The wisdom of Falstaff
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1417 (Published 27 August 2008) Cite this as: BMJ 2008;337:a1417
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The commonly held belief that lifestyle diseases result in excess
health care costs, and thus that preventing them would save money, may be
wrong. (1)
1. Lifetime Medical Costs of Obesity: Prevention No Cure for
Increasing Health Expenditure
van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al.
PLoS Medicine Vol. 5, No. 2, e29 doi:10.1371/journal.pmed.0050029
Conclusions
Although effective obesity prevention leads to a decrease in costs of
obesity-related diseases, this decrease is offset by cost increases due to
diseases unrelated to obesity in life-years gained. Obesity prevention may
be an important and cost-effective way of improving public health, but it
is not a cure for increasing health expenditures.
Dr Stephen Workman
Halifax, Nova Scotia,
Canada
Competing interests:
None declared
Competing interests: No competing interests
Theodore Dalrymple is right to be amused by a bingo hall full of
elderly people having a lovely time, and admiring of Jack Falstaff as an
outrageous non conformist.
Shakespeare also said that all progress depends on the unreasonable man.
But are we to believe therefore that there no reason to plan for
healthy living or take account of the massive evidence showing the huge
impact of those many powerful and vested influences whose side effects
include illness, disease and death, or the impact of long established
cultures where, for example, diets high in fat are there from the earliest
age and are thus just fine? Are we mistaken in making smoking more and
more difficult, or suggesting that unprotected sunbathing can be a killer?
I think not. Equally I do not support putting undue pressure on
people who suffer ill health, including those who are overweight, and
targetting their behavour, for the simple reason that such pressure is to
blame the victims of influences like commerce, cultural values or peers.
What we desperately need is sufficient political courage combined
with clear evidence to change central policies, example and practice for
healthy living at all levels. This does not have to be killjoy or devoid
of foolishness and humour. The devil may not have the best tunes.
Competing interests:
None declared
Competing interests: No competing interests
What is fun?
The Shakespearean character of Falstaff is a tragic-comic embodiment of self-
indulgence in vices. Unfortunately, many people equate such self-indulgence
with fun. This is unfortunate, because most fun is imaginary, harmful, and
expensive. The fun of being tipsy from alcohol, high from marijuana, or sated
from sweets, is flimsy and ephemeral, compared to the lingering and painful
after-effects of addiction. The sad truth is that most fun is hell you enjoy.
Competing interests:
None declared
Competing interests: No competing interests