[Breast cancer: dangers of alleged certainties]. / Cancer du sein: danger des certitudes prétendues.

The artificial increase of breast cancer incidence is estimated as amounting to 30,000 new cases in the year 2000 in France. This increase would be attributable to a 1.2% lack of specificity for the whole range of diagnostic procedures. Sociologically, it appears that the Hippocratic devise "primum nil nocere" ("first don't harm") has been replaced today by "primum agere" ("act first"). Professionals should give information about both limitations and risks of screening. From an ethical point of view, screening programs justify themselves arguing that "there can't be harm in doing good". Absence of alternative strategies is not a sufficient argument for justifying screening with its uncertain consequences.

[Critical analysis of health priorities determination in France]. / Analyse critique de la détermination des priorités de santé en France.

Since the mid 1970's, reforms to the health care system were aimed at controlling expenditures. Furthermore, there was not much of a relationship between public health policies and expenditure control policies. The reforms of 1996 aimed to introduce a new paradigm. The French health care system, based until then upon the biomedical model, now must adopt public health tools: Definition of health objectives; Development of priorities; Evaluation; Allocation of resources based on needs; Public debates. The objective of this study is to evaluate the move toward defining priorities, three years after the introduction of this reform. The study focused on the type of priorities implemented (e.g. implicit or explicit priorities, access to health care services, or severity of health problems) and their links to the allocation of resources; and the practical development of priorities (e.g. political or technocratic procedure, the role of public debates). In France, priorities are defined by health problem and not by service. They are explicit, but the link to allocation of resources isn't clear. Despite a wide consultation, the system of defining priorities is more technocratic than political. Moreover, the system is more concerned with including health professionals (doctors, administrators) in this new approach to public health, than with taking public opinion into account.

[Elementary school health and the national education physician-teacher partnership: apropos of 2 surveys conducted by national education physicians in training]. / Santé à l'école primaire et partenariat médecin de l'éducation nationale-enseignant: à propos de deux enquêtes réalisées par des médecins de l'éducation nationale en formation.

This article presents the methods and results of two surveys aiming to contribute to the development of partnerships between doctors and teachers in primary school. The first study, carried out with a sample of elementary school teachers, shows the interest they have in health promotion at school, their desire to see national education doctors become involved in health education, and their misunderstanding of the role of national education doctors and nurses, especially in training and participation in school projects. The second study, carried out among a sample of national education doctors, shows their felt sense of "friction" between the individual medical approach within which they were trained and for which they are known and solicited, and the public health approach that they would like to develop. To ameliorate the partnership, the inspector of national education, as the responsible party for educational policies within his district, is the necessary "link" between doctors, school directors and teachers.

[General practitioners' experience in a mass screening campaign of colorectal cancers]. / Vécu d'une campagne de dépistage de masse des cancers colorectaux par les médecins généralistes.

In a mass screening campaign of colorectal cancer, general practitioners play an essential role for obtaining a high rate of participation from people. It is important to analyze the reasons for the participation and their actual experiences in the campaign. Out of 71 GPs participating in the campaign, 67 have been interviewed by a sociologist and 51 GPs (76%) considered themselves "motivated" for participating after an instruction course in small groups. Sixteen GPs were sceptical about the outcome or not highly motivated. However thirteen of them participated by moral obligation vis à vis their patients or for not being different from their colleagues. All GPs appreciated being actively involved in the organization of the screening campaign and considered that the public had been well informed. Such information covered the information leaflet, the press campaign at the beginning of the campaign and the recall letter for those who had not been consulted during the time when the test was distributed by GPs. The main constraint was the time spent to convince the patients to do the screening test and explain its importance. The additional time, 5 to 10 minutes per consultation was important to the GPs. They thought it was fair to be paid for their active participation. These data suggest that it is possible to motivate GPs for a mass screening campaign, on the condition that they are actively involved and participate in an instruction course for small groups.