Presidente decreta o fim da vitimização.

Sua Excia, o Presidente da República Federativa do Brasil na data de ontem proferiu frase histórica. Será o fim da vitimização coletiva?

“Nós temos que parar de viajar o mundo chorando a nossa miséria e importando culpados pela nossa desgraça. Muitas vezes, a responsabilidade é nossa”!

Tratamento da degeneração macular: marcha a ré importante.

Esse blog é sempre crítico quanto às novidades. No entanto, em 8/10/07 destacou a importância dos resultados do novo tratamento para da degeneração macular, uma causa cada vez mais importante de cegueira por que associada à idade. No entanto, salvei-me pelo parágrafo onde afirmei que:

Os primeiros ensaios clínicos foram “excitantes”. Vamos aguardar o que virá, porque se confirmar esses resultados a longo prazo com pouco risco haverá um tratamento efetivo para a doença.

Ontem, a Genentech informou que o medicamento em questão aumentou a incidência de acidente vascular cerebral. Em outras palavras, para cada 110 tratamentos, um poderá provocar um caso de doença cerebrovascular. Várias revistas americanas e, uma cópia brasileira, afirmaram que esse foi o maior avanço da medicina em 2006. Infelizmente, não foi o caso. Abaixo a reportagem do The New York Times.

Eye Drug Might Raise Risk of Stroke, Genentech Says By ANDREW POLLACK Published: January 27, 2007 LOS ANGELES, Jan. 26 — Use of Genentech’s new eye drug, Lucentis, might raise the risk of stroke, the company said Friday. The company posted on its Web site a letter it sent to retina specialists this week. According to the letter, 1.2 percent of patients treated with a high dose of Lucentis in a clinical trial suffered a stroke, compared with only 0.3 percent of those treated with a low dose. The difference was statistically significant. The new findings could conceivably damp some demand for Lucentis, because the high dose, 0.5 milligrams per injection, is the one that is marketed. Shares of Genentech fell 89 cents, or 1 percent, to $86.57. Dawn Kalmar, a spokeswoman for Genentech, said Friday that the company wanted to move quickly to communicate the information. But she said the company did not expect the new data to prompt a change in the drug’s label, which already contains a warning about risks of blood-clotting events like strokes. Lucentis, also called ranibizumab, is approved to treat age-related macular degeneration, the leading cause of blindness in the elderly. It is the first drug shown in clinical trials to improve eyesight for a significant number of patients, as opposed to merely slowing the rate of vision loss. Approved in June, the drug had sales of $380 million for the rest of 2006, an amount that greatly exceeded some analysts’ expectations. Genentech executives have cautioned, though, that sales growth may moderate as patients on the drug are treated less frequently. The new data was preliminary, from 2,400 patients who had been followed for an average of 230 days since beginning treatment. The full study will continue and will follow them for a year. Dr. Philip J. Rosenfeld, a retina specialist, said the preliminary data would not influence him because it could later change. “Right now, it will have no impact on my use of Lucentis,” Dr. Rosenfeld, who is at the Bascom Palmer Eye Institute of the University of Miami, said in an e-mail message. “When given a choice between a high likelihood of blindness or a 1 percent risk of stroke, I think most patients will choose their vision.” The label for Lucentis notes a theoretical risk of blood-clotting events like strokes and heart attacks, though it says the rate seen in studies was “low,” at less than 4 percent. In the new study, the rate of heart attacks and deaths from cardiovascular incidents did not differ significantly between the dosages, the company said. The new findings could also raise questions about the risks of Avastin, a cancer drug sold by Genentech. It is being used off-label to treat macular degeneration because it is far cheaper than Lucentis, which costs about $2,000 per monthly injection. Both drugs work by a similar mechanism, although Lucentis was specifically designed to be injected into the eye. Doctors who use Avastin say they have experienced few if any safety problems. But Avastin has not been tested in extensive controlled clinical trials as Lucentis has.

Médicos cubanos na Venezuela: uma relação de trabalho bem conhecida.

O Estado de S. Paulo publica reportagem de Paulo Moreira Leite sobre os médicos cubanos na Venezuela. Vale a pena ler e guardar. Do ponto de vista estritamente técnico, as melhorias apresentadas são questionáveis, mas não tenho o relato completo para avaliar. Do ponto de vista dos direitos humanos, o texto do artigo de que merece muita reflexão é apresentado logo a seguir apresentado em negrito:

Mais de 80% dos custos da Missão Bairro Adentro, como o programa é chamado, são bancados diretamente pela PDVSA, a estatal de petróleo. Os médicos cubanos recebem salários que são uma miséria em Caracas - mas equivalem a rendimentos polpudos em Havana. Um médico cubano embolsa um modestíssimo salário mínimo mensal em Caracas (pouco mais de US$ 250) e uma ajuda anual de US $ 600 para seus familiares, que permanecem em Cuba. (Na ilha, um ótimo salário fica em torno de US$ 50 por mês). Os rendimentos dos cubanos explicam a rotina de sacrifícios a que são submetidos na Venezuela, onde não têm direito a recusar atendimento mesmo quando devem visitar um doente em casa, de madrugada. Muitos residem em casas coletivas onde se divide o trabalho de lavar roupa, cozinhar e varrer o chão. Nos fins de semana, os cubanos comparecem a cursos de atualização. Só passeiam em grupos, num regime de vigilância permanente que sugere o receio de que possam fugir do esquema e pedir asilo, como faziam tantos esportistas nos tempos da Guerra Fria. Aldo Muñoz, o vice-ministro da Saúde de Cuba, mudou-se para Caracas, onde mantém e dirige uma estrutura paralela que controla todos os profissionais estabelecidos no país, define seus passos, autoriza deslocamentos e define atividades nas horas de folga.

Como se define alguém que ganha menos do que o mercado de trabalho porque a família se encontra em outro país sem poder emigrar com regime de trabalho? Onde estão as ONGs e a Organização Internacional do Trabalho? O link do artigo é

http://txt.estado.com.br/editorias/2007/01/27/int-1.93.9.20070127.7.1.xml

Os médicos cubanos já encantaram aqui vários governantes, municipais, estaduais e federais há mais de uma década. Hoje, estão em baixa, tanto pela reação do Conselho Federal de Medicina como pela eficiência baixa desses médicos. A luta contra a efetivação desses profissionais foi chamada de "corporativista" por várias autoridades contrariadas em poder "controlar" os médicos tal como os venezuelanos fazem. Ainda bem que há corporações funcionando no país.

Medicamentos de alto custo: o cinismo a toda prova.

Valor Econômico publicou reportagem de André Vieira em 26/01/07 que pode ser considerada para o prêmio "curto e grosso". Poucas palavras foram reproduzidas de dirigentes da Big Pharma no Brasil, mas o suficiente para mostrar a farra que se vive aqui onde o orçamento de medicamentos de alto custo aumenta em taxa maior (16% entre 2006 e 2007) que os demais itens orçamentários. Um dirigente afirma que distribui gratuitamente o "seu" medicamento por 45 dias e, depois os pacientes conseguem o recebimento por via judicial. Bem, paro por aqui porque dá raiva saber que não recurso para atender a doença que mais mata os brasileiros, mas se paga o tratamento de doenças raras que não são cobertas na maioria dos países ricos. Quem puder leia a reportagem completa sobre esse setor da economia de 1,5 bilhão de reais que envolve médicos, advogados, ONGs e, obviamente os dirigentes da Big Pharma. Quem não tiver acesso, posso enviar uma cópia da reportagem.

Cartel dos Gases Hospitalares: transcrição sem comentários.

Na Folha de S. Paulo, 26 de janeiro de 2007:

A Secretaria de Direito Econômico, órgão do Ministério da Justiça, concluiu que as cinco principais empresas fornecedoras de gases industriais para hospitais públicos e particulares (como oxigênio usado no tratamento de pacientes) formaram um cartel, repartiram o mercado brasileiro entre si e combinaram preços mais altos.São acusadas a White Martins S/A, Aga S/A, a Air Products, a IBG (Indústria Brasileira de Gases) e a Air Liquide.Depois de três anos de investigação, a SDE recomendou ontem a aplicação de uma "multa exemplar" às empresas -o que pode ultrapassar R$ 640 milhões no caso da White Martins, líder do mercado. As 2.700 páginas do processo serão agora analisadas pelo Cade (Conselho Administrativo de Defesa Econômica), que decidirá se e como elas serão punidas.Além das empresas, os executivos podem receber multas. Neste caso, a punição varia de 20% a 50% do valor que a companhia for condenada a pagar."O objetivo era evitar a competição aguerrida entre as empresas. E há indícios da participação direta dos executivos", afirmou a secretária interina Mariana Tavares, ontem.A SDE não calculou o prejuízo causado aos cofres públicos ou a porcentagem de sobrepreço cobrada pelo cartel. Mas a secretária Tavares admitiu que praticamente todas as licitações de Estados e municípios de 2001 a 2003 foram afetadas.O caso foi considerado tão grave e sofisticado pela secretaria que, pela primeira vez, foi recomendada multa exemplar.

Derrame, acidente vascular cerebral ou encefálico: não interessa o nome, somente um problema de saúde pública.

Essa semana The Lancet publica uma edição ao acidente vascular cerebral. Brasil é um dos países com as maiores taxas de mortalidade no mundo. Já publiquei editorial afirma que essa, sim é uma doença negligenciada. Nesses artigos há pontos importantes que podem melhorar a qualidade do atendimento, mas com custo aumentado.

(1) diagnóstico: o uso da ressonância nuclear magnética aumenta a capacidade diagnóstica comparada ao da tomografia computadorizada;

(2) tratamento: o uso da alteplase com trombolítico na fase aguda mostrou-se benéfica mesmo em hospitais regionais . A alteplase é mais cara que a estreptoquinase que é utilizada largamente no infarto agudo do miocárdio. A estreptoquinase é contra-indicada na isquemia cerebral;

(3) internação: as unidades de avc, chamadas de stroke unit mostram uma relação custo-benefício favorável porque melhoram a qualidade do atendimento da mesma forma como as unidades coronarianas se consagraram há 40 anos como local e forma de atendimento ao infarto do miocárdio.

Outros textos recentes estão mostrando que a relação custo-benefício do tratamento da hipertensão, o principal fator de risco para o acidente vascular cerebral, é melhor do que o tratamento da tuberculose.

Abaixo, trechos do editorial do The Lancet. A favourite interview question put to aspiring doctors applying to be a Lancet editor is: “How many people do you think die each year?” For readers familiar with global burden of disease statistics, this might appear to be an easy question. But for many doctors, who perhaps have not been required to think globally before, it can prove to be a difficult one to answer. Most candidates know that there are around 6·5 billion people living on the planet, so those who guess that around 1% of the population dies each year are not far wrong—around 59 million people will die in 2007. But, perhaps surprisingly, one disease—stroke—will kill 10% of these and leave millions of others disabled.

Unfortunately, despite years of research, alteplase is still the only approved treatment for ischaemic stroke. More than a decade has passed since the publication of the first trial showing that alteplase is efficacious in some patients if given within 3 h of stroke onset. But even now only a tiny proportion of patients who could benefit are given the drug. As the investigators of the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) show in an Article, substantial evidence now exists that intravenous alteplase is safe and effective, even when administered in hospitals with relatively little previous experience of thrombolytic therapy for stroke. However, most stroke researchers would agree that dedicated stroke centres are needed to deliver the best quality of care, a conclusion that is supported by research done by Italian investigators in an Article on page 299. Ideally, a stroke centre will have access to MRI, which, according to Julio Chalela and colleagues, is better than computed tomography for detection of acute ischaemia, and is also able to detect acute and chronic haemorrhage.

Libia: Gaddafi transformou médico e enfermeiras em reféns.

Esse blog talvez seja o único a se preocupar com a situação do médico palestino e das enfermeiras búlgaras presos na Líbia sob a acusação de terem contaminados crianças com o HIV em um hospital. Agora, na reportagem do The Lancet, fica evidente o caráter de retaliação do ditador líbio ao investir contra esses profissionais de saúde.

Libya bargains with lives of imprisoned medics Katy Duke , The Lancet, 27/01/07 Six medics remain sentenced to death in Libya, accused of deliberately infecting hundreds of children with HIV in a city hospital. Libya's leader, Muammar Gaddafi, is attempting to trade their lives for one of the country's agents, currently serving life in prison in the UK. Katy Duke reports. Five Bulgarian nurses and a Palestinian doctor were controversially convicted late last year of deliberately infecting hundreds of children with the HIV virus at a Libyan hospital—a ruling that brought condemnation from the international community. Despite repeated and intense pressure for their release from Bulgarian and other officials, who claim the six are innocent, the Libyan leader, Muammar Gaddafi, appears to be now using them as pawns in a political game. During a speech to officials in Tripoli at the end of last year Gaddafi said that he would only consider repealing a death sentence on the six medical staff if the UK agreed to release the Libyan agent sentenced to life in prison for putting a bomb on the Pan Am flight that exploded over the Scottish village of Lockerbie in 1988.

Plano Bush na saúde: mais atrapalha do que ajuda.

Analisei um pouco mais a proposta Bush para a atenção médica. Incrível, mas o "país com o melhor sistema de saúde e atenção médica do mundo" (Bush) está estimulando os planos individuais. Aqui, no Brasil, onde esquerdistas (versão sindical) e direitistas (versão corporativa) adoram falar na "vala comum do SUS" comprova-se dia a dia que planos individuais estão fadados ao fracasso, a não ser quando os valores dos prêmios são elevados, fora da possibilidade dos mortais. A solução são planos nacionais bem orçamentados com administração descentralizada, como cada vez mais se comprova desde a implantação do SUS, tanto pelos acertos, como pelos erros. Voltando aos EUA, O plano Bush irá atrapalhar as propostas de estados como a California que estão estimulando os empregadores por meio de subsídios. Lembro que Mitt Rommey, ex-governador de Masschusetts é candidato à Presidência pelo Partido Republicano e, criticou também a proposta. Se a questão Iraque estiver "resolvida" até 2008, Rommey será páreo duro aos democratas com a sua proposta na área da saúde.

Maiores detalhes na reportagem de hoje do The Wall Street Journal.

Bush Health Plan Shifts Onus to the Consumer Proposal Contrasts EffortsBy States, Democrats to Push Employers to Secure Coverage By JANE ZHANG and SARAH LUECKJanuary 25, 2007; Page A6 President Bush's proposal for easing the nation's health-care woes -- encouraging families to buy insurance on their own instead of relying on employer-provided insurance -- differs from approaches favored by Massachusetts and California as well as many Democrats in Congress. In their bids to extend health-care coverage to millions of uninsured, former Massachusetts Gov. Mitt Romney and California Gov. Arnold Schwarzenegger, both Republicans, aim to shore up existing coverage, which has been offered by fewer employers in recent years. The Massachusetts plan, which was supported by Democratic Sen. Edward Kennedy, requires all but the smallest employers to offer health insurance, or else pay an assessment to the state. In California, a similar requirement would compel employers that don't offer insurance to pay a 4% payroll tax. WALL STREET JOURNAL VIDEO President Bush outlines a new tax deduction for families and individuals with private health insurance and other health initiatives. Plus, Health-care policy expert Dr. Paul Ginsburg speaks with the Journal's Matt Murray about how Bush's health-care reform would be funded. Mr. Bush, in contrast, avoids mandates and instead would use the tax code to make individually purchased health insurance more appealing and affordable. In a break with the past, he would make employer-provided health insurance taxable, but create a tax deduction of $15,000 for families and $7,500 for singles, for everyone who gets insurance, through work or on the open market. That is designed, the White House says, to be fair -- by treating individuals who buy insurance and now receive no tax break, the same as employees who are covered through their work and can exclude the value of the insurance from taxable income. Another part of the president's plan would help states extend coverage to the uninsured by diverting money from hospitals that care for the poor into state insurance pools. "What you are seeing is indicative of sharp philosophical differences," said Robert Laszewski, a health-policy analyst. "One is to build on the employer-based system that most Democrats embrace and the other is to develop an entirely new system controlled by the consumer, not the employer," which many -- though far from all -- Republicans and the president endorse. Both states would require all residents to have health insurance, offering government coverage or subsidies to those who are without coverage through an employer. Whether Mr. Bush's plan will contribute to a further erosion of employer-sponsored health coverage was debated yesterday. Health and Human Services Secretary Michael Leavitt told reporters that the president's plan will "absolutely not" have a negative effect on the employer-based system. Rather, he said, it does something that states can't: changes the federal tax code to help individuals buy health insurance. "I do not see employers leaving the employment-based system," he said. Not everyone in the administration agreed. At a White House briefing on Tuesday, Joel Kaplan, deputy chief of staff for policy, acknowledged that the proposal could accelerate the trend of employers dropping insurance, but emphasized that workers left without coverage would, thanks to the new tax deduction, have the means to "buy insurance in the individual market in a way that they can't now." Some employer and industry groups fretted about the proposal. Neil Trautwein, vice president of the National Retail Federation, said, "The fear is that if it becomes more attractive for people to decline employer coverage and buy on the open market, then you could get great spirals in the employer plans. I'm not convinced we should take away one of the pillars that has been supporting the health-care system." Democratic lawmakers said that expanding government programs, not changing the tax code, is a cheaper, simpler way to lower the ranks of uninsured than relying on the individual market, where policies often are expensive and people with health problems have trouble buying coverage at any price. "With the individual market, people pay more for [policies]; they also pay for insurance company overhead. And [private insurers] traditionally discriminate against people with prior medical problems," said Rep. Henry Waxman, a California Democrat and a senior member of a House committee that oversees health-care issues. Nina Owcharenko, a senior policy analyst for health care at the Heritage Foundation, said the Bush plan would complement states' effort to expand coverage: "The states control the regulatory structure of the individual market," especially for small businesses and individuals, and "this proposal is saying, 'How do we work together?' " Ms. Owcharenko added: "This is trying to find a way to make sure there's a market for an individual so they can buy health insurance. Both can co-exist. "It's not removing the employer system. It's not keeping the individual market as it is," she said. "The overall impact is combining the tax code with state innovations. The end goal will be to increase the number of people who have private insurance."

Dirigindo as Diretrizes

O The New England Journal of Medicine publica o artigo Guidance for Guidelines de Robert Steinbrook, questionando os famosos "guidelines" ou diretrizes. Obviamente, o problema maior é a ligação estreita dos autores de diretrizes com a indústria farmacêutica e de equipamentos. Eu não gosto das diretrizes, por esse aspecto e, também por transformar a medicina em prática chata e burocrática. Posso parecer contraditório, mas as diretrizes são muito mais apropriadas às práticas de saúde pública como vacinação, check-up, atendimento de emergência do que à clínica do dia a dia. Abaixo, trecho do texto de Steinbrook.

Guidelines have also been questioned when pharmaceutical and medical-device companies with a financial stake in the outcome provide substantial funding for their development and implementation. When members of guideline committees also have substantial financial associations with industry, further questions inevitably arise. Some argue that public disclosure of sponsorship and of the financial associations of committee members, along with rules to prevent sponsors from influencing the selection of panel members and the content of guidelines, are adequate safeguards. Others maintain that practice recommendations will invariably be viewed with skepticism unless corporate sponsorship and experts with financial ties are completely avoided. At present, the financial ties between guidelines panels and industry are extensive. A survey of 685 disclosure statements by authors of guidelines concerning medications found that 35% declared a potential financial conflict of interest. In 2006, Eli Lilly was criticized for providing the impetus for the development of practice guidelines for sepsis treatment and coordinating the process with a marketing campaign for Xigris (recombinant human activated protein C). And Amgen and other companies that manufacture or market recombinant erythropoietin, as well as DaVita, a large company that provides dialysis services, have been criticized for their close relations to the development of the National Kidney Foundation's guidelines for managing anemia in chronic kidney disease. An alternative approach is government sponsorship, although it does not ensure that committee members are independent of commercial interests. In 2004, the National Cholesterol Education Program updated its guidelines for the detection, evaluation, and treatment of high blood cholesterol in adults. It was subsequently disclosed that most of the committee members had extensive financial connections to the manufacturers of statins, which stood to gain from increased use of these drugs.

Open Letter to Academic Medical Leaders

Lançado hoje no British Medical Journal, a carta aberta às lideranças médicas no mundo todo. O acesso é livre no link abaixo.

Apresentarei algumas partes com comentários nos próximos dias.

http://www.bmj.com/cgi/content/full/334/7586/191

A nova proposta de Bush na área da saúde e de ambiente

Abaixo a nova proposta da administração Bush apresentada ontem, dia 23/01/07 no Congresso sobre saúde. A frase provoca riso: os americanos têm a sorte de ter o mais avançado e inovador sistema de saúde do mundo. Mas, no restante representa um recuo das posições anteriores do Partido Republicano nessa área, bem como na questão ambiental. A taxa de aprovação de 21%, como divulgado antes da fala presidencial, induziu a mudança de pontos programáticos.

A proposta de redução da dependência da gasolina e diesel e, substituição por fontes alternativas terá impacto (positivo?) na economia brasileira e (negativo?) no ambiente e, merece análise séria por especialistas em economia e ambiente.

Health Care Americans are fortunate to have the most advanced and innovative health care system in the world.

The President's Plan Includes Two Parts: Reforming The Tax Code With A Standard Deduction For Health Insurance So All Americans Get The Same Tax Breaks For Health Insurance And Helping States Make Affordable Private Health Insurance Available To Their Citizens. 1. The President's Plan Will Help More Americans Afford Health Insurance By Reforming The Tax Code With A Standard Deduction For Health Insurance – Like The Standard Deduction For Dependents. The President's primary goal is to make health insurance more affordable, allowing more Americans to purchase coverage. The 1/23/07 White House Office Of Communications President's proposal levels the playing field for Americans who purchase health insurance on their own rather than through their employers, providing a substantial tax benefit for all those who now have health insurance purchased on the individual market. It also lowers taxes for all currently uninsured Americans who decide to purchase health insurance – making insurance more affordable and providing a significant incentive to all working Americans to purchase coverage, thereby reducing the number of uninsured Americans. ! Under The President's Proposal, Families With Health Insurance Will Not Pay Income Or Payroll Taxes On The First $15,000 In Compensation And Singles Will Not Pay Income Or Payroll Taxes On The First $7,500. o At the same time, health insurance would be considered taxable income. This is a change for those who now have health insurance through their jobs. o The President's proposal will result in lower taxes for about 80 percent of employer-provided policies. Those with more generous policies (20 percent) will have the option to adjust their compensation to have lower premiums and higher wages to offset the tax change. 2. The President's Affordable Choices Initiative Will Help States Make Basic Private Health Insurance Available And Will Provide Additional Help To Americans Who Cannot Afford Insurance Or Who Have Persistently High Medical Expenses. For States that provide their citizens with access to basic, affordable private health insurance, the President's Affordable Choices Initiative will direct Federal funding to assist States in helping their poor and hard-to-insure citizens afford private insurance. By allocating current Federal health care funding more effectively, the President's plan accomplishes this goal without creating a new Federal entitlement or new Federal spending. These Two Policies Will Work Together To Help More Americans Afford Basic Private Coverage. The President's proposed standard deduction for health insurance will help make basic private health insurance more affordable for families and individuals – whether they have insurance through their jobs or purchase insurance on their own. For those who remain unable to afford coverage, the President's Affordable Choices Initiative will help eligible States assist their poor and hard-toinsure citizens in purchasing private health insurance. There Are Many Other Ways That Congress Can Help. We need to expand Health Savings Accounts, help small businesses through Association Health Plans, reduce costs and medical errors with better information technology, encourage price transparency, and protect good doctors from predatory lawsuits by passing medical liability reform.

Uma ótima proposta: o propagandista acadêmico de medicamentos.

Abaixo, o texto de Jerry Avorn, professor titular de atenção primária da Harvard propondo que governos montem esquemas de propaganda da boa prática médica tal qual os laboratórios fazem há décadas.

When I was practicing primary care, each year it got tougher to stay on top of the medical literature. But I had unlimited access to dozens of attractive, articulate people who came right to my office, at my convenience, to "update" me on topics like "modern concepts in hypertension" or "how to lower your patients' cholesterol." Some brought me lunch while they taught me; others offered to provide the education at a Red Sox game. The material they provided was user-friendly, accessible, engaging, and clinically relevant. But the only reason these "detail men or detail women" did this was to increase the sales of products of the drug companies each of them worked for, and the data they presented were carefully selected to accomplish just that goal. I wished that someone would come to my office and give me user-friendly drug information that was more neutral, not designed primarily to push products. To address that unmet need, my colleagues and I created the concept of "academic detailing." We trained pharmacists to visit doctors in their offices to offer concise, clinically relevant overviews of various therapeutic categories. The only goal was to provide unbiased, commercial-free data about optimal care.[1] Sometimes they even brought lunch. The original program was funded by a federal grant, but today similar programs are in operation in several countries.[2] In Australia, the government pays for a nationwide program that covers 60% of the country's primary care doctors. We've recently begun a program in Pennsylvania funded by that state; our reviews and teaching materials are freely available to all at www.RxFacts.org.[3] We all benefit if doctors have access to even-handed, non-product-driven drug information. Such programs can improve appropriate prescribing, and over time should even be able to save more than they cost, while helping us make smarter prescribing choices for our patients. That's my opinion. I'm Dr. Jerry Avorn, Professor of Medicine at Harvard Medical School. Sign Up now for a free monthly email that brings you the top features from MedGenMed.Readers are encouraged to respond to the author at javorn@partners.org or to George Lundberg, MD, Editor of MedGenMed, for the editor's eyes only or for possible publication via email: glundberg@medscape.net

Carta ao secretário de saúde do Rio de Janeiro

Prezado Sérgio Côrtes, admirei seu trabalho no Into. Poucos dirigentes hospitalares tiveram coragem de enfrentar o esquema das "próteses-órteses". Dos que "peitaram" esse esquema, a maioria o fez em silêncio, mas você foi obrigado a se manifestar em auto-defesa pessoal e familiar. Entendo sua atitude. Desejo boa sorte na Secretaria de Estado, porque competência não lhe falta. Acuse à vontade, o governador e secretário anteriores, porque eles sabem se defender e, com certeza revidarão. Mas, por favor, não desqualique médicos e enfermeiros como na entrevista que li no Estadão de hoje. Se você quiser ter uma boa gestão, somente a fará com profissionais motivados e respeitados. O seu chefe, o Governador Sérgio Cabral, já deu um mal exemplo em falar coisas como "genocídio" e, acusar injustamente um hospital pela morte da empregada doméstica. Por fim, você caiu um pouco no conto do "8 ou 800". Não sei quanto um hospital precisa de despesas extraordinárias por mês, afinal depende do porte e complexidade, mas valorizar os 8 mil reais dos hospitais federais para uso contigencial, ofende a inteligência dos demais administradores hospitalares do país.

Lembre que sou de São Paulo, não voto no Rio e, não tenho nenhuma simpatia pelos governos que o antecederam.

Atenciosamente

Paulo Lotufo

Pfizer corta 10 mil funcionários no mundo

A maior da Big Pharma foi atingidia pela queda de patentes, redução da venda do Viagra e, por muito mais coisa que não divulgam. Apesar das críticas constantes à Big Pharma, o fato da maior empresa estar reduzindo gastos e cortando pessoal é muito ruim. Espero, sinceramente que os gastos sejam na parte pior dessas empresas:o marketing e os sales rep. E, em oposição, o setor de desenvolvimento seja mantido. Há muito tempo defendo que o marketing gasta mais do de arrecada de fato. O problema é que os marqueteiros são bons, principalmente, em fazer a propaganda deles próprios. Se as farmacêuticas tivessem mais ouvidos e olhos epidemiológicos do que a boca marqueteira, talvez estivessem em situação mais estável. Vide o exemplo anterior do lupus eritematoso que foi desconsiderado pela indústria por décadas.

Lupus: a Big Pharma acordou

Essa notícia relaciona-se a uma conversa com uma ex-residente que deve estar no momento acertando sua vida em uma nova casa no exterior onde estagiará em serviço especializado em lupus eritematoso. Concluímos que as pesquisas com lúpus não avançaram porque a indústria farmacêutica não tinha opção alguma ao conhecido esquema corticóide e imunossupressor.

O lupus é uma doença muito comum entre as brasileiras, acredito que com prevalência superior à da população americana. Agora, a Big Pharma acordou do erro em não dedicar pesquisa específica ao lupus eritematoso. Além do erro da taxa de prevalência que o artigo abaixo alega, também há uma hipótese sobre a distribuição social da doença lúpica, que seria muito mais frequente em mulheres pobres.

Abaixo, o parte de artigo do The Wall Street Journal de hoje;

Drugs in Testing Show Promise for Lupus New Treatments TargetDisease, Not Just Symptoms;First Big Advances in 50 Years By HEATHER WON TESORIEROJanuary 23, 2007; Page D1 Several drug makers are in advanced-stage trials for lupus drugs. Human Genome Sciences Inc. will begin enrolling patients in the next two weeks in the largest ever late-stage lupus trial, following positive results in earlier testing; Bristol-Myers Squibb Co. is conducting lupus trials on Orencia, its rheumatoid arthritis drug; and Genentech Inc. and Biogen Idec Inc. are conducting late-stage trials on Rituxan, a cancer drug that has been used off-label for lupus. See what lupus treatments are available and what's in the pipeline. For many years, lupus wasn't well understood by doctors, and can still be difficult to diagnose. There has been no drug that targets the disease itself, and doctors have been able to only treat complications. Growing Market With the lack of remedies for the disorder, the government began investing more heavily in lupus research and now spends roughly $89 million a year on the disease. As results emerged, doctors and researchers saw clues into how lupus works in the body's cells. And, while no reliable numbers on growth exist -- a deficit Dr. Lim's patient registry aims to fill -- experts agree the lupus population has expanded along with better diagnoses. In turn, some drug companies began to pay more attention to the disorder. "Drug companies weren't interested in it because they thought it was a small market," Gary Gilkeson, head of the medical and scientific board of the Lupus Foundation of America, says. "They realized that was wrong." By one estimate, the lupus drug market, which was $300 million in 2005, could reach $1.3 billion in 2015 if the potential treatments prove to be efficacious. There's now a horserace among a few drug companies to be the first one in 50 years to gain approval to make and market a lupus drug. There are currently four drugs in late-stage lupus trials, as well as two being tested for lupus nephritis. Most of these drugs are monoclonal antibodies, which attempt to target the cells that contribute to the damaging antibodies. Early results for a trial for Lymphostat-B, a collaboration between Human Genome Sciences and GlaxoSmithKline PLC, showed to reduce lupus disease activity. Now, the new international trial will enroll more than 1,600 patients to try and confirm the findings. Bristol-Myers is conducting late-stage trials with Orencia, its rheumatoid arthritis drug that came out in the U.S. last year, to see if it helps lupus patients. The international trial will enroll 180 to 190 patients. Orencia, which is administered about every 28 days via a 30-minute intravenous infusion, targets T-cells, which are believed to have a major hand in inflammation. And Genentech in collaboration with Biogen Idec is going ahead with plans to test Rituxan, a blockbuster cancer and rheumatoid arthritis drug, in lupus patients, both with and without lupus nephritis. The lupus trial will enroll 250 patients and the nephritis trial will enroll 140. Last month, the FDA issued a warning following two deaths from a viral infection of lupus patients using the drug off-label. Doctors and analysts took heed, but say that they're still hopeful that the drug will be approved, noting that because lupus patients have compromised immune systems, it's impossible to determine whether Rituxan was responsible. Aspreva Pharmaceuticals Corp. is testing anti-organ-rejection treatment CellCept for lupus nephritis. CellCept, a drug for organ transplant recipients, is often prescribed off-label to lupus patients. Results from the first phase of its late-stage trials are expected this year

Um basta ao sensacionalismo, verifiquem a EC 29

Há um ano, a maioria absoluta dos jornalistas, cronistas e blogueiros se questionados pelos termos abaixo responderiam que

(1) Marcola é a nova revelação do Santos F.C. e, cotado para jogar na Ucrânia:

(2) transponder era o instrumento utilizado pelo Dr McCoy em Jornadas nas Estrelas;

(3) grua é uma ave comum no Pantanal;

Em questões de minutos, todos eles passaram a falar e comentar sobre o indivíduo e os produtos acima como se fossem algo familiar como Ronaldinho Gaúcho, ventilador de teto e pardal.

Como a crise aérea afetou muito São Paulo, mas não foi aqui originada, os ataques figadais à cidade não ocorreram. Mas, agora na tragédia do metrô em Pinheiros, a quantidade de asneiras e ataques à cidade passaram do razoável. Não vou citar o nome dos "respeitáveis jornalistas" que assim agiram, somente vou recomendar o ótimo artigo de Ricardo Kotscho criticando a mania de odiar São Paulo. (http://www.nominimo.com)

Desconfio que os adeptos do governo federal, devido ao fato de São Paulo, Estado e cidade serem governados pela oposição exageram e recalcam o seu ódio à cidade.

A eles e demais, um desafio: descubram, avaliem e verifiquem o que se passa com a EC 29. O que será EC 29?