Quaternary Prevention and the Challenges to Develop a Good Practice; Comment on “Quaternary Prevention, an Answer of Family Doctors to Overmedicalization”

Document Type : Commentary


Curitiba Health System Physician, Curitiba, Brazil


The article analyzes literature problems using as a parameter the quaternary prevention concept, introducing guidelines to have good shared decisions that avoid overdiagnosis and overtreatment and improve the quality of life. The author proposes a four-step approach: reliable evidence, awareness about populations profile, independent research analysis, and an understandable format by ordinary people.


Main Subjects

  1. Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. Int J Health Policy Manag 2015;4:61-4. doi:10.15171/ijhpm.2015.24
  2. Jamoulle M. Information et informatisation en medecine generale. Torisieme rounees de reflexion sur l’informatique. Presses Universitaires de Namur; 1986.
  3. Sackett DL, Richardson SR, Rosenberg W, et al. Evidence-Based Medicine: How to Practise and Teach EBM. Edinburgh: Churchill Livingstone; 1997.
  4. Gøtzche PC. Deadly medicines and organized crime, how does big pharma has corrupted health care. London: Radcliff; 2013.
  5. St-Onge JC. Tous fous? Québec: Écosocieté; 2013.
  6. Every-Palmer S, Howick J. How evidence-based medicine is failing due to biased trial and selective pubication. J Eval Clin Pract. 2014;20(6):908-914. doi:10.1111/jep.12147
  7. Greenhalgh T, Howick J, Maskrey N. Evidence based medicine: a movement in crisis? BMJ 2014;348:g3725. doi:10.1136/bmj.g3725
  8. Ioannidis JPA. Why most published research findings are false. PLoS Med. 2005;2:e124. doi:10.1371/journal.pmed.0020124
  9. Senn S. Three things that every medical writer should know about statistics. The Write Stuff 2009;18(3):159-162.
  10. AKST J. Dealing with irreproducibility. The Scientist. April 8, 2014. http://www.the-scientist.com/?articles.view/articleNo/39654/title/Dealing-with-Irreproducibility/
  11. Gérvas J, Fernández MP. Sano y Salvo y libre de intervenciones médicas innecessarias. Barcelona: Los Libros del Lince; 2013.
  12. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 2010;182:E839-842. doi:10.1503/cmaj.090449
  13. Atkins D, Eccles M, Flottorp S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res. 2004;4:38. doi:10.1186/1472-6963-4-38
  14. Christie-Seely J, Ford J, Warner M. The healthy family. In: Chistie-Seely J, ed. Working with the family in primary care. Westport: Praeger; 1984.