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

Her webpage offers also a Global (Industry-Independent) Resources for Patients and Healthcare Providers:

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.


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.


In WONCA webpage:


First National Quaternary Prevention Course in Perú / June 2018

Bilingual post / Nota en dos lenguas


More is not always better / Less is more


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

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



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

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:

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.