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Index case for the fungal meningitis outbreak, United States

13 May

Publications about the fungal meningitis outbreak (USA) do not address whether these injections were appropriate for low back pain. Physicians, patients, payers and regulators should question the role which overuse of injections for low back pain in the US played in this outbreak. Index case for the fungal meningitis outbreak, United States. Gérvas J, Kovacs FM. [...]

Trials of improve care for the elderly

7 Mar

Clinical randomized trials are experimental situations where some patients might received excellent care. What happens after the end of the trial? This a key ethical question should be answered in all proyects and programs of clinical trial.  Trials of improve care for the elderly. Gérvas, J., Pérez Fernández, M. N Engl J Med. 1996; 334: [...]

Medicalization of aging and the testosterone deficiency syndrome

16 Dec

Over the last few years it has been proposed that the simple fact of having testosterone below the normal levels, which occurs with the passage of time, provokes a constellation of disorders. Testosterone therapy in the management of TDS (testosterone deficiency syndrome) is not justified, because there is no clear benefit in the relevant primary [...]

Crying patients in general/family practice: incidence, reasons for encounter and health problems

16 Dec

Despite evidence demonstrating the benefits of understanding patients, there is a paucity of information about how physicians address psychological and social concerns of patients. Patients cried in 157 encounters out of a total of 18,627 giving an incidence rate of 8.4 per thousand. More frequent reasons for encounters were: feeling depressed (12.7%), social handicap (mainly [...]

Overenthusiastic interpretation of a nonetheless promising study

10 Apr

A recent study concludes that mesenchymal stem cells (MSC) therapy provides the “same or better” relief for pain and disability, as current gold standard treatments for chronic unspecific low back pain (cLBP) caused by degenerative disc disease (DDD), namely spinal fusion and total disc replacement. This conclusion lacks scientific base, as pointe out in this [...]

Logical graphical representation of medical activity

20 Dec

The health system has four functions: 1/ health protection, 2/ health promotion, 3/ health prevention, and 4/ care of diseases and helping to die. In this text there is a proposal for a graphical representation that helps in understanding the medical activity. Logical graphical representation of medical activity. Gérvas, J. Diciembre 2011. Download English version here.

Quaternary prevention: theory and practice

13 Oct

All health services have adverse effects, all health services might produce damage to health. A few services produce more benefits than harms in specific situations. Unnecessary and inappropriate services mainly produce harms, and few benefits if any. Quaternary prevention is the prevention of unnecessary and/or inappropriate services and the prevention of over-medicalisation. Quaternary prevention refers mainly to personal services, [...]