The president of Conass (National Council of Health Secretaries) and Health Secretary of Maranhão, Carlos Lula, said that there are still doctors who prescribe the “Covid kit” in the SUS.
These are drugs such as hydroxychloroquine and ivermectin, with proven ineffectiveness against the disease.
“There is still [medicamentos sendo prescritos]. I get scared, there are doctors who prescribe and there are doctors who still tell the father not to vaccinate the child. It is an absurd type of conduct, but it exists. Of course, with much less intensity, but they still prescribe,” Lula said in an interview with leaf.
The Secretary of Health said that this has still occurred because the CFM (Federal Council of Medicine) has not changed the understanding of the physician’s autonomy in relation to these drugs.
Opinion No. 4/2020 of the CFM says that the doctor has medical autonomy so that, in agreement with the patient, he establishes which treatment will be carried out. This understanding opens a gap for ineffective drugs to continue to be prescribed.
“Medical autonomy is not that, it does not mean that I can prescribe what I want, that is not medical autonomy. It has limits. If I have scientific evidence that a certain drug is not effective in changing the clinical condition of the patient , the doctor cannot prescribe the medicine”, he said.
Upon taking over the Ministry of Health, in March 2020, Marcelo Queiroga announced that he would promote the debate at Conitec (National Commission for the Incorporation of Technologies in the SUS) to end the discussion on the use of the so-called Covid kit.
However, the topic has gained the spotlight in recent days after the Ministry’s Secretary of Science and Technology, Hélio Angotti, rejected a directive that contraindicates drugs.
Lula also highlighted that the pandemic was the most challenging moment faced by Conass in the last 40 years and that, during this period, the relationship with the Ministry of Health was put in check. For him, it is no longer possible to dialogue with Queiroga, who, in his view, has hindered the conduct of the pandemic.
The percentage of vaccinated in some Brazilian regions is low, as in the North and Northeast. Why does this occur mainly in these regions? It is very difficult to give a general explanation of the low vaccination rate. But vaccination is generally lower in poorer cities.
Where is the lowest vaccination? Indigenous area, quilombola, rural population. In these regions it is often difficult to [de a vacina] reach people.
in Mirador [no Maranhão], for example, has a huge reserve that is 100 kilometers away from the headquarters. Does this person go to headquarters just to get vaccinated? It’s difficult. If the municipality does not create strategies to bring vaccines to these people, it is difficult for them to be vaccinated.
And you have to deal with another problem, there is a huge difference between who is vaccinated and what is on the ministry’s website. In the South and Southeast more than 70% of Basic Health Units have electronic medical records and enter them directly into the system, but in the North and Northeast this does not happen, they do everything on paper.
Conass turned 40 last week. Was the pandemic one of the most challenging moments in this period? I believe it was the most challenging period on the board, a period when our relationship with the ministry [da Saúde] was put in check the whole time, which shuddered a lot.
Because we are an integral body of the SUS, many public policies are decided together with the representative of the states, the representative of the municipalities and the ministry. But the possibility of dialoguing, the possibility of building, was put in check during the period.
I have no more relationship with the minister [Marcelo Queiroga], I don’t talk to him. Below him we can have [relação]but with him we cannot have.
As much as Conass often antagonizes the ministry, because this is also its role, I cannot simply stop the dialogue. There is something much greater than the role of one or the other established here, it has a much greater policy than Minister A or Secretary B.
It is important to say that Conass is made up of secretaries who represent the governors, most governors support the president. At least supported.
We have a closed council in opposition to the policy developed by the President of the Republic [Jair Bolsonaro] it’s not something simple, it’s something that is indeed complex and more than that, surprising.
You have already said before that there is no way to dialogue with the minister. Why? He is not very fond of dialogue, he is rude in that manner.
We deal with people who oppose us all the time, this is natural for the position we occupy. We have to know how to deal with someone who contradicts, with someone who says something that we won’t like to hear.
He does not have the institutional democratic maturity to be in the position he occupies. He has a low ability to build rapport with those who differ from him.
We have this institutional difficulty, which we don’t have with those below him. I will quote Rodrigo [Cruz, secretário-executivo do Ministério da Saúde]we talk to him and not to the minister.
The AMB (Brazilian Medical Association) released a note criticizing the minister’s stance on several points. Has the minister somehow hindered the conduct of the pandemic? It got in the way the whole time. His attitude is like this: he got in the way of vaccinating teenagers, he got in the way of vaccinating children, trying to please the denialists, Bolsonarism.
Then he says he got the vaccines. He only does it by pressure, if he left, he would not allow vaccination.
The posture is regretful. You can pick up various bodies that make health policy: the vast majority is opposed to Queiroga’s stance in recent months.
Almost two years since the beginning of the pandemic and the CFM still gives a gap to prescribe the Covid kit by justifying medical autonomy. Is it time to review this? The position of the CFM in all this is sad. The organ stopped having evidence-based medicine to have medicine based on Bolsonaro.
Medical autonomy is not that, it does not mean that I can prescribe what I want, that is not medical autonomy. She has limits.
If I have scientific evidence that a particular drug is not effective in changing the patient’s clinical condition, the doctor cannot prescribe the drug. The way CFM talks, it’s as if I could prescribe stone for someone with a fever.
If I have drugs X, Y, and Z that are proven to be ineffective against the disease and I still prescribe them, the person should be held accountable. He should answer in the council, civilly and criminally, if something happened to the patient.
It is not that we are against medical autonomy, it exists. Medical autonomy is not what CFM stands for, and it knows it. It’s just being convenient to defend this kind of stance.
Are these drugs that are not effective in the SUS still being prescribed? There is still [medicamentos sendo prescritos]. I get scared, there are doctors who prescribe and there are doctors who still tell the father not to vaccinate the child.
It is an absurd type of conduct, but it exists. Of course, with much lower intensity, but they still continue to prescribe.
Something that has generated a lot of controversy is the technical note published by secretary Hélio Angotti that rejects the guideline against the “Covid kit”. What is your view on this? Science is not opinion, it is method. Even more health science.
I have the repetition of this method to arrive at a certain result, which politics does not always like. their speech [governo] you cannot run away from what they started back there because otherwise the narrative loses meaning.
The Ministry of Health said it will keep paying daily rates for the operation of 14,000 Covid-specific ICU beds until the end of February. Will it be enough? The minister has said is that there will be no shortage of resources. Having the need to expand, he says it will be expanded.
What are the guidelines that Conass will work on this year? The agenda that we should work on this year is how to rebuild the health system after these two years of pandemic.
We have a huge queue of delayed exams, delayed consultations, patients who got worse. It’s as if we’re coming out of a war and there’s a country to rebuild. It will have to be the reconstruction of that.
X-RAY
Carlos Lula, 39
He is a lawyer, career legislative consultant and university professor. Postgraduate in Civil Procedural Law and Constitutional Law, he has an MBA in business management and has been Secretary of Health of the State of Maranhão since 2016. In 2018, he was elected vice president of Conass for the Northeast Region, having been reelected in 2019. Covid-19 pandemic, was elected Chairman of the Board in 2020 and re-elected in 2021
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