Pulmonology professor Carlos Carvalho, from the Faculty of Medicine of the University of São Paulo (USP), and other researchers coordinated by him are preparing a request for a review of the technical note on the treatment of covid-19 in the Unified Health System (SUS), signed in January by the Secretary of Science, Technology, Innovation and Strategic Inputs in Health of the Ministry of Health, Hélio Angotti Neto.
The official text, which defends the use of ineffective drugs against the disease, such as chloroquine, and denies the certainty of the benefits of vaccines, triggered an online petition, in repudiation of Angotti Neto’s note, already signed by more than 80 thousand people.
At the request of Health Minister Marcelo Queiroga, Carvalho coordinated the analysis of scientific evidence on the hospital and outpatient treatment of covid-19 for eight months. The guidelines that contraindicate the use of ineffective medicines, such as the so-called covid kit, were approved in December by the National Commission for the Incorporation of Technologies in the Unified Health System (SUS).
Instead of publishing the guidelines approved by the commission subordinate to its secretariat, Angotti Neto issued the technical note in the opposite direction. In an interview with EstadãoProfessor Carvalho evaluates the decision.
What was Minister Marcelo Queiroga’s request when Mr. was asked to coordinate the group that would prepare the COVID-19 treatment guidelines?
Minister Marcelo Queiroga requested that a unification of information and guidelines be made for family members, patients and health teams who cared for people with covid-19. He made it very clear that this was to be done based on science, on the best national and international scientific knowledge. The first thing he said was that we didn’t need to discuss vaccines because that was undisputed and he wanted to be recognized as the minister who vaccinated Brazil. He believes that immunization is the solution to the pandemic. Our group was never asked to give any opinion on vaccines.
How was this group composed?
More than 150 researchers from different medical societies and institutions participated in the development of these guidelines. The result of this work was presented at Conitec meetings and unanimously approved. Our group was praised more than once by the Conitec plenary because of the quality of the document we were generating.
Did the secretary of Science, Technology, Innovation and Strategic Inputs in Health, Hélio Angotti Neto, make any requests?
In mid-2021, he requested that an assessment of pre-hospital care be added and nominated half a dozen people to join the group. People who, in his view, could contribute to the discussion. We accepted the nominations and started to have discussions about pre-hospital treatment.
What happened at the October Conitec meeting, when the vote ended in a 6-6 tie?
When we generated the pre-hospital care document, some participants in the Conitec plenary began to complain about things they had praised in the past. Like the methodology we used and the care we took. The representative of the Secretariat of Specialized Health Care (Saes) of the Ministry of Health, Strategic Affairs (SAES), Maria Inez Gadelha, said that our group was not competent to make the guidelines.
How did you react?
I countered what she said at the time, but it made us pretty upset. The group I coordinate is made up of professors from the best universities in the country. If these people from the Ministry of Health thought that we were not competent, they should have warned us beforehand. That way we wouldn’t waste time. The vote ended in a tie and went to public consultation. We reviewed the document. He returned to Conitec, was approved by 7 to 6, but secretary Hélio Angotti did not publish the directive. He decided to ask for a new public consultation, which took place on December 28, between Christmas and New Year.
Did you get to talk to the secretary after that?
I sent him a message asking if he needed anything else. He replied that all pending issues were resolved. I understood that I would publish the guideline approved by Conitec. At the end of January, he publishes a technical note rejecting our work.
What is your assessment of this technical note?
The secretary rejected our work. The most absurd part of the technical note was the table that mentions the vaccine, something that the minister had not asked to be discussed. Vaccine was never on our agenda. In this technical note, the secretary compares chloroquine with vaccine (a form of prophylaxis) and techniques such as non-invasive ventilation and placing critically ill patients in the prone position. Scientific studies evaluating these techniques are not comparable to drug studies. The secretary made a salad and included a totally inappropriate and absurd table.
This provoked an immediate reaction from scientific societies. What happened afterwards?
The secretary decided to take the goat out of the room. He withdrew the table but kept the contents of the technical note. It doesn’t. In the text, he implies that our group did an inadequate job because we did not indicate any treatment for covid-19. How are we going to indicate a treatment that doesn’t exist? That note from the secretary is nonsense. The reasons he alleges are easily contradicted.
Are you preparing an appeal to challenge this grade?
We are making a response and a request for a review of this technical note. We request the publication of guidelines that contraindicate the use of ineffective drugs for covid-19. The sooner this occurs, the population and health professionals can be informed with a document validated by the Ministry of Health to finally support the treatment of covid-19 patients.
Who will decide on the appeal?
Within the procedural rite of the Ministry of Health, the appeal must be filed with the secretary. We are asking him to go back, withdraw the technical note and publish the guidelines approved by Conitec. He must evaluate the appeal and send it to the minister, who has the final word. Minister Queiroga will have to decide whether to support secretary Hélio Angotti or the researchers.
What attitude do you expect from Minister Queiroga?
I hope that our work, carried out over eight months of discussions, with the objective of improving care for the Brazilian population in the SUS, will be valued and the guidelines will be published.
This episode indicated a politicization of Conitec, a body that should make technical decisions. What did you observe during this process?
Since May 2021, I have attended virtually all Conitec meetings. During the discussions, I observed the technical work of the members that make up the plenary and I even learned a lot from them. The aggressiveness of the representatives of some Secretariats of the Ministry of Health came as a surprise to me at the last meeting. It’s not up to me to judge whether it was pressure or political imposition. I do not believe that there was interference on the part of the minister.
Why do you believe that the interference did not come from the minister?
The minister never asked me to “relieve”, remove or put something in the opinion. As he invited me to coordinate the group of researchers, it would be strange for him to approve a document that says that this group he helped create is not competent to make the guideline. The minister was president of the Brazilian Society of Cardiology. I hope he remains true to the principles of science. Unless something happened along the way that I don’t know about.
What harm does the federal government’s insistence on kit-covid do to patients?
This feeds misinformation. It creates a false sense of security. The person thinks he will be protected. There is no scientific basis for the use of the covid kit. For patients who do not need hospitalization and oxygen, there is no drug authorized in Brazil. Some studies came out in the last four months that showed that some antivirals and monoclonal antibodies play a role in preventing the progression of the disease, but these drugs are not authorized by Anvisa to be used in the country. In addition, they are very expensive drugs.
In this episode of the covid kit, what can Brazil not forget?
We cannot forget how we waste time discussing an unjustifiable matter. It’s been a year and a half since science proved that the covid kit would not be useful. Even so, they kept insisting on meaningless alternative treatments.
Do you regret being involved in this mess?
I still don’t feel defeated. I hope that the document we are producing to ask for the revision of the technical note and the publication of the guidelines approved by Conitec will be successful. I don’t believe this is a losing battle. The reason is on our side. I hope that the work of the researchers who produced the guidelines will be recognized. It will only be worth having gone through all this if the population will benefit from the information in the guidelines. If colleagues can use the best scientific knowledge.
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