Epidemiology and Evidence-Based Medicine

tensions and corrections for the realization of the right to oncological health in Brazil’s SUS

Authors

DOI:

https://doi.org/10.62530/rbdc25p122

Keywords:

Right to health, Unified Health System, Epidemiology, Evidence-Based Medicine, Oncology

Abstract

ABSTRACT: Contextualization: the realization of the right to health in Brazil requires reconciling scientific rigor and social justice. Problem: this article critically analyzes the relationship between epidemiology, Evidence-Based Medicine (EBM), and the Unified Health System (SUS), with emphasis on oncology. Objectives: to demonstrate that EBM, although necessary, is insufficient when applied in isolation, and that only when articulated with epidemiology – a structuring principle established in Article 7 of Law No. 8,080/1990 – can it support equitable and legally legitimate decisions. Methods: the study adopts a qualitative and descriptive approach, with bibliographic and documentary analysis of legal norms, technical reports, and national and international scientific literature between 1990 and 2025. Results: three critical points emerge: (i) the low external validity of oncological clinical trials when applied to the SUS context; (ii) the predominance of budgetary impact in CONITEC decisions over ethical and social aspects; and (iii) the contradiction between high-cost biomedical innovation and the epidemiological priorities of vulnerable populations. Cost-effectiveness evidence of interventions on social determinants of health, such as screening programs and community support, shows robust gains at reduced costs, in contrast with oncological therapies of marginal benefit. Conclusions: the integration of EBM and epidemiology is a necessary condition to materialize constitutional universality and equity, preventing scientific evidence from becoming an exclusionary technicism and ensuring its role as a criterion of distributive justice.

Author Biographies

  • Juliana dos Santos Tavares, Santa Cecília University

    Graduated in Medicine from the Faculty of Medical Sciences of Santos (2000–2005).
    Completed a residency in Internal Medicine at Hospital Santa Marcelina (2006–2008).
    Completed a residency in Clinical Oncology at the Arnaldo Vieira de Carvalho Institute – ICAVC (2009–2012).
    Postgraduate training in Palliative Care at Instituto Paliar in 2014.
    Received the title of Specialist in Palliative Medicine from the Brazilian Medical Association (2019).
    Has worked as a clinical oncologist at Santa Casa de Misericórdia de Santos since 2012.
    Has worked as an oncologist and palliative care physician at Hospital Guilherme Álvaro since 2013.
    Served as a professor at Fundação Lusíada, School of Medicine, from 2014 to 2020.
    Coordinator of the Academic Center for Palliative Care from 2018 to 2020.
    Supervisor of the Clinical Oncology team at Santa Casa de Misericórdia de Santos since 2020.
    Supervisor of the Internal Medicine residency at Hospital Guilherme Álvaro since 2022.
    Clinical preceptor for the 12th term of the Medicine program at Universidade de Ribeirão Preto, Guarujá campus.
    Master’s degree student in Health Law (stricto sensu) at Universidade Santa Cecília since March 2025.

  • Andrea Sander, Santa Cecília University

    Physician. Bachelor of Medicine from Universidade Lusíada de Santos (UNILUS). Medical residency in Clinical Oncology. Lato sensu postgraduate degree in Palliative Care. Master’s student in Health Law at the Graduate Program in Health Law, Universidade Santa Cecília (UNISANTA).

  • Marcelo Lamy, Santa Cecília University

    Lawyer. Bachelor of Legal Sciences (UFPR). Master in Administrative Law (USP). PhD in Constitutional Law (PUC-SP). Postdoctoral researcher in Public Health Policies (Fiocruz Brasília). Postdoctoral researcher in Fundamental Rights and Access to Justice (UFBA). Permanent Professor and Vice-Coordinator of the Graduate Program in Law (Master’s Degree), Universidade Santa Cecília (UNISANTA). Professor of the Master of Science in Legal Studies, Emphasis in International Law (MUST University). Professor in the Law and International Relations courses (UNISANTA). Leader of the CNPq/UNISANTA Research Group “Human Rights, Sustainable Development and Legal Protection of Health.” General Director of the Observatory of Migrant Rights (UNISANTA). Coordinator of the Laboratory of Public Policies (UNISANTA). Professor at the Faculty of Law (ESAMC-Santos).

  • Marcos Montani Caseiro, Santa Cecília University

    Physician. Bachelor of Medicine (UNILUS). Residency in Infectious and Parasitic Diseases (Instituto de Infectologia Emílio Ribas). Master’s degree in Preventive Medicine (USP). PhD in Infectious Diseases (UNIFESP). Infectious disease specialist at Hospital Guilherme Álvaro (Santos/SP). Professor at Santa Cecília University (UNISANTA), São Judas Tadeu University, and Centro Universitário Lusíada (UNILUS). Experienced in Infectious and Parasitic Diseases, with emphasis on epidemiology, HIV/AIDS, and public health.

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Published

2025-11-14

Data Availability Statement

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Issue

Vol. 25 (2025)

Section

Artigos

How to Cite

DOS SANTOS TAVARES, Juliana; SANDER, Andrea; LAMY, Marcelo; MONTANI CASEIRO, Marcos. Epidemiology and Evidence-Based Medicine: tensions and corrections for the realization of the right to oncological health in Brazil’s SUS. Revista Brasileira de Direito Constitucional, [S. l.], v. 25, p. 122–137, 2025. DOI: 10.62530/rbdc25p122. Disponível em: https://www.rbdc.com.br/revista/article/view/411. Acesso em: 17 nov. 2025.