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Overdiagnosis as an extreme form of length-time bias. Breast cancer screening as an example

14 Oct

Overdiagnosis is an error of prognosis. Overdiagnosis is not an error of diagnosis. Overdiagnosis is a “true positive” diagnosis. We cannot distinguish between overdiagnosis cancer and non-overdiagnosis cancer. In this presentation the focus is on the vision of overdiagnosis as extreme form of length-time bias, and the research lines which might help in the future to resolve the problem. Please, download the presentation because it is a dynamic one.

  • Overdiagnosis as an extreme form of length-time bias. Breast cancer screening as an example.  Gérvas J. Madrid (Spain). October 2014. Download presentation here.

See more in:
The overdiagnosis of cancer: when the diagnosis undermines the quality of life. http://pharmawatchcanada.wordpress.com/2014/01/10/the-overdiagnosis-of-cancer/

“Dr Cholesterol” against the “British Medical Journal”. Do not measure your cholesterol, be happy

26 May

The British Medical Journal has had problems with two papers about primary prevention of coronary artery disease (heart disease). Both papers have data that demonstrate statins have no use in primary prevention for most patients. The British Medical Journal problems relate to power, money and censorship. In this text a teacher explain the situation to her students.

  • “Dr Cholesterol” against the “British Medical Journal”. Do not measure your cholesterol, be happy. Gérvas J. August, 2014. Download document here. Download whole document here.

Organization of Spanish Consumers against “medicalization of daily life”

8 May

Last 25th March, OCU joined and signed “Action on Selling Sickness” during a public action in a press conference. The Organization of Spanish Consumers is a private and independent one.

OCU has translated into Spanish the document, and have started a campaign againts “medicalization of daily life” http://www.ocu.org/salud/medicamentos/informe/demasiados-medicamentos/stampa

Notice the Spanish impact in the call for action” after the OCU action http://sellingsickness.com/final-statement/

The OCU organization was created in 1975; is a non-profit organizationto defend the rights of consumers.

The OCU is not subsidized, but is financed by contributions from its members, currently over 315,000 members. -OCU belongs to “Consumer International” http://www.consumersinternational.org/our-members/member-directory/OCU%20-%20Organisation%20of%20Consumers%20and%20Users%20-%20Organizaci%C3%B3n%20de%20Consumidores%20y%20Usuarios

It is important that consumers associations joint health professionals and health intitutions. See its 3 recommendations for being aware about medicalization and selling sickness. Summary, be aware when:

  1. Speak only of great benefit without mention the risks or alternatives, where they exist (although they have nothing to do with taking pills).
  2. Exaggerate the dangers of a health problem or even a risk factor to the point of generating large dose of insecurity and alarm.
  3. Behind campaign, web, advertisement or any other form of communication that seeks to “inform” about a disease or health problem, is a company that can thereby obtain a direct economic benefit.

Sacred secrets broken. Threats to the confidentiality of medical records. The case of Osabide, the centralized data base of Osakidetza (Basque Health Service) in Spain

25 Mar

The Basque Health Service, Osakidetza, established in 2003 a centralized data base, Osabide, with two millions medical records in full without asking permission or even notifying patients or the public (in some cases against the written opposition of a few patients who knew about the initiative). Two general practitioners who rejected Osabide and prepared a piece of paper to inform patients in the waiting room were punished with a penalty of two years without work and salary (later on a jury order to repair all rights). This is a letter about the case.

  • Sacred secrets broken. Threats to the confidentiality of medical records. The case of Osabide, the centralized data base of Osakidetza (Basque Health Service) in Spain. Gérvas J. 2003. Download whole article here.

Link to first publication http://docpatient.net/ethics/pdf/Sacredsecretsbroken2003.pdf

Too much medicine. Less is more

13 Feb

Too much of a good thing is bad. Too much of good thing may not be wonderful. You can have too much of a good thing as food and alcohol and the excess of either can make you fat or drunk. In medicine, in general, the motto should be “maximum quality, minimum quantity”. Because more medical interventions, different patients-population expectations and the technology advances, medical activities are becoming dangerous. In this presentation we give a few examples and suggest some solutions.

  • Too much medicine. Less is more. Gérvas, J., Pérez Fernández, M. Vasco da Gama Movement Forum. Barcelona 7-8 Feb 2014. Download presentation or simple text.

Minimum data set in General Practice: definitions and coding

31 Jan

A minimum basic data set (MBDS) was designed and used in general practice. The most important purpose and need for establishing such a data set is to assist in the provision of patient care. MBDS is designed to meet common needs for many general practitioners. Minimum means that individual programmes or the GP are free to collect as much additional data as they may wish. The MBDS includes two kinds of data: permanent and dynamic/encounter items.

  • Minimum data set in General Practice: definitions and coding. Gérvas J, Pérez Fernández M. Fam Pract. 1992; 9: 349-52. Descargar artículo completo.

Multicasuality of falls and the role of drugs

17 Oct

Falls cause important morbidity and mortality in elderly people, but can occur at any age. They can be caused by various concurrent causes. Psychotropic agents such as benzodiazepines and other hipnotic drugs, antidepressants, antipsychotics and opioids have been associated with a higher incidence of falls. To avoid fractures the key question is to avoid falls. It has no sense to focus on osteoporosis and densitometry in postmenopausal females.