Public Note #38 – The Federal Council of Medicine and public health in Brazil

The Dom Paulo Evaristo Arns Commission for the Defense of Human Rights goes public to express its consternation and total indignation regarding the conduct of the Federal Council of Medicine (Conselho Federal de Medicina – CFM, in Portuguese) and its president, Dr. Mauro Ribeiro, observed throughout the pandemic.

On the pretext of defending medical autonomy, an ethical requirement of the profession that is not consistent with the violation of the dictates of conscience of health professionals, the aforementioned Council, a federal agency created precisely to supervise the conduct and practices within the sector, approved CFM’s Opinion No. 4/2020 and maintains it in force today, considering the use of chloroquine and hydroxychloroquine in different situations.

According to CFM’s Opinion No. 4/2020, the use of these drugs, which are currently known to be ineffective, is considered in relation to (i) patients with mild symptoms, (ii) patients with significant symptoms but without the need for intensive care, and even (iii) critically ill patients receiving intensive care, including mechanical ventilation and with identified lung injury, since it is difficult to imagine that these drugs could have a clinically important effect (these are the conclusions of the opinion itself!).

Both political motivation and the lack of scientific rigor were clearly demonstrated in a virtual meeting on May 7, 2020, before the Regional Council of Medicine of Goiás, when the president of the Federal Council of Medicine acknowledged that the aforementioned authorized drugs do not have any scientific evidence to prove their effectiveness and that the authorization was "completely against the Council’s norms." He stated, in the same online event – as if to explain the absurdity – that the medical community was deeply affected by the popularization of medicine at the time of President Dilma Rousseff’s term, and that the current President of the Republic meets all the demands of the Council!

It must be said that the ill-fated opinion does not make any reference to the health recommendations issued by the World Health Organization (WHO) and other organizations in the field, such as social distancing, quarantining, using face masks, mass testing, and vaccination, among other preventive measures. However, the opinion recognizes the experimental nature of the recommendation and recalls that the Infectious Diseases Society of America only consents to treatments using these drugs in hospitalized patients under clinical research protocols.

The question that remains unanswered is: if that is so, why authorize ineffective drugs, if not to strengthen the arguments from the negationist supporters of the President of the Republic, which have already been explicitly recognized as unfounded? It should also be said that these are not harmless drugs, on the contrary, these are drugs that can cause side effects on an already weakened health condition.

It should be noted that Article 99 of the Code of Medical Ethics prohibits physicians from participating in any experience involving human beings for war, political, ethnic, or eugenic purposes, or any other purposes that violate human dignity. Despite all this, like Pontius Pilate, the president of the Federal Council of Medicine asserts and repeats all the time: we are not recommending anything, we are only allowing the use of these drugs.

It is not medical autonomy that they wish but the encouragement of medical malpractice, for reasons of the internal policy of the Federal Council of Medicine and its president. They intend to make it clear that professionals who follow the wrong recommendation and go “against the CFM’s norms” will not be penalized. In this sense, the Council also expresses that a doctor who behaves within the conditions “recommended” by Opinion No. 4 does not commit an ethical violation. This is actually a disclaimer clause that is against the law and the Code of Medical Ethics!

A few days ago, the Federal Public Defender's Office distributed a public civil suit to the Federal Court in São Paulo, asking for the Federal Council of Medicine to be held accountable for all these conducts and requesting the immediate suspension of CFM’s Opinion No. 4/2020 and its validity.

In so doing, justice will be served to hundreds of thousands of Brazilians who died from COVID-19, among them hundreds of physicians and health professionals on the front lines of the fight against the pandemic, as well as to all the professionals who are still fighting to overcome the health crisis and the misinformation epidemic that subtly seeks to undermine mass vaccination by inducing herd immunity.

Brazilian physicians who honor, day after day, the Hippocratic Oath by risking their lives and the health of their families do not deserve the Federal Council of Medicine, which is expressing itself with such irresponsibility. We now give the floor to the Federal Court in São Paulo.

Photo: Isac Nóbrega/UOL