O tratamento de doenças raras no Brasil: a judicialização e o Complexo Econômico-Industrial da Saúde / The treatment of rare diseases in Brazil: the judicialization and the Health Economic-Industrial Complex

RESUMO Este estudo apresenta o panorama do tratamento de doenças raras no Brasil, enfocando questões relacionadas à judicialização e ao Complexo Econômico-Industrial da Saúde. São analisadas as estruturas jurídicas e econômicas pertinentes ao tema, questionando a ausência de soluções nacionais articuladas, o que torna a judicialização para o tratamento de doenças raras a solução - ineficiente e insatisfatória, segundo se diz - para o cumprimento do dispositivo. Saúde como um direito. Nesse contexto, são debatidas estratégias para mitigar a dependência tecnológica e econômica, a fim de sustentar o acesso universal, integral e equitativo à saúde. Metodologicamente, a perspectiva do trabalho é primariamente teórica, exploratória e baseada em informações documentais e literatura acadêmica sobre o assunto, passando pelas normas administrativas, decisões judiciais e textos explicativos sobre o assunto em sua dimensão jurídica, econômica e institucional. Concluindo, percebe-se que os gastos com saúde podem comprometer uma parcela significativa do orçamento nacional, dada a importação de medicamentos e outros tratamentos. Portanto, a interação entre o judiciário e o poder executivo e seus órgãos técnicos executivos é mensurada com urgência para fornecer uma racionalidade sanitária e econômica ao sistema, para garantir acesso universal, equitativo e integral ao atendimento de doenças raras.

ABSTRACT This study presents the panorama of the treatment of rare diseases in Brazil, focusing on issues related to judicialization and the Health Economic-Industrial Complex. The legal and economic structures pertinent to the theme are analyzed, questioning the absence of articulated national solutions, which makes judicialization for the treatment of rare diseases the solution - inefficient and unsatisfactory, it is said - for complying with the device. Health as a right. In this context, strategies are debated to mitigate technological and economic dependence in order to sustain universal, integral, and equitable access to health. Methodologically, the perspective of the work is primarily theoretical, exploratory and based on documentary information and academic literature on the subject, going through the administrative rules, court decisions and explanatory texts on the subject in its legal, economic, and institutional dimension. In conclusion, it can be noticed that health spending can compromise a significant portion of the national budget, given the importation of medicines and other treatments. Therefore, the interaction between the Judiciary and the Executive branch and its technical executive bodies is urgently measured to provide a sanitary and economic rationality to the system, to ensure universal, equitable, and integral access to care for rare diseases.

Mutagenic and Cytotoxicity LQB 123 Profile: Safety and Tripanocidal Effect of a Phenyl-t-Butylnitrone Derivative.

The therapeutic options for Chagas disease are limited and its treatment presents a number of drawbacks including toxicity, drug resistance, and insufficient effectiveness against the chronic stage of the disease. Therefore, new therapeutical options are mandatory. In the present work, we evaluated the effect of a phenyl-tert-butylnitrone (PBN) derivate, LQB 123, against Trypanosoma cruzi forms. LQB 123 presented a trypanocidal effect against bloodstream trypomastigotes (IC50 = 259.4 ± 6.1 µM) and intracellular amastigotes infecting peritoneal macrophages (IC50 = 188.2 ± 47.5 µM), with no harmful effects upon the mammalian cells (CC50 values greater than 4 mM), resulting in a high selectivity index (CC50/IC50 > 20). Additionally, metacyclic trypomastigotes submitted to LQB 123 presented an IC50 of about 191.8 ± 10.5 µM and epimastigotes forms incubated with different concentrations of LQB 123 presented an inhibition of parasite growth with an IC50 of 255.1 ± 3.6 µM. Finally, we investigated the mutagenic potential of the nitrone by the Salmonella/microsome assay and observed no induction of mutagenicity even in concentrations as high as 33000 µM. Taken together, these results present a nonmutagenic compound, with trypanocidal activity against all relevant forms of T. cruzi, offering new insights into CD treatment suggesting additional in vivo tests.