Innovation 3.8 over 10: a clear "not passing"

Josep Mª Monguet

Self-deception is the path to regression. A few years ago (in 2006), I was invited to speak at the opening course conference for one of the entities of my university. I spoke about the deficit in innovation observed in Spain, sustained by multiple data. The rector, who spoke later, did his best to deny it using the sole argument that the universities had a large scientific production [1]. It became clear that he didn’t understand the difference between innovation and academic scientific production. Well, ten years later, our country is still the same if not worse. We can continue doing nothing about it, but we must understand that for building an innovative country, the islands of excellence are essential, but not enough.

Non-pharmacological prescription, the first choice treatment

Cristina Roure

Regular physical activity, directed exercise, social prescription or cognitive therapies don’t perform miracles, but neither do the medications that are prescribed daily in consultations and instead we accept them as a necessary evil, allocating 1 in 5 euros that is spent on health to pay for medicines that are not always taken, that don’t always produce the expected benefits when they don’t cause more harm than good.

Surprisingly the medical community find it hard to accept the role that non-pharmacological interventions and particularly physical activity should have not only in the prevention and treatment of chronic diseases, but also to combat frailty in an aging population like ours which moreover, lives submerged in a lifestyle that, after the incessant search for comfort, avoids any effort.

Break the "ill-fated trio": falls-immobility-delirium, an outstanding issue in the quality of hospitals

Marco Inzitari

The pressure on the safety of patients and medical errors to which we are all subject, together with the fear of professionals for possible complaints resulting from adverse events within the hospital (Hospital Acquired Conditions - HAC, for Americans), are changing the hospital culture, prioritizing the prevention of falls, in many cases, on top of mobility, functionality and, finally, the well-being of patients.

This is what happened in the US from 2007-2008, when the Centre for Medicaid and Medicare Services decided to penalize the billing of episodes of patients affected by different HAC, including falls with injury, to the Affordable Care Act (Obamacare), which penalizes hospitals with worse results in this sense. In our context, in recent years some care areas have also been rewarded or penalized, at the contract level, according to an indicator of intra-hospital falls.

The laws of medicine

Siddhartha Mukherjee, oncologist, researcher and professor at the University of Columbia, is the author of a small essay, The Laws of Medicine: field notes from an uncertain science (2015), which I found interesting enough to recommend to clinicians who desire to think a little more about what they do. "In the medical school," says the author, "they taught me a lot of facts, but they did not prepare me to navigate the immense spaces between these facts. Right now I could write a thesis on the physiology of sight, but I feel lost when I try to understand the conniving network that makes a man, who was prescribed home oxygen, give a false address to the service providers, embarrassed (I later learned), because he lived on the street."

Social addiction to biometrics

Salvador Casado

Mirrors are polished surfaces that reflect the image projected on them.  It is a technology that the ancient Egyptians and Greeks already knew and that has evolved over time. Today the majority of the population carries a pocket mirror that also allows immortalizing the images that come to it in the form of an auto-photo. In addition, modern mirrors reflect multiple variables and information of their owner. They measure his steps and the distance he travels, his activity pattern, his movements, his level of communication. They can measure the sleep/wakefulness rhythm and give a report on the quality of sleep and if we connect some specific gadget they can measure blood pressure, blood sugar and even do an electrocardiogram.

Treatments, tested

The other day, Xavier Bonfill and Iain Chalmers presented the Catalan edition of the book Testing Treatments. Better Research for Better Healthcare. This caught my attention and after 12 years of delay, I was motivated to read the work. It’s necessary to clarify that in 2006, the year of its first edition; I was a hospital CEO and had neither the head nor the time for this. Maybe one day we will have to talk about what the executives read. Be that as it may, this text is considered one of those that have laid the foundations of modern clinical management, which concentrates its focus on effectiveness, a goal as coveted as it is difficult (1).

Journalist Nick Ross, in the presentation of the first edition of the book, wrote: "This book is good for health; it shines light on the mysteries of how decisions about life and death are made. It goes to show how these criteria are generally lacking and it challenges doctors from around the world to change their ways.” On the other hand, Ben Goldacre, in the prologue of the second edition (2011), provides a really interesting quote: "The true purpose of the scientific method is to make sure that nature doesn’t mislead us into thinking that we know something that we don’t really know".