Amaral Marise Basso, Rego Sergio
Faculdade de Educação, Universidade Federal Fluminense, Niterói, Brasil.
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2020 Dec 18;36(12):e00115720. doi: 10.1590/0102-311X00115720. eCollection 2020.
The article proposes to discuss the many complexities involved in the incorporation of new health technologies for rare diseases, with a central focus on the case of cystic fibrosis. Cystic fibrosis was chosen because it is a autosomal recessive genetic disorder, considered the most common of the rare diseases. The disease has also benefited greatly from investments in research in the field of molecular biology, mainly in the United States, but also among European research groups, which resulted in the registration and marketing of four new drugs. These new drugs act for the first time on the basic defect in cystic fibrosis. From a perspective that views rare diseases as a field of research woven among many others, the article aims to problematize cystic fibrosis from a more person-centered approach, the duality of witnessing from afar the molecularization of life, the emergence of last-generation drugs that interrupt, at the molecular level, the cascade of errors and thus the symptoms and evolution of the disease. The article aims to bring various elements to the debate that traverse the complex local reality of Brazilian cystic fibrosis patients in a global context of technological innovation and with a break in the treatment paradigm. Based on the field of rare diseases, including the presentation of cystic fibrosis in the age of precision medicine, alongside discussions on biopolitics in a context of health innovation and high-cost drugs, the article aims to shed light on the current challenges and possibilities.
本文提议探讨将新型医疗技术应用于罕见病所涉及的诸多复杂性,核心聚焦于囊性纤维化的案例。选择囊性纤维化是因为它是一种常染色体隐性遗传病,被认为是最常见的罕见病。该疾病也从分子生物学领域的研究投入中受益匪浅,主要是在美国,但欧洲的研究团队也做出了贡献,这促成了四种新药的注册和上市。这些新药首次作用于囊性纤维化的根本缺陷。从将罕见病视为众多交织研究领域之一的视角出发,本文旨在从更以人为本的方法、远距离见证生命分子化的二元性、新一代药物在分子层面阻断错误级联从而改变疾病症状和病程的出现等方面,对囊性纤维化进行问题化探讨。本文旨在引入各种元素参与辩论,这些元素贯穿了在全球技术创新背景下以及治疗范式转变中巴西囊性纤维化患者复杂的本土现实。基于罕见病领域,包括精准医学时代的囊性纤维化介绍,以及在健康创新和高成本药物背景下对生物政治学的讨论,本文旨在阐明当前的挑战和可能性。