Pros and cons of Medicine (including preventive) or the dangers of futility

23 Apr

Andreu SeguraAndreu Segura, Secretary of Catalan Public Health Interdepartmental Plan

My grandmother told me that everything has advantages and disadvantages, pros and cons. Without any philosophical claim I find that, at least when it comes to medicine, she was right. And, for the avoidance of any doubt, I want to make it clear that I value the net results of medical interventions as clearly positive. Even in some cases where medicine has been applied to more natural circumstances such as pregnancy and childbirth or menopause, although illness and death are also natural occurrences. As far as I’m concerned then, the introduction of medicine doesn’t need to be harmful but we must not underestimate the adverse effects that medical practice and health care, by extension, generate.

The fact that medicine can harm us is something that has been well known since long a time ago. The Hammurabi Code, one of the first normative texts of humanity written almost four thousand years ago, not only refers but also punishes harmful medical practices. Much more famous, however, is the aphorism “Primum non noccere” presumably a translation of the Greek Hippocratic attributed to Galen, most likely as a teaching resource in his classes Auguste Chomel, preceptor of Pierre Alexander Louys, the creator of Numerical Medicine, teacher to William Farr and Lemuel Shattuck and a fierce critic of indiscriminate bloodletting. The Hippocratics, to put it clearly, at least insisted that the doctor should try not to harm the patient. Continue reading

“The Poverty Hypothesis” versus “The Capacity Hypothesis”

16 Apr

Jordi VarelaJordi Varela, Editor of the blog “Advances in Clinical Management

The socioeconomic status influences the consumption of goods and services in each community in a very obvious way, a phenomenon which logically includes hospitalisation rates. But in what sense does poverty or wealth determine hospital utilisation? And what role does the accessibility to the number of installed beds in the community play in hospitalisation rates?

To try to answer these two questions I will examine two projects, an English one and an American one that emphasise two different hypothesis, the first one being based on the influence of poverty and the second one, on the installed capacity.

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Towards a characterisation of the social impact of biomedical research centres in Catalonia: are we going in the right direction?

9 Apr

Paula AdamPaula Adam, Head of Research Assessment AQuAS

While growing, the overall number of agents who are interested in evaluating the impact of research conducted in the R & D organizations meet a common concern: The need to define a set of indicators of results or impacts that are comparable and internationally accepted. In 2009 a Canadian panel of experts carried out one of the proposals with a global scope, using a set of indicators accompanied by a theoretical model and an appeal to the global community in helping advance the improvement and refinement. Since then, others have reported similar interests. However, we’re not yet aware of any successful wide-ranging initiatives. In literature the points of view favouring a mixed vision of quantitative metric indicators combined with qualitative approaches prevails. Continue reading

Implementing and evaluating the Essencial’s recommendations impact

2 Apr

carialmazanCari Almazán, Head of Essencial  Project

Essencial (Essential), in our context, is a pioneering project. Introduced in March 2013, it was the first initiative in Catalonia and Spain created with the objective of identifying and making the necessary recommendations for the avoidance of little value clinical practice. This objective is not confined to solely generate a periodic list of recommendations. Essencial also aims to promote real change in clinical practice. To achieve this, complementary strategies to implement the recommendations and measure their impact have been developed.

What is meant by little value clinical practices?

It’s clear that, apart from clinical practices with proven effectiveness, other clinical practices take place, some of low value and some that do not provide any substantial value whatsoever. When talking about clinical practice of little value, we mean health interventions that are inappropriate in certain circumstances, either because they are ineffective or because there is no scientific evidence of effectiveness, either because the risks outweigh the benefits or there are alternatives that are more cost-effective. The consequences of inappropriate practice are increased overdiagnosis and overtreatment, as mentioned in the recent medical article Update on medical overuse, published in JAMA. Continue reading