The corporate bias and the molding of prescription practices: the case of hypertension

Drug management of hypertension has been a noticeable example of the influence of the pharmaceutical industry on prescription practices. The worldwide leading brands of blood pressure-lowering agents are angiotensin receptor-blocking agents, although they are considered to be simply substitutes of angiotensin-converting enzyme (ACE) inhibitors. Commercial strategies have been based on the results of clinical trials sponsored by drug companies. Most of them presented distortions in their planning, presentation or interpretation that favored the drugs from the sponsor, i.e., corporate bias. Atenolol, an ineffective blood pressure agent in elderly individuals, was the comparator drug in several trials. In a re-analysis of the INSIGHT trial, deaths appeared to have been counted twice. The LIFE trial appears in the title of more than 120 reproductions of the main and flawed trial, as a massive strategy of scientific marketing. Most guidelines have incorporated the corporate bias from the original studies, and the evidence from better designed studies, such as the ALLHAT trial, have been largely ignored. In trials published recently corporate influences have touched on ethical limits. In the ADVANCE trial, elderly patients with type 2 diabetes and cardiovascular disease or risk factors, allocated to placebo, were not allowed to use diuretic and full doses of an ACE inhibitor, despite the sound evidence of benefit demonstrated in previous trials. As a consequence, they had a 14% higher mortality rate than the participants allocated to the active treatment arm. This reality should be modified immediately, and a greater independence of the academy from the pharmaceutical industry is necessary.

Practices and ethical concerns regarding preimplantation diagnosis. Who regulates preimplantation genetic diagnosis in Brazil?

Preimplantation genetic diagnosis (PGD) was originally developed to diagnose embryo-related genetic abnormalities for couples who present a high risk of a specific inherited disorder. Because this technology involves embryo selection, the medical, bioethical, and legal implications of the technique have been debated, particularly when it is used to select features that are not related to serious diseases. Although several initiatives have attempted to achieve regulatory harmonization, the diversity of healthcare services available and the presence of cultural differences have hampered attempts to achieve this goal. Thus, in different countries, the provision of PGD and regulatory frameworks reflect the perceptions of scientific groups, legislators, and society regarding this technology. In Brazil, several texts have been analyzed by the National Congress to regulate the use of assisted reproduction technologies. Legislative debates, however, are not conclusive, and limited information has been published on how PGD is specifically regulated. The country requires the development of new regulatory standards to ensure adequate access to this technology and to guarantee its safe practice. This study examined official documents published on PGD regulation in Brazil and demonstrated how little direct oversight of PGD currently exists. It provides relevant information to encourage reflection on a particular regulation model in a Brazilian context, and should serve as part of the basis to enable further reform of the clinical practice of PGD in the country.

Hygienic-sanitary working practices and implementation of a Hazard Analysis and Critical Control Point (HACCP) plan in lobster processing industries

This study aimed to verify the hygienic-sanitary working practices and to create and implement a Hazard Analysis Critical Control Point (HACCP) in two lobster processing industries in Pernambuco State, Brazil. The industries studied process frozen whole lobsters, frozen whole cooked lobsters, and frozen lobster tails for exportation. The application of the hygienic-sanitary checklist in the industries analyzed achieved conformity rates over 96% to the aspects evaluated. The use of the Hazard Analysis Critical Control Point (HACCP) plan resulted in the detection of two critical control points (CCPs) including the receiving and classification steps in the processing of frozen lobster and frozen lobster tails, and an additional critical control point (CCP) was detected during the cooking step of processing of the whole frozen cooked lobster. The proper implementation of the Hazard Analysis Critical Control Point (HACCP) plan in the lobster processing industries studied proved to be the safest and most cost-effective method to monitor each critical control point (CCP) hazards.

Profile of establishments in the supermarket sector with respect to good practices in the city of Santa Maria (RS), Brazil

The objective of this study was to verify the compliance of the supermarket sector with respect to the Good Practice Program standards of the city of Santa Maria (RS), Brazil. Sixty nine establishments were verified using a checklist of good practices for the supermarket sector in Santa Maria, RS (Brazil), from April to July 2011. The data were collected by a food safety and quality professional using this checklist. The results showed that the overall adequacy of the establishments surveyed was 29.07%. The highest percentage of compliance was found for storage at ambient temperature (64.13%). The lowest compliance percentage was also found in different sections and areas in the supermarkets such as bakery and confectionery (14.93%), water supply (18.30%), food handling (21.01%), sausage and cold meat (or deli meat) (36.38%), and documentation-related items (4.97%). None of the supermarkets evaluated had the necessary documentation for the implementation of good practices. The results of this study show the importance of effectively implementing a good practice program and quality systems by raising awareness among technicians and professionals of the importance of quality programs used in food companies and the need for more thorough inspection delivered by competent authorities to ensure food safety for consumers.

Effect of preparation practices and the cowpea cultivar Vigna unguiculata L.Walp on the quality and content of myo-inositol phosphate in akara (fried bean paste)

Akara is one of Brazil's national treasures prepared from cowpea (Vigna unguiculata L.Walp), grated onions and salt and deep-fried in crude palm oil. The results of this study on akara preparation methods showed that, in general, cowpeas were soaked for up 3 hours at room temperature, and the seed coats were then removed. The akara makers preferred the olho de pombo cultivar, because of its cream hue, or the macassar cultivar because it produces a crispier paste. The seeds purchased from street markets had lower ranges of InsP6, InsP5, and InsP4 (1.03-7.62 ∝mol.g- 1; 0.14-1.31 ∝mol.g- 1; and 0.0-0.10 ∝mol.g- 1, respectively) than both the paste and akara (6.72-19.24 ∝mol.g- 1; 1.29-4.57 ∝mol.g- 1; 0.0-0.76 ∝mol.g- 1; 3.31-13.71 ∝mol.g- 1; 0.0-4.48 ∝mol.g- 1; and 0.0-1.32 ∝mol.g- 1). These results suggest that other beans or cowpea varieties have been used in the preparation of akara and that the phytate levels do not affect its nutritional quality.