{"id":321554,"date":"2020-01-21T14:31:45","date_gmt":"2020-01-21T17:31:45","guid":{"rendered":"https:\/\/revistapesquisa.fapesp.br\/?p=321554"},"modified":"2020-01-21T14:31:45","modified_gmt":"2020-01-21T17:31:45","slug":"antonio-drauzio-varella-the-doctors-message-2","status":"publish","type":"post","link":"https:\/\/revistapesquisa.fapesp.br\/en\/antonio-drauzio-varella-the-doctors-message-2\/","title":{"rendered":"Ant\u00f4nio Drauzio Varella: The doctor\u2019s message"},"content":{"rendered":"

\"\"L\u00e9o Ramos Chaves <\/span><\/a>In 1983, during an internship at Sloan Kettering Memorial Hospital in New York, Drauzio Varella realized that AIDS would hit hard in Brazil. Although he already had more than ten years of experience in oncology and was accustomed to seeing seriously ill patients, the HIV-positive patients Varella saw in the United States made an impression on him. These patients were all young people, many of them artists and intellectuals. \u201cI was very touched by the experience,\u201d Varella recalls. \u201cI had the unmistakable feeling that a tragedy was about to happen.\u201d Varella began to study the subject. When he returned to Brazil, he was the only oncologist with experience in disseminated Kaposi\u2019s sarcoma, a rare type of cancer common in AIDS patients. Because infectious disease specialists had little experience with the new illness, Varella began to treat AIDS cases himself at the Hospital do C\u00e2ncer, in S\u00e3o Paulo. The patients came from around the country.<\/p>\n

Two years later, during a medical conference in Stockholm, Sweden, upon leaving a major discussion about the AIDS epidemic, the oncologist found himself thinking about another aspect of the disease, prejudice, and how to deal with it. \u201cAt that time, the ignorance was brutal. This is happening in Brazil and nobody\u2019s going to say a thing?\u201d Thus, Varella began a journey that would make him the best-known doctor in the country, first over the radio, followed by television, print journalism, books, and the internet.<\/p>\n

While Varella describes it as an educational project effected through the vehicles of mass communication, his communication work covers a multitude of themes and subjects, which sometimes extend beyond healthcare. Varella does not shy from controversy. At age 76, conscious that life is finite, he gives himself permission to say what he thinks. In his writing and public appearances, Varella speaks out on abortion rights, decriminalizing drugs, and the ineffectiveness of mass incarceration as a policy for combating violence.<\/p>\n

Age<\/strong> 76
\nSpecialty<\/strong>
\nOncology
\nInstitution<\/strong>
\nMember of the clinical staff of the S\u00edrio-Liban\u00eas Hospital, S\u00e3o Paulo
\nEducation<\/strong>
\nMedical degree from the University of S\u00e3o Paulo (1967)
\nProduction<\/strong>
\n16 scientific articles and 16 books, including Esta\u00e7\u00e3o Carandiru<\/div>\n

Married to actress Regina Braga since 1981, the father of two daughters from his first marriage, and a grandfather of two, the S\u00e3o Paulo oncologist divides his time among patients, communication, and writing, which is a source of happiness for him. In this interview, Varella tells us about his research activities, complains about the lack of importance Brazilians attribute to the Unified Health System (SUS), and talks about his communication work and his strong relationship with the prison world, where he learned to appreciate cacha\u00e7a [Brazilian rum].<\/p>\n

Among all your activities, your work related to scientific research is certainly the least well-known. How did your work with plants from the Amazon come about?<\/strong>
\nOn the weekend of the Carandiru massacre in October 1992, we organized a course on biotechnology in AIDS and cancer at a hotel in S\u00e3o Paulo. Biotechnology was just beginning; it was the hottest area in biology. Brazil had very little biotechnology development, and we wanted to bring the top people here to draw attention to the field. I talked to a friend at the Cleveland Clinic, Ron Bukowski, about organizing a course. He told me: \u201cBrazil is off the beaten track, internationally. If you want to bring people there, you need to offer a tour, a weekend at the beach…\u201d Since UNIP [Paulista University] had a boat on the Amazon, the Escola da Natureza<\/em> (Nature School), a typical Amazon riverboat, I thought, \u201cWhat if I took these people there?\u201d And Bukowski replied, \u201cWith that you could get whoever you want, even Robert Gallo.\u201d Gallo, at that time, was deservedly at the top of AIDS research. We conducted the course with more than 20 guests\u2014including Gallo, and it was broadcast to 20 auditoriums in a variety of cities by EMBRATEL and sponsored by UNIP, with which I had an informal connection.<\/p>\n

And from that trip a project was born?<\/strong>
\nFrom the boat you cannot see a single plant that is like any other on the shore. Observing this biodiversity, Gallo asked, \u201cFrom the biological point of view, do you have any screening studies being done here?\u201d He wanted to know if plant extracts were systematically analyzed and tested for treating diseases. This question remained in the back of my mind. As we had the necessary infrastructure, we could start up a project. I went to talk to [Jo\u00e3o Carlos] Di Genio, owner of the Objetivo private schools and UNIP. I had only occasional contact with him, but Di Genio has one characteristic, he perceives when things are interesting, and you do not need to do much explaining. \u201cHow do you want to do it?\u201d he asked. First we need to learn, I explained. I contacted Gordon Cragg, head of the natural products sector at the National Cancer Institute [NCI], which has the world\u2019s largest cancer screening project. I went there, and Cragg said that they had lost interest in Brazil because of the biopiracy charges. However, he did offer technical support; we could send people to NCI for training. We would have to learn to do the extractions, and then it would take rigorous taxonomy work because if there is any error in plant classification, everything is lost. The most respected researcher in the field of Amazonian plant taxonomy, Douglas Daly, worked at the New York Botanical Garden. I left the NCI and went to New York to meet him. I found an American speaking Portuguese with the accent of a backwoods Amazonian: \u201cRapaaaaiz…\u201d [Duuude..] Daly was passionate about Brazil and had an ongoing project with the Federal University of Acre. We set up an herbarium and sent a young woman who had recently graduated from the University of S\u00e3o Paulo [USP], Ivana Sufredini, who learned all the technical aspects of extraction. Sufredini came back here and set up the lab and then returned to NCI to test the extracts on medical tumor lines that NCI gave us.<\/p>\n

What was that experience like?<\/strong>
\nIt was epic. To collect the plants, we needed a permit from the Brazilian Institute of Environment and Renewable Natural Resources (IBAMA). At that time, it was a tragedy. We would deliver the project paperwork, which fell into a black hole. It went on like that for years. We collected everything we could. UNIP today has the largest extract collection from the Amazon forest, 2,200 extracts. We found five extracts that demonstrate more intense antineoplastic activity, which are being studied. It is a very interesting research project, which also depends on FAPESP funding. We have produced and published a lot.<\/p>\n

In the research conducted with Amazonian plants, we found five extracts with intense antineoplastic activity, which are under study<\/p><\/blockquote>\n

How did you choose oncology?<\/strong>
\nI graduated from USP in 1967. I started a residency in public health, but I got discouraged; it was very theoretical. I wanted to get my hands dirty, to work in a health clinic. I studied parasitology with Luis Rey, one of the greatest Brazilian authorities in malaria. Rey was kicked out of the university in 1964 along with Erney Plessmann de Camargo and Luiz Hildebrando Pereira da Silva. I had much admiration for the three of them. I created a movement, and we chose Luiz Hildebrando as our commencement speaker. As the college\u2019s board had declined to attend the graduation, it was unofficial. Rey returned to Brazil in 1969 and was hired by the Faculty of Public Health, but he needed to get a public health degree, so he was my colleague. I thought, \u201cA world-renowned guy is sitting here taking this course. I don\u2019t want this to be my future.\u201d The Secretary of Health had created the position of public health official, but the salary was the same as my rent\u2014and I was already married. It was the era of the dictatorship; I would teach in a college prep school at night and go out and meet with the staff of Jornal da Tarde<\/em> [an important daily newspaper at the time] and stay up talking into the wee hours. One day, I met Vicente Amato Neto, an infectologist my class thought very highly of. I told him I was lost, and Amato suggested that I study MI [infectious diseases] because I had a connection with public health. He invited me to do an internship at the Public Employee\u2019s Hospital. At Amato\u2019s suggestion, I began to take more interest in the immunological aspects of infectious diseases. Modern immunology was making great strides in the early 1970s. Alois Bianchi, the greatest pediatrician we have ever had, invited me to give an immunology class at the Hospital do C\u00e2ncer. I went, and I ended up staying.<\/p>\n

What did you start working on there?<\/strong>
\nAt that time, I began an experiment with the use of BCG [the tuberculosis vaccine] for the treatment of malignant melanoma. When I gave that class, the medical staff came to ask for help. It was a new thing; nobody knew anything about cancer<\/em> immunology. As I had already been reading up on it, I said that when there was a melanoma case, I would like to see it. I started going one morning a week and received some cases of melanoma. One of these cases was a man who had melanoma on his arm and was beginning to have nodules in various places. I proposed to try to treat him with oral BCG and see what happened. The lesions began to redden. I photographed and removed one of them. After a while, the lesions began to turn very red and regress. A few months later, the lesions completely disappeared and left a white halo in their place, which is characteristic of melanoma rejection. I was fascinated. After we had seen other cases, we published a paper in the journal Cancer in 1981, which was the first Brazilian research in the magazine. I presented these results twice at the Memorial Sloan Kettering Cancer Center in New York, which was the mecca of the world of oncology. It was one of the first scientific demonstrations of well-studied case, including images\u2014that demonstrated that it was possible to stimulate the immune system and provoke tumor rejection at a distance. That is how I became an oncologist.<\/p>\n

How did the shift from oncology to AIDS come about?<\/strong>
\nAt the end of 1981, Joe Burchenal, the head of oncology at Memorial, was in Brazil. At lunch one day, he commented that there were cases of Pneumocystis carinii<\/em> pneumonia that had appeared in New York in apparently nonimmunocompromised young men. At the same time, in San Francisco, cases of Kaposi\u2019s sarcoma were appearing in young men who were, coincidentally, homosexuals, as those patients in New York were. I read the case descriptions in the Morbidity and Mortality Report from the CDC [Centers for Disease Control and Prevention, in the United States] and became very interested. Here, we had a disease caused by an infectious agent, probably a virus, which caused immune deficiency, opportunistic infectious diseases, and cancer\u2014disseminated Kaposi\u2019s sarcoma\u2014in young homosexuals. I went to Memorial in 1983 and stayed for three months. There was a researcher there, Susan Krown, who was working with interferon in Kaposi. I was shocked because the patients were all young, mostly intellectuals, writers, journalists, and painters. I started studying like crazy. When I returned to Brazil, I was the only oncologist who had experience with disseminated Kaposi. I began to treat the first cases. Infectious disease specialists had little experience with it. I treated people from all over Brazil at the Hospital do C\u00e2ncer. I was consumed by the AIDS epidemic.<\/p>\n

Was that when you started your health communication work?<\/strong>
\nAt that time, the ignorance was brutal. People called it a gay plague, which implied that women, heterosexuals, and people using intravenous drugs were not at risk. In New York, I realized that a tragedy was about to happen in Brazil.<\/p>\n

\"\"

Personal archive<\/span><\/a> UNIP\u2019s boat Escola da Natureza, which was used to collect plants in the AmazonPersonal archive<\/span><\/p><\/div>\n

What did you do?<\/strong>
\nI was good friends with Fernando Vieira de Mello [1929\u20132001], director of Jovem Pan radio, who was an excellent journalist. He said, \u201cYou have to give an interview on the radio, it is no use just talking to me.\u201d I resisted quite a bit. At that time, a doctor who spoke on mass media was viewed negatively. I gave the interview; it was long, and he broke it up into segments that were inserted into the program schedule. I complained, \u201cYou can\u2019t do things like that, I\u2019m going to have problems with my colleagues; I\u2019m supposedly a serious doctor.\u201d Mello replied, \u201cDo you want to be on good terms with your colleagues or get this information out to the people?\u201d That question swayed me. I returned to the station after a few days and asked what I needed to do. Mello explained that the messages transmitted on the radio must be short and should not exceed two minutes. You have to introduce yourself and direct your message to the group you are trying to reach; it is no use talking to everyone. \u201cI am Dr. Drauzio Varella talking to those of you who are young and homosexual; to you who take intravenous drugs.\u201d For each group, different language is necessary.<\/p>\n

And your colleagues?<\/strong>
\nNo one ever said anything to me. I was sure that this kind of communication was important. I would see people talking about it on the street, talking to me, ordinary people. I thought, \u201cThat\u2019s what I want to do.\u201d If anyone thinks I just like the attention, it is their problem, not mine. To this day, I hear people saying that I was born for this job\u2014it is not true. It is training. I gave classes at prep school for 20 years, beginning in my first year of college. My father had four children and two jobs; I couldn\u2019t go to college without working. Objetivo [a network of private schools], which I helped to found and which I named, eventually had 25 classes of 400 students. We gave the same class 25 times a week. Teenagers do not quiet down, even at the movies; you have to keep their attention. It was a long process. It is not talent; it is training.<\/p>\n

From working with AIDS, how did you wind up at Carandiru [an infamous prison in S\u00e3o Paulo, now demolished] ?<\/strong>
\nBecause of the radio broadcasts, I was asked to make a video about AIDS. We did it with a professional producer who shot it on Indian\u00f3polis Avenue, in S\u00e3o Paulo, a transvestite hangout in the red-light district, and in the prison. In Brazil, we have conjugal visitation, and no precaution was taken to help those women, to inform them. We filmed at the state penitentiary, and I spent the day there. In the infirmary, there were people dying from cachexia [a wasting condition]; it was a tragedy. The experience made a deep impression on me. Ever since I was a kid, I have liked prison movies. There are people who are attracted to this environment, I have met other people like that. I spent the next few days thinking about the prison; my wife said she had never seen me so quiet. After a few weeks, I went to the head of the medical department of the S\u00e3o Paulo penitentiary system, Manoel Schechtman, and offered to do volunteer work. Schechtman said that the biggest problem was at the S\u00e3o Paulo Detention Center, Carandiru, which had more than 7,000 people, and nobody wanted to work there. I went to talk with the director, Ismael Pedrosa [1935\u20132005]. My thinking was as follows: \u201cFirst, we need to demonstrate what\u2019s happening here, how many people in here are infected.\u201d Based on that number, we can define what should be done.<\/p>\n

How did you begin?<\/strong>
\nI proposed to conduct a survey with the people who received conjugal visits. It was a significant sample; there were 1,500 people enrolled in the program. I got a donation of test kits, and the collection work could be done by the users in the prison, the \u201cmainliners,\u201d who know how to find a vein better than anyone. I spoke with the director, and he brought me five prisoners. I asked, and they had experience. \u201cWe can get a vein with a crooked needle, with this equipment of yours it\u2019s child\u2019s play,\u201d one of them replied. We collected blood from 1,492 people. We tested it, and 17.3% of them were infected. Of the transgender people imprisoned there for more than six years, 100% were infected. I started using these data to talk to the authorities. At a minimum, we needed to distribute condoms for the conjugal visits and alert the women and send them to health clinics. No one wanted to hear about it.<\/p>\n

\"\"

Personal archive<\/span><\/a> Varella interviews residents of Acre State about malaria for the national weekly television program Fant\u00e1stico<\/em>, in 2018Personal archive<\/span><\/p><\/div>\n

However, you insisted…<\/strong>
\nJail is the right place to spread this kind of information. Where do 7,000 criminals get together? They spend time in jail, they go back on the streets, they spread throughout the entire city, and then they go back to jail. The information transmitted inside can be disseminated throughout the city to a group that is unreachable outside the prisons. I proposed to the director that I give lectures on AIDS. UNIP donated the big screen and the microphone. I did two or three and realized it was not going to work. I wanted to do a systematic job, to reach the whole prison. Then, Valdemar Gon\u00e7alves, a prison guard, appeared and organized it so that each session would be seen by one floor of each cellblock. At 8 a.m., the prison would open these cells first, and then, the prisoners would come down and see the lecture. This occurred before opening the other floors; otherwise, the others would have mingled in. We held a meeting with the prisoners who were the chief custodians of each cellblock. At the time, there was no PCC [First Command of the Capital, a large organized crime gang throughout the state prisons], and the chief custodians were in charge of the prison. The custodians were watching people die; the epidemic was not theoretical for them. We explained that we wanted to pass along information, but there could be no incidents. If someone died, it would end our work. The custodians said, \u201cYou can rest easy, nothing will happen.\u201d Another problem was getting the prisoners out of bed at 7:50. Delinquents do not wake up early for anything. Then, Valdemar had the idea of showing a pornographic film. After the lecture, we would leave the room, \u201cso as not to lose their respect,\u201d and they showed the film. It was a package deal: you come in, the door closes, and you stay until the end. It worked beautifully. I did those lectures for approximately ten years.<\/p>\n

Then, you went from giving those lectures to being an attending physician?<\/strong>
\nWhen I finished a lecture, people would stop me in the corridors. \u201cUh, doctor, look at this…\u201d They would line up; it looked like a cour des miracles. I began attending one day a week. This state of affairs lasted until 2002, when the prison was shut down.<\/p>\n

Is your relationship with the prison still strong?<\/strong>
\nCarandiru was an unforgettable prison. It is not just me: the guards, who I still meet with even today, agree. I took a particular liking to walking around in it alone, going into the cells, and being respected in that environment due to the exercise of my profession. This was not respect for my own personal value. The social interaction was lasting, direct. The prison guards stood by, went up, and entered the cells. There were always factions, and the guards\u2019 function was to keep them from uniting. A guard once told me, \u201cTheir business is to grab power in jail; ours is to throw a monkey wrench in the works.\u201d If the prisoners started getting together, the guards would take one out and transfer another in, and they were able manage things like that. Cellblock 8 had 1,200 repeat offenders, and five or six employees watched over them. The guards have a very impressive knowledge of human nature. After the massacre, in 1992 [when over one hundred inmates were killed by the police], the relationship changed. When something such as that happens, it is pretty clear that it would not happen again. No one was going to send in the Military Police again, a week later. The prisoners began to thrive, to take over. The state was forced to retreat, to let up, and the power vacuum did not remain. Immediately, the factions began to take control. It was the beginning of the PCC.<\/p>\n

The Unified Health System, SUS, was the greatest revolution in Brazilian healthcare history. There is nothing comparable<\/p><\/blockquote>\n

Back to the topic of AIDS, what is the role of the media today?<\/strong>
\nThe media have to specifically target at-risk populations. There cannot be, at this point in time, bias against homosexuals, transgender people, etc. There is repression embedded in the discussion, a failure to speak clearly, and a fear of offending families. Eleven thousand people die every year in Brazil as a result of AIDS, and we are worried about prejudice?<\/p>\n

It is similar to abortion.<\/strong>
\nIt is the same thing. I once attended a meeting with the teacher Mario S\u00e9rgio Cortella and a young rabbi from Rio, Nilton Bonder. When it was the rabbi\u2019s turn, he was asked: \u201cHow do you see the abortion question?\u201d Bonder said, \u201cIn Judaism life begins when the child is born.\u201d Period. Some people think that life begins when the sperm enters the egg. One can also think that human life is characterized by the functioning of the central nervous system. What you cannot do is impose your way of thinking on others. Women lose their lives having unsafe abortions.<\/p>\n

What is the most difficult issue to resolve in Brazilian public healthcare?<\/strong>
\nOrganization. We have the basic healthcare units [UBS] and a public health program that is cited as one of the ten best in the world, which is the Family Health Strategy. There are community health agents who live in the districts, earn a salary, and are responsible for the families under their jurisdiction. There is also a nurse\u2019s aide, a nurse, and a doctor. Today, this program covers just over 60% of the Brazilian population, but it should cover 100%. When a local resident has a problem, this team usually resolves it. It is a bit like my experience in the prisons. There are no laboratories or X-ray machines there. Even so, I resolve approximately 90% of the cases myself.<\/p>\n

That many?<\/strong>
\nYes, if a basic drug kit available. Usually, the problems are simple. How often do we become seriously ill? Once or twice in our lives, for relatively normal people. Most of the time, things get resolved in primary care. We know today that a hospital with less than 100 beds is technically and economically infeasible. However, hospitals with 50 beds comprise the majority of hospitals in Brazil. Building these hospitals is easy. Then, you have to equip them and hire the doctors. The size of the hospital is very expensive for such a low patient-care capacity. This approach is not feasible.<\/p>\n

What is the solution?<\/strong>
\nTransform the small hospitals into outpatient centers. If there are 12 cities relatively close to each other, the biggest one is the one that should have a hospital with 100 beds or more, which all the municipalities and the state should collaborate on. Those who truly need the hospital would go there. In general, we have a health structure that is ready to go in Brazil. What does it need? In addition to organization, it needs more money because the total invested is small compared to what is necessary.<\/p>\n

I love doing these projects on the internet, with texts and videos, because they reach an audience that is inaccessible otherwise<\/p><\/blockquote>\n

How should healthcare be organized?<\/strong>
\nBrazil has no public health policy. In the last ten years, we have had twelve health ministers because the position is used as political currency among the political parties. In state and municipal governments, we find the same problem. How do you organize and establish health policy under these conditions? In the ministry and in the state and municipal secretariats, there are very competent people. When the Minister of Health goes down in Germany, he or she takes seven or eight assistants with him; they rise and fall with him. The minister\u2019s role is to establish policies to direct the public health system. In Brazil, the minister brings a multitude of people into positions of trust and swaps all the local government and hospital directors. Here, we cannot even show society the importance and relevance of SUS.<\/p>\n

What is the relevance?<\/strong>
\nThere is not another country in the world with more than 100 million inhabitants that has dared to offer free public healthcare to all. Not one. We are the only one. People do not know this. In regard to SUS, it is often said that \u201cIt\u2019s shameful; there are gurneys in the hallway, and children being attended to in chairs in the reception area.\u201d This is because SUS is not working at the primary care level. Just look at the lines at emergency rooms. If a doctor examines all these people, 80% to 90% will be released. The people go there because they cannot get care at their UBS. At the emergency ward of the hospital, the patient knows that they will be taken care of, one way or another.<\/p>\n

Most of these people are cared for by SUS.<\/strong>
\nSUS was the greatest revolution in Brazilian healthcare history. There is nothing comparable to it. I was a resident at the Hospital das Cl\u00ednicas of the USP Medical School. At that time, there was the INPS [the National Institute of Social Welfare]. Only workers with formal, registered employment were entitled to INPS benefits. Those who did not have this right were classified as indigent. It was not a theoretical supposition; that status would be written on their medical record. The self-employed and all the field workers were dependent on society\u2019s charity, such as the Santa Casa de Miseric\u00f3rdia [Holy House of Mercy, a centuries-old healthcare charity]. In 1988, the new Constitution included the idea that \u201cHealth is a right of all and a duty of the State.\u201d Although, I do not like this slogan very much.<\/p>\n

\"\"

Caio Guatelli \/ Folhapress<\/span><\/a> In Carandiru, in 2001, with the rap group Comunidade Carcer\u00e1ria [Prison Community]…Caio Guatelli \/ Folhapress<\/span><\/p><\/div>Why not?<\/strong>
\nFirst, the slogan does not include where the money comes from. Second, it infantilizes people. Taking care of one\u2019s health is a duty of the citizen, primarily. This responsibility must be attributed correctly. When citizens fall ill and cannot treat themselves, patients can be treated by the state. In Brazil, everyone has this right. The system is a hybrid since we also have paid supplementary healthcare. This system serves approximately 47 million people. The rest, approximately 160 million people, depend on SUS. The investment of private and public systems is similar. The difference is that one serves 47 million and the other 160 million. Even if I have a private health plan, I can still be taken care of by the public system. In Chile, for example, you opt for one or the other. SUS is the largest income distribution program in the history of Brazil. The bolsa fam\u00edlia (the federal Family Allowance) program is a timid project compared to SUS. A citizen may be living under a bridge, and if he or she needs a liver transplant, they can get it at Hospital das Cl\u00ednicas for free. How much would they spend in a private hospital? It is a system that reduces social inequality. No one sees this other aspect of SUS.<\/p>\n

How does your work as a writer happen? How do you prepare?<\/strong>
\nI read all the time. It is much easier today; we take in information from every direction. I became increasingly involved with writing. I wrote Esta\u00e7\u00e3o Carandiru, which was published in 1999. When it came out, that book was number one on the bestseller list for four years and has sold more than 500,000 copies to date. I think the book had the merit of bringing the reality of a highly representative prison such as Carandiru out of the jailhouse for the first time by a person who was not involved in that world. That is when I discovered a passion for writing. Journalism is also a very interesting exercise. You have to write within the allotted space, under deadline; you cannot be too fussy, and you must have a beginning, middle, and end. Unlike writing a book, where one wanders and often loses oneself in the writing, journalism gives you a goal, and I started to enjoy it.<\/p>\n

Does writing have a therapeutic effect for you?<\/strong>
\nThink about this: I sit facing a wall, with a computer, and I write. I have an idea, and I sit there putting down words, and suddenly\u2014sometimes this happens\u2014I find a connection that works well in the text, and I feel happy. I achieved this happiness alone while staring at a white wall. Such happiness does not exist in the world around us. With a small laptop in hand, one can arrive at that point. Once you have experienced that degree of happiness, you never stop writing.<\/p>\n

So, writing is not a long-suffering process?<\/strong>
\nFor me it never was. On Saturday morning, I go to the hospital, visit the sick, run back to the house, and write. It is a huge pleasure. Before lunch, I drink a cacha\u00e7a to \u201cimprove\u201d the work… I learned about cacha\u00e7a from the folks at Carandiru. Before cacha\u00e7a, I drank beer. Then, a guard said, \u201cDoctor, you have to drink cacha\u00e7a because if you get drunk, they\u2019ll say you\u2019re a drinker. If you spend money drinking champagne, they\u2019re going to say you\u2019re a drinker. Beer, when it\u2019s hot out, you drink one bottle after another, and by the time you feel it, you\u2019ve already drank too much. With cacha\u00e7a, you know who you\u2019re dealing with.\u201d It is true; it is easier to control.<\/p>\n

With cacha\u00e7a or without it, you became a writer…<\/strong>
\nI did follow that career path. I have my two columns, in the Folha de S\u00e3o Paulo newspaper and in CartaCapital magazine. For the internet, I take the text I write for Folha and summarize it in two minutes on YouTube, where I have a channel. Sometimes, it takes even in less time to transform the piece. So far, 350,000 people have already watched. I have one video with almost 2 million views. It is another world.<\/p>\n

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Personal archive<\/span><\/a> …and during a meeting with prison guard friends in 2018Personal archive<\/span><\/p><\/div>\n

The videos receive many comments… <\/strong>
\nThere are all sorts of comments. There are taboo subjects, such as talking about abortion. It is a matter of public health and not a religious question. When I talk about abortion, the reactions are terrible. I am 76 years old; I am starting to see things with a closer horizon in mind. I cannot be worried about people cursing me out. We have to put forward ideas that have social relevance. Every time the ignorant take power, during dictatorships, for example, what do they do? The subtext is always \u201clower the culture.\u201d At these times, the important thing is to maintain an open dialogue, a multiplicity of ideas. Self-censorship cannot take root.<\/p>\n

Does this also apply to taboo subjects?<\/strong>
\nI am an atheist. The religious think and act as if they have a monopoly on human generosity. We know that there is generosity in chimpanzees and gorillas\u2014who do not pray. What is the basic principle of all religions? Belief, you have to believe. What is the basic principle of science? You cannot believe in anything that is not associated with experiments and results that can be reproduced. Only from the basis of experimentation can we draw conclusions. Science is not the only way to see the world. There are other ways. However, I do not see how we can reconcile these other worldviews because they are antagonistic.<\/p>\n

Do you have a team that writes for the site and records videos?<\/strong>
\nThere is a group that started making recordings with me and set up their own agency, Uzumaki, which now provides services for the site. These languages change very quickly; we have to try to keep up. I love doing these projects on the internet because they reach an audience that is inaccessible otherwise. The other day, I was in a movie theater with my wife, and there were some kids there. Suddenly, a girl placed her phone in front of my face with a photo and said, \u201cAre you this guy here?\u201d \u201cI am,\u201d I said. \u201cCan we take a picture with you?\u201d These are kids, 12 and 13 years old, who I can talk to using the internet but not on television.<\/p>\n

Are you working on a new book?<\/strong>
\nI am, but it is still very early on. The book is basically about my memories, but the format is not well defined. I resisted the project for a long time. We go about doing things in life, and some work out, and some do not. Many of the outcomes depended on me, on my work, on some good decisions I made. Other outcomes depended on opportunities.<\/p>\n

You worry about turning chance events into personal merits…<\/strong>
\nExactly. In addition, when you appear on television, you become famous. Television is full of foolish people because they think that all that recognition is based on their personal merit. These people do not realize that if it were someone else, the same thing would happen. It is very mediocre to reach a mature age and still be looking at yourself in the mirror. There are other things that are more interesting.<\/p>\n

Is there something you would like to do and have not done yet?<\/strong>
\nWhen I got yellow fever, I was 61 years old. There was a moment, technically, when I saw the exams, and I thought I was going to die. I thought, \u201cWhat do you have left to do?\u201d Well, there were many things to do. Now, at this point in my life, I have done everything I needed and wanted to do, but of course, I can do more.<\/p>\n","protected":false},"excerpt":{"rendered":"The oncologist who treated the first AIDS cases in Brazil uses every media platform to clarify the issues he considers important regarding public health","protected":false},"author":15,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[161],"tags":[220,247,260,256,261],"coauthors":[104,2526],"class_list":["post-321554","post","type-post","status-publish","format-standard","hentry","category-interview","tag-communication","tag-medicine","tag-public-health","tag-public-policies","tag-sociology"],"acf":[],"_links":{"self":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/321554","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/comments?post=321554"}],"version-history":[{"count":1,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/321554\/revisions"}],"predecessor-version":[{"id":321587,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/321554\/revisions\/321587"}],"wp:attachment":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/media?parent=321554"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/categories?post=321554"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/tags?post=321554"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/coauthors?post=321554"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}