Problems in the regulatory policy of the drug market

OBJECTIVE Analyze the implementation of drug price regulation policy by the Drug Market Regulation Chamber.METHODS This is an interview-based study, which was undertaken in 2012, using semi-structured questionnaires with social actors from the pharmaceutical market, the pharmaceuticals industry, consumers and the regulatory agency. In addition, drug prices were compiled based on surveys conducted in the state of Sao Paulo, at the point of sale, between February 2009 and May 2012.RESULTS The mean drug prices charged at the point of sale (pharmacies) were well below the maximum price to the consumer, compared with many drugs sold in Brazil. Between 2009 and 2012, 44 of the 129 prices, corresponding to 99 drugs listed in the database of compiled prices, showed a variation of more than 20.0% in the mean prices at the point of sale and the maximum price to the consumer. In addition, many laboratories have refused to apply the price adequacy coefficient in their sales to government agencies.CONCLUSIONS The regulation implemented by the pharmaceutical market regulator was unable to significantly control prices of marketed drugs, without succeeding to push them to levels lower than those determined by the pharmaceutical industry and failing, therefore, in its objective to promote pharmaceutical support for the public. It is necessary reconstruct the regulatory law to allow market prices to be reduced by the regulator as well as institutional strengthen this government body.

The social adjustment of patients with schizophrenia: implications to the mental health policy in Brazil

A sample (n=124) of schizophrenic patients from a defined catchment area of the city os S.Paulo, Brazil, who had been consecutively admitted to hospital, was assessed for psychopathological status and social adjustment levels. Sociodemographic, socio-economic and occupational characteristics were recorded: almost 30% of the subjects had no occupation and received no social benefit, more than two-thirds had a monthly per capita income of US$ 100.00 or less. Sixty-five percent presented with Schneiderian firstrank symptoms. Nearly half the sample showed poor or very poor social adjustment in the month prior to admission. The most affected areas of social functioning were participation in the household activities, work and social withdrawal. The current mental health policy of promoting extra-mural care as an alternative to the previous hospital-based model will then mean the investment in a network of new community-based services, that give effective treatment and support to patients and their families. The need of further research into the current picture of mental disorders in the country is stressed.

How effective is dog culling in controlling zoonotic visceral leishmaniasis? a critical evaluation of the science, politics and ethics behind this public health policy

INTRODUCTION: Zoonotic kala-azar, a lethal disease caused by protozoa of the genus Leishmania is considered out of control in parts of the world, particularly in Brazil, where transmission has spread to cities throughout most of the territory and mortality presents an increasing trend. Although a highly debatable measure, the Brazilian government regularly culls seropositive dogs to control the disease. Since control is failing, critical analysis concerning the actions focused on the canine reservoir was conducted. METHODS: In a review of the literature, a historical perspective focusing mainly on comparisons between the successful Chinese and Soviet strategies and the Brazilian approach is presented. In addition, analyses of the principal studies regarding the role of dogs as risk factors to humans and of the main intervention studies regarding the efficacy of the dog killing strategy were undertaken. Brazilian political reaction to a recently published systematic review that concluded that the dog culling program lacked efficiency and its effect on public policy were also reviewed. RESULTS: No firm evidence of the risk conferred by the presence of dogs to humans was verified; on the contrary, a lack of scientific support for the policy of killing dogs was confirmed. A bias for distorting scientific data towards maintaining the policy of culling animals was observed. CONCLUSIONS: Since there is no evidence that dog culling diminishes visceral leishmaniasis transmission, it should be abandoned as a control measure. Ethical considerations have been raised regarding distorting scientific results and the killing of animals despite minimal or absent scientific evidence

Policies for decentralization and development of health education

How the policy of action and professional standards have influenced the development and decentralization of health education is discussed. It is concluded that a review of policies both of developing as well as of developed countries could help to put some observations into a perspective that is closer to the Brazilian reality.

Industrialization in Sub-Saharan Africa and import substitution policy

This article aims to contribute to the understanding of the process of import substitution in Sub-Saharan Africa. The process of industrialization in Sub-Saharan Africa occurred in two phases: a first step, even very early during the colonial regime began around the 1920s and ended in the late forties; a second phase of industrialization began in the late fifties and gained momentum in the sixties, when import substitution was implemented more widely. Although these countries were the last to embark on the strategy of import substitution, they followed the same steps of Latin American countries, and as the structural domestic and external constraints were too strong, the failure of the policy of import substitution arrived early and the negative impact on these economies had a greater magnitude.

The bussola study. Final results, conclusions and proposals

OBJECTIVE: To evaluate the use of thrombolytic and acetylsalicylic acid therapies in acute myocardial infarct patients as well as the availability of technical and human resources for the care of these patients in the emergency units of the city of Rio de Janeiro. Additional objectives were the evaluation of the use of primary angioplasty and the level of acceptance of SBC /RJ as an entity responsible for programs of continued medical education. METHODS: Interviews with physicians at 46 emergency units in the city of Rio de Janeiro. RESULTS: Of the 46 emergency units inspected, a policy of encouragement to use thrombolytic therapy was only prescribed in 6.5%. In 1/3 of the public wards no thrombolytic agents were available, and in none of them was access to primary angioplasty regularly available; 45.9% did not offer the minimal conditions required for the handling of cases of acute myocardial infarction; 60% of the physicians on-call (at both public and private emergency units), appeared not to know the importance of the use of acetylsalicylic acid in acute myocardial infarct patients; all physicians interviewed would participate in programs of continued medical education organized by the SBC/RJ. CONCLUSION: The study suggests there was: 1) the low probability of the use of thrombolytic therapy in the majority of the emergency units in of the city of Rio de Janeiro due to the inadequate policy of waiting for the transfer of the patient to coronary or intensive care unit; 2) a low awareness to the importance of early use of acetylsalic acid in acute myocardial infarct; 3) half of the emergency units of the public net do not have the minimal conditions required for the handling of cases of acute myocardial infarction; 4) a high level of credibility exists that would enable the SBC/RJ to set up programs for continued medical education to change the mentality regarding the use of thrombolytic therapy and of acetylsalicylic acid.

Tríade de Carney

The authors present a case of an incomplete form of Carney's Triad .They emphasize the use of immunohistochemistry to classify gastrointestinal stromal tumors and policy of long term follow-up .

Diferentes padrões de políticas salariais nos estados brasileiros: uma análise a partir do diferencial de salários público-privado

Public servant wages represent a significant part of Brazilian state governments' current expenses. Based on the literature, this paper has tried to identify which states practice efficient, compensatory or appropriation wage politics through the estimation of public-private wage differentials. The differential of salaries was calculated between 1995 and 2004 following the Oaxaca's technique. The results show that the wage policy of an important number of states has had efficiency and a numerous part of the North and the Northeast states have developed compensatory politics. The Federal District and Roraima practiced a wage policy characterized by explicit appropriation.

O mito do populismo econômico de Vargas

The myth of Vargas' economic populism. The Second Vargas Administration in Brazil (1951-1954) is commonly associated with the phenomenon of populism. However, based on the models of economic populism, it is clear that the economic policy of the period is not the one shown by those models. Besides, based on this historic experience, it is advocated that there is no incompatibility between developmentalism and the adoption of macroeconomic stability-oriented measures.

Desenvolvimentismo e novo-desenvolvimentismo: raízes teóricas e precisões conceituais

This paper starts from the conceptualism of New Developmentalism which was proposed by its formulators and their criticism of the "old" developmentalism in order to compare both. It is elaborate in both theoretical and historical levels. In the former, it explores the theoretical streams that contributed to the formulation of economic policies that designated the Latin American developmentalism. In the latter, it focuses on the economic policy of the Brazilian import-substitution industrialization and advocates the impropriety of associating it to the irresponsibility in the management of the foreign exchange, fiscal and monetary policies, as the proposers of New Developmentalism assert. Finally, in a third stage, it resumes the propositions of the New Developmentalism and debates the pertinence of some of its policy propositions based upon theoretical considerations and the Brazilian experience which were mentioned in the previous stages.

A política industrial chinesa como determinante de sua estratégia going global

China has experienced not only high rates of economic growth as well as an unprecedented competitive international insertion since the turn of the century. This process was not guided solely by market forces or influenced by Government intervention in the economy. Although much has been argued that China's "going global" strategy is rooted in state action, and especially its policy of exchange rate depreciation and trade policy incentives for exports and investments abroad, we argue that the major determinant of this strategy, which established the basic conditions for industrial competitiveness, was its industrial policy. The focus of this article is on the changes in China's industrial structure, emphasizing that Chinese industrial policy is a central determinant of its international insertion strategy.