Coercion is not justified in influenza vaccination

30 May

There are some countries (as Canada and the US) where mandatory influenza vaccine for health workers is a question in debate. There is good intention (to decrease influenza transmission) but has no scientific base, and has adverse effects in public health, as we consider in this paper.

  • Coercion is not justified in influenza vaccination. Gérvas J, Altisent R. Madrid, May, 2013. Download whole text here.

BRCA test, only for females of high familiar risk

22 May

BRCA genes are “normal” genes we all share in our cells. Some mutations of BRCA genes are associated with a higher incidence of breast and ovarian cancer. In this summary there is a few numbers to understand the problem.

  • BRCA test, only for females of high familiar risk. Gérvas J. Madrid, 21st May 2013. Download text here.

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. N Engl J Med. 2013; 368: 970. Download article here.

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: 665. Download full article here.

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 endpoints and there are alarming results on the possible risks.
Increasing consumption responds to the success of awareness raising campaigns. TDS is a clear example of disease mongering.

  • Medicalization of aging and the testosterone deficiency syndrome. Gérvas, J., Gavilán, E., Gorricho, J. BIT Navarra. 2012;20 (4):1-8. Download article here.

See also a “letter” about the same topic published by the authors in BMJ:

  • Marketing, not evidence based arguments has probably increased testosterone prescribing. Gorricho, J., Gavilán, E., Gérvas, J. BMJ 2012; 345: e6905 doi: 10.1136/bmj.e6905 (Published 17 October 2012). Download letter here.


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 social isolation/living alone) (6.4%), relationship problem with partner (5.1%) and feeling anxious (3.2%). More frequent health problems were: depressive disorder (23.6%), anxiety disorder (8.3%), cerebrovascular disease (5.1%) and loss/death of partner (3.8%).

  • Crying patients in general/family practice: incidence, reasons for encounter and health problems. Gérvas, J., Pastor-Sánchez, R., Pérez-Fernández, M. Rev Bras Med Fam Comunitaria (Florianópolis). 2012:7. Download article here.

A few reasons to say no, thanks, to influenza vaccines

13 Sep

Influenza is a very common infection that spreads during winter time. In general flu is a lightly disease, but it may complicate the evolution of chronic patients, and even healthy ones. The best answer to stop the propagation is just to wash your hands. But official institutions and private organizations push to introduce influenza vaccine in children, elderly and health professionals, even asking for mandatory vaccination. There are no scientific bases for this proposal. See the text with links to the best evidence about this question, many from Cochrane Reviews.