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PODC 2019 / Early Bird / Just one week left!

https://www.preventingoverdiagnosis.net/

If you are planning to attend Preventing Overdiagnosis Conference 2019 take this opportunity!

Registration Open

Early Bird Registration at £415 will stay open until July 31st 2019 unless sold out beforehand. Medical & Health Science Student rate and Patient/Charity Group rate will remain open until December 5th 2019. Please note there are limited numbers at this registration rate.

We are pleased to invite you to submit an abstract for the 2019 Sydney conference. You are welcome to submit an abstract relating to one of the conference themes, or about any topic related to overdiagnosis and its prevention. We accept abstracts for presentations, posters, seminars and workshops.

This year’s themes are:

· Commercial Drivers of Overdiagnosis / Commercial Determinants of Health
· Genomics / Precision Medicine / AI
· Overdiagnosis and the Media
· Addressing Overdiagnosis and Overtreatment in Musculoskeletal Conditions
· Screening and Overdiagnosis in the Asia Pacific Region.

QP&O is one of the Associate partners

Reforming disease definitions / Global proposal from Wonca leaders.

Nota Bilingue / Two Languages post

Moynihan R, Brodersen J, Heath I, Johannson M, Kuehlein T, Minué-Lorenzo S,
et al. Reforming disease definitions: a new primary care led, people-centred
approach. BMJ Evidence-Based Medicine [Internet]. 2019 Mar 28 [cited 2019 Apr
10];bmjebm-2018-111148. Available from:
https://ebm.bmj.com/content/early/2019/03/28/bmjebm-2018-111148 

EN

On April 8, this article was published in BMJ, generated by the interest of a group of family doctors and general practitioners from various parts of the Globe. It is a collaborative group focused on the interest of avoiding biases loaded with conflicts of interest, avoiding medicalization, on diagnosis and focusing on people-centred health care.

The article has had extensive collaboration, but it is honest to say that it has been led by Ray and Iona.

Here we only provide the links to access some of the impacts and dissemination of our article. ( See the hyperlinks below).

ESP

El 8 de abril ha aparecido en BMJ, este artículo generado por el interés de un grupo de medicos de familia y generalistas de varias partes del Globo. Se trata de un grupo de colaboración centrado en el interés de evitar sesgos cargados de conflictos de interés, evitar medicalización, sobre diagnóstico y por sobre todo poner la lupa en los cuidados de salud centrados en las personas.

El articulo ha tenido amplia colaboración, pero es honesto decir que ha sido liderado por Ray y Iona.

Aquí solamente les brindaresmos los enlaces para acceder a algunas de las repercusiones de nuestro artículo.
Plataforma NoGracias: http://www.nogracias.eu/2019/04/09/como-evitar-la-definicion-comercial-y-reduccionista-de-las-enfermedades-vision-generalista-independencia-y-participacion-de-ciudadanos/ 

El Gerente de Mediado ( Sergio Minué): https://gerentedemediado.blogspot.com/2019/04/reformar-la-definicion-de-enfermedades.html

The Conversation (Australia, Bond University): https://theconversation.com/we-need-new-rules-for-defining-who-is-sick-step-1-remove-vested-interests-114621

Royal College of General Practitioners (UK): https://www.rcgp.org.uk/about-us/news/2019/april/widespread-debate-needed-on-disease-mongering-and-overdiagnosis-of-patients-says-rcgp.aspx

news GP (Australia): https://www1.racgp.org.au/newsgp/clinical/gps-to-lead-the-charge-against-%E2%80%98too-much-medicine%E2%80%99

“Der Spiegel”, prensa quincenal de Alemania: https://www.spiegel.de/plus/wird-bald-jeder-fuer-krank-erklaert-kommentar-a-00000000-0002-0001-0000-000163403895
Por último comparto la traducción al español de la nota de prensa de Islandia, realizada a Johann Sigurdsson:

https://www.frettabladid.is/frettir/bregdast-thurfi-vid-ofgreiningu-sjukdoma/

Traducción libre:

Dos islandeses se encuentran entre los médicos y científicos que piden una nueva ciencia sujeta a un enfoque de diagnóstico alterado. Tratamientos excesivos e innecesarios son un problema creciente en el mundo.
La atención debe centrarse en el paciente, no en la enfermedad “, dice Jóhann Ágúst Sigurdsson, profesor emérito de medicina familiar.
 
Jóhann, que trabaja tanto en Islandia como en Noruega, es uno de los trece médicos y científicos que publicaron el artículo de esta semana en el British Medical Journal, donde piden un nuevo enfoque para el diagnóstico. Otro islandés está en el grupo, pero es Hálfdán Pétursson quien trabaja en Suecia.
 
“Este no es un grupo organizado, pero decidimos reunirnos y ver si no podríamos ofrecer nuevas ideas para abordar los problemas de crecimiento excesivo o diagnóstico innecesario de la enfermedad”, dice Jóhann.
 
Una gran parte del problema se debe al hecho de que las definiciones de enfermedad se han ampliado demasiado en los últimos años. Esto conduce al tratamiento excesivo y al tratamiento innecesario de sujetos sanos.
 
“Podemos tomar una presión arterial demasiado alta, por ejemplo. En el pasado, tuvimos los límites superior e inferior en 160/95, pero hace unos veinte años se redujo a 140/90. Los estadounidenses han sido mas exigentes reduciéndolo aún más, hasta 130/80. Pero entonces, casi todos terminarán por tener hipertensión “.
 
Jóhann dice que los médicos de cabecera están haciendo todo lo posible, pero deben seguir las instrucciones dadas por las autoridades. “La ciencia detrás de estas pautas esta sustentada con demasiada frecuencia, en investigación que ha sido financiada por la industria farmacéutica o por expertos con conflictos de interés, que desean aprovechar al máximo la enfermedad y así crear más pacientes”.
 
Otro problema está relacionado con los pacientes que tienen más de una enfermedad crónica. Por ejemplo, casi ningún paciente tiene más de cincuenta años solo con diabetes: A menudo esta se ve acompañada de obesidad, hipertensión, enfermedad cardíaca, ansiedad y más.
 
“Si el médico de cabecera tiene un paciente con muchas enfermedades crónicas, se enfrenta ante el desafío de aplicar tantas guías clínicas como lsea posible. Las pautas para cada enfermedad pueden sugerir tres medicamentos en cada caso, por tanto de repente, el paciente se ve ante una indicación que tiene facilmente veinte medicamentos.
 
Las guías clínicas para el tratamiento de enfermedades solo asumen que el paciente padece una sola enfermedad.
 
“Hay una guías para personas enfermas, pero no para la gente común. Hay una gran falta de investigación sobre personas multifacéticas. Estábamos tratando de formar un grupo que pudiera requerir la orientación para tener en cuenta a la persona, no a la enfermedad “.
 
Los autores destacan la necesidad de aumentar el papel de los médicos de cabecera en la determinación del tratamiento de los pacientes. “Los expertos son expertos en la enfermedad, pero los médicos de cabecera son especialistas en el individuo. Debemos poder combinar esto de alguna manera “.
 
Se trata principalmente de no enfermar a las personas innecesariamente. “Por supuesto, solo aumenta la carga sobre el sistema de salud. Así que también se trata de la eficiencia del sistema “.

 

 

WONCA / QP&O. Annual report on the period August 2018 to March 2019.

Members of Uruguayan Quaternary Prevention Group and health workers in academic activity about Quaternary Prevention concept and applications. March 2019, Young, Rio Negro, Uruguay.

Bilingual post EN/ESP

EN: WONCA web page has published the annual report of our Special Interest Group on Quaternary Prevention and Overmedicalization (QP&O). Period August 2018 to March 2019.

WONCA web page update available on https://www.globalfamilydoctor.com/News/SIGQuaternaryPreventionandOvermedicalizationupdate.aspx

Complete report available on

QP&O Annual report. Period August 2018 to March 2019.

 

ESP: En la página web de Wonca esta accesible en informe anual del grupo de interés especial en Prevención Cuaternaria y sobremedicalización de WONCA.

Noticia en Web de Wonca: https://www.globalfamilydoctor.com/News/SIGQuaternaryPreventionandOvermedicalizationupdate.aspx 

Reporte completo: QP&O Reporte Anual periodo agosto 2018 a marzo 2019.

Is there an (unbiased) doctor in the house? / Jeanne Lenzer: Industry Independent Experts.

Industry Independent Experts

Jeanne Lenzer created a list of industry-independent experts oriented to regulatory agencies, journalists, and guideline authors.

The full list was updated recently and is available on https://jeannelenzer.com/list-independent-experts/

Her webpage offers also a Global (Industry-Independent) Resources for Patients and Healthcare Providers: https://jeannelenzer.com/independent-organizations/

The proposal was published on: Lenzer J, Brownlee S. Naming names: is there an (unbiased) doctor in the house? BMJ. 2008 Jul 23;337:a930. doi: 10.1136/bmj.a930.
https://jeannelenzer.com/medical-examiner-blog/2017/11/21/naming-names

Overdiagnosis Position Paper / WONCA Europe Working Group on Overdiagnosis

Interesting position paper on Overdiagnosis.

The WONCA Europe Working Group on Overdiagnosis developed a position paper on Overdiagnosis and Action to Be Taken. The paper was endorsed by the WONCA Europe Council in Krakòw on 24th May 2018. The Working Group consisted of: Mateja Bulc, Andrée Rochfort, Johann A. Sigurdsson (chair), Shlomo Vinker and Giorgio Visentin.

Available: http://woncaeurope.org/content/overdiagnosis-position-paper

In WONCA webpage:

http://www.globalfamilydoctor.com/News/WONCAEuropePositionPaperonOverdiagnosis.aspx

 

First National Quaternary Prevention Course in Perú / June 2018

Bilingual post / Nota en dos lenguas

EN

More is not always better / Less is more

FIRST NATIONAL COURSE OF QUATERNARY PREVENTION IN PRIMARY HEALTH CARE / PERÚ

On June 1st and 2nd, the Family and Community Medicine Society of Perú (SOPEMFYC) organized the First national Course on Quaternary Prevention (P4). Sponsored by the WONCA SIG on Quaternary Prevention and Overmedicalization, it was held in the city of Lima. Dr. Miguel Pizzanelli, family and community doctor (GP) in Uruguay and international leader, conducted four workshops and accompanied us throughout the event.

It was attended by several national speakers such as Víctor Manchego and Sofía Cuba, current President and Past-President of the Peruvian Society of Family and Community Medicine. They spoke about Screening and Overdiagnosis in Prostate Cancer and Quaternary Prevention in Women’s Health, respectively.

A roundtable about experiences in research with quaternary focus was integrated by Dr. German Málaga (Internal Medicine Specialist) who gave a lectured on Quaternary Prevention in a hospital environment and Cinthya Vásquez Velásquez (Biologist researcher) presented her research results about anemia in children and pregnant women who living at high altitudes overdiagnosis. This activity is a clear example of how essential is to join efforts with different health professionals to carried out quaternary prevention perspective.

Thirty-one participants attended the event during the meetings and 15 in virtual mode. At the end of the event, the SOPEMFYC Quaternary Prevention working group was officially established. We assume the challenge of communicating through our social networks and propose activities to perform in our academic events like the Peruvian Congress of Family and Community Medicine to be held from November 29th to 1st December 2018.

Rosa Villanueva
Secretary of Scientific Action
SOPEMFYC

Interesting and stimulant to see so many young general practitioners motivated to improve critical thinking to provide better healthcare. We will wait with expectation for more activities like this one.

Miguel Pizzanelli

 

ESP

Mas no siempre es mejor

El 1 y 2 de Junio se realizó el Primer Curso sobre Prevención Cuaternaria (P4) en la Ciudad de Lima, Perú. Contamos con la presencia del Dr. Miguel Pizzanelli, médico de familia de Uruguay y referente internacional quien realizo 4 talleres y nos acompañó durante todo el evento. Conto con el auspicio del Grupo de interés en Prevención Cuaternaria y Sobremedicalización de WONCA y la organización del SOPEMFYC, Sociedad Peruana de Medicina Familiar y Comunitaria.

Se contó con la presencia de varios ponentes nacionales como Víctor Manchego y Sofía Cuba, actual Presidente y Past- Presidente de la SOPEMFYC; quienes nos disertaron sobre Tamizaje y Sobrediagnóstico en Cáncer de Próstata y Prevención Cuaternaria en la Salud de la Mujer, respectivamente.

Tuvimos una mesa de disertación sobre experiencias en investigación en P4 donde expuso el Dr. German Málaga Médico Internista, sobre P4 en ambiente hospitalario y la Licenciada en Biología Cinthya Vásquez Velásquez, quien nos presentó su investigación: ¿Existe un sobre diagnóstico de anemia en niños y gestantes que viven a grandes alturas? Estas ponencias son un claro ejemplo de que el quehacer de la prevención cuaternaria esta en muchos territorios y los realizan diferentes profesionales de Salud así que debemos mancomunar esfuerzos para este fin común.

Contamos con 31 inscritos al evento presencial y 15 inscritos a distancia. Al final del encuentro se conformó un grupo de trabajo de la SOPEMFYC sobre Prevención Cuaternaria quienes asumen el reto de seguir coordinando a través de Redes Sociales con miras de actividades en posteriores eventos como el Congreso Peruano de Medicina Familiar y Comunitaria a realizarse el 29 y 30 de Noviembre y el 1 de Diciembre del 2018.

Rosa Villanueva
Secretaria de Acción Científica
SOPEMFYC

Interesante y estimulante ver tantas y tantos jóvenes medicos de familia y comunidad motivados en desarrollar su pensamiento de un modo crítico para brindar mejores cuidados de salud. Esperamos muchas actividades mas como esta.

Miguel Pizzanelli

First Quaternary Prevention Workshop for residency training program in Uruguay


During March we organized the first workshop for family and community medicine residency students in Uruguay.
The experience was interesting: 3 days, 12 hs in total. 20 participants.

María Laura Fernandez member of the Quaternary Prevention interest group from Uruguay talked about the research performed. We share the pdf and video of her conference about Overscreening in cervical cancer.

Cardozo V, Fernández ML. Tamizaje de cáncer de cuello de útero en usuarias de la Policlínica Villa Farré (Uruguay). Una mirada desde la prevención cuaternaria. Archivos de Medicina Familiar y General [Internet].26 de dic 2017 [citado 24 de febrero 2018];14(2). Disponible en: http://revista.famfyg.com.ar/index.php/AMFG/article/view/17

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.

http://revista.famfyg.com.ar/index.php/AMFG/article/view/25/16

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.

SUMMARY

[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 http://www.ph3c.org/p4