This review does not intend to convey detailed experimental or bibliographic data. Instead, it expresses the informal authors’ personal views on topics that range from basic research on antigens and experimental models for Trypanosoma cruzi infection to vaccine prospects and vaccine production. The review also includes general aspects of Chagas’ disease control and international and national policies on the subject. The authors contributed equally to the paper. data Instead production Chagas subject paper

The perspectives for a Chagas Disease vaccine 30 years ago and today are compared. Antigens and adjuvants have improved, but logistic problems remain the same. Sterilizing vaccines have not been produced and animal models for chronic Chagas have not been developed. Vector control has been successful and Chagas incidence has come to a halt. We do not have a population candidate to vaccination now in Brazil. And if we had, we would not know how to evaluate the success of vaccination in a short time period. A vaccine may not seem important at the moment. However, scientific reasons and incertitudes about the future recommend that a search for a vaccine be continued.

Discutem-se os componentes biogeográfico e econômico das doenças tropicais, ou, em sentido mais amplo, das doenças definidas como negligenciadas pela OMS. Doenças tropicais surgem graças a um conjunto de fatores biológicos, ecológicos e evolutivos que condicionam a sua ocorrência exclusivamente às proximidades do Equador, entre os trópicos de Câncer e Capricórnio. Nesse sentido, reconhece-se que há, de fato, uma "fatalidade tropical". Porém, a perpetuação das doenças tropicais em países aí situados depende fundamentalmente da precária situação econômica vigente e é conseqüência direta do subdesenvolvimento.

We discuss the biogeographic and economical components of tropical diseases or of neglected diseases in general as defined by the WHO. Tropical diseases result from a conjunction of biological, ecological and evolutionary factors, which are determinant of their selective occurrence in the equatorial region between the Cancer and Capricorn tropics. We submit that indeed there is tropical fatality in that geographical distribution. However, the continued prevalence of Tropical Diseases in tropical countries basically results from their precarious economy and is an immediate consequence of the underdevelopment.

Ao fim do século 19, em seguida aos avanços na assepsia cirúrgica e no esclarecimento do papel de microorganismos como causadores de moléstias infecciosas, foram criados em escala mundial "institutos de pesquisa com os objetivos de conduzir pesquisa sobre as causas, prevenção e tratamento de homens e animais e de desenvolver produtos preventivos e curativos como vacinas e antitoxinas". Para atingir esses objetivos os institutos recrutaram os melhores cientistas disponíveis em todos os lugares. Este foi um período fulgurante para a pesquisa sublinhado por inúmeras descobertas sobre as doenças infecciosas. Passada essa fase, os institutos entraram em depressão e até mesmo insolvência. Muitos se recuperaram, alguns não. Muitos ainda sofrem de uma "crise de identidade". Neste ensaio analisamos o destino dos institutos de pesquisa em saúde no Brasil, as causas de seu sucesso e eventuais fracassos e as medidas possíveis de ajudá-los a contornar suas presentes dificuldades.

By the end of the 19th century, after the advances in surgical asepsis and the understanding of the role of microorganisms in the etiology of many infectious diseases, research institutes in the public health area were created worldwide with the objectives of undertaking "scientific research into the causes, prevention and treatment of disease in man and animals and to prepare and supply protective and curative materials such as vaccines and antitoxins". To pursue these objectives the institutes hired the best scientists from everywhere. This was an exhilarating period for research in which discoveries proliferated. After that, institutes got into depression and even insolvency. Most recovered, many not. Many are still suffering from an "identity crisis". In this paper we analyze the fate of the health research institutes in Brazil, the causes of their success and eventual failures and the possible ways to get out of their current difficulties.

Ao fim do século 19, em seguida aos avanços na assepsia cirúrgica e no esclarecimento do papel de microorganismos como causadores de moléstias infecciosas, foram criados em escala mundial "institutos de pesquisa com os objetivos de conduzir pesquisa sobre as causas, prevenção e tratamento de homens e animais e de desenvolver produtos preventivos e curativos como vacinas e antitoxinas". Para atingir esses objetivos os institutos recrutaram os melhores cientistas disponíveis em todos os lugares. Este foi um período fulgurante para a pesquisa sublinhado por inúmeras descobertas sobre as doenças infecciosas. Passada essa fase, os institutos entraram em depressão e até mesmo insolvência. Muitos se recuperaram, alguns não. Muitos ainda sofrem de uma "crise de identidade". Neste ensaio analisamos o destino dos institutos de pesquisa em saúde no Brasil, as causas de seu sucesso e eventuais fracassos e as medidas possíveis de ajudá-los a contornar suas presentes dificuldades.

By the end of the 19th century, after the advances in surgical asepsis and the understanding of the role of microorganisms in the etiology of many infectious diseases, research institutes in the public health area were created worldwide with the objectives of undertaking "scientific research into the causes, prevention and treatment of disease in man and animals and to prepare and supply protective and curative materials such as vaccines and antitoxins". To pursue these objectives the institutes hired the best scientists from everywhere. This was an exhilarating period for research in which discoveries proliferated. After that, institutes got into depression and even insolvency. Most recovered, many not. Many are still suffering from an "identity crisis". In this paper we analyze the fate of the health research institutes in Brazil, the causes of their success and eventual failures and the possible ways to get out of their current difficulties.

Este artigo relata a maneira pela qual a indústria farmacêutica organiza a experimentação de novas drogas em seres humanos, tal como vem ocorrendo a partir do início da última década do século 20 nos Estados Unidos. Ao fazê-lo, situa aspectos econômicos da produção de fármacos, e sua extraordinária expansão que é uma característica da contemporaneidade. Descreve também práticas tradicionais da clínica médica relacionadas aos ensaios clínicos, em especial as regras éticas aceitas internacionalmente para a investigação médica quando envolve pessoas, estabelecidas depois do horror suscitado pela divulgação dos “experimentos” de médicos nos campos de concentração nazistas. O artigo retrata parte do debate que o surgimento e a consolidação da “indústria dos ensaios clínicos” – clinical trials industry – suscita entre profissionais ligados à prática da medicina, revelado nas revistas The Lancet e New England Journal of Medicine e em relatórios de órgãos de supervisão do governo norte-americano. Conflito de interesses, má conduta científica, o desrespeito ao princípio ético primum non nocere e à regra do consentimento informado dos voluntários que participam de ensaios ocupam o centro das preocupações levantadas por esses profissionais.

This article describes the manner in which the pharmaceutical industry organizes its experimentation of new drugs in human beings, as has been occurring since the early 1990s in the United States. This practice is related to economic aspects of the production of medications and their extraordinary expansion, a characteristic of modern life. Traditional practices of clinical medicine related to clinical testing are also described, especially the internationally accepted ethical rules on medical investigation when human beings are involved. These rules were set down after the international reaction of horror which came in the wake of the disclosure of “experiments” carried out by physicians in the Nazi concentration camps. The article presents part of the debate that the appearance and consolidation of the clinical trial industry has encouraged among professionals working in the medical area, as described in two magazines, The Lancet and the New England Journal of Medicine, as well as in reports published by supervisory organs of the United States Government. Conflict of interests, scientific mal practice, disrespect for the ethical principle of primum non nocere, and the rule of informed consent by volunteers who take part in tests are at the center of the concerns brought up by these professionals.

Este articulo relata la manera por la cual la indústria famacéutica organiza la experimentación de nuevas drogas en seres humanos, asi como ocurre desde el inicio de la última decada del siglo 20 en los Estados Unidos. Así, situa aspectos económicos de la produción de farmacos, y su extraordinaria expansión que es una caracteristica de la contemporaneidad. Describe también practicas tradicionales de la clinica medica relacionadas a los ensayos clínicos, en especial las reglas eticas aceptas internacionalmente para la investigación medica cuando envolve personas, establecidas después del horror suscitado por la divulgación de los “experimentos” de medicos en los campos de concentración nazistas. El articulo retracta parte del debate que el aparecimiento y la consolidación de la “industria de los ensayos clinicos” – clinical trials industry – suscita entre profisionales vinculados a la practica de la medicina, revelado en las revistas The Lancet y New England Journal of Medicine y en informes de organes de supervision del gobierno norteamericano. Conflicto de interés, mala conducta cientifica, el desacato a lo principio etico primum non nocere y a la regla del consentimiento informado de los voluntarios que participan de ensayos ocupan el centro de las preocupaciones levantadas por estes profesionales.

Ce article relate le façon pour lequelle l’industrie pharmaceutique organize l’experimentation de nouvelles drogues dans etres humaines, comme a lieu depuis le début de la dernière décade du siècle 20 dans les Etats Unis. Ainsi, situe aspects economiques de la prodution de pharmacos, et sa extraordinaire expansion qui est une caracteristique de la contenporaneitée. Décrit aussi pratiques tradicionelles de la clinique medique lies a les essais cliniques, especialment les regles ethiques acceptes internationalment pour l’enquête médique quand enveloppe personnes, fondés après l’horreur de la divulgation d’experiments de médicins dans les camps de concentration nazis. L’article présent part du débat que le émergence et la consolidation de l’industrie des essais cliniques – clinical trials industry – allume entre professionnels liées a la pratique de la médicine, révélée dans las revues The Lancet e New England Journal of Medicine et dans des rapports des organes de supervision du governement americain. Conflit d’interesses, mauvaise procédé scientifique, le non-respect au principe ethique primum non nocere et a la regle du agrément des volontaires qui participent des essais occupent le centre des soucis levées par ces professionnels.

A malaria control pilot project was developed in the Urupá agro-industrial farm that is situated in the State of Rondônia (Western Amazon Region, Brazil). Around 180 inhabitants had been surveyed for the past five years. The control measures were based on (1) training a community agent to perform on the spot microscopical diagnosis of malaria and to treat the uncomplicated cases of malaria; (2) limiting the use of insecticides to a short period before the high transmission season. This resulted in a significant reduction in the time between the onset of clinical symptoms and specific chemotherapy which fell from 3.5 to 1.3 days. In relation to the previous three reference years the total number of malaria cases was reduced to 50% in the first year and to 25% in the second year. The introduction of these measures coincided with pronounced reduction in the frequency of Plasmodium falciparum infections but this was less marked for P. vivax infections. In the second year of the pilot experiment there was no P. falciparum transmission on the farm. During the last decade there was a general decrease in the endemicity of malaria in the State of Rondônia. The linear regression coefficient values indicate that the decline was more pronounced in Urupá than in the general municipality and that the falciparum malaria API in Urupá farm is significantly lower than in the general municipality of Candeias were the farm is situated.