Juan Gérvas

Instituto de Salud Carlos III, Madrid, Madrid, Spain

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Publications (70)59.15 Total impact

  • Source
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    ABSTRACT: The so-called «testosterone deficiency syndrome» is a blend of nonspecific symptoms typical of the physiological process of aging. This syndrome has been the subject of intense promotional activity that has presented the phenomenon as highly prevalent and with a major public health impact. This strategy has been accompanied by the emergence of new and easy to administer testosterone devices into the pharmaceutical market and has generated significant sales for drug companies. The commercial promotion of testosterone deficiency syndrome and its remedies has exploited cultural stereotypes of aging and sexuality through awareness campaigns promoted by the laboratories involved and has been disseminated by media with the participation of numerous experts and with the support of scientific associations, representing a paradigmatic case of disease mongering. This example might be of use in the response to disease mongering activities from the clinical and public health fields.
    Gaceta Sanitaria 01/2014; 28(2):173–176. · 1.12 Impact Factor
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    ABSTRACT: This paper examines strategies developed by Brazil and Spain for integrating Primary Health Care with Specialized Care. Common measures included: the filter role played by family doctors, territorialization of health services, specialist consultants/matrix support and consensual clinical protocols. Of particular note, in Brazil, is the recent introduction of decentralized regulation systems and, in Spain, the long established computerization of PHC clinical records. Both countries face the challenge of creating unified clinical records. Measures to foster more interpersonal relationship were considered the most successful strategies for integrating health workers from the two levels
    Saúde em Debate. 09/2013; 37(98):400-415.
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    FMC - Formación Médica Continuada en Atención Primaria 01/2013; 20(10):580–584.
  • Juan Gérvas
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    ABSTRACT: Quaternary prevention is a group of measures taken to prevent, decrease and/or alleviate the harm caused by health activities. Health activities not only generally produce benefits, but also harm. That is to say, although medical intervention is mainly favourable, there is a dynamic balance that requires continuous assessment of the clinical situation as naturally only those health activities that achieve more benefit than harm at the end are justified. Quaternary prevention is the avoidance of unnecessary medical activity, such as "check-ups". In another example, quaternary prevention is the recommendation of preventive measures of proven efficacy. As regards diagnosis, quaternary prevention is, for example, the avoidance of screening without foundation, such as in prostate cancer. The appropriate use of antibiotics in upper respiratory tract infections serves as an example of quaternary prevention in the field of treatment. Another example is the application of the correct rehabilitation techniques in non-specific low back pain, such as swimming and maintaining an active life as much as possible. Not to forget other important "non-classic" aspects in the elderly, such as to limit the harm that can be caused by physical movement restriction devices. These and other examples in daily practice are considered in this article to encourage the continual assessment of quaternary prevention, the classic primum non nocere "first, do no harm".
    Revista Española de Geriatría y Gerontología 10/2012;
  • Juan Gérvas
    Radiology 04/2012; 263(1):307-8; author reply 308. · 6.34 Impact Factor
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    ABSTRACT: Puntos clave Toda acción tiene una cara y una cruz; toda decisión clínica conlleva simultáneamente beneficios y per-juicios. Llamamos prevención cuaternaria al conjunto de ac-tividades que intentan evitar, reducir y paliar el daño provocado por la intervención médica. La prevención cuaternaria concierne por igual a la Atención Primaria y a la hospitalaria, pero es en la primera donde más actos se realizan, y por tanto, donde el potencial de evitar daños es mayor. La medicalización de la salud y la arrogancia de la medicina conllevan un mundo de excesos. La prevención cuaternaria debe impregnar desde las prácticas diagnósticas hasta las preventivas, pa-sando por las medidas rehabilitadoras y el uso de medicamentos dañinos. Además de estrategias prácticas conscientes de prevención cuaternaria, conviene desarrollar otras semiautomáticas, intuitivas, en el torbellino del trabajo clínico diario. Cabe hacer daño al ofrecer prevención cuaternaria en el día a día. No conviene, por ello, aceptar sin críticas las propuestas de prevención cuaternaria. Introducción En medicina, como en la vida, el bien y el mal están indi-solublemente unidos como las dos caras de la misma moneda; de este modo, toda decisión clínica conlleva be-neficios y perjuicios. Así, la anestesia que permite una cirugía indolora puede matar; la vacuna contra el saram-pión provoca encefalitis en un caso por millón; el consejo de lavarse las manos puede iniciar un comportamiento compulsivo, y la promoción del ejercicio físico puede des-encadenar la aparición de lesiones osteomusculares. Puesto que toda decisión médica puede provocar daños, es clave que los propios profesionales seamos conscien-tes de ello y recuperemos el viejo y milenario principio de actuación médica primum non nocere, por motivos éticos, pero también deontológicos; por ser nuestro deber y nuestra responsabilidad. Gran parte del crédito social y la confianza de los pacientes depende de la selección, oferta y realización de actividades que logren más beneficios que perjuicios.
    AMF. 01/2012; 8(6):312-317.
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    ABSTRACT: Objective: to carry out a critical appraisal of the Testosterone Deficit Syndrome (TDS), also known as low testosterone or T-low, its diagnosis and management. Materials and methods: a bibliographic search was carried out in the TRIP database and PubMed with the following key words: "testosterone deficiency", "late-onset hypogonadism", "male andropause" and "androgen deficiency in aging males" filtered by the type of study (clinical practice guidelines, systematic reviews, meta-analyses or clinical trials). Information on consumption and sales was obtained from invoiced prescriptions in Navarre from 2001 upto 2011. Results: many of the signs and symptoms that define this syndrome overlap with those produced by other health problems or even physiological conditions. Self diagnostic questionnaires present scarce predictive value and are not recommended for screening. Nor is there certainty about which biochemical parameter is clinically appropriate where even the interpersonal variability is high. The cut off points to determine the normality of the testosterone levels vary depending on the guidelines employed. Testosterone supplements do not modify total weight, nor do they improve muscular strength. There is no evidence of their effects on bone fractures and there is a very discrete increase in bone density. Evidence is lacking on whether there is a significant improvement on sex life. Far from reducing cardiovas-cular risk, as initially postulated, there are studies that actually show an increase. Other associated risks of this therapy include prostate morbidity, increase in hematocrit count, liquid retention, sterility and feminization. Conclusions: testosterone therapy in the management of TDS is not justified because there is no clear benefit in the relevant primary endpoints and there are alarming results on the possible risks. Increasing consumption responds to the success of awareness raising campaigns. TDS is a clear example of disease mongering.
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    BMJ (online) 01/2012; 345:e6905. · 17.22 Impact Factor
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    Boletín Información Terapéutica de Navarra. 01/2012; 20(4).
  • Juan Gérvas
    [Show abstract] [Hide abstract]
    ABSTRACT: Quaternary prevention is a group of measures taken to prevent, decrease and/or alleviate the harm caused by health activities.Health activities not only generally produce benefits, but also harm. That is to say, although medical intervention is mainly favourable, there is a dynamic balance that requires continuous assessment of the clinical situation as naturally only those health activities that achieve more benefit than harm at the end are justified.Quaternary prevention is the avoidance of unnecessary medical activity, such as “check-ups”. In another example, quaternary prevention is the recommendation of preventive measures of proven efficacy. As regards diagnosis, quaternary prevention is, for example, the avoidance of screening without foundation, such as in prostate cancer. The appropriate use of antibiotics in upper respiratory tract infections serves as an example of quaternary prevention in the field of treatment. Another example is the application of the correct rehabilitation techniques in non-specific low back pain, such as swimming and maintaining an active life as much as possible. Not to forget other important “non-classic” aspects in the elderly, such as to limit the harm that can be caused by physical movement restriction devices.These and other examples in daily practice are considered in this article to encourage the continual assessment of quaternary prevention, the classic primum non nocere “first, do no harm”.
    Revista Española de Geriatría y Gerontología 01/2012; 47(6):266–269.
  • Juan Gérvas
    Atención Primaria. 04/2011; 43(4):174–175.
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    ABSTRACT: Cuando el componente sanitario del Estado de Bienestar en España, y particularmente su AP, parece estar enferma, y al igual que ocurre con un paciente, tanto o más que un diagnóstico se precisa un pronóstico. Este libro pretende contribuir a ambos.
    01/2011; Springer, Healthcare., ISBN: 978-84-93806200
  • Juan Gérvas
    Fuel and Energy Abstracts 01/2011; 108(1):3-6.
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    Gaceta Sanitaria 01/2011; 25(5):443. · 1.12 Impact Factor
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    Juan Gérvas
    Atención Primaria 11/2010; 42(11):541-2. · 0.96 Impact Factor
  • Luís García Olmos, Juan Gervas
    Atencion Primaria - ATEN PRIM. 01/2010; 42(1):52-56.
  • Juan Gérvas
    Atencion Primaria - ATEN PRIM. 01/2010; 42(11):541-542.
  • Source
    Juan Gérvas, Peter R Mansfield
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    ABSTRACT: In the 1840s, many doctors carried out autopsies of women who had died of childbirth fever. The doctors sometimes became infected with bacteria without knowing it. When they delivered more babies, they transmitted the infection to more women, causing more to die. When it was suggested to the doctors that they might be unintentionally carrying harm- ful bacteria they felt insulted and reacted with angry denials. Fortunately, since then our profession has gone through a paradigm shift based on understanding the germ theory of disease. Initially, it was thought that doctors who deliver babies should never carry out autopsies, but methods of preventing and/or curing bacterial infection such as surgical gloves and hand washing have been shown to be effective. We now face a similar situation. In 2008, many doctors allowed themselves to be exposed to drug promotion. These doctors may have become infected with bias without knowing it. When they treat patients their decisions are not as good as they could be. When it is suggested to the doctors that they might be unintention- ally carrying harmful bias they feel insulted and react with angry denials. Our profession needs to go through a paradigm shift based on understanding theories of how decision-making can be biased, such as the Elaboration Likelihood Model and Cognitive-Experiential Self Theory. 1 Unfortunately, at this time, we do not have any proven methods for detecting, let alone preventing or curing, bias. Currently, many doctors deny that they are influenced by drug promotion, but are not so confident about their colleagues. This ''illusion of unique invul- nerability'' is common and makes people overconfident and thus at higher risk of being misled. 2 We live in a market society in which no product is sold without a comprehensive marketing plan, including advertising and incentives. In fact, when doctors prescribe new drugs, the first stage in the decision-making process is awareness of a new drug. The most important source of information is the pharmaceutical industry, in particular the company representatives. We are aware of seven studies of the impact of drug promotion on the quality of prescribing. One study found some good, but more harm. Two studies did not detect any effects. Four studies found only harm. Being marketing legitimate, we cannot accept crossing borders that carry needless injury (even death as the cerivastatin story shows) and cost. Inappropriate use of technology (medications, devices, infor- mation technology and others) carries the dangers of unnecessary labelling, poor treatment decisions, iatrogenic illness and economic waste. 3
    Journal of epidemiology and community health 10/2009; 63(10):773-4. · 3.04 Impact Factor
  • Atención Primaria 08/2009; 41(8):460–462. · 0.96 Impact Factor
  • Juan Gérvas
    European Journal of General Practice. 07/2009; 8(2).

Publication Stats

115 Citations
59.15 Total Impact Points

Institutions

  • 2013
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
  • 2012
    • Universidad Autónoma de Madrid
      Madrid, Madrid, Spain
    • Servicio Navarro de Salud
      Iruña, Navarre, Spain
  • 2009
    • Hospital Dr. Rodriguez Lafora
      Madrid, Madrid, Spain