As ações judiciais por anticorpos monoclonais em Minas Gerais, 1999-2009: médicos, advogados e indústria farmacêutica

Abstract

Introduction: The Constitution of the Federative Republic of Brazil 1988 points to health as a fundamental right and duty of State, that determination gave immediate applicability. SUS actions and services involves federal, state, district and local, organized according to thestrategies of decentralization, with a single management in each sphere of government, giving priority to preventive activities, and participation the community. Such prerogatives confirm their character social right. Because it is a constitutional right, health can be claimed by thejudiciary. The actions and requests for services are the most diverse, however, most are for drugs. It is undeniable failures in the provision of Pharmaceutical Assistance and inefficiency of the health care system in some situations, something that a shame and social law legitimizes the action of the judiciary. However, this intervention creates problems such as loss of equity and high budgetary impact, which has motivated the search for understanding and evaluation of this phenomenon called "Lawsuits of Health". Objectives: To describe the relationship between the prescribing physician, lawyer and the pharmaceutical industry inlawsuits by monoclonal antibodies, filed against the State of Minas General between 1999 and 2009 and the implications on the process of incorporation of these drugs. Methodology: A descriptive study based on retrospective data in a file court with demands for monoclonal antibodies, filed against the State of Minas Gerais, from October 1999 to in October 2009. Results: Between 1999 and 2009 were analyzed 787 lawsuits, totaling 787 drugs with 13drugs different. Among these, four have guaranteed supply by Pharmaceutical Policies SUS. Drugs adalimumab were more frequent (n = 353), infliximab (n = 138) and rituximab (n= 94). Among the diseases stand out arthritis arthritis (n = 219), ankylosing spondylitis (n = 73) and degeneration age-related macular (n = 35). Predominated representation by private lawyers and answering doctors in the private sector. Only one doctor was responsible for21.2% of prescriptions for adalimumab, being requested by only a private office of advocacy, in 45.0% of applications. Revealed the relationship between doctors and law firms the requests of the drugs. Among the shares represented in the office, 45.1% had the doctor prescribing for X as adalimumab, while another 29 doctors were responsible for 41.6% of the requests of the same drug. Monoclonal antibodies present in the lawsuits are registered in the main regulatory agencies worldwide, with the exception of daclizumab was withdrawn from the market in many countries. Conclusion: The higher representation of private sector doctorsand lawyers to private demonstrate injury access to health equity, in that many patients who access the judiciary and consequently receive medicines financed by SUS, have better socioeconomic conditions. The data presented show the high concentration of cases among the fewmedical and law offices. This may be a clue that justice and medicine have been used in certain times, to meet the needs of industry pharmaceutical. The increase in the number of shares in periods prior to the incorporation of drugs in the SUS, may denote the industryinfluence, via the judiciary, on the definition Policy of Pharmaceutical Assistance. On the other hand, there are empty assistance and difficulties in accessing health service in the three federal entities to gain greater visibility with the lawsuits that generate debate often necessaryand possible to reach solutions.