Public health policies and scientific evidence

DOI: 10.1590/S1679-45082017ED4314 Patients are the same all over the world. Evidence is the same in the entire world. However, care policies are not the same. This is impossible to understand and unacceptable, since there is no different evidence for public and private care; it is not a matter of being capitalist or socialist, of presence or distribution of money; it is the fight against consumerist, untruthful and voracious capitalism, encouraging licit “robbery”; it is an issue of equity and ethics; of assured constitutional rights; in which doing something means always doing it correctly and for everyone; where there is no freedom and no prohibition at the same time; where everything starts at standardization; where there is no room for futility; where excesses are banned; where not only is there orientation as to what to do, but also as to what not to do; where the patient is not the means, but the end; where variation by VALUE is combated; and where the concept of VALUE considers costs, as well as benefits and damage.(1) Nevertheless, how is it possible to not use evidence in health policies? Since evidence defines what is necessary and what is superfluous; provides options of equivalent benefits and forbidden practices; informs about the estimated amount of benefit and damage, and regarding the adoption of new practices with no benefit; defines the concept of value and the use of money with discrimination; leads the market towards its function and the media towards appropriate criticism; gives orientation as to priorities and strategies; reduces variations in practice and conflicts; and balances interests.(2) What has been done? How has the “quasi-evidence” been considered in the definition of access to care? Well, the health authorities are limited in deciding “what and how much is paid (or not paid)”, by means of their “technology” assessment centers, using expert ghost consultants, before, during, and after issuing their opinions based on “God only knows” what but always aligned with their own interests. What could and should be done initially with the evidence available? It is considered that, through the same health authorities, four different and complementary offices would be created with a core purpose of defining what is right or wrong to be offered to all patients, Public health policies and scientific evidence