Tag Archives: Overtreatment

Sometimes doing nothing is the right action

30 jul.

Joan-PonsJoan MV Pons. Head of Evaluation AQuAS

Doing or acting is irresistible; it must be a feature of being human, just like a spring is always ready to bounce, unless we’re talking about contemplators, hermits and stylites (St. Simeon). In medicine and public health we’re more afraid of failures by omission than of failures by commission, so we find ourselves unable to abstain from action. Often we act by asking for analytical or image tests, thinking that these, consisting in a mild pierce or radiation (a lot more if it’s a CT scan) can do no harm, can have no adverse effects. But it’s not quite so. Besides the fact that any unnecessary test (which will not bring new information and if it does will not alter patient management) means throwing money (tax payer’s money), any medical, preventive, diagnostic or therapeutic intervention, in whatever form, brings risks along with any benefits. It can not be otherwise. Needless to say, the main issue is properly knowing how to weigh the pros and cons and how to choose wisely. Continue reading →

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

23 abr.

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 →