Tag Archives: Public Health

La Meva Salut (My Health) and eConsulta (eConsultation): deploying the model of remote care in Catalonia

18 May
Òscar Solans

The management of information is key to the health system from the perspective of a greater integration between patients and professionals of different levels. Shared information, transparency, evaluation and the readjustment of healthcare processes need to be primary lines of action so as to situate the patient at the centre of the different interactions with professionals of different fields.

The expansion of information technologies has created new opportunities which enable people to participate actively in the monitoring of care processes offering a unique opportunity to facilitate communication and improve a patient’s commitment. The new model of care which the Health Plan Catalonia 2016-2020 proposes is aimed at putting more focus on patients and to that effect, tools have been developed that improve the relationship between citizens and the health system making it all easier.

In Catalonia, we have a personal health folder available since 2009, Cat@Salut La Meva Salut (LMS), accessed by using a digital certificate or using a user name and password which are provided by a citizen’s primary healthcare reference centre.

You can read this article published in the magazine Annals de Medicina.

La Meva Salut is a personal digital space for consultation and interaction, which puts relevant health information generated by public healthcare centres in Catalonia at the disposal of citizens, in a safe and confidential way. This information includes such things as the current medication plan, vaccines administered, diagnoses, clinical information, results of tests and complementary examinations

When considering La Meva Salut, we can say that it is a strategic project which promotes the participation and co-responsibility of citizens in prevention and the care of their health, fostering awareness and knowledge related to their pathologies and making it possible for them to participate in the clinical process of care.

La Meva Salut offers cross-cutting and strategic services of the Catalan Department of Health and it also allows different health providers to incorporate more personalised services according to the more specific needs of patients in each entity, which are standardised in La Meva Salut.

In this way, La Meva Salut offers a unique gateway to the virtual health system allowing citizens, who identify themselves only once, to use services of different centres in an integrated and personalised way. Some of these services already in use, are, among others: changing primary care doctors, requesting appointments to see a primary care doctor and for international vaccination services, service of patient communities (allows groups of patients to be created for sharing opinions and dealing with different pathologies with the help of an administrator that is usually a health professional), and the monitoring of patients with chronic pathologies.

This article has recently been published in the magazine New Perspectives in Medical Records.

The most noteworthy cross-cutting services that the Department of Health has made available are:
• Consultation of waiting lists for surgery
• Consultation of pending appointments and tests of any health provider in an integrated way
• Obtainment of organ donor’s card
• Consultation of the Advance Directives document
• Inclusion by the patient of clinical variables in their clinical history
• Secure mail service, eConsulta

The goals of La Meva Salut and the eConsulta service are in line with the Non-Face-to-Face Model of Care of the Catalan Health Department, which aims to guarantee, improve and facilitate the access to the Catalan Health System and to offer options for non-face-to-face care by providing added comfort both to professionals and citizens in the process of care.

Data for access to La Meva Salut

eConsulta is an asynchronous and bidirectional remote communications tool between a citizen and health professional that complements face-to-face care. The access by citizens is only possible via La Meva Salut, in a safe environment which guarantees confidentiality in communication. Citizens are authenticated each time they enter and the professional can only consult or respond from their work station; in this way, the information is stored in the repositories of the Health Dept. incorporating them into the electronic clinical history of each citizen.

This is a new channel of agile communication to resolve a citizen’s consultations in a virtual manner. Either the professional or the patient can begin a dialogue. The access of citizens to the health system is thus made easier and a solution is provided to a part of healthcare needs without needing to programme face-to-face visits, with the corresponding saving of paperwork and time this means for citizens and professionals.

Data used in eConsultation in Primary Care in Catalonia*

What do these two tools, La Meva Consulta and eConsulta, offer the professional?

We can answer this question briefly and clearly:

  • These tools represent a new model in the relationship with citizens where they are invited to participate in the care process and, moreover, have the possibility of adding information (via La Meva Salut)
  • The new channel of communication generated by these tools allows notifications and documents to be sent in a safe way and, ultimately, to establish a non-face-to-face type of relationship with patients. In models such as Kaiser Permanente in the United States, the number of face-to-face visits has been reduced considerably
  • Tele•    Substitution of face-to-face visits with virtual visits such as the updating of the online medication plan, results of normal tests and the monitoring of some types of pathologies

As happens with any change, the inclusion of technologies in processes requires users to adapt to new uses despite these having clear benefits.

This new way of interaction between patients and the health system has come to stay as happened in other sectors, such as in banking, for example, where processes have been changed significantly.

On the other hand, technologies increase the levels of security of access to information, enabling alerts of pathological results to be generated, providing support tools to clinical decision making, improving the self-management of agendas with the use of eConsulta, substituting low added value tasks with others that require a clinical interpretation and dedication to patients that need more time and knowledge.

The challenge in Catalonia is the deployment of a new model of care that promotes the use of online services, with the objective – once implemented – of fundamentally changing the care process in health centres by empowering patients and achieving a safer medical practice.

With careful development and the joint effort of professionals and citizens, each one in their role, these services can be incorporated  successfully into the organisation of healthcare.

Post written by Òscar Solans (@osolans), functionally in charge of eSalut (eHealth) in the Catalan Health Department.

Double health insurance cover

20 Apr
Lluís Bohígas

A double health insurance cover occurs when a person that has the right to public healthcare also has a private health insurance which allows them to receive private health services. Anyone can go to private health services if they pay from their own pocket but it is only defined as a double insurance cover when one has taken out a specific private health insurance. The population has a right to healthcare because they have contributed to social security – or they may find themselves in any one of the contexts that gives them the right to access – and this covers almost the entire population but not all; there is a segment that does not have the right to public healthcare and only has private cover if they purchase an insurance.

In the 80s of last century, the self-employed were not covered by social security and the majority had a private insurance. At that time, in Catalonia the Quinta de Salut l’Aliança was very popular. Ernest Lluch, the Minister of Health, made it compulsory for the social security to offer healthcare to the self-employed and, all of a sudden, many of those insured by l’Aliança found themselves having a double insurance. Some left l’Aliança but others stayed on. The public healthcare system and the majority of insurance companies only cover a basic part of dental healthcare. If you want a wider dental healthcare cover you need to purchase a specific insurance. This insurance is not considered to be double cover because it does not cover the services which are covered by the public insurance.

In 2014, the Generalitat recorded 2.032.911 people with a health insurance in Catalonia but not all had double cover. State civil servants and their families can choose to be attended by the autonomous community or by a private insurance and 80%, 160.815, choose private healthcare and so they do not have double cover. The difference between the total number of insured and the civil servants that have chosen a private insurance are 1.872.096 people; that is, 24,9% of the population has double cover.

Why do one out of every four Catalans buy a private health insurance, despite having the right to public healthcare?

There are several reasons for this. On the one hand, a private insurance gives them access to private health centres and to independent doctors who are sometimes doctors that work in a public centre in the morning and a private centre in the afternoon. In the afternoon, one can choose the doctor that it wasn’t possible to choose in the morning. Another reason is waiting times. Private centres and independent doctors have shorter waiting times than in public centres. And another frequent argument is that private doctors spend more time on each patient and that private centres provide better attention to patients.

These are the reasons that have usually been given to justify a person spending more than 700€ a year on average on a private insurance to benefit from services they in fact have access to in the public system.

But there are also other arguments. One is to see an insurance as a salary paid in kind and another is the response people have to cuts in public health. Some companies give their employees a private insurance as a complement to their salaries, partly for tax reasons but also as an incentive for some employees and for managers. 31,6% of people insured in Catalonia in 2014 were insured by their companies.

During the period 2009-2013, while cuts were being made in public health, health insurance companies grew in Catalonia and in Spain as a whole. During this period the insurance companies raised their rates quite considerably but despite this rise, and despite a decrease in the purchasing power of families, health insurance policies didn´t so much as become cheaper but rather increased in price.

More women than men have a double cover, are between 45 and 64, have a university qualification and belong to the upper social class according to the Generalitat’s health survey. Notwithstanding, 11% are older than 75 and 10% have no higher education qualifications or only have primary education and 11,5% belong to the lower social class.

The Generalitat’s statistics tell us which services are paid for privately in hospitals. Thus, for example, 31% of births are private and a large part of surgery is private: 35% of elective surgery and 25,8% of major outpatient surgery. 26% of hospital admissions and 21% of emergencies are also private.

Some of these private services in hospitals are paid for directly by the user but the greater part is financed by health insurances. Statistics only provide us with information of hospital services but it is probable that the private part is even greater in visits to doctors and other services.

Proposals have been made in the past to offer tax incentives to people purchasing a private insurance who waive their right to have access to public services. The aim would be to reduce waiting lists in the public system. I do not think that this would work because the majority of people that have a double cover do not relinquish access to public services but rather want to be able to choose between receiving private or public care.

Double cover is a stable data in the Catalan health system. It already existed when INSALUD managed public health and continues to exist. The number of insured may vary in time but the phenomenon is constant: an important part of the population, those who can afford it, prefer being able to choose between public or private healthcare.

Nowadays, one needs the other: if there were no private healthcare, the public system would collapse; if there was not a public system, the private sector would be incapable of providing the care it does at the price it does. The usual discourse is an ideological criticism of the other, the public system criticises the private and vice versa. I think it would be better for Catalan health as a whole to reach an agreement.

Post written by Lluís Bohígas (@bohigasl), economist.

Wishing you all a Joyous Festive Season from the AQuAS blog

29 Dec
nadal-2016-marta-millaret
Marta Millaret

From the blog AQUAS we hope you are having a good festive season and would like to thank you for reading and following us.

We publish weekly in Catalan, Spanish and English on subjects related to the projects that are being carried out at AQuAS and we also publish contributions from guest authors. The editorial line of the blog includes a focus on assessment from different points of view and areas of the health system.

Along these lines, we have dealt with healthcare and quality results presented by the different agents who make up the healthcare system, the whole range of observatories of the Catalan Health System (including that which deals with the effects of the economic crisis on the health of the population and innovation), qualitative research, integrated care, the assessment of mHealth, inequalities in health, patient involvement, doctor-patient communication, shared decisions, patient and citizen preferences, variations in medical practice, the prevention of low-value clinical practices, the impact of research, information and communications technology, data analysis in research, tools for the visualisation of data, innovation and health management, the gender perspective in science, statistical issues, clinical safety with electronic prescriptions, chronicity (not forgetting chronicity in children), the effects of air pollution in health and current topics.

blog-aquas

The most read articles in 2016 have been:

However, we have published many more texts, 51 posts to be precise, without counting this one, with the aim of sharing knowledge and generating a space for reflection, open and useful for everyone.

Thank you very much, a joyous festive season and see you in the new year!

Post written by Marta Millaret (@MartaMillaret), blog AQuAS editor.

nadal-2016-aquas-bicicleta

 

Extra motivational bonus and… Let them have fun! Key elements for qualitative research with adolescents

1 Dec
Santi Gómez

There is no doubt that a qualitative methodology considerably enriches the development and assessment of public health interventions. It is often the ingredient which gives a dish that very special flavour or sometimes is even its main ingredient which, if of quality, makes the dish a real winner.

When both quantitative and qualitative methodologies are applied respectively to the same project, the necessary nutrients are provided to make the project work and can even produce compound molecules of a high nutritional value if applied in combination. The flavours of qualitative methodology acquire specially relevance in the dish when an innovative intervention  is being cooked up using new channels of communication to reach the target population. We are talking of the PEGASO Fit for future.

The chefs at the the Agency for Health Quality and Assessment of Catalonia (AQuAS) and those at the Catalan Agency of Public Health (ASPCAT), together with other European chefs, have the PEGASO platform brewing on the stove. Centred around the smartphone, it aims to be a new creative recipe for the promotion of healthy lifestyles among adolescents. Eating habits, physical activity and hours of sleep are the real protagonists of the signature dish which has begun to be served in different secondary education schools in Catalonia, Scotland, England and Italy in the way of different health apps, games and movement sensors.

The PEGASO project is using qualitative methodology in all phases to ensure that the “food” gets to the table successfully and that it be a well-received recipe which spreads out cheerfully and quickly to all kitchens. Thus, the focus groups held with adults and adolescents before the start of pre-pilot phase allowed us to draw up a clear shopping list to get the necessary ingredients before we donned our aprons. Subsequently, and during the 3 stages of the pre-pilot phase, adolescents in several focus groups carved up the different prototypes of the platform’s components after having appraised their quality to decide whether they should be included in the recipe or not.

But what are the key elements for qualitative research with adolescents? A focus group with adolescents is an intense activity which is worth doing. In fact, in the pre-pilot phase of the PEGASO project, we had the opportunity to lead teams in different schools; Nou Patufet school in Barcelona, Verge de la Salut de Sant Feliu de Llobregat and IES Ramón de la Torre in Torredembarra. These teams were made up of wonderful players that converted each match into a real show. To be able to see thrilling sporting events, we used the extra motivational bonus before each match. This is the first key element for qualitative research with adolescents.

The setting up of a group is essential for its later development and just like a pep talk in the locker room, the tactics of the game were explained in a simple way and the importance of each individual’s contribution to working as a team was highlighted. Additionally, and also prior to setting up groups, the importance given by the PEGASO project that participants choose their best skills while also enjoying the match was highlighted. In this way, the players gave their best at all times leaving the supporters dumbstruck from minute 1.

When dealing with highly motivated groups, the coach has no need to scream and shout from the sideline but rather just guide the team with a simple gesture so that it can progressively achieve the pre-established objectives. In this way, spectacular goals are scored which surprise everyone, including the coach and technical staff. This is pretty much what happened to the PEGASO team where good communication and the initial extra motivational bonus helped great sporting events of two or more hours to take place.

In the focus groups of the PEGASO project, the dribbling and passing between participants has been constant and at an individual level, enjoyment was apparent. This is the second key element in qualitative research with adolescents: that they enjoy themselves. If this is achieved, a group of adolescents can get to wherever they want with endless energy. In this way, attributes which collective imagination often assigns to the adolescent population such as passiveness or a lack of interest have been totally ousted and annulled by freshness, creativity and the urge to participate. Undoubtedly, as Jaume Funes would say, the adolescents who have participated in the PEGASO project have been unbearably charming; and I would add, extremely funny and insatiable players.

And after a hard workout, to bed ….! All the information provided by adolescent genius must be given the chance to rest. Rest after an activity is also a nutritious element. A calm demeanour after the adequate hours of sleep enables one to carry out a qualitative in-depth analysis. It is under these conditions that an outcomes report can be written which gives value to the development of the intervention that, as we have already commented, aims to  promote a healthy diet, physical activity and rest. The PEGASO project aspires to be a useful tool in promoting these healthy habits among adolescents. Have a good day, a good match and good night!

Post written by Santi Gómez, AQuAS-APSCAT.

This text are part of a series of posts about qualitative research started at the Ibero-American Congress of Qualitative Health Research which was held in Barcelona several months ago. The other posts in the series are: Utilities and challenges of applying qualitative methodology in community health projects written by Dolors Rodríguez-Arjona and Broadening perspectives in health service assessment written by Vicky Serra-Sutton.

Saving lives, reducing vehicles in cities

23 Jun
CrisRibas
Cristina Ribas

Air pollution is a major public health concern, perhaps one of the most serious problems facing large developed cities. The evidence of the negative effects on health are growing day by day, with contributions from internationally renowned scientific groups such as the Centre for Research in Environmental Epidemiology (CREAL) which estimates that there are 3,500 premature deaths each year in the Barcelona area resulting from air pollution. Pollution not only affects patients suffering from respiratory diseases, but is also a cause of cancer and cardiovascular conditions when nitrogen oxides and smaller particles are capable of passing through the bronchi and enter the bloodstream. Recently, CREAL also discovered cognitive development impairment in children in schools in close proximity to highly contaminated streets.

Many European cities have done their homework focusing on one of the major causes of pollution: vehicle traffic, above all diesel engines which are the primary agent responsible for nitrogen oxide emissions reaching unacceptable levels, as revealed by the Volkswagen scandal. One of the most effective initiatives in this area is the delimitation of Low Emissions Zone (LEZ) in city centres, which restricts the access of the most pollutant vehicles to entering these areas in conjunction with improvements in public transport and promotion of sustainable mobility. These policies enjoy greater scientific consensus and have been implemented by more than 200 cities in 12 European countries, including Berlin and London.

None of the cities which have implemented measures restricting traffic wish to backtrack on these improvements, much in the same way as what we have experienced with the ban on smoking in public places. In fact, the story has a lot in common with the smoking ban if we consider for example that in Barcelona, only 15% of inner-city displacements use private vehicles. This means that most of the city’s inhabitants are passive smokers subject to emissions produced by others. Experts in mobility explain that traffic tends to adapt its behaviour. The greater the limitations in circulation, the less traffic there is and, inversely, when circulation is made easier and more channels are made available, the heavier traffic becomes to the point of collapsing entirely. Another advantage of reducing cars in cities, apart from the positive effects on health, is the greater occupation of public space by pedestrians and cyclists with the added benefit of an improvement in quality of life.

For all these reasons, courageous decisions are needed from governments, as they were when it came to the application of the smoking ban legislation. In order to promote these initiatives and help raising awareness about the problem of pollution, last year the Platform for Air Quality in Catalonia was set up, which includes neighbourhood associations, environmentalists, public transport activists and advocates for the use of bicycles, as well as citizen groups and professionals from the areas of health, the environment and mobility. One of these groups is the Catalan Association for Science Communication, which understands that scientific journalism should serve the community if it is to be responsible and play a leading role in a society where everyone is potentially a means of communication.

It is also vital for the authorities to understand that they must collaborate with the public and experts in disseminating and using information. Applications to measure contamination levels should not be limited only to warning us when European legal standards have been exceeded, but must in addition take into account the limits recommended by the WHO, the only secure parameters in terms of safeguarding health. This, together with the different data and models utilised, result in the fact that the services and applications which provide information on pollution in the Catalan region do not agree 100% in their forecasts: Aire.cat, Caliope, Plumbe, Real Time Air Quality Index… The most serious feature is that despite all these resources, people do not quite understand when, where and why it is dangerous to walk, play sports or simply breathe.

Thus, the platform calls for free and open access to all the data: pollution measurements and positioning, traffic, weather, models… so that one can create one’s own applications, extract the know-how and create services that the public feel are useful. With the data available, journalists can also provide reports of public interest such as this interactive map of the UK drawn up by The Guardian that shows the boroughs with the most deaths from particulate air pollution.

TheGuardian-InteractiveMap

Post written by Cristina Ribas (@cristinaribas), Catalan Association for Science Communication and Platform for Air Quality.

Ioannidis and the industry: a persistent distortion

7 Apr

John PA IoannidisJoanMVPons is a scientist and professor originally from Greece, currently working at Stanford (Meta-research Innovation Center – METRICS) who is, undoubtedly, among the most prolific authors of medical scientific literature.

Some of his papers, alone or in collaboration, have had a great impact. Who does not remember the one entitled “Why most published research findings are false?”. Nowhere in his large output will you find trivialities, and he recently came to Barcelona to speak about defective research and even about the waste of resources this implies. But we will leave the latter topic for another occasion.

The paper by this author I want to comment on is the one written in collaboration entitled “Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review” published in 2013 in European Journal of Clinical Investigation.

One might think that all has been already said about the (bad) influence of drug and health care products industries. There is even a literary body or genre in biomedical scientific publications exclusively devoted to this topic. And books abound, too. All that could be said has been said. Well, actually it hasn’t. Undue influence, such as biases, is far more subtle than we think. It is often hard to tell how, similarly to interest conflicts in biomedical research or in prescription practices, the one who does it refuses any influence, since science could not admit it, as its own deontology doesn’t. Fools!

What is interesting about this paper is its review nature, not only for the number of papers gathered, but because it provides a more integrated (re)view of the different elements upon which industry acts, or is allowed to act. It should be noted that the interests and profit of the drug and health care products industry are quite legitimate, but it clearly shows some specifics that put it aside from other manufacturing industries, and not just because its important investment in R+D+i. It is believed to be one of the most profitable industries, possibly due to its large margins, but also because human diseases and ailments are here to stay, even though their end –which both the poor and the rich want to delay– is ultimately inescapable.

Ever since I learned it, I am very fond of a quotation by George W Merck (1894-1957) who for 25 years chaired the drug company that bears his family’s name (1925-1950). As this visionary man said: “We try to remember that medicine is for the patient. We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.“ I wonder what he would think of it now.

Coming back to Ioannidis and his paper, there he follows the outline of how this (bad) influence acts, and the main elements –which changed with time– upon which it exerts its distorting effect, although not as an exclusive factor. Governments, as with other industries also regulated by them, play an essential role.

Evidence based medicine - Clinical practice guidelines - Medical practice

Post written by Joan MV Pons.

The Great Escape

21 Jan
Joan MV Pons, Head of Evaluation AQuAS
Joan MV Pons

A few days ago, Anna Garcia-Altés in a previous post referred to the Nobel Prize in Economics, which Alfred Nobel never granted – that was awarded in 2015 to Angus Deaton and his work on inequality. This is not the subject that I wish to talk about today but another that also features in the recent book from this Nobel proze winner which is titled “The Great Escape” (The Great Escape). Yes, just like the movie, set in a German camp for prisoners of war starring Steve McQueen and recalling a real fact of World War II. Unlike reality, the book predicts a better ending. For Deaton, the greatest escape in human history was in overcoming poverty and ageing.

For centuries, those who did not die at a young age could face years of misery. Beginning in period called the Enlightenment, with its scientific revolution and subsequent later industrial revolution, some people in certain countries began to escape this meagre fate.

Meanwhile, germ theories founded in the late nineteenth century surpassed the paradigm of the miasma theory in explaining contagious diseases. The key was and still is scientific knowledge and its dissemination. This point in history marks the extraordinary increase in life expectancy, initially for the better-off and then for the rest of the population.

This higher life expectancy, manifested especially in the developed countries, is largely due to the remarkable reduction in infant mortality and, more recently, to the epidemiological transition to chronic non-contagious diseases, the improvement in life expectancy in adulthood (increased life expectancy ≥ 50 years from 1950), but without a substantial improvement in longevity. Deaton shows us all this with data and graphics.

To illustrate it, Deaton mentions the progress in combating smallpox with a vaccination of smallpox (initially using matter from infected people and later the much safer vaccine Edward Jenner introduced in 1799). The public health measures introduced in the last few hundred years, including sanitation, water supply, nutrition and better hygiene, have led to a significant reduction in infant mortality.

Here, it was due to not only the knowledge but also the determination of the authorities in improving the conditions of the population. The improvement in life expectancy in adulthood is explained largely by reducing cardiovascular mortality through diagnostic and therapeutic advances in this field.

As mentioned before, we witnessed not only increased life expectancy but also a significant increase in the world population, an authentic explosion starting in the second half of the twentieth century. Malthusian alarms re-emerged but they were fortunately overcome by improvements in agricultural productivity, without excluding initiatives – for better or worse – for controlling the birth rate in developing countries; again, examples of scientific knowledge and its dissemination.

Deaton is very critical about the operating methods in which help flows from developed countries to developing countries. From the times of imperialism and colonization where (natural) resources were moved from poor countries to rich ones (Nineteenth century) and since the end of World War II we’ve also seen a flow of resources from developed countries to developing countries.

This external help, whether from governmental or NGO sources and despite the illusion that might it create if it continues as usual, may end up doing more harm than good. There’s no shortage of examples in the book of wasted resources by governments and corrupt politicians, granting donations or grants to countries (government to government) without these ever reaching the people. Not to mention situations where these grants are part of the geopolitics of the former colonies or contemporary powers.

Contrary to what an engineered hydraulic vision (communicating vessels) may show, we must invest in projects and programs that promote conditions for economic development to make external aid unnecessary, as is the reality in Africa, where paradoxically, the more external help yields the least growth in GDP per capita.

Health aid, without underestimating its achievements (vaccination campaigns, infrastructure construction, drugs against HIV / AIDS, mosquito nets), continues to be in most cases, vertical health programs with a very specific focus. This contrasts with the horizontal programs aimed at strengthening local health care systems, especially a good network of primary and community care.

Often foreign aid and the development of local capacity are not aligned; on the contrary, often one damages the other. Rich countries’ subsidies to their agriculture – consider the famous European PAC – is detrimental to farmers in poor countries where most of the workforce still works the land. There are more effective ways to help.

(It notes that another Nobel laureate in economics, Robert Fogel (1926-2013), had already written about the great escape in “The Escape from Hunger and Premature Death, 1700-2100” (2004), Deaton and had revised appointment. Thank Anna Garcia-Altés to call me about this)

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 →