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Doctors Sue Health System for Coercing Bad COVID Prescriptions

Natalia Pasternak, PhD

Disclosures

October 14, 2021

Early on in the COVID-19 pandemic, Minister of Health Luiz Henrique Mandetta called attention in São Paulo, Brazil, to an alarming number of deaths among elderly persons in a private healthcare setting.

Sixteen days later, Mandetta resigned, refusing to endorse President Jair Bolsonaro’s promotion of miracle cures for COVID-19 and denial of the need for physical distancing and mask wearing.

Now, a group of medical doctors recently fired by the private practice in question, Prevent Senior, is suing the company for allegedly coercing them into prescribing hydroxychloroquine along with other unproven drugs for COVID-19. Prevent Senior turned out to be one of the most enthusiastic advocates of unproven medications for COVID and issued what has become known in Brazil as the “COVID kit,” including different combinations of hydroxychloroquine, azithromycin, ivermectin, nitazoxanide, zinc, vitamin D, and flutamide, among others.

The lawsuit accuses Prevent Senior’s directors of pressuring them to recommend specific drugs and of setting goals as incentives to write more prescriptions.

The company has reported it was conducting a clinical trial. The problem is that the work was never published — not even as a preprint — even though it was highly publicized by the company’s marketing department as a “game changer” for the pandemic in Brazil.

The study was criticized by some in the scientific community for lacking scientific rigor.

Prevent Senior responded that it was not a real trial, just data collected from patients for a report.

However, the information was written up like a conventional scientific paper and sent to a select group of health and science journalists, along with an embargoed press release that promised the paper would appear in PLoS One, a renowned scientific journal.

But the so-called experiment described in the paper lacked randomization and proper controls, was unblinded, had no placebo group, and recorded no consent from at least one third of the enrolled patients.

Patients were asked whether they would take the drugs or not. Those who took them entered the treatment group of the study. Those who declined the medication were included in the control group without ever being informed that their data would be used in a trial.

Furthermore, there was no diagnosis. People with flu-like symptoms were enrolled, with no need for RT-PCR confirmation. Prevent Senior caters to senior citizens, so a high number of flu-like symptoms were probably wrongly regarded and treated as COVID.

This alone should have been enough to discredit the study. But despite never publishing the results, Prevent Senior kept prescribing the COVID kits and has done so for over a year now, with a guideline for doctors to withhold information from the patient and family as to what medication was being prescribed.

Recently, Pedro Batista, the company’s chief medical director, shared with Brazil’s Parliamentary Commission of Inquiry that the International Classification of Diseases (ICD) coding had been altered for every patient who came in with COVID after 14 days. In other words, after 14 days, if the patient wasn’t discharged (or deceased), their records would no longer indicate an ICD of COVID. It would be replaced by any other ICD for other diseases, which means that almost nobody died of COVID-19 at Prevent Senior’s hospitals­­ — at least, not officially.

With this paperwork illusion in place, owners and directors of the company bragged about their extremely low COVID-19 death rate.

The Declaration of Helsinki and the Nuremberg Code exist to protect people from being abused and used as human guinea pigs. These accusations are too serious to be cast aside. Replacing ICD codes, harassing doctors, and withholding medical information from patients and family are serious accusations and must be properly investigated.

In Brazil, the plethora of proposed COVID cures initiated an important conversation about the sovereignty of the doctor and whether the medical practitioner should be free to prescribe whatever they deem best for a patient, irrespective of the scientific evidence. But it would be tragic if all this debate ended up just being a smokescreen for the sovereignty of a private health system’s money.

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About Dr Natalia Pasternak
Natalia Pasternak, PhD, has a bachelor's degree in biology from the University of São Paulo and a PhD and postdoctoral fellowship in microbiology (bacterial genetics) at the Institute of Biomedical Sciences. In 2018, she founded the Instituto Questão de Ciência in Brazil, the first Brazilian institute for the promotion of skepticism and critical thinking. She is the publisher of Questão de Ciência magazine; a columnist or contributor for O Globo newspaper, CBN radio, and The Skeptic magazine (United Kingdom); and a fellow of the Committee for Skeptical Inquiry (United States). Currently, she works as a visiting scholar at the Center for Science and Society at Columbia University in New York, NY, and is a visiting professor at the Public Administration School at Fundação Getulio Vargas, São Paulo.

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