[Legal remedies: therapeutic markets and the judicialization of the right to health]. / Tratamentos jurídicos: os mercados terapêuticos e a judicialização do direito à saúde.

This study draw on the struggle of parents of children with mucopolysacchar idosis to access expensive drugs in the name of universal right to health. The work explores how, in Brazil, right-to-health litigation became an alternative pathway to access health care and shows that several public and private stakeholders dispute the judicialization of health. Biotechnology is, therefore, understood to remake human and social worlds as it opens up new spaces of ethical problematization, desire, and political belonging.

Tratamentos jurídicos: os mercados terapêuticos e a judicialização do direito à saúde / Legal remedies: therapeutic markets and the judicialization of the right to health

Resumo Esse estudo mostra a luta de pais para que filhos portadores de mucopolissacaridose tenham acesso a medicamentos caros, em nome do direito universal à saúde. O trabalho explora como, no Brasil, o litígio pelo direito à saúde tornou-se um caminho alternativo de acesso à saúde e evidencia a disputa de diferentes atores dos setores público e privado no processo de judicialização da saúde. Entende-se, portanto, que a biotecnologia recria valores humanos e mundos locais à medida que abre novos espaços de problematização ética, desejo e pertencimento político.

Abstract This study draw on the struggle of parents of children with mucopolysacchar idosis to access expensive drugs in the name of universal right to health. The work explores how, in Brazil, right-to-health litigation became an alternative pathway to access health care and shows that several public and private stakeholders dispute the judicialization of health. Biotechnology is, therefore, understood to remake human and social worlds as it opens up new spaces of ethical problematization, desire, and political belonging.

Tratamentos jurídicos: os mercados terapêuticos e a judicialização do direito à saúde / Legal remedies: therapeutic markets and the judicialization of the right to health

Esse estudo mostra a luta de pais para que filhos portadores de mucopolissacaridose tenham acesso a medicamentos caros, em nome do direito universal à saúde. O trabalho explora como, no Brasil, o litígio pelo direito à saúde tornou-se um caminho alternativo de acesso à saúde e evidencia a disputa de diferentes atores dos setores público e privado no processo de judicialização da saúde. Entende-se, portanto, que a biotecnologia recria valores humanos e mundos locais à medida que abre novos espaços de problematização ética, desejo e pertencimento político. (AU)

Peopling Global Health / A Saúde Global centrada nas pessoas

The field of Global Health brings together a vastly diverse array of actors working to address pressing health issues worldwide with unprecedented financial and technological resources and informed by various agendas. While Global Health initiatives are booming and displacing earlier framings of the field (such as tropical medicine or international health), critical analyses of the social, political, and economic processes associated with this expanding field — an “open source anarchy” on the ground — are still few and far between. In this essay, we contend that, among the powerful players of Global Health, the supposed beneficiaries of interventions are generally lost from view and appear as having little to say or nothing to contribute. We make the case for a more comprehensive and people-centered approach and demonstrate the crucial role of ethnography as an empirical lantern in Global Health. By shifting the emphasis from diseases to people and environments, and from trickle-down access to equality, we have the opportunity to set a humane agenda that both realistically confronts challenges and expands our vision of the future of global communities...

O campo da saúde global articula um diversificado leque de atores que trabalham para resolver problemas prementes de saúde em todo o mundo, com recursos financeiros e tecnológicos sem precedentes e munidos de agendas das mais variadas. Apesar das iniciativas em saúde global estarem crescendo de forma expressiva e deslocando enquadramentos anteriores do campo (como a medicina tropical ou saúde internacional), as análises críticas dos processos sociais, políticos e econômicos associados a essa expansão ainda são escassas. Neste artigo sustentamos, a partir de uma perspectiva que leva em conta os sujeitos, que o campo da saúde global é uma “anarquia de código aberto”. Em geral, perdem-se de vista os supostos beneficiários das intervenções, que aparecem como tendo pouco a dizer e nada a contribuir. Argumentamos por uma abordagem mais abrangente e centrada nas pessoas, demonstrando o papel crucial da etnografia como lanterna empírica na saúde global. Ao mudar a ênfase das doenças às pessoas e seus contextos e do acesso de cima para baixo para a equidade, temos a oportunidade de definir uma agenda humana que simultaneamente confronta realisticamente os desafios que enfrentamos e expande nossa visão sobre o futuro das comunidades globais...

Between the court and the clinic: lawsuits for medicines and the right to health in Brazil.

BACKGROUND: The Brazilian Constitution states: "Health is the right of all persons and the duty of the State." Yet individuals in Brazil frequently face barriers to health prevention and treatment. One response to these barriers has been a "judicialization" of the right to health, with an increasing number of patients suing the government for access to medicines. OBJECTIVE/METHODS: This study uses a mixed methods approach to identify trends in lawsuits for medicines in the southern state of Rio Grande do Sul (RS) and to characterize patient-plaintiffs. Electronic registries were used to determine the number of health lawsuits filed between 2002 and 2009. In-depth interviews were conducted with thirty patient-plaintiffs, and 1,080 lawsuits for medicines under review between September 1, 2008 and July 31, 2009 were analyzed to assess socio demographic, medical, and legal characteristics of patient-plaintiffs. RESULTS: Between 2002 and 2009, the annual number of health-related lawsuits against the state of RS increased from 1,126 to 17,025. In 2009, 72% of lawsuits sought access to medicines. In-depth interviews revealed that patients are desperate to access medicines for chronic and advanced diseases, and often turn to the courts as a last resort. Among the 1,080 lawsuits examined, patient-plaintiffs were more likely to be older than 45 years (68%), retired or unemployed (71%), and low-income (among those who reported income, 53% (n=350) earned less than the national minimum wage). Fifty-nine percent of all cases were represented by public defenders. Plaintiffs reported 1,615 diseases and requested 2.8 drugs on average (range 1-16). Sixty-five percent of the requested drugs were on government pharmaceutical distribution lists; 78% of the 254 drugs on these lists were requested. In 95% of the cases analyzed, district courts ruled in favor of plaintiffs. Among the 917 cases with a final state high court ruling, 89% were in favor of the plaintiff. In justifying their rulings, judges most frequently cited the government's obligation under the Constitution's provision of a right to health. DISCUSSION: Right-to-health litigation is a widespread practice in southern Brazil. Government pharmaceutical programs are struggling to fulfill their goal of expanded access and rational use of medicines, and poor patients are leveraging public legal assistance and a receptive judiciary to hold the state accountable to their medical needs. "Judicialization" is an alternative pathway for accessing health care, increasingly understood as access to medicines of all kinds. Tracking the health outcomes and budgetary impacts of right to-health court cases could help inform adequate treatment policy and evaluate trends in access.

Biological citizenship: the science and politics of Chernobyl-exposed populations.

In the transition out of socialism to market capitalism, bodies, populations, and categories of citizenship have been reordered. The rational-technical management of group affected by the Chernobyl disaster in Ukraine is a window into this contested process. Chernobyl exemplifies a moment when scientific knowability collapsed and new maps and categories of entitlement emerged. Older models of welfare rely on precise definitions situating citizens and their attributes on a cross-mesh of known categories upon which claims rights are based. Here one observes how ambiguities related to categorizing suffering created a political field in which a state, forms of citizenship, and informal economies were remade.