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

Attend next International Preventing Overdiagnosis Conference / 2018 Copenhagen

2017 Preventing Overdiagnosis Conference Quebec conference “Towards Responsible Global Solutions” has just finished.

BMJ Podcasts available on

Attend next Preventing Overdiagnosis conference!

It will take place in Copenhagen from 20 to 22 August.

QP&O Movement

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?

Family and Community Medicine Summit; Costa Rica 2016/ Cumbre de Medicina Familiar de San José de Costa Rica 2016



Acces to the synthesis document:



Documento de síntesis sobre Prevención Cuaternaria / Cumbre de Medicina Familiar de San José de Costa Rica 2016, WONCA / CIMF.

Nota bilingüe / ESP

Por vez primera, una cumbre Iberoamericana de Medicina Familiar y Comunitaria, dedicó un espacio de jerarquía para el concepto de “Prevención Cuaternaria”.

Esto permitió que se abordara en un grupo de trabajo, sobre tres aspectos relativos a la aplicación del concepto: a) la importancia de incorporarlo en la formación médica, b) los aspectos vinculados a la trasmisión del concepto a la comunidad, c) los aspectos político institucionales a los que nos lleva el encare de Prevención Cuaternaria.

Han participado muchos colegas y en la elaboración de los documentos preliminares y en este documento de resumen. Aunque muy contundente, en realidad solo muestra una apretada síntesis de todo lo trabajado durante mas de 8 meses.

Quisieramos agradecer el esfuerzo de todos los compañer@s de Iberoamérica que participaron en este trabajo luego de varios e intensos intercambios. Su aporte ha sido destacado aunque tal vez no aparezcan sus nombres explicitamente en la publicación, ni con la jerarquía que se merecerían.

Todo este trabajo ha hecho posible tener hoy un Grupo de Especial Interés en Prevención Cuaternaria y Sobremedicalización en WONCA, desde octubre del año pasado y comunicado en la Conferencia Mundial de Río de Janeiro, Brasil, en noviembre de 2016.

Tambien agradecer a la Revista Brasileira de Medicina de Família e Comunidade por comunicar y publicar.

Publicación accesible en español, portugues e ingles en:


Quaternary Prevention / Iberoamerican Family Medicine Summit of San José, Costa Rica 2016, WONCA / CIMF. Summary document

Bilingual Note / ENG

For the first time, an Ibero-American summit of Family and Community Medicine, dedicated a space of hierarchy to discuss Quaternary Prevention concept.

This allowed a working group to deal with three aspects related to the application of the concept: a) the importance of incorporating it into medical training; b) aspects related to the transmission of the concept to the community; c) Institutional and Political aspects to which the issue of Quaternary Prevention is linked.

We would like to thank the efforts of all our colleagues from Latin America who participated in this work after several intense exchanges. Their contribution has been highlighted although they may not appear explicitly in the publication, nor with the hierarchy they deserve.

All this work has made possible to have a Quaternary Prevention and Overmedicalization SIG in WONCA from October and officially communicated during the World Conference in Rio de Janeiro, Brazil (November 2016).

Also, thank the Brazilian Journal of Family and Community Medicine ( Revista Brasileira de Medicina de Família e Comunidade) for communicating and publishing.

Publication available in English/Spanish/Portuguese at:


Miguel Pizzanelli MD, WONCA Special Interest Group:Quaternary Prevention & Overmedicalization Convenor / Chair.

Quaternary Prevention Manifest / Manifiesto por la Prevención Cuaternaria


Tha WONCA executive council has approved, during the  Rio De Janeiro Meeting, Nov 2016 the creation of the WONCA Special Interest Group in Quaternary Prevention

The launch has been followed by the publication of a Manifesto

see below in 4 languages:

Source: Jamoulle M; WICC web page.
“Manifiesto por la Prevención Cuaternaria”

La salud como resistencia: un manifiesto por la prevención cuaternaria

Compartido en la plataforma  No Gracias

Este documento ha sido suscrito por mas de 100 colaboradores y luchadores de la prevención cuaternaria, en el mundo. Si bien contiene un posicionamiento my Latinoamericano, esperamos traducirlo a varios idiomas para lograr aún, una mayor difusión por su importancia.

Fue elaborado bajo la iniciativo y liderazgo del grupo de trabajo de P4 de Argentina en colaboración con el grupo de trabajo de P4 de CIMF y de lideres de todos los países de la región. Fue presentado en la Conferencia Mundial de Rio de Janeiro (5 de noviembre de 2016), en la primera reunión presencial del Grupo de especial interés en Prevención Cuaternaria de WONCA, recientemente creado.

Hemos dedicado este manifiesto, en honor a nuestro colega y amigo Mario Acuña, quien añoró siempre un futuro mejor para la medicina familiar, comunitaria y general y fue impulsor y referente de la Prevención Cuaternaria en la región.

Miguel Pizzanelli