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Applying the precautionary principle to breast cancer screening: implications to public health

23 Mar

This article discusses the Precautionary Principle to strengthen Quaternary Prevention when dealing with additive preventive measures such as breast cancer screening. According to Geoffrey Rose additive preventive measures are generally professional-led interventions that are alien to human ecology, economy, and physiology. These include drugs, vaccines and other biological, physical, and chemical products. Additive preventive measures can produce harm without potential benefit since most individuals are asymptomatic (healthy) and not destined to become sick in the future. Consequently, additive preventive measures cannot be considered safe and policymakers are accountable for providing evidence of their net benefit.

  • Applying the precautionary principle to breast cancer screening: implications to public health. Tesser CD, Norman AH, Gérvas J. Cad Saude Publica. 2019 Jul 22;35(7):e00048319. doi: 10.1590/0102-311X00048319. Download article here.

Coronavirus from Wuhan (China). 2019-nCoV. What you need to know to avoid a panic epidemic

23 Mar

Coronaviruses have been with us for thousands of years, and we are prepared to overcome their infections.  If you have traveled to Wuhan (China) or have had close contact with those who have traveled there and have severe catarrhal symptoms with respiratory distress, consult your doctor especially if you have any underlying disease.  In all other cases avoid a panic epidemic, be prudent.

  • Coronavirus from Wuhan (China). 2019-nCoV.  What you need to know to avoid a panic epidemic. Gérvas J. Madrid. February 2020. Download article here.

What has evidence based medicine (EBM) done for our patients? We do not know. We must abandon it

18 Sep

We must admit that: a / “if the final objective of EBM (Evidence Based Medicine) is to improve patients-populations’ health, do we have evidence of succeed in this objective?” No, b / is EBM harming patients-populations’ health? We do not know. Evidence-Based Medicine (#EBM) has not demonstrated any impact on patients’ health. It is honest to think that the EBM has become harmful and it is urgent to abandon it and replace it with a Medicine Based on Living.  See also: https://www.actasanitaria.com/what-has-evidence-based-medicine-ebm-done-for-our-patients/

  • What has evidence based medicine (EBM) done for our patients? We do not know. We must abandon it. Gérvas J. Madrid. September 2019. Download article here.

Quaternary prevention: a task of the general practitioner

18 Sep

-“Prevention is better than cure”. This principle is undisputed. New knowledge points to the fact that prevention can  also  do  harm.  Under  the  concept  “quaternary  prevention”  efforts  are  currently  focused  on  finding  the  right measure of preventive care, true to the old medical tenet “primum non nocere”.
  • Quaternary prevention: a task of the general practitioner. Kuehlein, T., Sghedoni, D., Visentin, G., Gérvas, J., Jamoule, M. [Quartäre Prävention, eine Aufgabe für Hausärzte]. PrimaryCare. 2010; 10(18): 350-4. Download article here.

Measles outbreaks, a public health focus

11 Apr

We have problems with measles. But the key question is not the acceptance of the vaccine, but access to it and problems with its effectiveness. Before thinking in mandatory policies, think in improving access and efectiveness.
  • Measles outbreaks, a public health focus. Gérvas J. Madrid, Spain. April 2019. Download article here.

Medicine and its preventive excesses

18 Dec

With practical examples based on the real impact of medicalization in people lives and on the results from relevant and well designed studies, Juan Gérvas analyses the importance of certain screening programmes as breast cancer, thyroid cancer, the relevance of health check-ups and the impact of certain vaccines. He discusses the examples of Public Health Programs in some countries and its null or negative effect in terms of health indicators and quality of life results.

Making use of the Food and Drug Administration briefing documents to reconsider the safety of the antipsychotic sertindole

2 Sep

Sertindole (Serdolect in the world, Zerdol in Germany) is an atypical antipsychotic agent, schizophrenia. Sertindole side effects include cardiac problems as prolongation of QT interval, arrhythmia and sudden deaths (higher than for other atypical antipsychotics). The FDA analysis of SCoP, made public in April 2009, estimated the hazard ratio for sudden cardiac death with sertindole versus risperidone as 5.102 (95% CI 1.453 – 17.913). In April 2009 an FDA advisory panel voted 13-0 that sertindole was effective in the treatment of schizophrenia but 12-1 that it had not been shown to be acceptably safe.
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/PsychopharmacologicDrugsAdvisoryCommittee/UCM198218.pdf

Sertindole was never approved for use in the USA and was discontinued in the U.K., Australia and the New Zealand. Sertindole was approved in the European Union (and others counytries) in 2002 (
http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Sertindole_36/WC500011855.pdf )

This manuscript is being released primarily for two reasons. First, the importance of accessing freely available FDA documents to obtain a more complete characterization of a drug’s safety and efficacy. Second, to alert patients and prescribers in other countries about the potential risks of sertindole. 

  • Making use of the Food and Drug Administration briefing documents to reconsider the safety of the antipsychotic sertindole. Sasich LD, Abi-Jaoude E. Ontario, Canada. September 2016. Download article complete here.