A resistência à cloroquina e a busca de antimalariais entre as décadas de 1960 e 1980 / Chloroquine resistance and the search for antimalarial drugs from the 1960s to 1980s

Em 1961, a Organização Mundial de Saúde (OMS) reconheceu a resistência de cepas de Plasmodium à cloroquina, o que estimulou programas de pesquisa e desenvolvimento de novas drogas sintéticas que pudessem substituí-la no combate à malária. Analiso o processo de pesquisa científica relativo à produção de antimalariais nos contextos nacional e internacional, em especial nos EUA e na China, entre as décadas de 1960 e 1980. Pontos de convergência e distanciamento são marcados pelas dinâmicas próprias de cada país e pelos interesses envolvidos nas relações internacionais, em relação aos quais fica evidente o papel central da OMS.

Um método chamado Pinotti: sal medicamentoso, malária e saúde internacional (1952-1960) / A method called Pinotti: medicated salt, malaria, and international health (1952-1960)

Analisa a criação, a recepção e o abandono do método Pinotti de combate à malária: sal de cozinha misturado com cloroquina. Idealizado no início da década de 1950 pelo malariologista brasileiro Mario Pinotti como ação profilática e terapêutica contra a malária, foi testado durante a primeira metade daquela década e utilizado no Brasil entre 1959 e 1961, como parte da campanha de erradicação da malária coordenada pela Organização Mundial da Saúde. Conquistou reconhecimento no cenário internacional da saúde, sofreu críticas e foi testado em outros países até meados dos anos 1960. Argumentamos que, no Brasil, o abandono foi devido, sobretudo, ao ocaso político de seu criador, a partir de 1960.

Ética e investigación en la historia de la malaria / Ethics and research in the history of malaria

Clinical research is absolutely necessary for the development of medical knowledge. However, progress of Medicine has not always been obtained respecting human rights. From 1880 onwards, after Laveran's discovery of the protozoan nature of malaria, the increase in knowledge on paludism has been remarkable. Much of the knowledge gained up to the middle of the twentieth century was based although on highly questionable experiments according to modern ethical standards in the fields of biology and phisiopathology, and specially in therapeutic clinical triáis with antimalarial drugs.

La investigación científica en clínica es absolutamente necesaria para el desarrollo del saber médico. No obstante, no siempre el gran progreso alcanzado por la Medicina se ha obtenido respetando la persona humana. En particular, a partir de 1880, cuando Laveran constató por primera vez la naturaleza protozoaria de la malaria, el desarrollo del conocimiento sobre el paludismo ha sido muy notable, pero hasta la mitad del siglo XX estos logros fueron, en muchos casos, fruto de experimentos que hoy resultan en extremo discutibles desde el punto de vista ético, tanto los dedicados al estudio de la biología y de la fisiopatología, como especialmente los ensayos de carácter farmacológico efectuados en individuos sanos para probar moléculas con acción antimalárica real o presunta.

Localized permanent epidemics: the genesis of chloroquine resistance in Plasmodium falciparum.

Localized permanent epidemics occur when, for an indefinite period of time, there is a temporary but continuous introduction of unprotected non-immunes into the same locality of a hyperendemic area. The main epidemiological factors involved in the genesis of localized permanent epidemics were encountered in Pailin (Cambodia) the epicenter of drug resistance in Southeast Asia: a very efficient vector, Anopheles dirus, exophilic and of limited distribution with, therefore, adjacent hyperendemic and non-endemic areas; a permanent pole of attraction in the hyperendemic area: Pailin's sapphires and rubies; a temporary but continuous influx of non-immunes into the pole of attraction: continuous influx of non-immunes into the Pailin gem mining area. In the gem-mining Pailin village drug pressure was considerable: mass drug administration, a medicated salt project and permanent self-medication with very high doses, much higher doses being required to cure non-immunes with heavy infections and severe clinical attacks in epidemic situations. It appears, therefore, that the emergence of chloroquine resistance in Southeast Asia was the consequence of the localized permanent epidemics in Païlin. High level resistance was the result of continuous and intensive serial passages of P. falciparum in the non-immune subjects, large numbers of parasites being exposed to a high level of drug pressure at each passage. Similar epidemiological conditions are encountered in some parts of South America where the exophilic vector is An. nuneztovari. In Colombia, whose eastern mountains bordering Venezuela yield the most highly prized emeralds in the world, chloroquine resistance was detected at about the same time as in Southeast Asia.(ABSTRACT TRUNCATED AT 250 WORDS)