Capítulo 4. Un sistema de salud integrado y centrado en los usuarios. Primum non nocere. Intervenciones sanitarias respetuosas con las preferencias de los individuos
Los efectos negativos de las intervenciones preventivas basadas en el individuo. Informe SESPAS 2008
Negative effects of individual-based preventive interventions
Soledad Márquez-Calderón
Autor para correspondencia
soledadm.marquez@juntadeandalucia.es
Correspondencia: Soledad Márquez-Calderón. Agencia de Evaluación de Tecnologías Sanitarias de Andalucía.
Correspondencia: Soledad Márquez-Calderón. Agencia de Evaluación de Tecnologías Sanitarias de Andalucía.
Agencia de Evaluación de Tecnologías Sanitarias de Andalucía, Sevilla, España
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Teresa Gea-Velázquez de Castro, Juana Requena-Puche, Milagros Rey-Talens" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Jesús M." "apellidos" => "Aranaz-Andrés" ] 1 => array:2 [ "nombre" => "Ramón" "apellidos" => "Limón-Ramírez" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Aibar-Remón" ] 3 => array:2 [ "nombre" => "Juan José" "apellidos" => "Miralles-Bueno" ] 4 => array:2 [ "nombre" => "Julián" "apellidos" => "Vitaller-Burillo" ] 5 => array:2 [ "nombre" => "Enrique" "apellidos" => "Terol-García" ] 6 => array:2 [ "nombre" => "M. 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Informe SESPAS 2008" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "205" "paginaFinal" => "215" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Soledad Márquez-Calderón" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Soledad" "apellidos" => "Márquez-Calderón" "email" => array:1 [ 0 => "soledadm.marquez@juntadeandalucia.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Agencia de Evaluación de Tecnologías Sanitarias de Andalucía, Sevilla, España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Soledad Márquez-Calderón. Agencia de Evaluación de Tecnologías Sanitarias de Andalucía." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Negative effects of individual-based preventive interventions" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec13675" "palabras" => array:7 [ 0 => "Prevención primaria" 1 => "Servicios preventivos" 2 => "Cribado" 3 => "Vacunas" 4 => "Fármacos preventivos" 5 => "Efectos adversos" 6 => "Medicalización" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec13676" "palabras" => array:7 [ 0 => "Primary prevention" 1 => "Preventive health services" 2 => "Mass screening" 3 => "Vaccines" 4 => "Preventive drugs" 5 => "Adverse effects" 6 => "Medicalization" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Como se suele suponer que las intervenciones preventivas tienen pocos riesgos, la investigación sobre sus efectos negativos es escasa, tal como pone de manifiesto una revisión de la literatura médica española. Esos estudios analizan efectos a corto plazo (como falsos positivos de los cribados), pero no tratan efectos a largo plazo de las medidas poscribado (p. ej., fármacos preventivos) ni efectos negativos más intangibles (como la medicalización). Se produce una expansión acrítica de la medicina preventiva: continuas propuestas de nuevos cribados (incluidas las preenfermedades y los factores de riesgo) y vacunas. El balance entre beneficios y riesgos de esta expansión es, como mínimo, dudoso.</p><p class="elsevierStyleSimplePara elsevierViewall">En este proceso la industria farmacéutica desempeña un papel clave, pero también hay que revisar cómo actúan otros agentes: profesionales y autoridades sanitarias, medios de comunicación y sociedad en general. Resaltamos sobre todo el papel de la profesión médica, pues sin ella no sería posible definir nuevas enfermedades y preenfermedades ni recomendar el uso de nuevas intervenciones preventivas.</p><p class="elsevierStyleSimplePara elsevierViewall">La profesión médica tiene el prestigio suficiente ante el resto de los agentes para liderar cualquier cambio. Previamente las sociedades científicas deberían tener un debate interno sobre su papel actual en la adopción de nuevas intervenciones preventivas, sus relaciones con la industria y sus conflictos de interés. Algunas asociaciones médicas ya están adoptando un enfoque más crítico y analizando el impacto de sus propias recomendaciones preventivas sobre la medicalización de la vida.</p><p class="elsevierStyleSimplePara elsevierViewall">Es necesario analizar de forma continuada los efectos adversos de las medidas preventivas implantadas en la práctica y establecer mecanismos para la evaluación crítica del balance beneficios-riesgos-costes de las nuevas intervenciones preventivas antes de incluirlas en la cartera de servicios. En la práctica clínica cotidiana habría que fomentar la participación de las personas en las decisiones y que los profesionales adopten el enfoque de la prevención cuaternaria.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Because preventive interventions are usually assumed to carry few risks, research on their negative effects is scarce, as revealed by a review of the Spanish literature. The studies retrieved analyze short-term effects (such as false-positive results of screening tests), but do not evaluate the long-term effects of postscreening interventions (for example: preventive drugs) or even less tangible negative effects (such as medicalization). Uncritical spread of preventive medicine is occurring, with continual proposals for new screening tests (for pre-diseases and risk factors) and new vaccines. The risk-benefit ratio of this spread is, at the very least, doubtful.</p><p class="elsevierStyleSimplePara elsevierViewall">The pharmaceutical industry plays a key role in this process but the role of other stakeholders (health professionals and health authorities, mass media and society) should also be reviewed. The present article highlights the role of the medical profession, since, without it, definition of new diseases and pre-diseases and the creation of guidelines on the use of new preventive interventions would not be possible.</p><p class="elsevierStyleSimplePara elsevierViewall">The medical profession has sufficient prestige to lead any change. Before any change occurs, however, scientific societies should conduct an internal debate on their current role in the adoption of new preventive interventions, their relationships with the pharmaceutical industry and their conflicts of interest. Some medical associations are already adopting a more critical approach to the evaluation of the benefit-risk trade-off of new interventions and are analyzing the impact of their own preventive recommendations on the medicalization of life.</p><p class="elsevierStyleSimplePara elsevierViewall">The adverse effects of the preventive measures implemented in health services should be continually assessed and procedures for the critical evaluation of the benefit-risk-cost trade-offs of new preventive interventions should be established before making decisions on their incorporation in the health services’ portfolio. Finally, in daily clinical practice, enhancing citizen participation in decisions and adopting the approach of quaternary prevention would be desirable.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:43 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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Un sistema de salud integrado y centrado en los usuarios" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02139111/00000022000000S1/v1_201301221349/S0213911108760941/v1_201301221349/es/main.pdf?idApp=WGSE&text.app=https://gacetasanitaria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911108760941?idApp=WGSE" ]
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