuaded by their arguments, said in a letter to the HHS secretary that “we have some concerns about this negative approach and how it will be received by the general public.” But in a separate letter, the head of the pediatrics group’s breastfeeding section said he had been unaware of Johnston’s letter and didn’t agree with its contents. (The AAP’s strong support of breastfeeding is evident in this position paper.) “This campaign needed to be much stronger than it was,” he told the Post.

A leitura de fim de semana: a "crise" da saúde

A leitura da Folha de S.Paulo e O Estado de S.Paulo nesse fim de semana permitiu ligar alguns pontos da atual crise da saúde:

1. FSP: O governo federal transferiu R$ 41,8 milhões para ONGs ligadas à CUT e à CGTB (Central Geral dos Trabalhadores do Brasil);

2. FSP:Elio Gáspari: a greve de dois meses nas universidades federais (incluindo hospitais) foi ignorada pelo governo federal;

3. FSP: todos hospitais federais estão com dívidas sérias, à exceção dos hospitais da Universidade Federal de Santa Catarina e o Hospital de Clínicas de Porto Alegre, esse o único federal que não é ligado ao MEC, mas empresa pública onde há o ensino e pesquisa da Universidade Federal do Rio Grande do Sul;

4. OESP: a liberação de R$ 2 bilhões para o Ministério da Saúde não foi confirmada pelo Ministro da Fazenda;

5. OESP: Adib Jatene mostra que o orçamento da Saúde está em queda, não em elevação. Jatene afirma que há "desvios" da destinação do orçamento da saúde para outros setores nas esferas federal e estadual.

Tal como ocorreu na segurança pública, aviação e , agora hospitais o problema está no contigenciamento do orçamento, não na famosa "gestão".

O fato positivo até agora é que o MEC quer se livrar dos hospitais. Aliás, seria bom, que por simetria, o Ministério da Saúde parasse de brincar de ser "escola". Há técnicos e assessores do Ministério da Saúde que negam o conhecimento acadêmico e a universidade. Quem nega a sapiência, não são sábios, mas muito sabidos.