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Friday, December 31, 2004

Fast Food Linked To Obesity And Diabetes

Fast Food Linked To Obesity And Diabetes
Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis
Clear link between increased fast-food consumption and obesity Fast-food consumption has strong positive associations with weight gain and insulin resistance, suggesting that fast-food increases the risk of obesity and type 2 diabetes, concludes a US study by David Ludwig and colleagues. In an accompanying Comment, Arne Astrup says: "Fast-food restaurants may argue that the evidence that customers are being super-sized by their meals is too weak. But should customers not be given the benefit of the doubt? ? Recently, some major fast-food companies have taken positive steps by launching new healthier choices, such as porridge for breakfast, and fruit and vegetables for desert."

Para ser coerente com nossa preocupação com obesidade e diabete, deveríamos de cobrar um imposto maior para as empresas de fastfood (a começar pela MD)!

[2216 - AMICOR - 31/12/2004] New fashion for AMICOR; Conflict of Interest.

We will try a new experimental style for the AMICOR presentation. During an initial period we will keep both: the traditional presentation in the AMICOR SERVER and this new one as a blog,
If you know any member of the list no more receiving the alert messages, please ask them to send again a message to reactivate participation in the list. I will cancel from the list all addresses with difficult delivery.

You may also visit other three blogs I will maintain:
* related with the Health Priorities consultation
* where I use to keep of my interest but with doubtful general interest.
* related with medical education issues.

Direct to consumer advertising -- Mansfield et al. 330 (7481): 5 -- BMJ

Direct to consumer advertising -- Mansfield et al. 330 (7481): 5 -- BMJ
This article deals with a new industry strategy, bypassing professionals, as they are progressively aware of the conflict of interest, and pressed by scientific societies and ethical committees to control manipulation of physicians.

FDA to review "missing" drug company documents -- Lenzer 330 (7481): 7 -- BMJ
Eli Lilly & Prozac affaire.
The additional question is not just scientific, but moral: is it right to hidden documents and lack of transparency for secondary interest?

SCIELO list of scientific publication references

Subject list of serials

Tuesday, December 28, 2004

Consulta sobre prioridades em Saúde.

Com vistas num estudo sobre impacto econômico das doenças cardiovasculares em países em desenvolvimento foi apresentado junto com a mensagem AMICOR 2191, um questionário respondido por vários especialistas (lista anexa aos resultados). O que foi colhido até o presente momento pode também ser visto através de um hiperlink (

O questionário continua aberto a quem quiser colaborar respondendo ou comentando os resultados. Os respectivos créditos serão respeitados.

Há planos de expor estes resultados a uma amostra mais extensa da população, para colher também sua percepção, porém através de um questionário mais fechado.

[2214-AMICOR - 27/12/2004] Ethics & Professionalism

ACCF/AHA Consensus Conference Report on Professionalism and Ethics
(Full article available on request. Artigo completo deve ser pedido por e-mail:

Richard J. Popp, Conference Co-Chair Sidney C. Smith, Jr, Conference Co-Chair

The recommendations set forth in this report are those of the conference participants and do not necessarily reflect the official position of the American College of Cardiology Foundation and the American Heart Association, Inc.
When citing this document, the American College of Cardiology Foundation and the American Heart Association would appreciate the following citation format: ACCF/AHA consensus conference report on professionalism and ethics. Presented in Bethesda, Maryland, June 2–3, 2004. Circulation. 2004;110:2506 –2549.

The health care professions have always enjoyed special trust and position in our society. Patients trust health care professionals (HCPs) to guard their health, inform them, and put a patient’s interests above any other consideration.
This is one definition of “professionalism.” When HCPs deal with human subjects in research there are basic ethical principles, articulated in the classic Belmont Report of 1979, that have been accepted by all (1).
We believe from our experience that the members and staff of the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) strive to do “good” for society in general and for patients specifically.
They put patients’ interests first, above their own, in an overwhelming majority of situations. There are virtually hundreds of thousands of patient-HCP encounters daily in the U.S. It is assumed that HCPs are trying their utmost to benefit their patients even when the outcome is not optimal or when disease progression cannot be effectively treated. Complications of therapy occur despite the best of intentions. Clinician-scientists and the medical industry develop new therapies to improve the lives of patients living with cardiovascular disease, and society has seen the benefits of this effort over the past several years. Everything in this system works well until or unless a conflict between the HCP’s interests and those of the patient results in actions that harm the patient. Then it is assumed that there has been a breach of that respected patient-HCP trust. Many modern situations exist in which the personal interest of the HCP may not be aligned with that of the patient. Ethical choices must be made by the HCP in these situations. Examples include:

● A physician is awakened and gets out of bed in the middle of the night to assess a patient with chest pain.

● A procedure is done or an antibiotic is given with marginal indication by the HCP to satisfy the patient’s wishes rather than the HCP providing a long or detailed explanation of why the action need not be taken.

● Procedures produce income for HCPs and provide experience and prestige that are valuable for the HCP in ways beyond those only for the individual patient’s direct benefit.

● Medical scientists have a deep interest in developing new methods or therapies requiring testing in humans despite the initial imperfection of the agents being tested.

● HCPs continue to devote precious time to help patients make important behavioral changes (smoking and substance abuse cessation, dietary counseling, and so on), despite a lack of reimbursement or support from health care delivery systems and payers.

● An HCP advocates for a product or procedure because of his or her role as an adviser or consultant to a company profiting from the product or procedure while trying to differentiate this role from that of an impartial physician or other HCP educator.

● The HCPs are chosen for their opinions to serve as paid experts in legal actions, de facto taking “sides” in cases related to patient care or product liability issues.

● A physician prescribes a new statin drug for secondary prevention because he or she heard about it at a recent meeting hosted by a drug representative, although this drug is less proven to prevent subsequent events than older medications.