Richard Weiler

Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review

Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice.

Prescribing exercise in primary care

Ten practical steps on how to do it

Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue

Background The rapidly increasing burden of chronic disease is difficult to reconcile with the large, compelling body of literature that demonstrates the substantial preventive and therapeutic benefits of comprehensive lifestyle intervention, including physical activity, smoking cessation and healthy diet. Physical inactivity is now the fourth leading independent risk factor for death caused by non-communicable chronic disease. Although there have been efforts directed towards research, education and legislation, preventive efforts have been meager relative to the magnitude of the problem. The disparity between our scientific knowledge about chronic disease and practical implementation of preventive approaches now is one of the most urgent concerns in healthcare worldwide and threatens the collapse of our health systems unless extraordinary change takes place. Findings The authors believe that there are several key factors contributing to the disparity. Reductionism has become the default approach for healthcare delivery, resulting in fragmentation rather than integration of services. This, in turn, has fostered a disease-based rather than a health-based model of care and has produced medical school curricula that no longer accurately reflect the actual burden of disease. Trying to ‘fit’ prevention into a disease-based approach has been largely unsuccessful because the fundamental tenets of preventive medicine are diametrically opposed to those of disease-based healthcare. Recommendation A clinical discipline within medicine is needed to adopt disease prevention as its own reason for existence. Sport and exercise medicine is well positioned to champion the cause of prevention by promoting physical activity. Conclusion This article puts forward a strong case for the immediate, increased involvement of clinical sport and exercise medicine in the prevention and treatment of chronic disease and offers specific recommendations for how this may begin.

Prevention and management of non-communicable disease: the IOC consensus statement, Lausanne 2013

Morbidity and mortality from preventable, non-communicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology, and design thinking. The purpose of this paper is to summarize the results of a consensus meeting on NCD prevention sponsored by the International Olympic Committee (IOC) in April, 2013. Within the context of advocacy for multifaceted systems change, the IOC’s focus is to create solutions that gain traction within health care systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following:1.Focus on behavioural change as the core component of all clinical programs for the prevention and management of chronic disease.2.Establish actual centres to design, implement, study, and improve preventive programs for chronic disease.3.Use human-centered design in the creation of prevention programs with an inclination to action, rapid prototyping and multiple iterations.4.Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programs for the prevention and treatment of chronic disease focused on physical activity, diet and lifestyle.5.Mobilize resources and leverage networks to scale and distribute programs of prevention.True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programs within health care. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad-hoc Working Group charged with the responsibility of moving this agenda forward.

Physical activity education in the undergraduate curricula of all UK medical schools: are tomorrow's doctors equipped to follow clinical guidelines?

Physical activity (PA) is a cornerstone of disease prevention and treatment. There is, however, a considerable disparity between public health policy, clinical guidelines and the delivery of physical activity promotion within the National Health Service in the UK. If this is to be addressed in the battle against non-communicable diseases, it is vital that tomorrows doctors understand the basic science and health benefits of physical activity. The aim of this study was to assess the provision of physical activity teaching content in the curricula of all medical schools in the UK. Our results, with responses from all UK medical schools, uncovered some alarming findings, showing that there is widespread omission of basic teaching elements, such as the Chief Medical Officer recommendations and guidance on physical activity. There is an urgent need for physical activity teaching to have dedicated time at medical schools, to equip tomorrows doctors with the basic knowledge, confidence and skills to promote physical activity and follow numerous clinical guidelines that support physical activity promotion.

2014 Consensus Statement from the first Economics of Physical Inactivity Consensus (EPIC) Conference (Vancouver)

This article describes major topics discussed from the ‘Economics of Physical Inactivity Consensus Workshop’ (EPIC), held in Vancouver, Canada, in April 2011. Specifically, we (1) detail existing evidence on effective physical inactivity prevention strategies; (2) introduce economic evaluation and its role in health policy decisions; (3) discuss key challenges in establishing and building health economic evaluation evidence (including accurate and reliable costs and clinical outcome measurement) and (4) provide insight into interpretation of economic evaluations in this critically important field. We found that most methodological challenges are related to (1) accurately and objectively valuing outcomes; (2) determining meaningful clinically important differences in objective measures of physical inactivity; (3) estimating investment and disinvestment costs and (4) addressing barriers to implementation. We propose that guidelines specific for economic evaluations of physical inactivity intervention studies are developed to ensure that related costs and effects are robustly, consistently and accurately measured. This will also facilitate comparisons among future economic evidence.

Medicolegal neglect? The case for physical activity promotion and Exercise Medicine

Whether measured subjectively or objectively, a large proportion of the population are living sedentary and physically inactive lives.1 ,2 This should be a major public health focus given the overwhelming evidence demonstrating that physical inactivity increases an individuals risk for all-cause mortality and may be one of the leading causes of non-communicable chronic disease in the world, responsible for about 60% of worldwide deaths3,–,6 and probably more in developed countries. Pandemic levels of physical inactivity result in a huge burden of unhealthy consequences within populations and for society, across all socioeconomic classes, all ethnicities and phenotypes. However, attempts to explain the precise causes of chronic diseases and resultant deaths, for each individual, are very difficult. We are all exposed to multiple risk factors in variable quantities throughout our lives and, currently, these are virtually impossible to measure. Consequently, despite our remarkable growth in the medical field, explanations for precise causes of death remain speculative. To attribute causal status of risk factors for non-communicable disease is fraught with difficulty both clinically and medicolegally. For example, it is baffling that despite scientific progress since Richard Dolls landmark findings 60 years ago, strongly linking smoking with lung cancer,7 causation of smoking and lung cancer has still not been upheld in a court of law.8 Duty of care is a legal obligation imposed on a doctor requiring, via the Bolam test,9 that their actions conform to those of a responsible body of professional opinion, even if others have a different opinion. More recently, the Bolitho v City and Hackney Health Authority case, entitled a judge to choose between two bodies of expert opinion and reject an opinion, which is ‘logically indefensible’. …

Physical activity in the UK: a unique crossroad?

Recent objective evidence from England and the USA suggests that low physical activity is the most prevalent chronic disease risk factor, with 95% of the adult population not meeting the modest physical activity guidelines.1 ,2 In the UK, the annual cost of physical inactivity has been estimated at £8.2 billion, whereas the annual cost of smoking has been estimated at £1.5 billion,3 alcohol at £3.0 billion4 and obesity at £4.2 billion.1 However, despite this enormous burden on our public health and finances, the relative importance of physical inactivity as a primary cause of many chronic diseases is largely neglected within modern medicine and by health strategy. Surrogate risk factors for disease, such as hypertension, type II diabetes, obesity and dyslipidaemia, receive ample attention in medical education, have incentivised interventions embedded within primary care and are routinely reviewed during visits to a general practitioner (GP). Yet, despite physical inactivity being the most prevalent modifiable affliction and possibly the greatest chronic disease risk factor,5 it is still not receiving the attention that scientific and clinical evidence would seem to merit. There is a unique structure to general practice and primary care within the UK National Health Service (NHS). UK GPs, who are usually the first point of contact for patients, have a unique position and opportunity to combat physical inactivity and its numerous associated comorbidities. Through the Quality and Outcomes Framework (QOF), GPs are financially rewarded for achieving healthcare targets. Setting up a new QOF point is relatively very cheap, costing approximately £1 million across the UK, and GPs have proved adept at reaching QOF targets.6 GPs are not trained to give lifestyle modification advice, but last year QOF included physical activity for the first time under a ‘cardiovascular risk assessment and management’ indicator. Specifically, …

Is the lack of physical activity strategy for children complicit mass child neglect

A rapidly burgeoning evidence base demonstrates a link between academic performance and physical fitness (closely linked to physical activity) for children of all ages and socioeconomic groups.1–3 There is also an inverse association between physical fitness and reported violent and antisocial incidents in school.2 Physical education, games and sport for children have a demonstrable positive impact on physical health, and affective, social and cognitive function.4 Furthermore, physical activity habits in childhood seem to determine, in part, adult physical activity behaviour,5 ,6 which is a key determinant of adult health.7 A recent BMJ editorial8 suggested that child health in the UK lags behind most European counterparts,9 and that despite numerous initiatives since 1999, only children from wealthier and more advantaged families seem to have benefited.10 A recent British Medical Association (BMA) report called for the need for a total prevention approach for children, but the leadership and strategy for such urgent and challenging public health measures are totally absent.11 The apparent importance and pervasiveness of physical inactivity among school children has led to a recent Lancet call for physical activity to be ‘a priority for all schools’ that requires ‘whole school’ strategies and government support12 and the Welsh government has committed ‘to make physical literacy as important a development skill as reading and writing’, yet has failed to deliver this pragmatic strategy.13 The English Secretary of State for Education recently announced a set of reforms to school curriculums for 2014, but showed no commitment to revolutionising physical activity and physical education for children. These physical activity-lacking reforms were announced with a great fanfare to the media and praised by the Prime Minister as providing the ‘very best education for their future and for our country’s future’. School age boys …

Prevention of cardiovascular disease: why do we neglect the most potent intervention?

Despite a large volume of evidence supporting its cardioprotective properties and its other numerous established health benefits, physical activity is not a serious prescription option for the primary prevention of cardiovascular disease. On the other hand, health services increasingly focus on pharmacological prevention without considering properly the long-term consequences of medication. Ethical and feasibility considerations suggest that evidence on the protective value of physical activity may need to be evaluated using criteria different from those applying to pharmacological trials. The collateral health benefits of physical activity prescription support its use as standard option in preventive health care.