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Conflict of interests and circumstances.

"I am myself and my circumstances"

José Ortega y Gasset

standard is now widespread, finding scientific publications in the declaration of conflict of interest. Everyone seems logical enough to quarantine the conclusions of a scientific study of a drug that is directly sponsored (financed directly by the research) or indirectly (the research is funded by the sponsor, although such funding is not directly devoted to research in progress) by a laboratory to which you are interested in selling the drug (we call this a direct conflict of interest) or otherwise to assume that competition for their own products (we call this an indirect conflict of interest .) However, not finish be usual to detail everything that could be considered a conflict of interest in this field. When making a declaration of interests, are generally exposed conflicts of interest directly, when it has received direct funding, being much more rare to declare other types of conflicts.

But it's not conflict of interest of what I write, but conflicts of circumstances. These are much more hidden and perhaps more momentous occasion. They are still conflicts in which the end is put into play an income that may not be monetary, but in one way or another can result in economic benefits: prestige that translates into more clients in private practice in contracts as a lecturer in higher sales for a book, and why not a greater number of visits on a blog that translate into higher advertising revenues.

But explain what I mean. Conflict of circumstances when personal circumstances (where you work, fitted with whom you work, number of patients served, help from other professionals, private practice, specialty or possesses and exercises could potentially exercise, family circumstances , political opinion or religious beliefs) could influence the findings of a study or in the statements made in public or what is written in an editorial of a scientific journal. Of course, there are conflicts of circumstances which are legally protected and not have to be declared (political leanings or religious beliefs), even if they miss.

a few examples:

Could be influenced a study on the advisability of circumcision to all newborns, the researchers religion they profess?

Could be influenced a study comparing public and private health systems on the political leanings of the authors?

Could be influenced a study on the healthcare professional to meet a condition, circunstancia fisiológica (embarazo) o una etapa vital (infancia, adolescencia, senectud), por la especialidad que se ejerce o se posee?

¿Podría estar influido un estudio sobre factores de riesgo que precisarán valoración por un médico, por el hecho de que los investigadores tuviesen ejercicio público o privado?

¿Podría estar influida una opinión en una editorial por el hecho de trabajar en atención primaria, secundaria o terciaria?

¿Importaría conocer el número de pacientes que atiende a diario? ¿Si dispone de enfermera? ¿Si tiene una reducción de jornada por liberación sindical o por asunción de otras tareas distintas the directory assistance? If you have an emergency service that attends to all patients not listed? If watchkeeping? The

or asked another way:

Should we take into account the conclusions of a group of cardiologists in private practice on the desirability of specialized cardiological evaluation of all patients before initiating ADHD drug therapy? What if at the time of signing or declare a conflict of interest only place they receive no assistance of any kind of drug lab?

Should we listen to someone who does not work in primary care on how best to organize care pediatric? What if the sign it is as though the primary care pediatrician is in a zone address without basic health care burden?

Should we listen to the gynecologist in private practice defending the need for monthly visits during pregnancy including ultrasound normal? What if he is a pediatrician in private practice who wish to extend childhood to age 21? Should we listen to a trade union cabinet released on private radiological signs of chest radiology in primary care? What if no one declares these circumstances?

Say, I'm quite curious and would like to learn more often the circumstances surrounding those who advocate a particular model of care, for care of a particular age group, by specific diagnostic technique for specific therapeutic technique and, unfortunately, I have an extreme tendency to think badly, perhaps because mixed in me suicidal (thinking is an act quasi-paraphrase autolytic Cioran, "every thought is a thought of more" * or more colloquially "thinking is losing" -) and perfectionists (I do not like mistakes and it forces me wrong thinking - "think wrong and you will succeed," says the English proverb-).

Hopefully whoever ends or say something that means more to others than himself, was aware of all the bad thoughts that unnecessarily causes ...

And now, is when I clear my conflicts of interest and my circumstances: I am ...

I'm a provocateur.

* "Every word is a word more" EM Cioran

Cieling Fan Connection

Flu and quiet: a virtual medical group with influenza A (2009-2010) Fanning the flame

In the spring and summer 2009, the news media on called influenza A were each passing day more frequent, alarming and overwhelming. The scenario he painted was almost gruesome and forecasts of health authorities suggested a pandemic that would reap the lives of many tens of thousands of people around the world.

However, in August 2009 and it could be presumed that the development of the pandemic in the autumn-winter would be like that took place during the winter the southern hemisphere (Argentina, Australia, Chile, New Zealand, Uruguay and other countries) and in the last month of spring in the northern hemisphere (Canada, USA. UU., Mexico and other countries). Both the epidemiological data published, as our perception in the day to day, were showing that the morbidity and mortality from influenza were even lower than the corresponding to a regular seasonal flu outbreak. This benign behavior contrasted sharply with the health authorities, the various contingency plans and correlative (different for each autonomous region) caused a significant impact on the organization of services and health care costs, apart from increasing public alarm. In fact, in primary care consultations perceive a state of increasing public concern. Examples such as consultations on voluntary abortion to prevent damage to the flu epidemic or young frightened by the apparent particular susceptibility of these to "new" virus, were not rare in medical clinics and nursing.

Moved by the turn events were acquired, several professionals in the English health system (general practitioners, pediatricians, pharmacists, family medicine residents, medical students and others) whose only common denominator was the editing blogs and web pages, we decided to take action on the matter and package it in order to find, analyze, develop and disseminate rigorous and accurate information on pandemic flu and the more cautious and scientific answer to it.

The movement began in mid-August 2009 and caught on with the name, logo and summary of "gripeycalma" for what was intended to put, to Influenza A, tranquility in the population and professionals. The work was carried out in a coordinated manner using new technologies of network communication, which is an innovative and perhaps unique in our country. As initial work product was spread in unison, on a day like today, in all blogs participating in the initiative, a statement in which he analyzed the epidemiological situation and proposed a series of advice for citizenship. Likewise, it created a blog ( Influenza A: first of all very quiet ) which served as a common platform of the movement, which were being made available to all new documents (organizational proposals, questions and answers), with translations into several languages \u200b\u200band in different formats (video, presentation, disclosure sheets, etc).

The echo of the initiative was immediate and intense. It added more blogs, both health professionals and general population interested in health, to nearly 200, and page of the group had, in just 3 months, some 80,000 visitors. And indeed, in practice it was possible to transmit the network through virtual communities, the message sought to influenza A, of calm and tranquility, serenity and rationality, both the population and the profession itself health. The impact was even the authorities, who moderated their response.

The end of the story can be written and are writing done after a birth year of the initiative. Influenza A had a peak of higher incidence in mid-November 2009 and has been a mild flu, with little impact on morbidity and mortality. The call for calm was because the scientific basis and little by little revealing that los escenarios apocalípticos no tenían razón de ser. Solo esperamos que la experiencia de esta pandemia sirva para mejorar y manejar, de forma más eficiente y ponderada, crisis futuras, evitando, en la medida de las posibilidades, caer en un consumo desmedido de recursos - que siempre implica dejar de atender otros problemas - y en una desproporcionada oleada de pánico colectivo.

Este texto cierra el primer episodio de la unión temporal de blogs y páginas de profesionales sanitarios y de otros relacionados con la salud en la Red. Muchas gracias a todos los que han colaborado de una u otra forma y a los que han visto y sentido a gripeycalma como lo que es: una iniciativa profesional que ha buscado go beyond our consultations and jobs. We just tried to bring a message of common sense and science both the public and health professionals to communicate our knowledge and understanding about a health problem, in this case to influenza A. Thanks to the work of many and the power they give us new information technologies, we can say that we succeeded.

temporary posts Union (UTB) Influenza and Calm