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Resumo A sociedade contemporânea convive com incertezas e vulnerabilidades que exigem a atuação dos sistemas regulatórios na fiscalização do comércio eletrônico de medicamentos não registrados e/ou falsificados. Investiga-se o trabalho dos profissionais da vigilância sanitária federal na fiscalização de medicamentos na internet e os elementos que orientam sua decisão técnica. A metodologia utilizada foi a pesquisa qualitativa, do tipo estudo de caso único, ancorada na abordagem ergológica, entre dezembro de 2020 e setembro de 2021, por meio de entrevistas e observação participante. Os mapas ergodialógicos, elaborados no Atlas.ti, subsidiaram a análise das práticas discursivas classificadas conforme esquema tripolar saber-agir-valor, resultando em três categorias. O profissional é sempre convocado a fazer escolhas e gerir situações imprevisíveis, havendo inquietações sobre a capacidade institucional para compreender e agir sobre o problema. O trabalho adquire, assim, o sentido de "enxugar gelo", em função do volume de demandas e dos poucos efeitos da fiscalização no mercado eletrônico de medicamentos. As normas, o conhecimento técnico, a experiência e a responsabilidade social, dentre outros elementos, estão presentes na tomada de decisão dos profissionais, conscientes de que, ao agir, protegem a saúde da população. Constata-se que diferentes saberes, científicos ou empíricos, podem qualificar melhor o sistema decisório na fiscalização, tornando-o mais efetivo, assertivo e transparente.
Abstract Contemporary society is plagued with uncertainties and vulnerabilities, demanding from regulatory systems the surveillance of unregistered and/or falsified medicines sold online. This study investigates the work of federal health surveillance professionals in the inspection of medicines sold online and the elements that guide their technical decision. A qualitative, single case study based on the ergological approach was conducted between December 2020 and September 2021, with data collected by interviews and participant observation. Ergodialogical maps, developed using Atlas.ti, underlined the analysis of discursive practices classified according to the tri-polar knowledge-action-value schema, resulting in three categories. Professionals are always called upon to decide on and manage unpredictable situations, questioning the institutional capacity to understand and act on the problem. The work thus takes on the sense of "rolling a stone uphill" due to the volume of demands and the limited effects of surveillance on the e-commerce of medicines. Norms, technical knowledge, experience, and social responsibility, among other elements, inform the decision-making process of professionals, who are aware that, by acting, they protect public health. Different forms of knowledge, scientific or experiential, can better qualify decision-making in surveillance, making it more effective, assertive, and transparent.
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Drugs are used in veterinary medicine to prevent or treat animal diseases. When rationally administered to livestock following Good Veterinary Practices (GVP), they greatly contribute to improving the production of food of animal origin. Since humans can be exposed chronically to veterinary drugs through the diet, residues in food are evaluated for effects following chronic exposures. Parameters such as an acceptable daily intake (ADI), the no-observed-adverse-effect level (NOAEL), maximum residue limits (MRLs), and the withdrawal periods (WPs) are determined for each drug used in livestock. Drug residues in food exceeding the MRLs usually appear when failing the GVP application. Different factors related either to the treated animal or to the type of drug administration, and even the type of cooking can affect the level of residues in edible tissues. Residues above the MRLs can have a diverse negative impact, mainly on the consumer's health, and favor antimicrobial resistance (AMR). Drug residue monitoring programmes are crucial to ensure that prohibited or authorized substances do not exceed MRLs. This comprehensive review article addresses different aspects of drug residues in edible tissues produced as food for human consumption and provides relevant information contributing to rational pharmacotherapy in food-producing animals.
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This article traces the transformation of the system of control and repression of Brazilian pharmaceutical activities between the 1930s and the 1970s, through a Foucauldian framework of "differential management of illegalisms." The period between 1930 and 1960 can be understood as a process of negotiation between pharmacists and state agencies that achieved a compromise on the differential management of illegalisms in relation to drugs, with a clear distinction between "laymen" and "professionals." This compromise came into question during the dictatorship, due to institutional transformations that reinforced the autonomy of institutions of repression and a military struggle against subversion and corruption. Pharmacists and laymen alike were considered potential suspects. This suspicion even extended to the civilian agencies that were at the core of the regulation of the licit drug market. These developments profoundly changed the way illegalisms committed by professionals and state officials were treated, blurring the boundaries that had been established between laymen, professionals, inspectors, and industrialists. The final section of the article focuses on the various ways in which institutions of repression focused on pharmacists and state regulatory control agencies as potential places of subversive activity or corruption.
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Militares , Farmacêuticos , HumanosRESUMO
Most of the unfractionated heparin (UFH) consumed worldwide is manufactured using porcine mucosa as raw material (HPI); however, some countries also employ products sourced from bovine mucosa (HBI) as interchangeable versions of the gold standard HPI. Although accounted as a single UFH, HBI, and HPI have differing anticoagulant activities (~100 and 200 IU mg-1, respectively) because of their compositional dissimilarities. The concomitant use of HBI and HPI in Brazil had already provoked serious bleeding incidents, which led to the withdrawal of HBI products in 2009. In 2010, the Brazilian Pharmacopeia (BP) formed a special committee to develop two complementary monographs approaching HBI and HPI separately, as distinct active pharmaceutical ingredients (APIs). The committee has rapidly agreed on requirements concerning the composition and presence of contaminants based on nuclear magnetic resonance and anion-exchange chromatography. On the other hand, consensus on the anticoagulant activity of HBI was the subject of long and intense discussions. Nevertheless, the committee has ultimately agreed to recommend minimum anti-FIIa activities of 100 IU mg-1 for HBI and 180 IU mg-1 for HPI. Upon the approval by the Brazilian Health Authority (ANVISA), the BP published the new monographs for HPI and HBI APIs in 2016 and 2017, respectively. These pioneer monographs represent a pivotal step toward the safest use of HBI and HPI as interchangeable anticoagulants and serve as a valuable template for the reformulation of pharmacopeias of other countries willing to introduce HBI.
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Over recent years Brazil has played an increasingly active role internationally, the result of its model of integration and its foreign policy directives. The health sector is a valuable and strategic area for Brazilian technical cooperation to achieve various objectives, including its development goals. This article describes the main directives of Brazilian foreign policy, conceptually defining and characterizing South-South Cooperation, illustrated through an analysis of two Brazilian technical cooperation initiatives in healthcare: one in South America, the other in Africa. The study concludes that, irrespective of the interests and power asymmetries existing in South-South Cooperation, the objectives of this cooperation were achieved through the technical work.
Nos últimos anos, o Brasil foi ativo no âmbito internacional, tanto por seu modelo de inserção como pelas diretrizes de política externa. O setor saúde é uma ferramenta valiosa e estratégica utilizada pela cooperação técnica brasileira para lograr seus objetivos de desenvolvimento. Este artigo descreve as principais diretrizes de política externa brasileira, conceitua e caracteriza a Cooperação Sul-Sul, ilustrada mediante análise de duas iniciativas de cooperação técnica em saúde do Brasil: na América do Sul e na África. O estudo conclui que, independentemente dos interesses e das assimetrias de poder que existem na Cooperação Sul-Sul, os objetivos dessa cooperação foram alcançados por meio do trabalho técnico.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Surtos de Doenças , Febre do Nilo Ocidental/epidemiologia , Vírus do Nilo Ocidental/isolamento & purificação , Fatores Etários , Anticorpos Antivirais/sangue , Anticorpos Antivirais/líquido cefalorraquidiano , Líquido Cefalorraquidiano/imunologia , Líquido Cefalorraquidiano/virologia , Ensaio de Imunoadsorção Enzimática , Mortalidade , Reação em Cadeia da Polimerase , Reação em Cadeia da Polimerase Via Transcriptase Reversa , RNA Viral/sangue , RNA Viral/líquido cefalorraquidiano , Análise de Sobrevida , Soro/imunologia , Soro/virologia , Tunísia/epidemiologia , Febre do Nilo Ocidental/patologia , Febre do Nilo Ocidental/virologiaRESUMO
La Autoridad Reguladora de Medicamentos de Cuba, coordina un Proyecto de la Alianza Bolivariana para los pueblos de América-Tratado de Libre Comercio (ALBA-TCP), dirigido al desarrollo de un Centro Regulador para los países del ALBA como nuevo organismo regional de integración farmacéutica, en aras de contar con un Registro Grannacional válido en todos los países partes, como herramienta para facilitar el acceso a medicamentos esenciales de calidad. Esta investigación tuvo como objetivo diseñar y conducir desde el punto de vista técnico un proyecto para crear las bases legales y metodológicas del futuro centro y sus funciones básicas. Se emplearon técnicas de grupo nominal, puntos de referencia, consultas a expertos y se crearon metodologías específicas para planear y confeccionar los documentos necesarios. Se utilizaron lineamientos de organismos reguladores internacionales, cuadros básicos de medicamentos y reglamentación farmacéutica de los países participantes. Se desarrollaron y aplicaron documentos y estrategias para el trabajo del proyecto durante la etapa de preinversión, se definió el primer listado de medicamentos esenciales del ALBA y se aprobaron las fundamentales disposiciones legales y la reglamentación para las funciones de registro, vigilancia, inspecciones, laboratorios y liberación de lotes. El Proyecto Grannacional ALBASALUD Centro Regulador de Medicamentos del ALBA-TCP aplicado ha demostrado su eficiencia y capacidad para alcanzar los objetivos trazados mediante un trabajo científico-técnico con participación colectiva, que ha garantizado las disposiciones y lineamientos requeridos para sus funciones básicas y respaldo legal
The Drug Regulatory Authority of Cuba is coordinating a Project of the Bolivarian Alliance for the Peoples of America- Free Trade Agreement (ALBA-TCP) aimed at developing a Regulatory Center that will operate as a new regional body of pharmaceutical integration for the ALBA countries. It will provide a Grand-national Register that will be valid for all the member states to facilitate the access to quality essential drugs. The objective of this research work was to design and to conduct a project from the technical viewpoint in order to lay down the legal and methodological basis of the future center and its main functions. Some techniques like nominal group, points of reference and expert consultation were used, and the specific methodologies to plan and to prepare the required documents were devised. The guidelines of international regulatory bodies, the basic groups of drugs and the pharmaceutical regulations of the participating countries were reviewed. Several documents and strategies for the project work in the pre-investment stage were developed, the first listing of essential drugs for the ALBA countries was defined and the main legal provisions and the regulation that states the functions of registering, surveillance, supervision, lab work and release of batches of the new entity were approved. The Grand-national Project ALBASALUD Regulatory Center of Drugs for the ALBA-TCP has proved its efficiency and capacities to achieve the set objectives through collective involvement-supported scientific and technical work that has guaranteed the required provisions and guidelines for the basic functions and the legal endorsement of the center