Dr. Florentino Cardoso, president of the Brazilian Medical Association, discusses the challenges of navigating Brazil’s healthcare system and reveals his aim to promote the needs of the medical community to ultimately ensure the best patient outcomes.

Can you describe your background and introduce yourself to our executive readership?

I have a medical educational background, with specialization in oncological surgery enriched with an extensive experience in health and care assistance, specifically related to cancer and surgery. Additionally, I dedicated a lot of time to teaching and assistance. After 20 years of experience, I entered the health management area by joining the biggest hospital of the country and university hospitals from Federal University of Ceará. After working as a President of Medical Association of Ceará, I became President of Medical Association of Brazil six years ago. I am currently finishing my second and last mandate after I was re-elected at the position of the president of the association three years ago.

Could you introduce us to the Brazilian Medical Association (AMB) and its main specificities?

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Brazilian Medical Association is an organization whose main mission is to seek for scientific improvement and the professional valuation of the doctor contributing to the health of the Brazilian population. In this regards, AMB is mostly focused on the scientific area. With national presence, we gather all the 56 medical specialties existing in Brazil. Moreover, the societies representing certain specialties, for instance the Brazilian Society of Cardiology, form our scientific board.

Besides the scientific focal point representing the center of our activity, we are dedicated to advancing the work conditions of doctors and protecting the interests of the profession. Nevertheless, our fundamental mission is to advance the scientific level in the country and support physicians in ameliorating their performance. In terms of membership, it is comparable to AMA (American Medical Association), and around 13 percent of all the physicians in Brazil are members of our association.

What are some of the main initiatives the AMB is promoting with regards to the improvement of doctor’s working conditions?

As medical performance is of critical importance in achieving the best patient outcomes, we put our efforts into advancing the medical work based on the most recent scientific evidences. Our medical practice should be very strong in recommending, prescribing and indicating treatments displaying a strong scientific evidence. What I would like to highlight are the four steps that are central in navigating the health system: teaching, assistance, research and health management.

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In terms of assistance, we study and collect the updated information to be able to prescribe the best treatment based on scientific evidences. We share and promote our opinion of offering the efficient medication, regardless of the cost. This topic is indeed sensitive in Brazil, as 76 percent of the population is exclusively dependent on the public health system and only 24 percent can access the supplementary healthcare system through private insurance companies. Therefore, it is very difficult to manage a system that has a limited budget availability and set the criteria to use the best treatments while optimizing the resources that we have at our disposal.

Unfortunately, this is our reality at the moment; as the government is facing lack of resources, we often accept less efficient medication to provide for all patients in need. In the meantime, the government and insurance companies claim to be providing the best treatments, while in reality they often settle for less effective products by exclusively favoring a cost analysis. In this regard, the recent economic crisis has indisputably affected the Brazilian health system. As a physician, I however believe we should tirelessly fight for the rights of our patients to receive the best treatments available on the market.

Additionally, continuous medical education is something we plead to improve the standard of care in all therapeutic areas, accompanied by having the best medical equipment at our disposal.

From a scientific standpoint, the Brazilian medial community has successfully increased the number of scientific papers published, but the number of quotes of our papers still has to reach the most advanced countries.

As for healthcare management, we have to ensure that people shaping new healthcare policies in the country are well educated from technical and scientific standpoints and have at hand our insights on the healthcare systems. This can consequently result in bringing the right policies for Brazil and the revolution we need in our overall healthcare sector.

What is your view on the topic of judicialization of health? Is that something that you are talking about at AMB?

Our Constitution states the right to healthcare for all citizens, with government’s obligation to guarantee access to healthcare services. This means that any Brazilian citizen can enter the justice court and demand to access treatments that he is constitutionally eligible to receive. After receiving the authorization from the judge, the government is then obliged to pay for it. Nonetheless, the judicialization of health is cruel in many aspects; it is a process against the government and the public health system. Furthermore, judicialization nurtures segregation: citizens that hold a higher purchasing power are the main group involved in this phenomenon, while lower class population are less involved in the judicialization of health.

What would be your final message to our international readers?

Firstly, what I would like to highlight is the necessity of augmenting the transparency of clinical researches performed in Brazil. For instance, if a laboratory is currently doing 20 clinical studies and only three of them turn out to be efficient, a higher level of transparency would lead to more efficient process as it would not imply the repetition of the previously made mistakes. Nowadays, the information we possess is so far very limited as we only know the results of the final research carried out and do not have access to information detailing all phases of the process. As a result, we cannot fully prevent the phenomenon of inefficient drugs reaching the market. For example, we had a situation when a given inflammatory drug hit the market- it was a very successful launch- but the clinical research previously performed showed that this drug could cause serious side effects on human’s heart. This drug caused several deaths which could have been prevented by holding a more transparent and comprehensive information about its side effects.

Additionally, we see that prices of drugs of the same quality in the same therapeutic areas sometimes highly differ. This is a very interesting phenomenon present in the Brazilian market which is accompanied by the oversupply of certain medications – for example, analgesics, and it would be interesting to truly evaluate if we really need to offer as many different options on the Brazilian market.

In the grand scheme of things, we need to have better results to help the patients: at the end of the day, the patient should be offered the best option available at the market.

You have been President of AMB for six years. What would you highlight as your proudest achievement?

First of all, we have managed to enhance the credibility, reputation, strength and representativeness of the organization. Our fundamental mission is to work towards building a better health, medicine and the conditions for work of doctors. We want to see Brazil growing and gradually improving. Nonetheless, doctors do not create the health ecosystem, nor they can build a better system by themselves. However, we cannot create a better health system without the physicians; the latter undoubtedly stand as one of the pillars of the healthcare ecosystem and therefore should be heard, valued and offered good working conditions. This is what AMB is aiming at; spreading the voice of the medical community to ultimately benefit the health system as a whole and the overall Brazilian population.