Acesso Universal: eleitores democratas e republicanos pensam diferente

The Wall Street Journal publicou pesquisa sobre a questão importantíssima da cobertura universal à atenção médica no país. Americans Want Leaders to AddressCoverage for Uninsured, Poll Shows By BECKEY BRIGHTSeptember 19, 2007 A new poll shows providing health-insurance coverage for more Americans is a top priority for U.S. adults and a majority believe it is the government's duty to ensure all Americans have adequate coverage. The Wall Street Journal Online/Harris Interactive health-care poll, conducted Sept. 10-12, asked how much Americans trust policy makers to come up with good policies for improving and reforming U.S. health care. Overall, the Democrats are more trusted than the Republicans (39% vs. 26%), the poll shows, but both parties as well as all of the leading 2008 presidential candidates included in the survey have seen a decline in the public's trust since February 2007. However, Sen. Hillary Clinton is both the most trusted and the least trusted of the candidates, according to the poll. Four in ten adults say they would trust her, but another one-third say they would not trust her at all to make good policies when it comes to health-care. (The poll was conducted before Sen. Clinton announced on Sept. 17 her plans to guarantee health coverage for all Americans.) Across party lines, there is widely held belief that the U.S. health-care system works better for the very poor and the wealthy than it does for the middle class. (A Harris poll conducted Sept. 7-10 showed health care second only to the war in Iraq as the most important issue Americans want the government to address.) For most U.S. adults, the top health-related issue they would like to see the presidential candidates address is providing coverage for the uninsured. This is the top issue for Democrats and Independents, while Republicans feel containing medical care costs is the No. 1 priority. In addition, the poll shows 82% of Democrats agree with the notion that it is the government's duty to ensure health-care coverage for Americans, compared with 66% of Independents and 47% of Republicans. Sixty-nine percent of Democrats and 55% of Republicans believe the U.S. health-care system could be improved by creating an insurance program that isn't linked to individuals' employers. Only 6% of those polled disagree strongly with that proposal, while 21% said they aren't sure.

Gary Taubes, a volta do velho polemista.

O The New York Times publicou artigo de um brilhante polemista, Gary Taubes, sobre as assim chamadas "verdades" da medicina e da saúde pública. Ele estava sumido, agora volta a toda "pegando no pé" da questão da reposição hormonal, ou seja a difícil questão entre estudos observacionais e ensaios clínicos. O texto é longo e está com acesso livre (clique aqui). A procura por temas médicos e de saúde pública se avolumou com a permissão da propaganda de medicamentos na mídia americana que mudou o rumo editorial para essa temática. Taubes procura sempre resposta. Pena que se dirija a pesquisadores. Cientistas não têm respostas, somente perguntas. Caso contrário, seriam outra coisa, menos cientistas.

Oswaldo Paulo Forattini: adeus grande mestre

Morreu Oswaldo Paulo Forattini, um dos mais brilhantes intelectuais da saúde pública. Avesso a participação política ou corporativa, atuou como pesquisador, docente e pensador de forma inflexível. O adjetivo severo parece que foi criado para ele. Tive a honra em 1989 em assistir a um dos seus cursos de pós-graduação, onde a quantidade de conceitos discutidos era tal, que nos motivava a estudar e aprofundar os assuntos muito mais do que o solicitado. Há poucos como ele, que afirmava que "vivia para a ciência". Abaixo, o obituário do Boletim Fapesp

Forattini, ex-diretor da Faculdade de Saúde Pública (FSP) da USP, faleceu na madrugada de sábado (15/9), vítima de insuficiência respiratória. Tinha 83 anos. Epidemiologista reconhecido internacionalmente, foi pioneiro na produção de metodologias de coleta e de identificação de vetores de agentes etiológicos de doenças como dengue, febre amarela, doença de Chagas, encefalite e malária. Foi fundador da Revista de Saúde Pública e editor da Editora da USP. Entre os prêmios que recebeu estão a Medalha do Centenário do Instituto Oswaldo Cruz, o John Belkin Memorial Award e o Prêmio Jabuti de 1996, pelo livro Culicidologia Médica vol.1 1996. Formado em 1949 pela Faculdade de Medicina da Universidade de São Paulo, obteve em 1954 o título de livre-docente junto à Cadeira de Parasitologia da FSP. A carreira de pesquisador começou antes mesmo de terminar o curso de medicina, com a publicação de seu primeiro artigo em 1946. Na extensa relação de contribuições científicas deixada por Forattini, observa-se forte tendência aos estudos biológicos e ecológicos de artrópodes de interesse médico. Sempre imprimiu a esses trabalhos um sentido dinâmico ao estudo da epidemiologia das doenças endêmicas, identificando relações entre homem-ambiente-artrópode. Entre as doenças estudadas pelo professor Forattini destacam-se a leishmaniose, a febre amarela, a malária, a tripanossomíase americana e a encefalite por vírus, cujos resultados das pesquisas realizadas e publicadas foram importantes na determinação das principais modalidades de transmissão dessas parasitoses.

Doenças Negligenciadas e Autonomia Farmacêutica

Na revista Nature há artigo de Carlos Morel e José Carvalheiro da FIOCRUZ sobre medicamentos no Brasil. Trata-se de reflexo da encruzilhada que o país se meteu quando por um lado estimulou a pesquisa científica, via fomento e pela pós-graduação e, de outro não permitiu que esse conhecimento se transformasse em inovação. Daí o descompasso entre produção científica e patentes. O nome do artigo é The Road to Recovery. Cópias podem ser fornecidas em Renata.Maia@saude.gov.br

Chagas: há algo de novo no tratamento e controle?

Há um ano publiquei o post: Doença de Chagas: a negligenciada das doenças negligenciadas. Passou despercebido (ao menos, a esse blogueiro) os esforços para "erradicação" da Doenças de Chagas. Abaixo, reproduzo o texto completo do The Lancet Infectious Diseases. Aguardo ainda, manifestação do Ministério da Saúde e da Schering-Plough para testar o posoconazole, visto os resultados iniciais do Instituto Rene Rachou de Belo Horizonte. Aguarda-se também a conclusão do The BENEFIT Trial: Evaluation of the Use of an Antiparasital Drug (Benznidazole) in the Treatment of Chronic Chagas' Disease idealizado pelo McMaster University com participação de cardiologistas brasileiros. Ilustro essa mensagem com foto pouco conhecida de Carlos Ribeiro Justiniano das Chagas (Oliveira, MG, 1879- Rio de Janeiro, 1934) em pose de contemplação hipocrática, da menina Rita (fonte: arquivo do Instituto de Pesquisa Evandro Chagas).

The WHO Global Network for Chagas Elimination was launched in July, 2007, to coordinate global efforts to eliminate this neglected disease in the next 3 years. Jean Jannin, coordinator of the initiative at WHO's neglected tropical diseases unit (Geneva, Switzerland) told TLID that the target date of 2010 is “perhaps optimistic” but he hopes the project will substantially reduce the global burden of Chagas disease. The disease is caused by infection with the protozoan parasite Trypanosoma cruzi, which passes to human beings via insects of the Triatominae subfamily of predatory assassin bugs. These “kissing bugs” live in cracks in poor housing and emerge at night, biting people near the mouth or eyes. The faeces of triatomes, which can be heavily infected with parasites, are easily ingested or taken in through mucosal surfaces. T cruzi can also be transmitted in blood and organs from infected donors, and may pass across the placenta of infected mothers to the fetus. Vector-borne transmission is confined to the Americas, mainly rural areas in parts of Mexico, Central America, and South America. During the 1980s, an estimated 25 million people were infected, but control programmes in the past 15 years, including three multinational campaigns, have had impressive results. “Uruguay, Chile, and Brazil have certified the interruption of vector transmission and disease prevalence generally has been reduced”, commented Janis Lazdins-Helds (WHO Special Programme for Research and Training in Tropical Diseases [TDR], Geneva, Switzerland). “Estimated case incidence has declined from more than half a million new cases every year to around 50000 and will probably reduce further”, agreed Chris Schofield (London School of Hygiene and Tropical Medicine, London, UK). About 8 million people in Latin America are carriers of the disease. “Chagas disease cannot be eradicated: a reservoir of infection will always exist in the wild irrespective of human infection, but it is feasible to eliminate if we understand elimination as the interruption of disease transmission”, said Roberto Salvatella (Pan American Health Organization, Montevideo, Uruguay). Continuing objectives of the WHO programme will be improving case detection and treatment, and keeping tighter control of insect vectors. “Periodic serological screening of schoolchildren is necessary in all endemic areas so that vector control can be targeted effectively”, said Schofield. Better serological tests are also needed. Lazdins-Helds told TLID: “We still lack adequate confirmatory tests and diagnostics to establish a cure for Chagas disease”. This is a major hurdle because the disease is largely “silent”. Early symptoms can include fever, fatigue, swollen glands, and heart pain, but in many cases there may only be a minor swelling around the insect bite. Years, sometimes decades later, chronic disease with severe cardiopathy can occur, sometimes associated with swelling and disruption in the oesophagus and colon. Around 14000 people die from complications of Chagas disease every year. According to Lazdins-Helds, “eliminating Chagas disease presents considerable challenges”. Early treatment by one of the two drugs currently available—benznidazole or nifurtimox—can be successful but both have 30–60-day treatment regimens with associated compliance issues. The drugs can also have severe side-effects and might not help with advanced disease. However, he added, “if today's estimated 8 million Chagas disease carriers are not diagnosed, treated, and cured, not only will they continue to suffer, but they can infect others through blood transfusion or by perpetuating congenital transmission”. New treatments are being actively sought and TDR, with the Canadian Institutes of Health Research, is supporting BENEFIT, a multinational clinical study to investigate whether benznidazole treatment in the chronic phase of Chagas disease can halt or reverse disease progression or eliminate parasitic infection, or both. Results are due in December, 2010. “The acknowledgment of the globalisation of Chagas disease in non-endemic countries in Europe (Spain, France, UK, Belgium) and North America (USA and Canada) was a another major achievement of our meeting in July”, commented Jannin. Conservative estimates suggest that about 14 million people from Chagas disease endemic countries are living in non-endemic areas. “Non-endemic Chagas disease is emerging as an important issue”, commented James Diaz (Louisiana State University School of Public Health, New Orleans, LA, USA). Since 2001, five cases of acute Chagas disease following solid organ transplantation have been reported in the USA, of which four were fatal. “More deaths are likely”, predicts Diaz, who says there may now be more than 100000 T cruzi-seropositive people living legally or illegally in the USA having acquired infections as children in Latin America, some of whom will be blood and organ donors. In January, 2007, the US government implemented a programme to screen all blood donors for T cruzi infection. “Other non-endemic countries may need to follow suit”, said Diaz.