Friday, August 31, 2007

But he has nothing on!

Hans Christian Andersen
Denmark has a good reputation as an export nation of fairy tales. As soon as I have been able to read books, I have liked Hans Christian Andersen and in particular his Emperor's New Clothes. And I never have dreamt of once being in the role of the little girl that said: But he has nothing on! But today is the day.

The story begins in the Ugeskrift for laeger, a Danish medical journal of a good reputation. This journal has published a study in Danish language, where an abstract in English is available at PubMed: The cost of obesity on the Danish health care system.

The study authors have analyzed medical and economic data and have fabricated a piece of cloth and present it to the public. But when I take a closer look at it, I see that it is made out of nothing. The weavers have woven air, just as in the fairy tale.

The study in brief: Based on earlier studies that figure out the number of obese Danes, and on other studies that figure out the risk of various diseases in the obese, the authors have estimated that 177 thousand obese persons that have been treated in hospitals in 2003, causing estimated costs of 137 million Euro. In the conclusion, the authors say that these health-economic costs are related to obesity.

Nothing but air

What does obesity-related mean? Nothing more than this: A patient is sick, lying in a hospital bed, and doctors say that he is obese. We call this a correlation. Or a relation if you want. Anyway, this proves nothing. In particular, it does not prove any cause. If studies fail to prove that obesity causes disease, this "relation" would be meaningless, nothing but air.

In fact, this is what studies tell us: Obesity is NOT established as a major cause of disease, possibly as a weak cause in some diseases. And this effect is offset by a possibly greater positive effect because, among the sick, the obese have better survival odds than the so-called normal-weights. (Cynical remark: patients who die fast are less of an economic burden.)

Junk health economics

This is not yet the end of the story. The Emperor's New Clothes aren't worth anything if they are not presented in public. Such a presentation is what the title does: "The cost of obesity on the Danish health care system." I turn it back and forth in my head, and always find that they mean a cause and not a simple (meaningless) correlation. They call obesity even more than a cause of disease, but itself a disease, its spread being an "obesity epidemic". Obviously, I am too stupid to see this cloth.

Dear reader, please help me. Can you see any cloth here? Any tissue woven from hard, proven facts? If so, drop me a mail - your find it in the top link of my sidebar. If not, you may help me spread the real truth to the world: He has nothing on!

Photo source: Wikipedia

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