A jurisprudência dos tribunais Superiores e o direito à saúde – Evolução rumo à racionalidade / Jurisprudence in Brazilian Superior Courts and the right to health – progress toward rationality

O direito à saúde tem sido objeto de intensa judicialização no Brasil, com um número crescente de ações ano a ano. Este cenário tem gerado debates acerca do alcance deste inquestionável direito fundamental e suas repercussões na administração judiciária e nos orçamentos públicos. O presente trabalho estuda a posição adotada pelo Supremo Tribunal Federal e pelo Superior Tribunal de Justiça acerca do direito à saúde, mediante análise da jurisprudência das duas cortes, classificando-a em fases distintas segundo critério material e cronológico. Em um primeiro momento, a jurisprudência negou a viabilidade judicial do direito à saúde. Depois, passou-se a uma etapa na qual o acesso às prestações materiais em saúde foi entendido praticamente como ilimitado. Atualmente, prevalece uma posição conciliadora entre as inadiáveis necessidades do cidadão em saúde pública e a observância da racionalidade das políticas públicas sanitárias, sem embargo da flexibilidade cabível em casos específicos.

The right to health has been an object of intense court action in Brazil, with a growing number of lawsuits each year. This situation has led to debates on the reach of this fundamental and unalienable right, in addition to its repercussions in judiciary administration and public budgets. The current study examines the positions adopted by the Brazilian Federal Supreme Court and the Brazilian Superior Court in regard to the right to health. The paper includes an analysis of the jurisprudence of the two courts and classifies it into distinct phases according to material and chronological criteria. First, jurisprudence denied the judicial viability of the right to health. Later, it became a step in which access to material benefits involved in healthcare became understood as essentially unlimited. Currently, a conciliatory stance prevails between the urgent needs of the citizen in the public health system and observance of the rationality of public health policies, with some flexibility in specific cases.

Dieta e medicamentos no tratamento da hiperuricemia em pacientes hipertensos / Diet and medication in the treatment of hyperuricemia in hypertensive patients

OBJECTIVE: To evaluate the effects of diet and medication, either isolated or associated, on serum levels of uric acid in patients with hyperuricemia. METHODS: We studied patients from the Hypertension Unit of the University of Goias who had hyperuricemia (men > or = 8.5mg/dL and women > or = 7.5mg/dL). We divided the patients into three groups: G1 (low purine diet), G2 (low purine diet + medication), and G3 (medication only). Patients received allopurinol, 150mg/day titrated up to 300mg/dL when necessary. Patients were evaluated with regards to their lifestyles (diet, smoking, physical, activity, alcohol consumption), uric acid, blood pressure, use of medication, body mass index, cholesterol, and triglyceride. Follow-up took place in weeks 0 (M1), 6 (M2), 12 (M3) during the intervention and in week 36(M4) after the study was completed. RESULTS: Fifty-five patients participated in the study, 31 women, mean age 54.4 + or - 10.6 years, body mass index 28.6 + or - 3.9kg/m². A similar reduction (p<0.001) in uric acid levels occurred in the three intervention groups. In week 36 (M4), after 24 weeks without intervention, a tendency toward elevation of uricemia was noted in G2 and G3, and a continuous drop in uricemia was noted in G1. No significant modifications were observed in the other variables analyzed. CONCLUSION: Considering the cost x benefit relationship, a diet low in purine should be the 1st therapeutic option for controlling hyperuricemia in patients with similar characteristic to the ones presented in this study