Merck Sharp & Dhome forçava a barra para impor a vacina para o HPV.

Notícia do The Wall Street Journal (abaixo) revela a ação da empresa Merck (no Brasil, Merck Sharp & Dhome) em forçar que os Estados americanos tornassem o Gardasil, vacina para o HPV, fator de risco para o câncer de colo uterino, obrigatório para adolescentes. A reação dos pais e educadores foi grande o suficiente para que a empresa suspendesse o lobby nos Estados.

Aqui, haverá uma reportagem de capa em um das semanais, uma reportagem de duas páginas em um dos três grandes jornais e, um hospital jetset irá abrir uma clínica de HPV. Aguardem.

Já foi dito aqui que a vacina será disponível em Brasília, mas não em Brasília Teimosa em Recife.

Merck Suspends Campaign to MakeGardasil Vaccination Mandatory By JOHN CARREYROU and SARAH RUBENSTEINFebruary 20, 2007 6:39 p.m. Merck & Co. said it would stop lobbying states to pass laws requiring that preteen girls be vaccinated against cervical cancer in the face of a growing backlash among parents, physicians and consumer advocates. Merck's aggressive lobbying campaign was intended to boost sales of its Gardasil vaccine, which received Food and Drug Administration approval last year. Gardasil provides protection against two strains of the human papillomavirus that are thought to cause the majority of cervical-cancer cases. But unlike a number of other diseases that U.S. schoolchildren are required to be vaccinated against, HPV isn't an airborne virus that can spread easily in a group setting. Rather, it is sexually transmitted. Gardasil also stands apart from other vaccines that are compulsory because of its high cost: $360 for a three-dose regimen. In recent weeks, opposition to state mandates has grown among parents who want the freedom to make such a medical decision on their own and are worried about exposing their children to the unforeseen side effects of a new vaccine. Physicians and consumer advocates have also questioned the need to immunize young girls against a disease that is no longer very prevalent in the U.S. and doesn't develop until much later in life. Merck's lobbying efforts have become a distraction from the company's goal of immunizing as many women as possible against cervical cancer, said Richard Haupt, Merck's executive director of medical affairs. Merck has "decided at this point not to lobby for school laws any further." More than 20 states have drafted bills that would make vaccination of pre-teen girls against HPV compulsory. Earlier this month, Texas Gov. Rick Perry issued an executive order mandating that the vaccine be administered to all girls entering the 6th grade in the state as of September 2008. One of Merck's lobbyists in Texas is Gov. Perry's former chief of staff, and Merck's political action committee contributed $6,000 to the governor's re-election campaign. Merck has also been funding Women In Government, a Washington, D.C.-based advocacy group made up of female state lawmakers. An executive from Merck's vaccine division, Deborah Alfano, sat on Women In Government's business council last year, and a number of the bills across the country have been introduced by members of the group. A spokesman for Merck, Ray Kerins, declined to say how much money the company had spent on the lobbying campaign. Merck is eager to build Gardasil's sales quickly to offset patent expirations on some of its bestselling drugs and its mounting legal costs over its withdrawn painkiller Vioxx. "It's a good decision because I think it's true that the discussion about mandates was a distraction -- it is a distraction," said Joseph Bocchini, chairman of the committee on infectious diseases of the American Academy of Pediatrics. Dr. Bocchini said he was concerned that parents would decide against vaccinating their children because of the controversy when they might have otherwise opted to do so. Merck recently asked Dr. Bocchini about his opinion on the controversy, he added. Dr. Bocchini noted that state mandates are usually passed to control the spread of a highly infectious disease like chicken pox. The focus with Gardasil at this point should be on educating patients about the vaccine and cervical cancer, and making sure that patients can afford the vaccine, he said. Merck's marketing campaign for Gardasil has emphasized that cervical cancer is the second-leading cancer among women around the world. But screening with Pap smears has dramatically reduced the disease's incidence in the U.S. The American Cancer Society estimates that 3,670 American women will die from cervical cancer this year, the equivalent of 0.65% of U.S. cancer deaths. Cervical cancer is a much bigger problem in the developing world. Moreover, inoculation with Gardasil won't obviate the need for regular Pap tests because some 30% of cervical cancers are thought to be caused by other HPV strains not covered by the vaccine.

Privacidade de bancos de dados eletrônicos.

A existência do prontuário médico eletrônica é postulada desde o início dos anos 80, mas somente agora está se concretizando. A vantagem de acesso por outro médico, em outro local, a qualquer hora é fascinante. Porém, a possibilidade de manter a inviolabilidade do sistema é muito mais difícil do que atualmente com os prontuários de papel. Uma piada é que a letra é tão ruim, que não há quem consiga decifrar as informações presentes. Abaixo, texto do The Wall Street Journal.

Warnings Over Privacy of U.S. Health Network By ROBERT PEAR Published: February 18, 2007 WASHINGTON, Feb. 17 — The Bush administration has no clear strategy to protect the privacy of patients as it promotes the use of electronic medical records throughout the nation’s health care system, federal investigators say in a new report. In the report, the Government Accountability Office, an investigative arm of Congress, said the administration had a jumble of studies and vague policy statements but no overall strategy to ensure that privacy protections would be built into computer networks linking insurers, doctors, hospitals and other health care providers. President Bush has repeatedly called for the creation of such networks, through which health care providers could share information on patients. In 2004, Mr. Bush declared that every American should have a “personal electronic medical record” within 10 years — by 2014. With computerized records, he said, “we can avoid dangerous medical mistakes, reduce costs and improve care.”

Projeto no Congresso americano para barrar "discriminação genética".

O Congresso americano avança para impedir que testes genéticos sejam utilizados por empregadores e por empresas de seguro. Se aprovado será um exemplo bom para os demais países. Ao que consta, há locais com teste para doenças como a coréia de Huntington.

Abaixo, trecho de reportagem do The Wall Street Journal.

Genetic-Discrimination BanNears Congressional Approval By JANE ZHANGFebruary 15, 2007; Page A11 WASHINGTON -- A bill barring discrimination by employers and insurers based on genetic information is moving swiftly through Congress, drawing praise from privacy advocates and objections from business groups that the measure is too broad. The legislation would be the first federal law prohibiting health insurers from denying coverage or charging higher premiums based solely on genetic information. It also would forbid employers from using the information to make hiring, firing and other job-placement decisions.

J&J e Ethicon do Brasil: quero certidão negativa do Brasil.

A Johnson & Johnson declarou nos Estados Unidos que um de seus executivos prevaricou em países não identificados com produtos da Ethicon. Como a Ethicon atua em quase todos os hospitais do país, gostaria muito de ver uma declaração negativa oriunda da matriz isentando os executivos brasileiros da empresa. A ANVISA precisa agir de imediato, afinal estamos todos sob suspeita: órgão regulador, a filial brasileira, gestores públicos e privados e dirigentes hospitalares. Abaixo, artigo de The Wall Street Journal sobre o tema.

J&J Reports Improper Payments Drug Firm Tells RegulatorsOf Expenditures Overseas;A Senior Executive Resigns By AVERY JOHNSON, KARA SCANNELL and JON KAMPFebruary 13, Johnson & Johnson said it alerted federal officials to improper overseas payments and that one of its senior executives is resigning over the probe. The New Brunswick, N.J., health-care conglomerate voluntarily told the Department of Justice and the Securities and Exchange Commission that it believes its subsidiaries made improper payments in two countries regarding the sale of medical devices. Michael J. Dormer, world-wide chairman for Medical Devices & Diagnostics, stepped down as a result of the revelations. Mr. Dormer had been in charge of several medical-device divisions, including Ethicon, Ethicon Endo-Surgery and DePuy. The company didn't name the countries involved. A J&J spokesman declined to comment beyond the press release, which said that Mr. Dormer told the company in a letter that he has "ultimate responsibility by virtue of my position" for the subsidiaries involved in the disclosure. The J&J spokesman said Mr. Dormer was not available. An SEC spokesman declined to comment. Get alerts for breaking news -- such as Fed moves, major world events and big mergers -- delivered straight to your desktop. Alerts will appear in a small window on your screen, much like an instant-messaging window. The disclosures are a bitter pill for a company that prides itself on its clean corporate image. It was not immediately clear whether the probe extended beyond the countries, which J&J described as "small" markets, or what specific allegations or subsidiaries it involves. But J&J said that the payments in question may fall within the jurisdiction of the federal Foreign Corrupt Practices Act, which prohibit improper payments to foreign officials in order to win or keep business. The Justice Department and SEC have stepped up their pursuit of foreign-bribery cases in recent years, including a record $28.5 million collection against Titan Corp. in 2005. Titan pleaded guilty to settle allegations involving improper payments to Titan's agent in Benin, Africa, some of which were passed on to the re-election campaign of the country's then-president, according to government papers. The government alleged that Titan paid the money in an effort to win higher fees for a telecommunications project. Other companies have reached settlements, which generally involve deferred-prosecution agreements with federal prosecutors where the company or its subsidiary agrees to settle the allegation instead of facing an indictment. In a deferred-prosecution agreement, an indictment is usually filed but is dismissed if the company adheres to the terms of its settlement. As part of a joint settlement, most companies also agree to have a corporate monitor in place to inspect internal controls and book-and-record keeping. The SEC and Justice Department have several open joint investigations. Johnson & Johnson has a huge medical-devices business, with products ranging from replacement hips and knees to blood glucose meters and drug-coated heart devices. The company's Medical Devices & Diagnostics division registered $20.28 billion in sales last year, about 38% of total corporate sales. Device sales were split about evenly between the U.S. and international markets.

Pague seu almoço, doutor!

The New York Times divulga o Projeto Prescrição destinado a acabar com os famosos almoços de divulgação onde a indústria farmacêutica divulga seus produtos. Nos EUA com comida chinesa, aqui com sanduíches de quinta categoria. Yale, Penn U e Stanford já proibiram essa prática. Aqui, o Hospital Universitário da USP há mais de dois anos decidiu encerrar a festa e, pagar ele mesmo lanche de reuniões científicas com produtos de melhor qualidade. Ganham todos, dos pacientes aos acionistas da Big Pharma e, principalmente a academia. Aliás, pagar o próprio almoço é um exercício de autonomia. Perdem os marqueteiros, sales rep e, padarias de qualidade discutível. A Universidade e a Big Pharma necessitam colaborar, mas em pesquisas científicas e de incorporação tecnológica. Lanche ruim, caneta, bloco de notas e canecas definitivamente não agregam valor ao produto acadêmico. Porém, pior do que uma caneta que dura dois dias e uma baguete insossa com patê de fígado é a prática de autoria disfarçada de artigos científicos de pesquisas da própria indústria.

Doctors and Drug Makers: A Move to End Cozy Ties By STEPHANIE SAUL Published: February 12, 2007 More Hippocrates, less Hunan hot sauce. Free lunches for doctors are under attack yet again. Free lunch deliveries to medical offices, along with those ubiquitous drug company logo pens, have come to symbolize the extensive financial ties between doctors and the drug industry. And there is evidence they influence which drugs are prescribed. But pressure is building against the widely reported gifts and other potential conflicts, an effort that took hold last year when a group of influential doctors condemned financial arrangements between doctors and drug companies in The Journal of the American Medical Association. Tomorrow, a new push is scheduled to be announced by Community Catalyst, a health care consumer advocacy group based in Boston, and the Institute on Medicine as a Profession, a research group at Columbia University. With a $6 million grant from the Pew Charitable Trusts, the organizations plan a national campaign calling for restrictions on the interactions between doctors and drug companies, and urging doctors to base their prescription writing more on medical evidence than on marketing. “If you’ve been in the waiting room when these Chinese lunches are taken into the back office, it may raise the question whether the decisions are based on the best scientific evidence about medication or whether or not those Sichuan shrimp have something to do with the prescribing patterns,” said Jim O’Hara, the managing director of policy initiatives at Pew. The pharmaceutical industry spends $12 billion a year marketing to doctors, and much of that money is in the form of free samples delivered to doctors’ offices, often accompanied by lunch for the entire staff. When the University of Michigan health systems banned such lunches in 2005, they calculated that the lunches had been worth $2.5 million a year. The free drugs are samples of the newest and most expensive branded products. The drug industry hopes that by starting patients with free samples, they will remain on the more expensive medication rather than using a cheaper generic. And there is evidence that doctors who have relationships with the pharmaceutical industry prescribe more of the expensive drugs. The new initiative, called the Prescription Project, is an outgrowth of an article published in January 2006 in The Journal of the American Medical Association in which a coalition of scholars and doctors proposed that academic medical centers across the country take the lead in restricting interactions between doctors and the health care industry. Several medical centers, including those at Yale, the University of Pennsylvania and Stanford, have announced such restrictions. The Prescription Project aims to spread those restrictions to other academic medical centers, doctors’ organizations and third-party payers. Some medical school deans are reluctant to impose such restrictions, fearing that they will lose research money, according to David J. Rothman, an author of last year’s journal paper who is also president of the Institute on Medicine as a Profession. “They say, ‘If we did this, we would lose a third of our faculty. They’ll go to places with less stringent requirements; if we did this, we’ll tick off the drug companies and there’ll be payback,’ ” said Professor Rothman. One of the group’s plans is to document the impact of changes at Yale, the University of Pennsylvania and Stanford. “Did the drug companies stop giving Penn research money?” he said. “I don’t for a minute believe that is going to happen.” The organization’s goal is not to prohibit research grants or consultancies, but to limit gifts, travel fees, speakers’ bureaus and ghostwriting while at the same time encouraging prescriptions based on a medical evidence. “Gifts bring with them the felt need to reciprocate,” said Professor Rothman, who teaches social medicine at Columbia. “We’re not saying you’re being bribed,” he added. “We’re saying you’re being gifted. Some of it could be raw monetary hustling. But some of it is this psychological — ‘Well, they just sent me out to Las Vegas, their drug is as good as anybody else’s, why not just say thank you.’ ”

NEJM arma um terreno minado: vários estudos sobre stent coronariano

The New England Journal of Medicine adiantou a sua edição de 13 de março apresentando seis artigos sobre a discussão sobre o melhor tipo de stent coronariano. O editorial escrito pelo próprio editor Jeffrey Drazen é um primor de tucanagem científica. Mas, parabéns a ele por ter apresentado tantos pontos de vista e, nos deixado confuso. Afinal, ciência é dissenso e, quem gosta de consenso que vá para a igreja ou viver em Cuba, Líbia, e quetais.

A revista armou um terreno minado com mais de um artigo analisando o mesmo banco de dados. Talvez, no feriado de carnaval consiga andar na ponta do pé e, tentar desarmar as armadilhas que cada autor colocou nos textos.

Já discuti bastante esse tema anteriormente. Amanhã, publicarei o impacto na mídia. Vamos ver o que acontecerá com as ações dos dois principais fabricantes do stent farmacológico: a J&J e a Boston Scientific.

Por ser assinante e, com o cookie,não consigo identificar se os artigos estão liberados para acesso livre em http://www.nejm.org

Imperdível: Revista Pesquisa Médica

Encontra-se no número 1, a revista Pesquisa Médica editada pela Segmentofarma e dirigido por Sílvia Campolin, jornalista sênior de ciência e saúde. Imperdível a edição impressa e, também o site http://www.revistapesquisamedica.com.br

A linguagem é concisa e precisa. Algo raro que somente jornalistas tarimbados são capazes.

A indústria dos protetores solares agradecem ao IUV.

A Folha de S.Paulo (11/02/06) informa que publicará diariamente o índice de radiação ultra-violeta (IUV) na secção de metereologia, tal como ocorre na maioria dos jornais do mundo. Tudo bem, teremos uma informação a mais para nos preocupar, junto com o fantasioso "risco-país".

Esse IUV irá estimular ainda mais a indústria da proteção da luz solar como os fabricantes de protetores de luz solar.

Pobre astro-rei! Fundamental para a vida no Planeta, agora é acusado de causar doenças. A relação entre irradiação solar e câncer de pele (não-melanoma) de letalidade baixa é decorrente do tempo de exposição e, não da intensidade. Ou seja, o problema é muito maior para o trabalhador do campo e da cidade expostos todos os dias do que para crianças e jovens mimados que se lambuzam de protetores solares em breves períodos do ano. Lembro que os "protetores não protegem" do melanoma, um câncer com letalidade alta.

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.

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.

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 http://www.scielo.br/csp

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.

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

isabensenor@hu.usp.br . 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.