26 sep
En este texto se comentan 10 artículos publicados en el último año que demuestran el abuso de la Medicina en diversos campos. Se trata de la seguridad de los medicamentos (con el dietilestilbestrol de ejemplo), de los ensayos clínicos manipulados y otros campos.
21 sep
Se nos ha insistido año tras año en la necesidad de vacunar contra la gripe cada otoño. Aparentemente, por las mutaciones del virus. Pero en la temporada 2011-2012 se recomienda exactamente la misma composición de la vacuna previa de 2010-2011, y sin embargo se insiste en la necesidad de vacunar. Ahora, la inmunidad de la vacuna dura un (1) año. Es una vacuna “terminator”, como las semillas estériles que hay que comprar en cada temporada. En el texto anexo se examina esta vacuna “terminator”.
Sobre la pandemia de gripe A, ver el vídeo de las Jornadas de Farmacriticxs (estudiantes de Medicina) y NoGracias (profesionales sanitarios a favor de unas relaciones sanas con las industrias), celebradas en Oviedo, noviembre de 2010
21 sep
La enfermedad es en cierta manera un estado de desvalimiento. Por ello es importante que el profesional trate con dignidad y respeto al paciente, para compensar la “minusvalía” del enfermar. En el caso de los enfermos mentales todavía es más importante el trato como persona, la defensa de los derechos del paciente. En este texto se examinan cinco ejemplos en los que los enfermos mentales “reclaman” ser vistos y atendidos como personas.
21 sep
Primary health care have a different status across countries. This paper is an exploration of the reasons why. Much can be learned by analysing Spain as a benchmark, and comparing it with other Mediterranean countries (Greece, Italy, and Portugal).
21 sep
Primary health care provides services fitted to health needs of the population. To understand the way of working in PHC we need to consider a general framework with focus in the workforce (providers) and the way of payments (and incentives). Considerations around the Duth model helps in this paper to make proposals for improvement.
20 sep
Rethinking the health service production function: What role for primary health care in modern health service provision?
Seminar of Innovation in Primary Care. Oxford (UK), 29nd September 2012
Organized by Juan Gérvas MD, PhD (general practitioner, Equipo CESCA, Madrid, Spain; visiting professor, International Health, National School of Public Health, Madrid) and José M. Valderas MD, PhD (Professor, Department of Primary Care, Oxford, United Kingdom).
Health policy-making is by definition concerned with selecting health interventions between different alternatives. Evidence exist that some of those interventions have to be inter-sectoral actions, prompting other sectors to “do something good for health”, such as increasing tobacco taxes in order to reduce smoking. However, the bulk of the actions promoted by most health policies are (hopefully cost-effective) health services in response to well assessed health needs. There are very many types of services, defined in many different ways (e.g. laboratory services, nursing services, emergency services).
When defining those services we prescribe the use of well defined inputs in the expectation to produce some precise outputs and outcomes. For example, without narcotic analgesics and skilled primary care professionals it will extremely difficult to take care of terminal patients at home. Having both, however, is not sufficient guarantee that the above mentioned outputs and outcomes will be optimum. A number of important issues emerge therefore: what is the best mix of skills?, for example; or how to offer continuity of care for these patients (and relatives) during out-of-working schedule?; or, what is the role of palliative teams, and in general that of the hospital?; etc.
The answers to those questions have been the body of intense debate for decades, and they have remained reasonably stable. We now need to think about health systems, however, as organizations which offer services in a changing world, with changing technologies and therefore changing boundaries regarding the “best location” for the services, with private and public stakeholders wanting to participate in what has become a phenomenally important economic activity, strong resistance to change by many who fear that change may mean the end on long-cherished privileges, and so on and so forth.
In other words, there is a need to answer (again!) a number of critical questions that will determine the way health care will be delivered in the coming decades, such as:
and indeed many others.
I would like to suggest the document about “What role for primary health care in modern health service provision?” for launching the debate that should lead us to the seminar proposed for the Autumn of 2012. The paper is the product of a number of reflections by me, Juan Gervas, with open discussions for a number of months with Antonio Durán and Barbara Starfield, unfortunately interrupted by Barbara’s death. It is not certainly not presented as any kind of dogma but rather as a sincere review of what used to be solid certainties and now are openly challengeable convictions, open to criticism. An ongoing on-line debate is also expected to take place along the tradition of our seminars, ending with a paper to be published in a peer-review journal after the face-to-face meeting.
Inscription for the seminar will be free but request is needed to Juan Gérvas (jgervasc@meditex.es as well as mpf1945@gmail.com) and to Raimundo Pastor (rpastors@meditex.es).
Thanks to you all.
20 sep
Los errores médicos son inevitables, pero algunos errores médicos no son tales, sino empecinamiento y “malicia”. Este es el caso de la terapia hormonal en la menopausia, que se implantó en contra de toda prudencia. Es, también, el conjunto de actividades médicas diagnósticas y terapeúticas que se ejercen “contra” las mujeres hasta llegar al encarnizamiento. En este editorial se repasan estos excesos.
