{"id":14548,"date":"2020-01-20T14:23:25","date_gmt":"2020-01-20T14:23:25","guid":{"rendered":"http:\/\/www.re-check.ch\/wordpress\/?p=14548"},"modified":"2024-10-28T12:12:20","modified_gmt":"2024-10-28T12:12:20","slug":"erice","status":"publish","type":"post","link":"https:\/\/www.re-check.ch\/fr\/erice\/","title":{"rendered":"Reflets du Forum 4Es sur les effets n\u00e9fastes des produits m\u00e9dicaux"},"content":{"rendered":"<p>Du 7 au 9 octobre 2019, Catherine Riva a particip\u00e9 au <a href=\"https:\/\/www.cebm.net\/4es\/\" target=\"_blank\" rel=\"noopener noreferrer\">4Es Forum Improving the detection, analysis and reporting of harms in medicines<\/a>, un workshop de trois jours organis\u00e9 par le Centre for Evidence-Based Medicine (<a href=\"https:\/\/www.cebm.net\/\" target=\"_blank\" rel=\"noopener noreferrer\">CEBM Oxford<\/a>) et le Centre de pharmacovigilance d\u2019Uppsala (<a href=\"https:\/\/www.who-umc.org\/\" target=\"_blank\" rel=\"noopener noreferrer\">Uppsala Monitoring Centre<\/a>), centre collaborateur de l\u2019OMS pour la pharmacovigilance internationale. Cette rencontre, qui s\u2019est tenue \u00e0 l\u2019Ettore Majorana Foundation and Centre for Scientific Culture, \u00e0 Erice (I), a r\u00e9uni une trentaine de participants venus de diff\u00e9rents pays et d\u2019horizons professionnels tr\u00e8s divers: chercheurs, cliniciens, professionnels de sant\u00e9, responsables de programmes de pharmacovigilance, journalistes et repr\u00e9sentants d\u2019initiatives de d\u00e9fense des patients et de consommateurs.<\/p>\n<p>Partant du constat que les proc\u00e9dures d\u2019homologation actuelles pr\u00e9sentent des lacunes, que de nombreux produits m\u00e9dicaux disponibles sont inefficaces et que la surveillance post-marketing \u00e9choue r\u00e9guli\u00e8rement \u00e0 d\u00e9tecter les effets ind\u00e9sirables qu\u2019ils induisent avant que des personnes ne soient l\u00e9s\u00e9es, ce workshop visait \u00e0 explorer pendant trois jours des pistes d\u2019analyses et de solutions pour progresser sur cette question.<\/p>\n<p>Chaque journ\u00e9e \u00e9tait consacr\u00e9e \u00e0 une th\u00e9matique sp\u00e9cifique: la premi\u00e8re \u00e0 la phase pr\u00e9-marketing (avant la mise en march\u00e9), la deuxi\u00e8me \u00e0 la phase post-marketing et la troisi\u00e8me \u00e0 la communication sur les effets ind\u00e9sirables des produits m\u00e9dicaux. Chaque matin\u00e9e et chaque apr\u00e8s-midi s\u2019articulaient autour de trois pr\u00e9sentations dont les contenus devaient susciter la r\u00e9flexion et \u00eatre d\u00e9velopp\u00e9s ensuite dans le cadre de s\u00e9ances pl\u00e9ni\u00e8res et de travaux de groupe.<\/p>\n<p>A l\u2019occasion de la session \u00abPotential solutions to the problems of pre-marketing approvals\u00bb, Catherine Riva a pr\u00e9sent\u00e9 les r\u00e9sultats de l\u2019enqu\u00eate Re-Check sur le ghost-management et les captures \u00e0 l\u2019\u0153uvre lors de l\u2019homologation du premier vaccin anti-HPV, ainsi que notre projet de recherche en cours sur le ghost-management (<a href=\"https:\/\/www.re-check.ch\/fr\/projets\/ghoman-6\/\" target=\"_blank\" rel=\"noopener noreferrer\">GhoMan \u2013 Chasing the Ghosts<\/a>).<\/p>\n\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-1 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-1 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 33%;\n\t\t\t}\n\t\t\t#gallery-1 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-1 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-1' class='gallery galleryid-14548 gallery-columns-3 gallery-size-medium'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_04.png'><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"217\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_04-300x217.png\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_04-300x217.png 300w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_04-200x144.png 200w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_04-400x289.png 400w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_04.png 579w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_03.png'><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"235\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_03-300x235.png\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_03-300x235.png 300w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_03-200x157.png 200w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_03-400x313.png 400w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_03.png 586w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_02.png'><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"217\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_02-300x217.png\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_02-300x217.png 300w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_02-200x145.png 200w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_02-400x290.png 400w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_02.png 588w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_01.png'><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"284\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_01-300x284.png\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_01-300x284.png 300w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_01-200x189.png 200w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_01-400x378.png 400w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Tweet_01.png 588w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a>\n\t\t\t<\/dt><\/dl>\n\t\t\t<br style='clear: both' \/>\n\t\t<\/div>\n\n<p>Les organisateurs avaient <a href=\"https:\/\/www.cebm.net\/4es\/\" target=\"_blank\" rel=\"noopener noreferrer\">annonc\u00e9<\/a> d\u2019embl\u00e9e qu\u2019ils attendaient des conf\u00e9renciers des contenus provocants de nature \u00e0 lancer et nourrir le d\u00e9bat. Pari r\u00e9ussi: les discussions ont \u00e9t\u00e9 effectivement vives et engag\u00e9es.<\/p>\n<p>Les participants se sont rapidement accord\u00e9s sur un premier constat: la situation est extr\u00eamement grave et pr\u00e9sente toutes les caract\u00e9ristiques d\u2019une crise. Les effets ind\u00e9sirables des produits m\u00e9dicaux repr\u00e9sentent en effet une cause majeure et croissante de maladies, d\u2019invalidit\u00e9 et de d\u00e9c\u00e8s, voire sans doute de recul de l\u2019esp\u00e9rance de vie dans certains pays industrialis\u00e9s. Une grande partie de ce fardeau est d\u00fb \u00e0 la surm\u00e9dicalisation, qui aggrave les risques li\u00e9s \u00e0 des conditions courantes au lieu de les am\u00e9liorer. Et le probl\u00e8me semble vou\u00e9 \u00e0 empirer avec l\u2019acc\u00e9l\u00e9ration des proc\u00e9dures d\u2019homologation des nouveaux traitements. Par ailleurs, le syst\u00e8me actuel \u00e9choue trop souvent \u00e0 rendre compte des dommages r\u00e9ellement induits par les prescriptions inad\u00e9quates, des traitements inefficaces et la polypharmacie.<\/p>\n<p>Autre constat partag\u00e9 par l\u2019ensemble des participants: la surveillance des effets ind\u00e9sirables des m\u00e9dicaments d\u00e9pend en grande partie de la recherche observationnelle sponsoris\u00e9e par les soci\u00e9t\u00e9s qui commercialisent les produits m\u00e9dicaux et des plans de gestion des risques qu\u2019elles dirigent. Ceux-ci sont g\u00e9n\u00e9ralement trop petits, pr\u00e9sentent d\u2019importantes faiblesses m\u00e9thodologiques et leurs r\u00e9sultats sont gard\u00e9s secrets. Or les principales agences de r\u00e9gulation (FDA, EMA) s\u2019appuient pr\u00e9cis\u00e9ment sur eux pour la surveillance de la s\u00e9curit\u00e9 des produits m\u00e9dicaux. Enfin, si la notification spontan\u00e9e permet d\u2019identifier de nombreux effets ind\u00e9sirables de ces produits inconnus jusque-l\u00e0, elle ne permet pas d\u2019estimer leur incidence et le probl\u00e8me de la sous-notification reste entier.<\/p>\n<p>Cet \u00e9tat des lieux a tr\u00e8s vite amen\u00e9 un autre probl\u00e8me cl\u00e9 sur la table: comment \u00e9tablir avec un haut degr\u00e9 de certitude qu\u2019il existe bel et bien un rapport de cause \u00e0 effet entre un produit m\u00e9dical et un dommage subi? Cette question de la causalit\u00e9 se heurte souvent aux limites m\u00e9thodologiques actuelles de la pharmacovigilance. Elle est aussi compliqu\u00e9e par l\u2019influence d\u2019acteurs dont les agendas sont en conflit avec l\u2019int\u00e9r\u00eat des patients. Par ailleurs, elle se pose de mani\u00e8re tr\u00e8s concr\u00e8te, mais en d\u2019autres termes, pour chaque cas de personne l\u00e9s\u00e9e: car m\u00eame si la recherche sugg\u00e8re que tel produit m\u00e9dical peut occasionner certains effets secondaires, comment \u00eatre s\u00fbr qu\u2019il est vraiment responsable des effets ind\u00e9sirables subis par tel individu? Ces questions ne sont toujours pas r\u00e9solues et les patients concern\u00e9s restent souvent tr\u00e8s seuls. De nombreux participants ont rappel\u00e9 l\u2019urgente n\u00e9cessit\u00e9 d\u2019une r\u00e9forme du syst\u00e8me pour enfin accorder la place aux r\u00e9cits des patients et des victimes la place qu\u2019ils m\u00e9ritent et trouver d\u2019autres voies pour communiquer \u00e0 ce sujet.<\/p>\n<p>D\u2019importants d\u00e9saccords sont \u00e9galement apparus lors des \u00e9changes concernant certains aspects fondamentaux: l\u2019analyse des causes et des principaux moteurs de la situation actuelle, le r\u00f4le de l\u2019Evidence-Based Medicine (EBM) \u2013 notamment de la pyramide des preuves et de la valeur des essais randomis\u00e9s contr\u00f4l\u00e9s (RCT) \u2013 ainsi que le degr\u00e9 de radicalit\u00e9 \u00e0 adopter dans les prises de position et les cons\u00e9quences \u00e0 tirer des discussions.<\/p>\n<p>Au vu de ces divergences, les trois jours de rencontre \u00e0 Erice ne pouvaient donc que constituer un premier pas dans un processus qui s\u2019annonce long et difficile. Les participants pr\u00e9sents \u00e9taient presque tous des personnalit\u00e9s connues pour leur positionnement tr\u00e8s critique par rapport au syst\u00e8me actuel et favorable \u00e0 des r\u00e9formes profondes. Mais, \u00e0 l\u2019\u00e9vidence, pour l\u2019heure, ils ont d\u2019importantes difficult\u00e9s \u00e0 s\u2019accorder sur certains points fondamentaux et les directions \u00e0 adopter.<\/p>\n<p>Au-del\u00e0, cette rencontre a \u00e9t\u00e9 productive. Plusieurs documents (prises de positions et feuilles de route) ont notamment \u00e9t\u00e9 produits \u00e0 l\u2019occasion de ce workshop et offrent tous une base sur laquelle travailler. Le premier est maintenant disponible: il s\u2019agit du Statement d\u2019Erice qui inclut notamment dix recommandations.<\/p>\n<p><a href=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Erice-infographic-final.png\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-14551 aligncenter\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Erice-infographic-final-183x300.png\" alt=\"\" width=\"544\" height=\"892\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Erice-infographic-final-183x300.png 183w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/Erice-infographic-final-200x329.png 200w\" sizes=\"(max-width: 544px) 100vw, 544px\" \/><\/a><\/p>\n<p>Le British Medical Journal (BMJ) a \u00e9galement r\u00e9alis\u00e9 un <a href=\"https:\/\/soundcloud.com\/bmjpodcasts\/talk-evidence-talking-about-harms?in=bmjpodcasts\/sets\/the-bmj-podcast\" target=\"_blank\" rel=\"noopener noreferrer\">podcast<\/a> avec certains participants au workshop, dont Catherine Riva de Re-Check. A \u00e9couter <a href=\"https:\/\/soundcloud.com\/bmjpodcasts\/talk-evidence-talking-about-harms?in=bmjpodcasts\/sets\/the-bmj-podcast\" target=\"_blank\" rel=\"noopener noreferrer\">ici<\/a>.<\/p>\n\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-2 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-2 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 33%;\n\t\t\t}\n\t\t\t#gallery-2 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-2 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-2' class='gallery galleryid-14548 gallery-columns-3 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191006_084335.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191006_084335-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191006_084335-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191006_084335-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191006_122707.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191006_122707-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191006_122707-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191006_122707-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGbTyTPWsAAV5zJ.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGbTyTPWsAAV5zJ-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-2-14566\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGbTyTPWsAAV5zJ-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGbTyTPWsAAV5zJ-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-2-14566'>\n\t\t\t\tTom Jefferson, Rebecca Chandler @RebeccaChandle1, Peter G\u00f8tzsche @PGtzsche1\n\t\t\t\t<\/dd><\/dl><br style=\"clear: both\" \/><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGgz0ShWoAAZasy.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGgz0ShWoAAZasy-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-2-14567\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGgz0ShWoAAZasy-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGgz0ShWoAAZasy-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-2-14567'>\n\t\t\t\tNicholas DeVito @NDevito1, Carl Heneghan @carlheneghan, Ruth Davis @CebmOxford, Georgia Richards @Richards_G_C\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGhHrRCWsAAoady.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGhHrRCWsAAoady-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-2-14568\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGhHrRCWsAAoady-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/EGhHrRCWsAAoady-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-2-14568'>\n\t\t\t\tCatherine Riva @RecheckHealth, Kath Sansom @MeshCampaign, Kim Witczak @woodymatters\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_100050_001.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_100050_001-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_100050_001-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_100050_001-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_100729.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_100729-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_100729-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_100729-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_094541.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_094541-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_094541-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_094541-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095259.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095259-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095259-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095259-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_095109.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_095109-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191007_095109-150x150.jpg 150w, 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decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095550-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095550-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095550-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095736.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095736-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095736-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_095736-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_100204.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_100204-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_100204-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_100204-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_100951.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_100951-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_100951-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_100951-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_143025.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_143025-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_143025-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_143025-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_143211.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_143211-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_143211-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191008_143211-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_091943.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_091943-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_091943-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_091943-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_093432.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_093432-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_093432-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_093432-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_094544.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_094544-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_094544-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_094544-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_094630.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_094630-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_094630-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_094630-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_095242.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_095242-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_095242-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_095242-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111411.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111411-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111411-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111411-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111911.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111911-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111911-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111911-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><br style=\"clear: both\" \/><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111959.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111959-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111959-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_111959-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_131432.jpg'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_131432-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-2-14591\" srcset=\"https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_131432-150x150.jpg 150w, https:\/\/www.re-check.ch\/wp-content\/uploads\/2020\/01\/20191009_131432-66x66.jpg 66w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-2-14591'>\n\t\t\t\tCatherine Riva @RecheckHealth, Kath Sansom @MeshCampaign, Carl Heneghan @carlheneghan\n\t\t\t\t<\/dd><\/dl>\n\t\t\t<br style='clear: both' \/>\n\t\t<\/div>\n\n<p><strong>Improving the detection, analysis, and reporting of harms in medicines and devices \u2013 Statement from the 2019 4Es Forum (Exploring, Enhancing, and Empoweringin Erice) (<a href=\"https:\/\/www.cebm.net\/wp-content\/uploads\/2019\/12\/The-Erice-Statement.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">t\u00e9l\u00e9charger le PDF<\/a>)<br \/>\n<\/strong><\/p>\n<p><strong>Serious global challenges exist in recognizing and minimizing harms from medicines and devices<\/strong><\/p>\n<p>Harms from medicines and devices are increasingly recognized as important causes of morbidity and mortality worldwide. Given the current and future levels of their use in clinical practice, the total burden from harms of medicines and devices is a serious and growing global public health problem.<\/p>\n<p>Examining the benefit-harm profile of medicines and devices is the collective responsibility of multiple stakeholders, including industry, regulators, policymakers, healthcare systems, healthcare professionals, patients, and their carers. However, the current states of development, approval processes, surveillance, and use of medical products limit the abilities of all parties to fulfil their respective responsibilities. The competitive environment of research and development in industry and the shift towards rapid access by regulators have resulted in a growing number of new medicines and devices with marginal effectiveness and unknown harms receiving marketing authorization. Decisions by regulators are based on data of benefits and harms that are chosen by the sponsor and may be incomplete. Furthermore, estimates of benefit-harm at the time of marketing authorization are made using pre-selected populations which may fail to reflect the heterogeneity of users in clinical practice.<\/p>\n<p>Harms caused by medical products not only depend on the intrinsic properties of the product and on the susceptibility of the individual patient, but also on how they are prescribed and used within and outside of healthcare systems. Post-authorization surveillance of the adverse effects of medical products predominately relies on company-sponsored studies, as part of their regulatory commitments, and case reports collected by regulators from industry or directly from health professionals and patients. The results of post-authorization studies contained within risk management plans are often not completed and their results are often not published, while serious harms experienced in clinical practice are often under-reported. Furthermore, case reports are currently under-appreciated in the hierarchies of evidence used for the development of guidelines for clinical practice.<\/p>\n<p>The 4Es Forum on Improving the detection, analysis, and reporting of harms in medicines and devices was held in Erice, Italy between 7-9 October 2019. It provided an opportunity to build a foundation for future collaboration between two disciplines \u2013 evidence-based medicine and pharmacovigilance \u2013 which share common concerns regarding harms from medicines and devices. This statement represents the common ground of agreement established at the conclusion of three days of intensive discussion and debate.<\/p>\n<p><strong>Our recommendations for improving patient safety<\/strong><\/p>\n<p>To improve the detection, analysis, and reporting of harms in the interests of patient safety, we recommend the following:<\/p>\n<ol>\n<li>Raise public and professional awareness of the harms from medicines and devices.<\/li>\n<li>Shift the culture within regulatory and health care management systems from one of secrecy to one of transparency.<\/li>\n<li>Enforce existing effective regulations, revise ineffective ones, and implement effective regulations in those areas lacking appropriate regulatory infrastructure.<\/li>\n<li>Transfer from industry to healthcare systems the responsibility for providing information and support to healthcare providers on the use of medicines and devices.<\/li>\n<li>Encourage and enable prescription and use of medicines and devices that are appropriate and tailored to the needs of individual patients.<\/li>\n<li>Facilitate access to all relevant data.<\/li>\n<li>Recognize case reports, including those written by patients, as a valid and important form of evidence of harms.<\/li>\n<li>Improve baseline and continuing education of all stakeholders, including healthcare professionals, policymakers, and the public.<\/li>\n<li>Recognize the importance of patients and carers, as well as healthcare professionals, in studying all aspects of therapy.<\/li>\n<li>Establish and continuously develop effective communication with patients and other relevant stakeholders about the potential benefits and harms of interventions to improve the basis for shared decision making about treatments.Mechanisms of change We believe that patient safety requires constant vigilance of safety systems, structures, organizations, and processes. Therefore, we encourage the formation of open, inclusive, and collaborative efforts to identify challenges and develop practical, implementable solutions that improve patient safety worldwide.<\/li>\n<\/ol>\n<p><strong>About this statement<\/strong><\/p>\n<p>This statement was created at the 4Es Forum on Improving the detection, analysis, and reporting of harms in medicines and devices in Erice, Italy, 7-9 October 2019. The 4Es Forum was co-organized by the International School of Pharmacology Giampaolo Velo, Verona, Italy; the Centre for Evidence-Based Medicine, Oxford, UK; and Uppsala Monitoring Centre, Uppsala, Sweden. The Steering Committee included Georgia Richards (Chair), Dr Rebecca Chandler, Professor Carl Heneghan, Dr Marie Lindquist and Ruth Davis. It was hosted by the Ettore Majorana Foundation and Centre for Scientific Culture, Erice, Italy and was attended by health professionals, researchers, academics, journalists, patient advocates, and consumers.<\/p>\n<p><strong>Signatories<\/strong><\/p>\n<ol>\n<li>Rebecca E Chandler, MD, Uppsala Monitoring Centre, Sweden<\/li>\n<li>Anthony Cox, BSc PhD FHEA FRPharmS Clin Dip Pharm, University of Birmingham, UK<\/li>\n<li>Nicholas J. DeVito, MPH, DPhil Candidate, University of Oxford, UK<\/li>\n<li>Kay Dickersin, PhD, Professor Emerita, Johns Hopkins University, USA<\/li>\n<li>I Ralph Edwards, Professor, Editor-in-chief International Journal of Risk and Safety in Medicine, Sweden<\/li>\n<li>Su Golder, BSc MSc PhD FRSA, University of York, UK<\/li>\n<li>Peter C G\u00f8tzsche, MD Institute for Scientific Freedom, Denmark<\/li>\n<li>Carl Heneghan, BM, BCH, MA, MRCGP, DPhil, Professor, University of Oxford, UK<\/li>\n<li>Bruce Hugman, Communications consultant, Oxford, UK<\/li>\n<li>Florence van Hunsel, PharmD-epidemiologist, Lareb, Netherlands<\/li>\n<li>Tom Jefferson, MD MSc FFPHM MRCGP, CEBM University of Oxford, UK<\/li>\n<li>Lars J\u00f8rgensen, MD PhD GP-fellow, Nordic Cochrane Centre, Denmark<\/li>\n<li>Joan-Ramon Laporte, Professor Em\u00e8rit de Farmacologia, UAB; Fundaci\u00f3 Institut Catal\u00e0 de Farmacologia, Spain<\/li>\n<li>Tianjing Li, MD MHS PhD, University of Colorado Denver, USA<\/li>\n<li>Marie Lindquist, Director, CEO, Uppsala Monitoring Centre, Sweden<\/li>\n<li>Helen Macdonald, MD BA MSc, BMJ, UK<\/li>\n<li>Gilles Mignot, MD, Founder, Prescrire, France<\/li>\n<li>Asger Sand Paludan-M\u00fcller, MSc, Nordic Cochrane Centre, Denmark<\/li>\n<li>Georgia Richards, BSc (Hons I), DPhil Candidate, University of Oxford, UK<\/li>\n<li>Catherine Riva, Investigative journalist, Re-Check, Switzerland<\/li>\n<li>Gerard Ross, Uppsala Monitoring Centre, Sweden<\/li>\n<li>Kath Sansom, Journalist, Founder of Sling the Mesh Advocacy Campaign, UK<\/li>\n<li>Kim Witczak, Drug safety advocate and public speaker, consumer representative on FDA Psychopharmacologic Drugs Advisory Committee, USA<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Du 7 au 9 octobre 2019, Catherine Riva a particip\u00e9 au 4Es Forum Improving the detection, analysis and reporting of harms in medicines, un workshop de trois jours organis\u00e9 par le Centre for Evidence-Based Medicine (CEBM Oxford) et le Centre de pharmacovigilance d\u2019Uppsala (Uppsala Monitoring Centre), centre collaborateur de l\u2019OMS pour la pharmacovigilance internationale. Cette<a class=\"excerpt-read-more\" href=\"https:\/\/www.re-check.ch\/fr\/erice\/\" title=\"ReadReflets du Forum 4Es sur les effets n\u00e9fastes des produits m\u00e9dicaux\">&#8230; Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":14555,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[105,121,119,115,168,103,162],"tags":[],"class_list":["post-14548","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-conflits-dinterets-conflict-of-interest-fr","category-effets-indesirables-adverse-effects-fr","category-essais-cliniques-clinical-trials-fr","category-homologations-approvals-fr","category-hpv-vph-hpv","category-methodologie-methodology-fr","category-risque-risk"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/posts\/14548"}],"collection":[{"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/comments?post=14548"}],"version-history":[{"count":13,"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/posts\/14548\/revisions"}],"predecessor-version":[{"id":19855,"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/posts\/14548\/revisions\/19855"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/media\/14555"}],"wp:attachment":[{"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/media?parent=14548"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/categories?post=14548"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.re-check.ch\/fr\/wp-json\/wp\/v2\/tags?post=14548"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}