Tesser Charles Dalcanale
Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Departamento de Saúde Pública. Florianópolis, SC, Brasil.
Rev Saude Publica. 2017 Dec 4;51:116. doi: 10.11606/S1518-8787.2017051000041.
Quaternary prevention consists in the identification of persons at risk of excessive medicalization and their protection against new unnecessary interventions, avoiding iatrogenic damages. Here, we argue about the importance of quaternary prevention in specific primary and secondary prevention. The recent great development of preventive medicine, biomedicalization of risks and their treatment as if they were diseases, and the powerful influence of the commercial interests of pharmaceutical industries on the production of medical-sanitary knowledge alter classifications, create diseases and pre-diseases, lower cutoff points, and erase the distinction between prevention and healing. This situation converts larger amounts of asymptomatic persons into sick individuals and diverts clinical attention and resources from sick persons to the healthy, from older adults to young persons, and from the poor to the rich. Quaternary prevention facilitates and induces the development and systematization of operational knowledge and guidelines to contain hypermedicalization and the damages of preventive actions in professional care, especially in primary health care.
四级预防在于识别有过度医疗化风险的人群，并保护他们免受新的不必要干预，避免医源性损害。在此，我们讨论四级预防在特定的一级和二级预防中的重要性。预防医学最近的巨大发展、风险的生物医学化以及将其当作疾病进行治疗，再加上制药行业商业利益对医疗卫生知识生产的强大影响，改变了分类，制造了疾病和前期疾病，降低了临界值，并消除了预防与治疗之间的区别。这种情况将大量无症状的人转变为患病个体，并将临床关注和资源从病人转移到健康人身上，从老年人转移到年轻人身上，从穷人转移到富人身上。四级预防促进并推动了操作知识和指南的发展与系统化，以遏制过度医疗化以及专业护理中预防措施的损害，尤其是在初级卫生保健中。
