Can innovation increase the therapeutic options but accentuate the inequalities in the healthcare system?

Causal Link between Technological Innovation and Inequality Moderated by Public Spending, Manufacturing, Agricultural Employment, and Export Diversification

Sustainable Development Goal 10 (SDG10) proposes the reduction of inequalities. This research highlights the importance of considering short- and long-term mechanisms for designing and applying policies to reduce income inequality. Specifically, we test for the causal link between technological innovation and income inequality using a balanced panel data sample from 73 countries worldwide. The inequality–technological innovation relationship is moderated by public spending, manufacturing, employment in agriculture, and export diversification. We use quantile regression techniques to test the impact of technological innovation on income inequality. The results offer robust empirical evidence that in most quantiles, the impact of technological innovation on inequality is positive. This result suggests that the dark side of technological innovation is that it increases income inequality. Furthermore, we find that government spending reduces inequality across all quantiles, while the effect of employment in agriculture and export diversification is inconclusive. Those responsible for social policy towards the achievement of SDG10 must include the advantages of public spending to reduce social disparities and promote social cohesion within countries.

Is a law enough to provide a better prognosis for Brazilian melanoma patients or education is still a gap?

According to Brazilian Law 12.732/12 ("60-day law"), cancer patients have 60 days after diagnosis for beginning treatment at the Unified Health System (SUS). The study aimed to evaluate the achievement and effectiveness of the '60-day law' for melanoma patients in a SUS cancer reference unit. A retrospective study analysed 58 medical charts from patients with the initial diagnosis performed before and after the "60-day law". The Law does not change the time interval between diagnosis and the beginning of treatment, and after the Law, patients presented a worse overall survival (p < 0.001). In conclusion, the '60-day law' was not effective.

Assessment of retraction in surgical specimens in melanoma patients submitted to oncological amplification of margins

INTRODUCTION

Skin cancer is the most common type of cancer and represents more than half of the diagnosed malignant tumors. There are more than one million new cases per year in the United States and about 120.000 new cases in Brazil. Cutaneous melanoma represents 5% of all primary cutaneous neoplasms; however, it has a worse prognosis. Adequate treatment of the primary lesion is the main cure factor, with free surgical margins, thus avoiding recurrences of the lesion.

OBJECTIVES

The present study aims to evaluate and quantify the retraction of the surgical specimen in three moments, in-vivo, ex-vivo and in-vitro, and also evaluating possible factors related to retraction, such as formalin fixation, age, patient's gender, and lesion location.

METHODS

This is a prospective, single-center cohort that evaluated 145 surgical specimens from patients who underwent oncological surgery of cutaneous melanoma margins enlargement. Lesions were marked with a standard brush, and surgical margins were measured with a sterile ruler, according to their initial staging. After resection, new surgical specimens measurements were obtained, and, after fixation in formalin, the last measurement was performed. The same oncological surgeon performed all procedures, and the same pathologist analyzed the specimens.

RESULTS

Regarding the area of the specimens, there was a general median retraction of 38.15% between in-vivo and ex-vivo (p < 0.001), and 43.97% between in-vivo and in-vitro. When the measure of the specimen length (L) was evaluated, there was a 17% retraction between in-vivo and ex-vivo, and 20.42% between in-vivo and in-vitro, with statistical significance. The younger population has a higher rate of retraction, and lesions on the back have a lower rate of shrinkage on the opposite of lower limbs that had higher shrinkage.

DISCUSSION

Corroborating the literature, this study showed an average shrinkage of 20.42% for length measurements between in-vivo and in-vitro, and the main predictors of greater or lesser retraction were age and location of the lesion. It is also noted that the most considerable retraction occurs immediately after surgical resection, indicating that skin characteristics, such as degree of elasticity and tension, are determinant for the retraction. Formalin action does not significantly impact retraction. This study shows the importance of adequate treatment of the primary lesion, with adequate surgical margins, and that the measure measured by the pathologist, in general, represents 80% of the margins performed in the perioperative time.