The evolution of drug therapy and the challenges to physicians, patients and healthcare systems

Abstract

Without doubt we are living through a singular era in the evolution of oncohematology owing to our biological understanding of diseases and all the characteristic developments that go with it in respect to diagnosis, prognosis and treatment. The development of drugs with specific therapeutic targets constitutes a new stage, in many ways revolutionary, in medical practice and oncology. This has been an important reason for the constant rise in life expectancy related to our specialty. In some diseases, such as in chronic myeloid leukemia and malignant lymphoma, this increase has been such that it has definitively changed the natural evolution of illnesses by the significant increase in response rates and complete cure. In other diseases, such as in multiple myeloma, there has been a remarkable improvement in survival and quality of life. And there are many other examples. However, these achievements are not easy and definitely not cost-free; this progress should always be analyzed and sanctioned by society. Brazil certainly has one of the most advanced legislations in terms of public health. No country in the world, as far as I know, has included in its constitution the guarantee of universally free access to healthcare to its citizens. In recent publications in the prestigious British journal Lancet(1,2) these facts were reported and discussed and Brazil was highly commended for the fact that public health policies are at the center of government decisions. We look forward to the vote in Congress on a supplementary law known as Amendment 29, which should set percentages for healthcare financing. We live with our day-to-day problems that range from regulation issues, with the excessive sluggishness and bureaucracy of our system, to constant difficulties to access new procedures and modern therapies. Of course we understand the difficulties and the dilemma of public healthcare worldwide. However, we must always defend science and the evidence to incorporate new diagnostic and treatment methods. This is why our Association is developing its project of guidelines(3) and aims to, on issues of great importance and complexity, make it clear to organized society, governments, the Brazilian National Health Agency (ANS) and to whoever else is interested, our position on the state-of-the-art technology. In the field of drug therapy, this matter is very complex and troubling. We see a huge delay in the incorporation of new therapeutic methods with clear and unacceptable harm to our patients, not to mention the embarrassment that this fact causes doctors and institutions. Brazil is experiencing a time of accelerated progress and increased wealth that places us as one of the emerging countries heading towards the developed world. These difficulties are not sustainable when we analyze our development. Our investment in health is less than many poorer countries without our infrastructure. Brazilian hematology and transfusion medicine has also been contributing to science, education and healthcare. But it is also suffering from tremendous, often overwhelming difficulties to accelerate and implant scientifically based procedures of absolute necessity created by our scientific community. Thus, we warn that a new modern development policy on oncohematology for the healthcare system focused on the unique and set interests of patients and based on indisputable scientific criteria should prevail in our society and in our specialty.