Science of Uncertainty: Making Cases for Drug Incorporation in Brazil

Public health efforts around the globe are increasingly dominated by concerns over access to high-cost medicines. These drugs bring new benefits and potential risks to bear on populations and greatly impact government budgets and priorities. This article explores how scientific evidence is being mobilized to inform decisions concerning the incorporation of health technologies in Brazil. I conducted interviews with experts and observed the work of a start-up company based in Rio de Janeiro that performs economic analyses on behalf of the pharmaceutical industry. These analyses are used by the Ministry of Health to decide whether or not to incorporate new technologies.

The article shows that, in performing economic analyses, company employees sought to locate/construct from known/measured parameters, a need/demand for the drug within the public system, thus creating a market. Uncertainty is not merely an incidental obstacle of the company's work but a core feature of its practice. The strategic use of uncertainty allows for the displacement of public health priorities by commercial interests and the supplanting of what is sensibly sound by what is methodologically permissible.