More than 50 entities and groups working in the areas of psychiatry, psychology and human rights published today a protest note against a public consultation carried out by Conitec (National Commission for the Incorporation of Technologies) in the SUS (Unified Health System) on the treatment with electroshocks in patients of the autistic spectrum.
Known as electroconvulsive therapy, the technique uses an electrical current to produce a generalized seizure in order to control the patient’s behavior. This type of procedure is advocated by Conitec to treat aggressive behavior in patients on the autism spectrum in Brazil.
But, according to the entities that signed the repudiation note, the method, in addition to being archaic, violates the human rights convention and is considered torture by the UN (United Nations Organization).
“The bibliographic references presented in the Ministry of Health protocol point to catatonia situations [caso em que psiquiatria argumenta que há evidências cientÃficas para o seu uso] and studies of precarious scientific value. Of the 17 citations to substantiate the procedure, none of them address the central issue of the document, which is aggressive behavior”, the entities affirm.
Although indicated as a resource for the treatment of patients with severe depression, electroconvulsive therapy in the past has been associated with torture in patients and abuse committed by professionals in psychiatric hospitals.
In 2013, a UN report found that the use of shock treatment to control the behavior of patients violated the UN convention against torture.
Last year, the FDA, the equivalent of Anvisa (Agency for Sanitary Surveillance) in the United States, banned the practice in people who can be aggressive or who offer danger of getting hurt. The FDA justified that the method exposes patients to “irrational and substantial risk of illness or injury.”
what does health say
The agency, linked to the Ministry of Health, opened the survey this month and indicated its favorable recommendation for the procedure.
Sought by UOL, the Ministry of Health informed that, in the proposal to update the Clinical Protocol and Therapeutic Guidelines (PCDT) on Aggressive Behavior in Autism Spectrum Disorder (ATE), there is no recommendation for the use of electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).
“This is a preliminary document demanded for evaluation by Conitec, responsible for the recommendations on the constitution or alteration of PCDT, in addition to matters relating to the incorporation, exclusion or change of technologies within the scope of the SUS. It is worth noting that the public consultation is a an important stage of external review of the PCDT and the contributions of society will be considered for the elaboration of the final proposal of the text”, said the ministry, in a note.
“The folder clarifies that the health technology assessment process comprises stages such as the preparation of reports on clinical, epidemiological and diagnostic aspects of the evaluated clinical condition; the search for scientific evidence; risk analysis; economic and budgetary impact assessments; evaluation of technologies in other countries, in addition to the qualitative and quantitative analysis of the contributions sent through the public consultation to be discussed in the Plenary of the National Commission for the Incorporation of Technologies in the Unified Health System (Conitec), with a view to final deliberation,” he said .
what inspired the query
Based on a report titled “Clinical Protocol and Therapeutic Guidelines for Aggressive Behavior in Autism Spectrum Disorder,” the Conitec report, published in November, said the results of the procedure “have been promising.”
In the evaluation of the commission, the evaluation is the result of inadequate “media coverage” and “indication” that occurred previously.
“The use of ECT in psychiatry and neurology declined significantly in the 1970s and was due to several reasons: the advancement of pharmacological therapies, inadequate media coverage during anti-asylum combat and reports of patients who underwent this technique without indication appropriately or even punitively, all these factors stigmatized the use of ECT”, says the text of the government agency.
According to the report, current techniques would allow the method to be applied safely.
“Currently, the technique used uses more modern devices, allowing a more adequate regulation of the load, the possibility of controlling the wavelength used and the frequency of the electric current triggering. In addition, for the comfort and safety of the patient, anesthetics are used , muscle blockers and drugs that prevent the vagal effects of the procedure”.
According to the opposing entities, the version of the document submitted to public consultation uses a vague and contestable definition of what aggressive behavior is. “These behaviors are closely related to the environment, barriers and lack of access to support and other fundamental rights, which are often ignored”, say the signatories.
“For this reason, there is an urgent need for a paradigm shift with regard to access to health and training and rehabilitation: capacity building and the lack of accessibility cannot be tackled with medical interventions”, complete the entities opposed to the consultation. public.
what experts say
To Estadão, pediatrician and child neurologist Clay Brites, from the NeuroSaber Institute, says that autistic people need quality care in the public system and that electroconvulsive therapy is a “regression”.
“This is a mistaken health policy because autism cannot be seen as a process in which this therapy will solve all the problems. The release in specific or generalized SUS centers is foolhardy. Before this concern, the SUS should seek correct, multidisciplinary care, applied in a broad way, with families, and improving access to patients who need it most,” says Brites.
For Rosana Onocko, from Abrasco (Brazilian Association of Collective Health), the encouragement to purchase this type of device is not a concern because of the effectiveness or not in some cases, but because of the risk of uncontrolled use.
“Since the SUS already has this [em alguns hospitais, mas sem financiamento federal], this raises suspicion about who is interested in these purchases,” Rosa told leaf.
In the assessment of psychiatrist Leon Garcia, from the Psychiatry Institute of the Hospital das ClÃnicas at USP (University of São Paulo), the measure should be preceded by studies.
“With the history of electroconvulsive therapy in Brazil, any step towards financing should be preceded by strong regulation and inspection structure, because the history is very negative”, he says, recalling the cases of misuse of this type of therapy in the past. “Starting now with financing devices seems to me the worst way.”
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