Evidence-Based Medicine in judicial decisions concerning right to healthcare

Abstract

Objective To analyze, from the examination of decisions issued by Brazilian courts, how Evidence-Based Medicine was applied and if it led to well-founded decisions, searching the best scientific knowledge.Methods The decisions made by the Federal Courts were searched, with no time limits, at the website of the Federal Court Council, using the expression “Evidence-Based Medicine”. With regard to decisions issued by the court of the State of São Paulo, the search was done at the webpage and applying the same terms and criterion as to time. Next, a qualitative analysis of the decisions was conducted for each action, to verify if the patient/plaintiff’s situation, as well as the efficacy or inefficacy of treatments or drugs addressed in existing protocols were considered before the court granted the provision claimed by the plaintiff.Results In less than one-third of the decisions there was an appropriate discussion about efficacy of the procedure sought in court, in comparison to other procedures available in clinical guidelines adopted by the Brazilian Unified Health System (Sistema Único de Saúde) or by private health insurance plans, considering the individual situation. The majority of the decisions involved private health insurance plans (n=13, 68%).Conclusion The number of decisions that did consider scientific evidence and the peculiarities of each patient was a concern. Further discussion on Evidence-Based Medicine in judgments involving public healthcare are required.

Economic evaluation of an active search system to monitor the outcomes of health-related claims

“…Therefore, even data on "Prescription compliance" may be subject to discussion, as reported in other articles, (26) and that would potentially disclose a more problematic situation, particularly if the relevance of scientific evidence is taken into account. (11) In the first 6 months after NAJS implementation, the number of claims filed in court continued similar to the previous period. On the other hand, in the 6 months thereafter, there was a trend towards the decrease of claims, and also in the quantity of executed proceedings.…”

“…(9) On the other hand, health outcomes are rarely recorded not to mention the recognized need for further academic-scientific background to expand the support to legal decisions. (10) Such decisions have been studied, and high judicial interference is acknowledged (11) particularly due to technical and scientific matters ignored in the decisionmaking process. They refer to medical prescriptions that are noncompliant with the good prescription practices, (12) despite the existing legal directions for this purpose; plaintiffs' motivations for the prescription for medicine by brand, (13) questions regarding efficacy of their clinical indications (14) and lack of scientific evidence in the prescriptions.…”

“…They refer to medical prescriptions that are noncompliant with the good prescription practices, (12) despite the existing legal directions for this purpose; plaintiffs' motivations for the prescription for medicine by brand, (13) questions regarding efficacy of their clinical indications (14) and lack of scientific evidence in the prescriptions. (11) Despite all that, medical prescription is the supreme element to support court decisions. (11) Conflicts of interests are also discussed, considering the substantial volume of lawsuits filed by the private sector, (15) concentrated in a limited number of physicians and lawyers.…”

“…(11) Despite all that, medical prescription is the supreme element to support court decisions. (11) Conflicts of interests are also discussed, considering the substantial volume of lawsuits filed by the private sector, (15) concentrated in a limited number of physicians and lawyers. (6) In spite of government efforts to mitigate the costs of fraud, corruption and embezzlements, substantial sums are misused.…”

The High “Cost” of Experimental Drugs Obtained Through Health Litigation in Brazil

“…The expenses resulting from litigation have an impact on the medicines policy budget, with a reduction in the offer of other listed medicines, exams, and consultations to the general population (Paim et al, 2017). On the other hand, there seem to be inconsistencies and information failures even in the application of the SUS Protocolos Clı́nicos e Diretrizes Terapêuticas (Clinical Protocols and Therapeutic Guidelines, PCDT) (Figueiredo et al, 2013;Dias and da Silva, 2016) when regarding litigated medicines. In 2017, an audit of 414 judicial demands for medicines in Brazil showed that around half did not even include a diagnosis of the disease to be treated (Ministeŕio da Saude do Brasil, 2018d).…”