Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention

Tesser, Charles Dalcanale; Norman, Armando Henrique

doi:10.1590/0102-311x00012316

Cited by 18 publications

(36 citation statements)

References 46 publications

(58 reference statements)

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“…This has helped blur the division between normal and pathological (Tesser;. For Rose, the diagnostic criteria with their nosological entities (i.e.…”

Section: Continuum Of Risk and Severitymentioning

confidence: 99%

“…The understanding of diseases as quantifiable entities has facilitated researchers to gradually transform risk factors into diseases (Tesser;) but more importantly, have allowed them mathematically reduce the cut-off threshold for interventions based on relative risk reduction in RCT. This can convey the notion of 'maximising benefit' for a given intervention despite low baseline susceptibility.…”

Section: Solving the Paradox: Reducing The Cut-off Points For Biomedimentioning

confidence: 99%

“…(Malhotra et al, 2015. These asymptomatic patients have been transformed into sick individuals and exposed to a range of psychological and physical side-effects without the prospect of benefit because they have been overtreated (Tesser;. Thus, an increased body of evidence shows that some current preventive medicine activities may either lead to harm or suggest uncertainties surrounding its benefits (Welch;Fisher, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Linking high-risk preventive strategy to biomedical-industry market: implications for public health

2017

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This paper takes Geoffrey Rose's concepts on preventive strategy as the basis for theoretical framework to critically analyse the current approach to disease prevention. Rose's "continuum of risk and severity" has widened the scope for preventive actions and underpins two approaches: high-risk strategy (HRS) and population strategy (PS). Both of them produce paradoxes: HRS, despite having a good harm-benefit ratio, offers little impact on public health; PS has greater impact on public health, but offers minimal benefit at individual level. We argue that HRS is being misapplied by reducing cut-off points for preventive interventions to impact morbimortality attributed to specific diseases. This tends to medicalize prevention, producing more disease related phenomena through screening techniques, and inducing individual affective reactions, which require action in the present to secure better future health. This context has paved the way for speculative preventive medicine, which perceives health as a commodity but ignores its implications for public health services.

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“…This has helped blur the division between normal and pathological (Tesser;. For Rose, the diagnostic criteria with their nosological entities (i.e.…”

Section: Continuum Of Risk and Severitymentioning

confidence: 99%

Section: Solving the Paradox: Reducing The Cut-off Points For Biomedimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Linking high-risk preventive strategy to biomedical-industry market: implications for public health

2017

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“…Hekimlerin hastanın haksız istemlerini karşılamak için aşırı tetkik ve ilaç kullanımı yerine kendi sağlıklarının sorumluluğunu almaları için onları bilgilendirmesi ve güçlendirme-sinin hem hasta hem de hekim için uzun erimde daha verimli olacağı kabul edilmektedir. [1,[26][27][28] Bu durumda kanıta dayalı tıp ve paylaşılmış karar alma hekime yardımcı olabilir. Hasta-hekim ilişkisi güçlü ise hekimin açıklamaları hasta tarafından kabul edilebilir.…”

Section: (üçüNcül Koruma)unclassified

“…[27][28][29][30][31][32] Dördüncül korumanın uygulanmasında ve gereksiz tıbbi süreçlerden kaçınmada en güçlü yöntemlerden biri kanıta dayalı tıp (KDT) verilerini ve paylaşılmış karar almayı kullanmaktır. Klinik çalışmaların verileri ve uygulama rehberleri, kullanılacak girişimin yarar ve zararlarına dair veriler hasta verileri ile karşılaştırılır ve hasta için en uygun karar hasta ile birlikte alınmaya çalışılır.…”

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Quaternary prevention: First, do not harm

Kavukçu¹,

Akdeniz²

2017

tahd

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Por que é importante a prevenção quaternária na prevenção?

Tesser

2017

Rev. saúde pública

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Quaternary prevention consists in the identification of persons at risk of excessive medicalization and their protection against new unnecessary interventions, avoiding iatrogenic damages. Here, we argue about the importance of quaternary prevention in specific primary and secondary prevention. The recent great development of preventive medicine, biomedicalization of risks and their treatment as if they were diseases, and the powerful influence of the commercial interests of pharmaceutical industries on the production of medical-sanitary knowledge alter classifications, create diseases and pre-diseases, lower cutoff points, and erase the distinction between prevention and healing. This situation converts larger amounts of asymptomatic persons into sick individuals and diverts clinical attention and resources from sick persons to the healthy, from older adults to young persons, and from the poor to the rich. Quaternary prevention facilitates and induces the development and systematization of operational knowledge and guidelines to contain hypermedicalization and the damages of preventive actions in professional care, especially in primary health care.

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Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention

Cited by 18 publications

References 46 publications

Linking high-risk preventive strategy to biomedical-industry market: implications for public health

Linking high-risk preventive strategy to biomedical-industry market: implications for public health

Quaternary prevention: First, do not harm

Por que é importante a prevenção quaternária na prevenção?

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