Médicos, advogados e indústria farmacêutica na judicialização da saúde em Minas Gerais, Brasil

Abstract

OBJECTIVE: To describe the relationship between the prescribing physician, lawyer and pharmaceutical industry in lawsuits against the state. METHODS:Retrospective descriptive study based on data from administrative fi les, relating to lawsuits involving medicine demands, in the State of Minas Gerais, from October 1999 to October 2009. The variables studied were: gender, age, benefi ciaries' illness, type of medical care (public or private), prescriber, type of legal representation and requested medication. A descriptive analysis of the variables with the distribution of frequencies was carried out. RESULTS:A total of 2,412 lawsuits were analyzed with 2,880 medicine requests, including 18 different drugs, 12 of them provided through Pharmaceutical Policies of the Brazilian National Health System (SUS). The most frequent medicines requested were adalimumab, etanercept, infl iximab, insulin glargine and tiotropium bromide. The main diseases were rheumatoid arthritis, ankylosing spondylitis, diabetes mellitus and chronic obstructive pulmonary disease. Private lawyers and doctors were predominant. The results revealed the association between doctors and law offi ces on drug requests. Among the lawsuits fi led by the offi ce A, 43.6% had a single prescriber of adalimumab, while 29 doctors were responsible for 40.2% of the same drug prescriptions. A single doctor was responsible for 16.5% of the adalimumab prescriptions, being requested through lawsuits fi led by a single private law offi ce in 44.8% of legal proceedings. CONCLUSIONS:A greater representation of doctors and lawyers from the private sector can hinder equity in health. The results revealed the association between doctors and law offi ces on drug requests. This is an indication that justice and medical practice have been used, at certain times, to serve the interests of the pharmaceutical industry. DESCRIPTORS:Health lawsuits and access to health . Equity in health. Pharmaceutical industry. Incorporation of medicines. Lawsuit offi cials. Doctors.

Policy Change and the National Essential Medicines List Development Process in Brazil between 2000 and 2014: Has the Essential Medicine Concept been Abandoned?

“…The Scottish model to improve the rational use of medicines includes multiple measures to enhance adherence to the recommended list of drugs. These include academic detailing, prescribing targets and financial incentives [9,31,32]. There is also no 'carte blanche' for specialist physicians, with the formulary and its guidance applying equally across sectors [35].…”

“…Universal access, comprehensive care, equity and public control of the Brazilian Health System are policy landmarks (http://www.pla nalto.gov.br/ccivil_03/leis/L8080.htm/July 2017) [8]. Federal and regional governments must uphold patients' individual rights, while coping with the financial pressures from the introduction of technological innovations [9,10]. While expanding access to new medicines, lack of their timely delivery by local governments, market pressures and less than rational prescribing have caused increasing numbers of judicial demands based on the right to new treatment options [2,11].…”

Judicialization 2.0: Understanding right-to-health litigation in real time

“…These early studies succeeded in demonstrating that judicialization of health increased significantly over time, both in terms of the number of lawsuits being filed and in terms of the amount of resources mobilized. Studies tended to agree on key points: that the phenomenon was growing in all contexts where it was occurring; that multiple populations, and multiple state and legal actors were involved; that lawsuits originated in both private and public sectors but that the main target of the lawsuits was the government (overwhelmingly state governments); that the most frequent form of health care sought by lawsuits was access to medicines; that a wide range of different medicines were sought, from cheap, off-patent drugs that were part of government formularies to expensive, branded drugs that were sometimes not even approved for commercialization; and that courts by and large sided with patient/litigants (Biehl, Amon, Socal & Petryna, 2012;Biehl, Socal & Amon, 2016b;Borges & Uga, 2010;Campos Neto, Acurcio, Machado, Ferré, Barbosa, Cherchiglia, & Andrade, 2012;Chieffi & Barata, 2009;Da Silva & Terrazas, 2008;Messeder, Osorio-de-Castro & Luiza, 2005;Pepe, Ventura, Sant'Ana, Figueiredo, de Souza, Simas, & Osorio-de-Castro, 2010;Pereira, dos Santos, do Nascimento Junior & Schenkel, 2010).…”

“…Over the past two decades, debates over the whys, the hows, and the effects of the everexpanding phenomenon of the judicialization of the right to health have been marked by polarized arguments and limited information. A majority of judicialization studies have used imperfect data, focused on short-term outcomes, and implicitly or explicitly advocated for the containment and management of the phenomenon (Borges & Uga, 2010;Campos Neto, Acurcio, Machado, Ferré, Barbosa, Cherchiglia, & Andrade, 2012;Chieffi & Barata, 2009;Da Silva & Terrazas, 2008;Vieira & Zucchi, 2007). An alternative approach recognizes that judicialization is an integral part of contemporary democratic life, something to be understood in its complexity and possibly tweaked or reoriented so as to promote substantive human rights.…”

Análise dos fatores que condicionam os processos de Judicialização na Divisão Regional de Saúde DRS XIII: um estudo sob a perspectiva dos prescritores

“…Assim, a prática da judicialização da saúde está interligada com o modo optativo de acesso dos pacientes aos medicamentos no SUS, como por exemplo, aos medicamentos oncológicos no HCRP-USP, afinal, estes são alguns dos produtos de maior repercussão na atuação deste fenômeno (CAMPOS NETO et al, 2012).…”