For the Federal Council of Medicine (CFM), faced with the lack of therapeutic alternatives, it is up to the doctor, together with the patient, to decide which drug to use. This, however, is not the understanding of other scientific organizations or learned societies, which highlight the ineffectiveness and suggest banning the early treatment covid kit – can one read in one article of the site Saude.Estadao.com.br translated below.
« Our media always talk at best about scientific controversy. The highest medical authority CFM at the federal level has already stated that physicians are free to prescribe. Now CFM is sued Says Dr Alexander Wolkoff. In Brazil the situation is therefore reversed compared to France since the CFM has recommended early treatment and is being attacked by groups of doctors; while in France the ANSM does not recommend early treatments and is attacked by medical associations to obtain a temporary recommendation for use for hydroxychloroquine, azithromycin or ivermectin!
Résumé
- The early treatment of Covid-19 creates tension between scientific organizations.
- For Bruno Caramelli, a cardiologist and professor at the USP who is against the CFM’s recommendation “Prescribing a covid kit is not an appropriate decision, it is a mistake”. He filed a complaint with the Federal Public Prosecutor’s Office (MPF) against the Federal Council of Medicine for authorizing the prescription of drugs for the early treatment of covid-19.
- The early pro-treatment association has grown in importance with the announcement and participation of eminent physicians. Created last year to advocate for early treatment of coronavirus by a group of doctors from Pernambuco, the Doctors for Life Association its imposed this year by publishing half-page advertising reports in eight major newspapers nationwide in February and organizing lives with the participation of renowned doctors, some researchers from mainstream universities. Like Paolo Zanotto, professor at the Institute of Biomedical Sciences of the University of São Paulo, Paulo Olzon, retired professor at Escola Paulista de Medicina / Unifesp and immunologist Roberto Zeballos, who is part of the clinical staff of Albert Hospitals Einstein.
Divergent opinions
The adoption of early treatment for covid-19, leads to conflicts between scientific and medical organizations in Brazil. Some doctors, believing that these drugs are ineffective or have shown no proof of effectiveness against the disease, have taken the federal public prosecutor against the CFM.
Brazilian doctors continue to prescribe them, usually combined with other drugs and vitamins in what is known as the covid kit. The distribution of the kit has started to be adopted by some town halls. And this despite the fact that several scientific studies have already shown that drugs such as hydroxychloroquine and azithromycin do not work against the coronavirus.
Boxes containing ivermectin Photo: PRF DR
In Brazil, CFM endorses early treatment
The prescription of these drugs is endorsed by the CFM who, in April 2020, issued an advisory authorizing doctors to indicate hydroxychloroquine and azithromycin. At the time, there was still no definitive proof that the drugs were effective.
A year later, however, with several studies showing that they do not reduce the risk of worsening the disease, the council maintains the opinion, supported by the argument of medical autonomy.
“For the CFM, given the lack of treatment alternatives for the disease, it is up to the doctor, along with the patient, to decide which drug to use. “
This, however, is not the same understanding of other medical entities. In March, the Brazilian Medical Association (AMB) published a document signed by dozens of scientific societies and federated associations in which it advocated the prohibition of the use of these drugs. On its own initiative, the AMB designated the 81 members as signatories, but after the publication of the document, 15 of them requested that their names be removed from the document.
« We included them all because they are affiliated with AMB and because we wanted to highlight them all, thinking they were all going to join. I forgot something fundamental: our country is polarized and has heads of entities who oppose it. Looking at it now, we shouldn’t have done it this way », Declared César Eduardo Fernandes, president of the AMB at the time, acknowledging the split within the AMB. Among the companies that have spoken out publicly against the AMB letter are the Brazilian Psychiatric Association and the National Association of Occupational Medicine. In a note, the latter argued that the relationship between doctor and patient is ” very personal, based on trust, empathy and respect, and treatment is the prerogative of the attending physician as it occurs in any other disease ».
The Estadão site noted that this event resulted in a very conflictual situation. Some directors of scientific societies that support “early treatment” have accused the AMB of being under political influence.
« It was under the influence of a group of “leftists” who are in charge of the association One of the directors wrote in an email.
CFM President Mauro Ribeiro said that “ the difference of point of view existed between doctors “But that no entity” does not have the knowledge », With reference to AMB’s position.
Omission
In addition to the fights between entities, some doctors dissatisfied with the maintenance of the position of the CFM on the prescribing of these drugs decided to act of their own accord. This was the case with the cardiologist Bruno Caramelli, Associate Professor at USP Faculty of Medicine. He has filed a complaint with the Sao Paulo MPF, asking prosecutors to open an investigation ” to determine the civil, administrative or criminal liability of the board of directors of the CFM ” on the subject. In the legal document, the doctor classifies the counsel’s position as ” silent and serious about the measures that should be taken against the spread of the misconception that there is an effective early treatment for covid-19 ».
Caramelli said he feared that ” belief in early treatment does not encourage people to follow other health guidelines ». « I couldn’t stand still. This supposed quick fix takes people away from concentration to isolate themselves and follow other protective measures “. The cardiologist also organized an online petition asking the CFM to condemn “early treatment”.
After the performance, 29 other doctors became aware of Caramelli’s initiative and joined the motion, as explained by retired lawyer Cecília Mello, a federal judge and group representative. « these doctors joined the petition, also taking into account new facts that have emerged, such as reports of side effects from these drugs », She comments.
The MPF explains that it is still in the study phase to decide whether or not to open an investigation. The CFM said “ not having received any conclusions Of the MPF-SP on this subject.
MPF-São Paulo has been investigating the situation since January
Even before receiving the representation of the doctors against the CFM, the Federal Public Prosecutor’s Office of São Paulo has already investigated the behavior of the agency in terms of “ early treatment “. On January 20, as part of a public policy monitoring process linked to covid-19, prosecutors in São Paulo sent an official letter to CFM president Mauro Ribeiro, asking, among other things, whether the agency intended to see again the 2020 opinion which authorizes the prescription of early treatments in the face of new scientific evidence.
Not having received a response, the MPF sent back a letter on February 12 which received a response from the CFM ” the argument of medical autonomy “. On March 30, the MPF returned a letter to the CFPM with new evidence including possible side effects of the drugs and gave 15 days to respond.
The situation in Brazil is therefore reversed compared to France since the position of the Federal Council of Medicine is “medical autonomy of the doctor and the recommendation of the use of early treatments“. The Federal Public Prosecutor’s Office, faced with pressure from the ABM and scientific organizations, asked the CFM to clarify its medical opinion on two occasions by providing scientific elements on the lack of efficacy and the side effects of early treatments. To date the CFM has not changed its mind.
In France, let us recall that the position of the authorities (Ministry of Health, ANSM (National Agency for Safety and Medicines), HAS, HCSP) is “that there are no early treatments against Covid and that if doctors prescribe hydroxychloroquine, azithromycin or ivermectin it is without marketing authorization and under the responsibility of the doctor “. Some medical associations have attacked the ANSM to obtain an RTU for these drugs.
This is one of the differences between two countries of opposite hemispheres. Order and Progress versus Freedom, Equality, Fraternity are the currencies of the two countries, however, the Covid also divides science and medicine.
Note: In a recent study on HIV with Dr. Franck Boccara (248,771 euros of statements) in eurofordocs), Dr. Caramelli declares links of interest
Funding for the study was provided by Amgen Inc. Dr. Boccara received research grants from Amgen; received conference fees from Janssen, Gilead, ViiV Healthcare, Amgen, Sanofi, Merck Sharp and Dohme, and Servier outside of the submitted work. Mr. Kumar has received grants from Amgen, GlaxoSmithKline, Merck, Gilead and Thera-technologies; received consulting fees from Amgen, GlaxoSmithKline, Merck, Gilead and TheraTherapeutics; and owns shares of GlaxoSmithKline, Merck, Gilead, Pfizer and Johnson & Johnson. Dr Caramelli received support from Boehringer Ingelheim and Amgen; received consulting fees from Amgen and Bayer; and received a fee for unemotional talk of Servier, Boehringer Ingelheim, and Elsevier Order sets.
