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.

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.

Ovarian cancer screening: could you recommend it? No

15 Aug

In December 2015, The Lancet published the final results of The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)  which “was designed to determine how many lives could be saved by screening for ovarian cancer”.  The UKCTOCS is another ovarian cancer screening that demonstrates that screening did not reduce  ovarian cancer specific mortality neither all-cause mortality. Ovarian cancer screening should not recommended.

  • Ovarian cancer screening: could you recommend it? No. Gérvas J. Evid Based Med. 2016. 10.1136/ebmed-2016-110385. Download whole article here.

Ten commandments for the rational use of vaccines. November 2015

1 Nov

Vaccines are a treasure that is not defended and it is improved by simply repeating that mantra. The vaccine treasure requires good use and a continuous critical evaluation, in relation to developing and maintaining the vaccination schedules. Vaccination policies have been very poor in the recent decades, in the scientific, professional and political areas. This has arose “vaccine hesitancy” in the population and in some extreme cases, rejection as a whole. The medical students integrated into Farmacríticx and IFMSA-Spain and healthcare providers members of NoGracias are developing a project that promotes the best use of vaccines, and they have develop the decalogue commandments to promote the rational use of vaccines

Social egg freezing (oocyte banking for anticipated gamete exhaustion). Ethical, practical and social problems

18 Sep

This text has two objectives: 1/to draw attention to an important issue in women’s health; and 2/to help train health professionals by providing evidence-based information about and criteria for what is called “social egg freezing.” Why don’t we extract eggs or ovarian tissue from women who are still young and then freeze and store them until they are needed at a later age? At first glance, this may seem to be a kind of preventive measure, one that could achieve “better health of the embryo”, that “buys time” and allows “breathing”, since freezing offers a de facto stopping of the clock. Regression and atresia of eggs are avoided, since frozen eggs remain as they were when initially removed many years earlier.

Unfortunately, however, only the eggs or ovarian tissue fragments remain the same: real time passes for the woman herself, her own body ages, so that if she becomes pregnant at a much later time, more complications are expected in pregnancy, childbirth and the postpartum period. Freezing eggs and ovarian tissue fragments for use in reproduction for social causes raises serious ethical, practical and social issues that require reflection to prevent “normalization” and trivialization and to ensure there is no medical violence against women.

  • Social egg freezing (oocyte banking for anticipated gamete exhaustion). Ethical, practical and social problems. Juan Gérvas and Mercedes Perez-Fernandez. Madrid (Spain) September 2015. Download whole document here.