Quaternary Prevention activity, Lecce, Italy September 2017 / Reports available


Overmedicalization and Quaternary Prevention

Lecce (Italy) – September 28th – 30th 2017

From the home page, you can have access to an Italian or English version of a brief report and to all presentations in PDF.

Please follow the links:

We thank Ernesto Mola for sharing the conference reports.


WONCA SIG QP&O Coordination

Related post:


Quaternary Prevention Manifest / Prevención cuaternaria, presente y futuro

Family and community doctors in Lima, Perú. CIMF conference, August 2017.

Recently published: Quaternary Prevention: present and future.

Official statement of the WONCA SIG QP&O.

Available in Archivos de Medicina Familiar y General (on line Journal), Argentina.

Languages available: ESP, PORT, EN, FR, IT.

Document first communication was done at XV Congreso de la FAMFyG – Buenos Aires, Argentina, 2016 by Jorge Bernstein y Ricardo La Valle.

Round table. Quaternary Prevention(P4) or first do not harm/Mesa redonda. Prevención Cuaternaria (P4) o primero no dañar/Mesa redonda. Prevenção Quaternária (P4) ou primeiro não prejudique/Table ronde. Prévention quaternaire (P4) ou d’abord ne nuire pas

Siguiendo el vínculo Round table. Quaternary Prevention(P4) or first do not harm.


[en] Quaternary prevention (P4), born from a reflection on the doctor-patient relationship, began as an answer of family doctors facing overmedicalization. It aims to protect the patient or population against the danger of medicine. Harmful effects can appear with preventive activities (example: prostate cancer screening by PSA) as well as by therapeutic interventions (example: disruptive medicine). P4 promoted by the World Organization of Family Doctors (WONCA) is practiced in different ways around the world through the activity of the WONCA Special Interest Group on Quaternary Prevention and Overmedicalisation (P4&O).
There are multiple initiatives and backgrounds of P4. All these multiple initiatives that lead to P4 have their origin in denouncing the inadequacies of the Hegemonic Medical Model and the excesses perpetrated in the pursuit of profit. There are many schools of thought that try to solve this situation, such as “Medicines Based on …” These contributions are valuable but usually point to a single dimension of the problem so they do not change the situation too much. The P4, however, have understood the centrality of the political and economic dimensions and, that is why, P4 has become a movement.
P4 has understood that the root causes far exceed the limits of medicine, have understood that the problem includes ethical, political, economic and epistemological aspects of medicine. It is for this reason that the definition of P4 has shifted to the function of foundational idea since the movement that has been generated around this concept has surpassed this initial definition centered in a, yet complex, but still medical vision. P4 has understood that a new model of medicine and a new pact with society is necessary.
P4 is a counter-hegemonic movement with predominant development in peripheral countries. This movement includes many other perspectives developed in the central countries but is the only one that has an ideological position that discusses the current paradigm of medicine that legitimates the same causes that give rise to P4, proposing to think a new way of practice the medicine that includes Ethical values, other forms of knowledge and the return to human medicine for humans with place for uncertainty, compassion, the encounter between people and non-commodified.
Justice in health care is a central aspect of this new way of conceiving the medicine that we propose. Remember what Rudolf Virchow said in the nineteenth century “Physicians are the natural advocates of the poor and social problems fall largely under their jurisdiction. Medicine is a social science, and politics is nothing more than medicine in large scale”. We must reformulate our contract with society and for this we must be very clear that our loyalty must always be with the sick, the poor and those who are weak. For this new contract we must also take into account the magnitude of the power that has been given to us and to live up to such responsibility.
In the Rio manifesto (2016) we propose to “Avoid and denounce the naturalization of: hunger, exclusion, manipulation, inequality, violence, racism, exploitation, which harm health more than “diseases”” . There is a better and fairer world, let’s fight to get it!
More about P4 on

Quaternary Prevention activity / Lecce, Italy, September 28th – 30th 2017

We are pleased to invite you to the Conference organized by the Italian Network of Scientific Association with the endorsement of the WONCA SIG on Quaternary Prevention & Overmedicalization.
Miguel Pizzanelli
Chair of the QP&O WONCA SIG

Preventing Overmedicalization by listening and sharing.
Overmedicalization and Quaternary Prevention

Lecce (Italy) – September 28th – 30th 2017
I am pleased to invite you to the International Conference organized by the Italian Network of Scientific Associations affiliated with  WONCA.

During the last decades, scientist medicine made impressive strides. Developing imaging and diagnostic techniques, drug therapies, new surgery and interventional techniques made cures remarkably improved. At the same time, they led diseases once considered as incurable to healing. Nevertheless, there are negative effects arising not only from inappropriate intervention, adverse reactions and collateral effects but also from the consequences of practising some of the diagnostic and therapeutic techniques. One of the most significant examples is over-diagnosis in mass screening tests. Although, when severe conditions occur, early diagnosis allows less invasive and better treatment, there is still a share of patients who are diagnosed with and treated for those conditions who would have never shown any symptoms or health-threatening consequences. How to be aware of the phenomenon and properly inform the patients?

Marc Jamouille (creator of the definition of Quaternary Prevention),
Anna Stavdal (President of WONCA Europe),
Maria del Rosario Perez (coordinator of WHO Global Initiative on Radiation Safety in Health Care Settings),
Roberto Satolli (doctor and medical journalist)
are some of the welcomed guests of the Conference, that will be held from 29th to 30th September.
Moreover, on 28th September the National Giotto Movement workshop will take place.

Ernesto Mola
President of Italian Network
of Scientific Associations
Affiliated with WONCA

For more information and registration procedure please visit the
following website:

Closing on 31st August

Simultaneous translation will be provided

Quaternary Prevention Manifest / 5 languages versions

Quaternary prevention, present and future.
To the memory of Mario G. Acuña

“Quaternary prevention (P4) is the collection of health activities that attenuate or avoid the consequences of unnecessary or excessive interventions in the health system, mostly originated in the medicalization and the commercial approach promoted by interests opposed to those of the patients. As a result, we’re not only facing the health system but also the economic and social systems. We advocate for a scientific medicine, one that is humane and ethical, accessible to
those who need it and based on equity. Therefore, our actions are necessarily political and their content is democratic.” (fragment)

On the WICC web page are available five languages PDF versions.

La Prévention quaternaire, présent et futur
Manifiesto por la Prevención Cuanternaria
Prevenção quaternária: presente e futuro
Quaternary prevention, present and future
Prevenzione quaternaria, presente e futuro

Please follow clicking on each title.

Quaternary Prevention Library and Resources / Biblioteca Virtual de Prevención Cuaternaria / Biblioteca Virtual de Prevenção Quaternária / Bibliothèque virtuele et ressources sur la prévention quaternaire

Quaternary Prevention Library and Resources (QP Library)
Biblioteca Virtual de Prevención Cuaternaria (Biblioteca Virtual P4)
Biblioteca Virtual de Prevenção Quaternária (Biblioteca Virtual P4)
Bibliothèque virtuele et ressources sur la prévention quaternaire

Collaborative Database on Quaternary Prevention Resources and References.
Base de datos colaborativa de recursos y referencias bibliográficas sobre Prevención Cuaternaria.
Base de Dados Colaborativa de Recursos e Referências sobre Prevenção Quaternária.Réseau collaboratif de ressources et de références en matière en Prévention du Quaternaire.1 Quaternary

Prevention Bibliography Committee / WONCA SIG Quaternary Prevention and Overmedicalization Comité de Bibliografía en Prevención Cuaternaria / Grupo de Interés en Prevención Cuaternaria y Sobremedicalización de WONCA Comitê de Bibliografia sobre Prevenção Quaternária / Grupo de Trabalho de Prevenção Quaternária e Sobremedicalização WONCA Comité Bibliographie sur Prévention Quaternaire / Groupe d’intérêt spécial WONCA sur la Prévention Quaternaire et la Surmédicalisation.

Background and development of the idea

Since the beginning of the work on Latin American networks on Quaternary Prevention, it has been necessary to provide a database and resources with the objective of disseminating the concept and its application. This idea has been in our minds and discussions for a long time. From the first face-to-face meeting of the Special Interest Group on Quaternary Prevention and Overmedicalization of WONCA (November 2016, Rio de Janeiro, Brazil), we decided to undertake the implementation of this idea. The current platform has been designed to be augmented from various sources and shared with whomever necessary. The documents and materials that are uploaded to the platform can be shared through an Excel document. The entries have been coded with the multilingual terminology of general practice and family medicine, Q-Codes ( ).2

Four languages document: English, Español, Português, Français / Documento en cuatro lenguas: English, Español, Português, Français / Documento em quatro idiomas: Inglês, Espanhol, Português, Français / Document en quatre langues: Inglés, Espagnol, Portugais, Français

Authorship / Autoría / Autoria / Auteur: Comité de Bibliografía en Prevención Cuaternaria / WONCA SIG Quaternary Prevention and Overmedicalization. Pizzanelli M, La Valle R, Jamoulle M. 2017

To collaborate contact:

More details available / Disponible / Disponibel / Ce est disponible à l’adresse:

Published on / Publicado en / Publicado em / Publié en :

Quaternary Prevention Manifest: version in Italian / Manifiesto por la Prevención Cuaternaria: traducido al italiano

A new translation of the Quaternary Prevention Manifest. Now in Italian!
Thank´s to Ernesto Mola
Follow the link:


Nueva versión del Manifiesto por la Prevención Cuaternaria (Manifiesto de Río de Janeiro/2016)

Gracias a Ernesto Mola

Vea el documento en:

Primer Foro Europeo sobre Prevención y Atención Primaria/First European Forum Prevention and Primary Care/ Premier forum européen prévention et soins primaires

See the program:

Quaternary Prevention agenda

Marc Jamoulle: From the clinical practice to the concept of Quaternary prevention

John Brodersen: Quarternary prevention – a new definition proposal

Leo Pas: Mental health – a rational strategy to avoid underdiagnosis and overtreatment

Carlos Martins: Possible strategies to reduce unnecessary tests

Bruno Heleno: Overdiagnosis in cancer screening with a focus on lung cancer screening with low dose CT-scans

Maciek Godycki-Cwirko: Prevention: regulated or recommended?

Mateja Bulc: strategies in DEPRESCRIBING

Jasna Vucak: OTC self prescribing medication: more good or harm?