A ética do bazar de órgãos: debate na Harvard School of Public Health

The Ethics of the Organ Bazaar The event, entitled "Markets for Kidneys? The Ethics of the Organ Bazaar," was held on February 8 in Snyder Auditorium. Speakers presented the often harsh realities of the international organ trade. Ethicists, economists, and audience members struggled to define the compelling issues and circumstances that could make selling organs palatable. The event was organized by HSPH Professor Daniel Wikler. The latest headlines showcase some of the problems with the international organ trade. In India, for example, there appears to be an illicit organ market, despite being outlawed, that includes the participation of some doctors. Some donors appear to be abducted or conned, and many of their organs are sold to people from other countries. Demand for organs vastly outpaces the supply, said Luc Noël, coordinator of the Clinical Ethics Team for the World Health Organization. The total number of annual kidney transplants, for example, estimated at 66,000 worldwide, far from meets the needs of the 1 million people suffering from end-stage renal disease, even if only one-half of them meet surgical criteria. The critical shortage of organs has led to "transplant tourism," a term that describes patients, donors, or physicians who travel to other countries to obtain organs through commercial transactions, typically from the poor and vulnerable. "We must have a global consensus of objection to commercialization of transplantation," said Francis Delmonico, a surgery professor at Massachusetts General Hospital and Harvard Medical School and director of medical affairs for the Transplantation Society. In the 1990s, the WHO drafted guiding principles on human organ transplantation that prohibited giving or receiving payments for organs. Taking it further, a 2004 World Health Assembly adopted a resolution where delegates agreed to "take measures to protect the poorest and vulnerable groups from ‘transplant tourism' and the sale or trafficking of tissues and organs." Even with global censure of a commercial organ market, the ultimate solution lies in the willingness and ability of each country to become self-sufficient in organ transplants, providing a fair system within its borders to satisfy the medical demand there, several speakers said.

Uma vez mais, a doação de órgãos

Hoje,um despacho Associated Press. Novamente, a venda de rins.

Philippine Health Chief Orders Eradication of Kidney Black Market Associated PressMarch 26, 2008 9:55 a.m. MANILA, Philippines -- A new order aimed at eradicating a thriving black market in kidney sales by desperately poor Filipinos would restrict foreigners traveling to the Philippines in search of donors, the health secretary said Wednesday. Health Secretary Francisco Duque said the order, which he signed Monday, called for the creation of a government board to oversee kidney donations and transplants, ensure proper care of donors and make more transparent and ethical a disturbing practice that has flourished in secrecy. Kidney trading in the Philippines, involving poor people and prisoners who sell their organs for paltry sums to syndicates catering mostly to foreign clients, has been reported by the local media and reflects the depth of the Southeast Asian nation's poverty. A TV network once featured a Manila slum in which dozens of men sported abdominal scars after giving up their kidneys. The order seeks to provide a more benevolent image to kidney donations by prohibiting the payment of money as a precondition. It says donations must be done "out of selflessness and philanthropy" to save and ensure the quality of life of the beneficiary. "We want to remove this black market," Mr. Duque said. "We want to protect our already poor countrymen from abuse." Health Undersecretary Alexander Padilla said the order, which took more than two years to craft, was sought specifically because of numerous reports of foreign patients traveling to the Philippines in search of kidney donors. "We don't want to be known as the kidney capital of the world," Mr. Padilla said. A 1991 law only regulated transplants of kidneys and other organs from brain-dead donors. One contentious issue was whether to ban foreigners from securing kidneys from local donors -- a move backed by private advocacy groups to prevent the exploitation of the poor in Third World countries, Mr. Padilla said. Authorities eventually decided against such a ban but made it difficult under the new order for foreign patients to obtain kidneys, he said. The order prioritizes Filipino patients in the allocation of donated kidneys and prohibits their export to any other country. About 10,000 to 12,500 Filipinos develop serious renal diseases each year and about half could be saved by kidney transplants, according to the health department. Only about a tenth of those who could have transplants actually do so because kidneys are in short supply and the procedures cost so much. There are no existing statistics on the number of foreigners seeking local kidney donors.

Como o mundo está ficando sem graça: teste de paternidade nas drogarias

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Homicídios em Belo Horizonte: aqui, primeiro e mais confiável.

O faroeste da blogosfera está discutindo os homicídios em Belo Horizonte. Os leitores desse blogue estão informados há muito mais tempo, ou seja desde julho, quando os dados do Ministério da Saúde foram liberados. A origem da informação foram as secretarias de estado e dos municípios.

Quarta-feira, 4 de Julho de 2007 Mortalidade 2005 (3): Taxas de homicídio em SamPa, Rio e BH de 2001 a 2005. O quadro mostra a evolução das taxas de homicídios nos cinco primeiros anos da década nas regiões metropolitanas de São Paulo, Rio de Janeiro e Belo Horizonte. São Paulo começa com os valores mais elevados, mas ano a ano vai apresentando redução impressionante, tanto que hoje a região encontra-se na 18a posição nesse ranking infeliz. Belo Horizonte - em contraste - teve aumento expressivo, passando para a 4a posição, próximo aos valores do Rio de Janeiro. O Rio de Janeiro também vem apresentando taxas declinantes, mas com desacelaração inferior à observada em São Paulo. Mais uma vez, os dados atrapalham as análises com o viés ideológico, político e partidário. Atenção, acadêmicos, vamos estudar a fundo esses dados. Afinal, não servimos somente para escrever artigos indignados na grande imprensa, mas para interpretar o mundo! Postado por Paulo Lotufo às 15:46 1 comentários Mortalidade 2005 (2): as maiores taxas de homicídio nas regiões metropolitanas Os dados de mortalidade de 2005 do Ministério da Saúde permitiram calcular a taxa de homicídios nas regiões metropolitanas do país naquele ano. Utilizei somente a população masculina. Em resumo, dividi o número de óbitos pela população total de cada área. Sempre utilizando os dados disponíveis em http://www.datasus.gov.br Recife continua na liderança desse ranking infeliz, mas está administrando bem a situação vide o post anterior Pacto pela Vida em Pernambuco. No mesmo estado, a região de Petrolina/Juazeiro ocupa a sexta posição. Depois de Recife, temos Vitória, Maceió, Belo Horizonte, Rio de Janeiro, a já citada Petrolina, Curitiba, Salvador, Belém e João Pessoa. Muita gente não gosta desses dados, mas foram disponibilizados pelo Ministério a partir da informação dos próprios estados. Um momento a refletir, no próximo post mais comentários sobre mortes por homicídios. Postado por Paulo Lotufo às 15:28 0 comentários

Vitória da Autonomia Universitária: Big Pharma não consegue "estourar" a revisão por pares.

Em primeiro de março noticiei aqui o ataque à autonomia univesitária por parte de advogados da Pfizer americana, que a pretexto de municiar a defesa de processos de pacientes no caso "Cox-2" exigiam que as revistas "abrissem" a relação de revisores. JAMA conseguiu sentença judicial contra a demanda da empresa, preservando a confidencialidade do processo de revisão por pares.

Preserving Confidentiality in the Peer Review Process Catherine D. DeAngelis, MD, MPH; Joseph P. Thornton, JD JAMA. 2008;299(16):(doi:10.1001/jama.299.16.jed80000). For the past year or so, JAMA and the Archives of Internal Medicine have been involved in litigation that significantly threatened the integrity of our peer review process. We now inform our reviewers, authors, and readers about the results of this litigation that preserve the confidentiality of our peer review process. Pfizer Inc is a defendant in more than 3000 lawsuits across the country alleging that Pfizer advertised and marketed the cyclooxygenase 2 inhibitors celecoxib and valdecoxib as likely to provide pain relief without the adverse effects that had accompanied earlier anti-inflammatory medications. The plaintiffs contend that false representations were made to drive demand for these higher-priced prescription drugs, when lower-cost nonsteroidal anti-inflammatory drugs would have been as safe or safer for most patients. The plaintiffs include consumers, health plan providers such as unions, and third-party payers that manage formularies and reimburse claims. The defense attorneys for Pfizer issued subpoenas to a host of journals, but it appears the first 2 were directed at JAMA and the Archives of Internal Medicine (AIM). On May 9, 2007, Pfizer served federal court subpoenas on JAMA and AIM seeking 4 broad categories of documents and information. In response, JAMA and AIM provided copies of hundreds of pages of published articles regarding celecoxib and valdecoxib. However, the subpoenas sought all documents regarding the decision to accept or reject manuscripts, copies of rejected manuscripts, the identities of peer reviewers and the manuscripts they reviewed, and the comments by and among peer reviewers and editors regarding manuscripts, revisions, and publication decisions. For months JAMA and AIM consistently argued that the sanctity of the confidential peer review process should not be violated. We asserted privileges and public policy reasons against production, including the Federal Rules of Civil Procedure, which protect nonparties like JAMA and AIM from unreasonable litigation burdens and abuses. On January 17, 2008, JAMA and AIM were served with a Motion to Compel production of confidential editorial judgments, unpublished manuscripts, and unpublished peer review comments. Among other things, JAMA and AIM argued that this unpublished and privileged material could not have been known to Pfizer or played any role in its advertising and marketing decisions. Likewise, the plaintiffs could not have known and relied on them in making purchasing decisions. We asked the federal district court in Chicago to deny the Motion to Compel, essentially quashing the Pfizer subpoenas, and that is precisely what Magistrate Judge Arlander Keys did. In a ruling issued March 14, 2008,1 the Court agreed with JAMA and AIM that information kept confidential from Pfizer, the general public, and the medical community at large was irrelevant to the pending claims. Magistrate Judge Keys observed that the published articles themselves would satisfy the lawyers' needs. When pondering Pfizer's involvement in and responses to scientific publications, Magistrate Judge Keys remarked that "this evidence would seem to be just as easily accessible from Pfizer as from the Journals."1 He concluded that "Especially given the strong policy behind preserving confidentiality in the peer review process, the Court finds any probative value would be outweighed by the burden imposed on the Journals in invading the sanctity of that process."1 We firmly believe that ensured confidentiality of reviews allows reviewers to provide professional critiques of manuscripts without fearing potential repercussions from authors. To that end, JAMA and our Archives Journals have historically and deliberately kept unpublished manuscripts and peer reviewer comments confidential. This promise to reviewers and authors allows the peer review process to work in an unrestrained environment. Producing any of these documents, with or without names, would seriously compromise the process and the trusting relationship among the editors, authors, and reviewers. The subpoenas attempted to invade the peer review process, and we are delighted that Magistrate Judge Keys said so when he ruled they could not be enforced against us.

Discriminação e doença: dekasseguis no Japão.

American Journal of Public Health publica artigo original mostrando os problemas de saúde dos dekassegui no Japão. Cópia deverá ser solicita ao autor no email abaixo que segue o resumo do estudo. Um bom tema na comemoração dos 100 anos da Imigração Japonesa no Brasil.

Returning to the "Homeland": Work-Related Ethnic Discrimination and the Health of Japanese Brazilians In Japan Takashi Asakura, PhD, Gilbert C. Gee, PhD, Kazuhiro Nakayama, PhD and Sayuri Niwa, MA, RN (e-mail: asakurat@u-gakugei.ac.jp Objectives. We investigated whether self-reported ethnic discrimination in the workplace was associated with well-being among Japanese Brazilians who had returned to Japan. Further, we examined interactions between discrimination and education on well-being. Methods. We obtained data from a cross-sectional survey of Japanese Brazilian workers (n = 313) conducted in 2000 and 2001. Outcomes were self-rated health, psychological symptoms as measured by the 12-item General Health Questionnaire (GHQ-12) score, and a checklist of somatic symptoms. Results. Reports of ethnic discrimination were associated with increased risk of poor self-rated health and psychological symptoms (GHQ-12 score), after we controlled for self-assessed workload, supportive relations at work, physically dangerous working conditions, workplace environmental hazards, shift work, number of working hours, age, gender, marital status, income, education, Japanese lineage, length of residence, and Japanese language proficiency. Further, the relationship between discrimination and self-rated health and somatic symptoms was most robust for those with the least education. Conclusions. Ethnic discrimination appears to be a correlate of morbidity among Japanese Brazilian migrants. Future research should investigate how educational and workplace interventions may reduce discrimination and possibly improve health.

Enquanto isso, na Semana Santa

Postei

(1) "Medicina do Viajante": acidentes com serpentes e acidentes com relâmpagos.

(2) A formação médica em Boston e São Paulo.

(3) Mestiçagem na América Latina.

(4) O crime em negar vacina a crianças.

(5) "Clínica & Epidemiologia": o mito da síndrome metabólica.

(6) La Ninã e El Niño: explicam a dengue?