Pharmaceutical lobbying in Brazil: a missing topic in the public health research agenda

ABSTRACT In the US, where registration of lobbyists is mandatory, the pharmaceutical industry and private health-care providers spend huge amounts of money seeking to influence health policies and government decisions. In Brazil, where lobbying lacks transparency, there is virtually no data on drug industry expenditure to persuade legislators and government officials of their viewpoints and to influence decision-making according to commercial interests. Since 1990, however, the Associação da Indústria Farmacêutica de Pesquisa (Interfarma - Pharmaceutical Research Industry Association), Brazilian counterpart of the Pharmaceutical Research and Manufacturers of America (PhRMA), main lobbying organization of the US pharmaceutical industry, has played a major role in the advocacy of interests of major drug companies. The main goals of Interfarma lobbying activities are: shortening the average time taken by the Brazilian regulatory agency (ANVISA) to approve marketing authorization for a new drug; making the criteria for incorporation of new drugs into SUS (Brazilian Unified Health System) more flexible and speeding up technology incorporation; changing the Country's ethical clearance system and the ethical requirements for clinical trials to meet the need of the innovative drug industry, and establishing a National Policy for Rare Diseases that allows a prompt incorporation of orphan drugs into SUS. Although lobbying affects community health and well-being, this topic is not in the public health research agenda. The impacts of pharmaceutical lobbying on health policies and health-care costs are of great importance for SUS and deserve to be investigated.

Food and beverage industries' participation in health scientific events: considerations on conflicts of interest / Participación de las industrias de la alimentación y las bebidas en acontecimientos científicos sobre temas de salud: consideraciones sobre conflictos de intereses

Several sectors of the industry (pharmaceutical, food, and other) often occupy a prominent position in scientific meetings on health. The aim of this article is to discuss the participation of food and beverage industries (Big Food and Big Soda) in events organized by scientific institutions in health and nutrition, highlighting potential conflicts of interest in such partnerships. As an example, the authors report the case of a Brazilian national event organized by a nutrition scientific association in 2011. Focused on the theme "Evidence-based Nutrition," the event's scientific program was largely influenced by corporate sponsors. For example, a symposium at this congress was organized by a beverage company known worldwide for its sugar-sweetened products and classified as the "diamond sponsor" of the event. While debating the adoption of healthy lifestyles in the current scenario of rising occurrence of obesity, the rationale for health promotion was reduced to providing information that would motivate rational individual choices, thus ignoring any political, economic, cultural, marketing, and social factors involved in the global process of nutrition transition. The authors conclude that conflicts of interest are present in the participation of food and beverage industries in health scientific events. The industries' strategy attempts to grant legitimacy to the production and marketing of their products through an association with adequate health practices. Health professionals and policy-makers should reflect on such partnerships because their main purpose is to generate profit, not the promotion of public health.

Diversos sectores de la industria (farmacéutico, alimentario y otros) a menudo ocupan una posición prominente en las reuniones científicas sobre temas de salud. El objetivo de este artículo es tratar sobre la participación de las industrias de la alimentación y las bebidas (Big Food and Big Soda) en acontecimientos organizados por instituciones científicas del ámbito de la salud y la nutrición, señalando los potenciales conflictos de intereses que surgen de tales asociaciones. Como ejemplo, los autores comentan sobre el acontecimiento nacional organizado el año 2011 en el Brasil por una asociación científica del ámbito de la nutrición. El programa científico de este acontecimiento, dedicado al tema de "La nutrición basada en datos probatorios", se vio influido en gran parte por sus patrocinadores corporativos. Por ejemplo, un simposio de este congreso fue organizado por una empresa productora de bebidas, conocida a escala mundial por sus productos azucarados y clasificada como "patrocinador diamante" del acontecimiento. Mientras se debatía sobre la adopción de modos de vida saludables en el contexto actual de incremento de los casos de obesidad, el ámbito de promoción de la salud se redujo a suministrar información que incitara a elecciones individuales racionales, sin que se tuvieran en cuenta los factores políticos, económicos, culturales, mercadotécnicos y sociales que el proceso mundial de transición nutricional involucra. Los autores concluyen que los conflictos de intereses existen en la participación de las industrias de la alimentación y las bebidas en acontecimientos científicos sobre temas de salud. La estrategia de las industrias intenta dar legitimidad a la producción y comercialización de sus productos mediante una asociación con prácticas de salud adecuadas. Los profesionales de la salud y las instancias normativas deben reflexionar sobre tales asociaciones, ya que su principal finalidad no es la promoción de la salud pública sino la generación de beneficios.

Entre vecinos: Retos de la justicia transicional a nivel local: el caso de la sierra de la Macarena, Colombia / Between neighbors: challenges in the local transitional justice: the case of the “ la sierra de la macarena, ” colombia

El actual proceso de paz entre el Gobierno Colombiano y las FARC- EP en la Habana ha reavivado el debate en torno a los límites y alcances de la justicia transicional. Fenómenos como la victimización horizontal, consecuencia de la participación indirecta de los civiles en el conflicto, plantea una serie de retos para el modelo de justicia transicional que sedefina en la mesa; en particular cómo proceder cuando la violencia ha sido utilizada entre vecinos. Este artículo se centra en esta tensión y para ello presenta una caracterización de los límites de la justicia transicional y analiza los contextos de oportunidad donde la victimización horizontal ha tenido lugar en una región colombiana fuertemente afectada por el conflicto armado, la Sierra de La Macarena. El artículo concluye con la formulación de una hipótesis orientada a proponer una posible alternativa para superar la violencia horizontal en el post conflicto: la posible complementariedad entre los mecanismos de transición y las experiencias locales de justicia comunitaria.

The current peace process between the Colombian Government and FARC - EP in Havana has rekindled the debate over the limits and scope of transitional justice. Phenomena suchas horizontal victimization, result of the indirect participation of civilians in the conflict, poses a number of challenges for the transitional justice model, which is defined at the table; in particular how to proceed when violence has been used among neighbors. This article focuses on this tension and, for that, this presents a description of the boundariesof transitional justice and discusses the contexts of opportunity where the horizontal victimization has taken place in a Colombian region strongly affected by the armed conflict, la Sierra de La Macarena. The article concludes with the formulation of a hypothesis aimedat proposing a possible alternative in order to overcome the horizontal violence in the post conflict:, which is the possible complementarity between transitional mechanisms and thelocal experiences of community justice.

Paz, la tarea es fortalecer la participación social y popular / Peace, the task is to strengthen the social and popular participation

Asistimos a un momento histórico en Colombia, se marca posiblemente, el cierre de una cruenta confrontación armada de más de 50 años, entre las Farc-Ep y el gobierno Colombiano, este solo hecho ya de por sí, es bien importante, pero no suficiente.

We are witnessing a historic moment in Colombia. It possibly marks the end of a bloody armed confrontation of more than fifty years, between FARC-EP and the Colombian government. This very fact per se is very important, but not enough.

Ticagrelor en el síndrome coronario agudo. Explicando lo inexplicable / [Ticagrelor in acute coronary syndrome. Explaining the inexplicable]

The PLATO study evaluated the efficacy of adding ticagrelor, instead of clopidogrel, to aspirin in patients with acute coronary syndrome, which showed surprisingly positive results making the drug acceptable to regulatory agencies and specialty societies worldwide. Notwithstanding the aforementioned success, contradictory information supplied by critical analysis was submitted by the sponsor. The controversial findings revealed several aspects that are difficult to explain, threatening the veracity of the study’s conclusions. Mortality rate pattern, excessive benefit not comparable to prior studies, unexplained loss of follow-up development and inconsistency in findings in accordance with the country, the type of events arbitrator and monitoring committee are some of the most questionable issues. Dubious reaction to this trial is based on the fact that the information could not be found in published articles. This complex situation poses a challenge to the critical analysis of the text and raises questions as to how far the conflicts of financial interest influenced the development of the study, the communication of its results and probably, acceptance of the drug for commercial use.

Como Cirujanos ¿Qué sabemos de publicar? / As surgeons, What do we know about publishing

La publicación de un artículo científico es la culminación de todo trabajo de investigación. Las guías internacionales de publicación determinan las normas actuales para autores de manuscritos. El objetivo de este trabajo era determinar el grado de conocimiento de los conceptos de publicación sobre revisión por pares, autoría, conflicto de intereses y publicación secundaria aceptable de los cirujanos graduados y de los residentes de cirugía...

Enfrentamento do controle do tabagismo no Brasil: o papel das audiências públicas no Senado Federal na ratificação da convenção quadro para controle do tabaco (2004 – 2005) / Coping with tobacco control in Brazil: the role of public hearings in the Senate to ratify the framework convention for tobacco control (2004 - 2005)

O tabagismo é uma epidemia mundial baseada na dependência química à nicotina e a outras 4.700 substâncias tóxicas, das quais, 70 são cancerígenas. A produção da folha do tabaco envolve muitos trabalhadores rurais organizados geralmente em base familiar. A transformação do tabaco em cigarro e sua comercialização são atividades controladas por empresas transnacionais. O tabagismo é responsável por cerca de seis milhões de mortes ao ano. Por essa razão a ONU, depois de longo processo de negociação, aprovou a “Convenção-Quadro Para o Controle do Tabaco” (2005). Para entrar em vigor, tal acordo deveria ser ratificado pelos países membros. Este trabalho descreve e analisa o processo histórico inédito de utilização das Audiências Públicas para a aprovação desse acordo internacional pelo Brasil. Trata-se de um estudo de base qualitativa que utiliza como fonte de informação as notas taquigráficas resultantes desses eventos. O estudo revela a importância desempenhada pelas Audiências Públicas no estabelecimento do Programa de Apoio à Diversificação Produtiva nas Áreas Cultivadas com Fumo”, que criou uma alternativa para as famílias produtoras de fumo sobreviverem, após serem atingidas economicamente com a redução do consumo do tabaco decorrente da aprovação desse acordo internacional pelo Brasil.

Conflitos e riscos socioambientais: análise da relaçäo entre o complexo Costa do Sauípe e atores locais / Socioenvironmental conflicts and risks: analysis of the relationship between the Costa do Sauípe complex and local actors

Analisa o processo de construçäo de mecanismos político-institucionais de coordenaçäo a partir do estudo de conflitos socioambientais existentes entre o complexo turístico-hoteleiro Costa do Sauípe - localizado na área de proteçäo ambiental do litoral norte da Bahia (APA LN-BA) - e atores locais. Parte da investigaçäo de situaçöes-problema envolvendo riscos socioambientais. Busca contribuir para a discussäo e compreensäo dos desafios envolvidos na construçäo da sustentabilidade dessa área de proteçäo ambiental e subsidiar a formulaçäo de políticas de intervençäo dos diversos atores envolvidos com a questäo.

Conflito ambiental na costa de Säo Paulo: o plano diretor de Säo Sebastiäo / Environmental conflict on the coast of Säo Paulo: Säo Sebastiäo's directive plan

Procura documentar e discutir um episódio de conflito ambiental, tomando a experiência de discussão pública, negociação e votação do Plano Diretor Municipal de São Sebastião, Município da costa norte de São Paulo. Discute o avanço em termos de mediação de conflitos, com utilização de técnicas de negociação e a relaçao deste processo com a dinâmica da política local, em especial marcando os papéis do Executivo e dp Legislativo no processo participativo. O principal tema que emerge em relação à pauta da sustentabilidade é a competição entre o turismo e o veranismo na ocupação do território costeiro