Queiroga cannot please Bolsonaro and doctors, says AMB president

President of the AMB (Brazilian Medical Association), César Eduardo Fernandes said that the “inconstancy of speeches” by Minister Marcelo Queiroga (Health) causes deep disappointment.

“Now he gives his opinion in one way, probably to please his superior. [o presidente Jair Bolsonaro], now he wants to be okay with the doctors. He’s not getting well with us,” Fernandes told leaf.

The association even defended the Bolsonaro government’s banners, but changed its stance in early 2021, when Fernandes’ administration took office.

Since then, the AMB has asked for the banning of drugs such as hydroxychloroquine and has moved away from the CFM (Federal Council of Medicine). “We defend that the doctor’s autonomy is not a blank check to do what he wants,” he said.

Fernandes said that AMB does not rule out going to court to contest government actions, as a veto of the directive that contraindicated the so-called “Covid kit”. He also defends that the association does not ask for a vote for a candidate for president this year, as it did with Aécio Neves (PSDB) in 2014.

“I think the doctors didn’t vote for a candidate [em 2018]Bolsonaro, I think the doctors voted against a situation”, he said. “The impression I have is that the context has now changed, I don’t know if the doctors will do it again.”

AMB has 54 affiliated specialty societies, including cardiology, which was chaired by Queiroga.

Does the AMB assess that the medical profession is divided on early treatment? I wouldn’t consider medicine to be divided. I think there are some individuals who cling to some works of questionable methodology, published in less impactful journals. I want to believe that it is a minority.

In March 2021, we reviewed all the national and international literature on what is conventionally called the Covid treatment kit in Brazil. These medications have failed in good quality studies.

These groups [pró-kit Covid] are very organized. When we took a stand against early treatment, they promptly attacked the AMB. With disrespectful, cruel, threatening criticism. We realize that this is not a scientific discussion.

On the other hand, a digital petition was made, with 90 thousand signatures contrary to the position of Hélio Angotti [secretário do Ministério da Saúde que vetou diretrizes anticloroquina].

Is Minister Queiroga’s work being decisive in hampering the response to the pandemic? Mr. Do you think he can be punished for that? We had a lot of hope that, by bringing in a medical minister, although in a management position, he would continue to respect ethical principles. I am sorry to say that, this inconsistency of the minister’s opinions caused us deep disappointment.

Now he gives his opinion in a way probably to please his superior. [o presidente Bolsonaro] and now he wants to be okay with the doctors. With us he is not getting well. We are not happy with the minister’s performance.

And his inconsistency, procrastinating the beginning of the children’s vaccinations, raising doubts about safety, then, on the contrary, going there to unload the plane when the vaccines arrive, seems to me a dubiousness that does not fit in a public man. He has obligations that the common citizen does not have.

This lack of assertiveness on the part of the minister, oscillation of positions, is very harmful.

If I am in favor of vaccines, at any time I have to say that I am in favor. Can it have side effects? Of course, and the population needs to be warned about this. There is no pharmacological or vaccine intervention that does not have risk.

What is the incidence of serious side effect? It is very small and most of it is reversible.

A lawsuit runs at the National Academy of Medicine [sobre retirar título de vice-presidente honorário de Queiroga]. For the first time in history there is an ongoing process to withdraw this title, I don’t know what the outcome will be.

Mr. Do you think it is fair to withdraw this title? It’s not up to me to talk about this process, I’m not participating. But this certainly shows the doctors’ displeasure. That never happened at the academy. It is an indication, it shows dissatisfaction of the doctors.

The medical council, initially made in the jurisdiction in which it is written, is the one who makes the judgment of the doctor’s conduct.

Does AMB consider going to court against any government action, such as the veto of an antichloroquine directive? Or do you still intend to keep the debate in the administrative route? I do not exclude this possibility. But at the moment we want to exhaust the resources in the administrative sphere.

A contesting piece is being prepared for administrative appeals to ask that this position of secretary Hélio Angotti be revoked and not accepted by the minister.

Now everything is possible. We always have collegiate decisions, it is possible that at a given moment this will come to light and we will appreciate it in our legal department.

AMB will be a signatory of this resource among other medical societies. That [discussão sobre kit Covid] It’s more or less like jabuticaba, only available in Brazil. There is a clamor for this to be reversed.

AMB supported the candidacy of Aécio Neves in 2014. Do you think you should position yourself in this year’s presidential elections? I understand that AMB should not take a stand. I will make every effort so that the AMB does not take a stand in favor of this or that candidate.

I, a citizen, César Eduardo Fernandes, will have my opinions, but I will not make them public.

What we thought of doing is offering a public debate [com os candidatos]organized, on health aspects.

The medical profession was one of those identified as pro-Bolsonaro in the last election. CFM and AMB have already positioned themselves against some policies of past governments, such as the Mais Médicos program. Mr. Do you think that the medical class has lost its exemption a little? Is there now a conflict between AMB and CFM? I have made every effort not to create any institutional crisis.

CFM is a federal autarchy, it has its own prerogatives. It regulates the medical profession, supervises and is the one who can sanction it. We have, of course, different positions today, it is well known.

I have been talking to CFM, in the sense of saying that we have to respect each other. Of course, we don’t need to think the same way. What caused us discomfort in the relationship was precisely in relation to the Covid kit.

The CFM allowed this to be at the discretion of the physician. We defend that the doctor’s autonomy is not a blank check for the doctor to do what he wants.

In three, four, five treatments, he can decide what is best for his patient, even if it is “off label”, that is, it is not registered on the package insert. There is often the so-called compassionate treatment in which we physicians take advantage of our experience and provide treatments that are not on the package leaflet because other possibilities have been exhausted.

This is not the case here because it is showing that [o kit Covid] does not work and causes harm.

I think the doctors did not vote for a candidate, Bolsonaro, I think the doctors voted against a situation.

There was also a certain exhaustion in relation to the managers of the national policy that had been commanded with the PT, and it wore out. Some problems that deeply disenchanted the doctors.

Particularly, the financial deviations that were pointed out meant that doctors had no more tolerance for that. And I needed a new option.

In the only new option they saw, without knowing exactly the option, they elected Bolsonaro. The impression I have is that the context has now changed, I don’t know if the doctors will do it again.​

Cesar Eduardo Fernandes, 71

President of the AMB (Brazilian Medical Association) and professor of gynecology at the ABC School of Medicine. Graduated in medicine from the Faculty of Medical Sciences of Santa Casa de São Paulo, where he also did residency in obstetrics and gynecology, master’s and doctorate. Among the positions held is that of president of Febrasgo (Brazilian Federation of Gynecology and Obstetrics)