[Negative effects of individual-based preventive interventions. 2008 SESPAS Report]

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. 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. 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. 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.