Public Release:  Lifetime medical costs of obesity; nurses as 'soft targets' of drug company promotion

PLOS

A new research paper published in PLoS Medicine suggests that preventing obesity might result in increased public spending on medical care. Many countries are currently developing policies aimed at reducing obesity in the population. However, it is not currently clear whether successfully reducing obesity will also reduce national healthcare spending or not. Pieter van Baal and colleagues, from the National Institute for Public Health and the Environment in the Netherlands, created a mathematical model to try to answer this question.

In their study, van Baal and his co-workers created three hypothetical populations of 1000 men and women, all aged 20 years at the start: a group of obese, never-smoking individuals; a group of healthy-never smoking individuals of normal weight; and a group of smokers of normal weight. The model produced an estimate of the likely proportion of each group who would encounter certain long term (chronic) diseases, and then estimated what the approximate cost of medical care associated with each disease was likely to be. The researchers found that the group of healthy, never-smoking individuals had the highest lifetime healthcare costs, because they lived the longest and developed diseases associated with aging; healthcare costs were lowest for the smokers, and intermediate for the group of obese never-smokers.

However, the authors argue that although obesity prevention may not be a cure for increasing expenditures, it may well be a cost-effective cure for much morbidity and mortality and importantly contribute to the health of nations.

A Perspective by Klim McPherson, from Oxford University in the UK, who was not involved in the study, discusses the implications of these findings and comments that "it would be wrong to interpret the findings as meaning that public-health prevention (e.g., to prevent obesity) has no benefits"; the quality of life experienced by individuals, and other factors, must also be taken into account when planning interventions aimed at improving public health.

Citation: van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al. (2008) Lifetime medical costs of obesity: Prevention no cure for increasing health expenditure. PLoS Med 5(2): e29. doi:10.1371/journal.pmed.0050029

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050029

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-02-vanBaal.pdf

CONTACT:
Dr. Pieter van Baal
National Institute for Public Health and the Environment
Centre for Prevention and Health Services Research
A. van Leeuwenhoeklaan 9
Bilthoven, Utrecht 3720BA
Netherlands
+31 (0)30 274 3152
pieter.van.baal@rivm.nl


Related PLoS Medicine perspective article:

Citation: McPherson K (2008) Does preventing obesity lead to reduced health-care costs? PLoS Med 5(2): e37. doi:10.1371/journal.pmed.0050037

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050037

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-02-mcpherson.pdf

CONTACT:
Dr. Klim McPherson
Oxford University
Nuffield Department of Obstetrics and Gynaecology
Oxford,
United Kingdom
01865 740885
klim.mcpherson@obs-gyn.ox.ac.uk


FROM THE PLoS MEDICINE MAGAZINE SECTION:

Nursing education fails to prepare graduates to deal with the pharmaceutical industry's promotional tactics, and many nurses appear to accept promotional materials uncritically, according to an analysis of the nursing literature published in PLoS Medicine.

"The pharmaceutical industry recognizes nursing influence on medical prescribing and identifies nurses as a marketing target," say the authors, Annemarie Jutel (Otago Polytechnic, Dunedin, New Zealand) and David Menkes (University of Auckland, Hamilton, New Zealand). "The industry has had its eye on nurses and nurse practitioners for over a decade, and is heavily invested in wooing them."

Jutel and Menkes examined the published nursing literature, to look for papers that explored the influence of drug companies upon nurses and their education. Of the 32 articles that they found, only 13 expressed or reported any serious concerns about the role of the pharmaceutical industry in influencing nursing behavior. Four articles were "clearly industry-friendly," while 14 expressed mild concern about the pharmaceutical industry, viewed the support of the industry as generally favorable, or identified both the harms and benefits of the industry's involvement in health care.

Nurses should be encouraged to re-evaluate the educational benefits of promotional information, say the authors, "which is carefully selected, prone to bias, and hardly likely to be as beneficial as many believe."

Rather simplistically, they say, many articles about the undue influence of drug companies upon nurses argue that nurses simply need to be aware of the problem, and that through such awareness nurses will be able to avoid complicity in unethical drug promotion. "This optimistic approach belies the fact that many nurses are not trained in critical appraisal, and appear to understand little of the mechanisms by which marketing strategies operate," say Jutel and Menkes.

The authors call for a three-pronged strategy to tackle drug company promotion to nurses: train nurses to understand and manage the impact of commercial activity; institute broad health care policies to identify and prevent the intrusion of external commercial interests into clinical decision making at the bedside; and conduct research that will aid nurses with the challenges of pharmaceutical promotion.

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Citation: Jutel A, Menkes DB (2008) Soft targets: Nurses and the pharmaceutical industry. PLoS Med 5(2): e5. doi:10.1371/journal.pmed.0050005

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050005

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-02-jutel.pdf

CONTACT:
Dr. Annemarie Jutel
Otago Polytechnic
Dunedin, New Zealand
jutel@clear.net.nz
+64-21-513-305

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