The importance of the WHO/PEN Program (the Preferred Provider Organization for Interventional Drug Monitoring) has increased tremendously over the past decade. WHO is part of the United Nations system and PEN stands for the Prevention, Evaluation, and Research on Cures for Communicational, Preventive, and Recurative Diseases (PRC-CRD). PEN PLUS is an integrated approach that builds on this World Health Organization s Pack of Essential Non-Communicable Disease interventions (WHO PEN). It is designed to improve the quality of healthcare delivery for people who are at high risk of developing communicable diseases.
WHO developed PEN by pooling the data from several studies that addressed key factors that affect individuals at risk of developing communicable diseases. These include age, sex, geography, occupational settings, access to healthcare, socioeconomic status and other exposures. WHO then performed systematic reviews and pooled all the results from various countries in the Global Burden of Disease study. The overall result of these studies was that there were about one million deaths due to diseases that had been preventable with simple interventions against five key risk factors.
Using a mortality rate from the pooled analysis, WHO then conducted a case-by-case study to identify interventions that would reduce these deaths. Those were selected that could have a significant reduction in the number of deaths. The next step was to conduct a series of analyses to evaluate the effect of each intervention on health risks and identify what aspects of the interventions needed to be adjusted. All of this work has been described in detail in the PEN PLUS Clinical Trial report published by WHO.
The main outcomes of the WHO PEN intervention and its Case-by Case study include reduced frequency and severity of hospitalization, mortality, decreased cost and improved quality of life. However, the study also found that who Pen users did not experience increased stroke or cardio respiratory disease mortality. It also identified that there was a significant reduction in the number of strokes that occurred in those who took the Pen. It also found that there was a significantly lower incident of relapses in those who had completed the who Pen regimen compared with those who had not.
Who Pen?
The reasons for these findings are that while the who Pen users did not experience an increase in cardiovascular diseases and they did see a significant reduction in the number of strokes they suffered, the improvements in the quality of life did not extend to diabetes and type II diabetes. The investigators also saw that the who Pen users were more likely to use diabetes medication on a regular basis than the control group. Finally, it was found that people who had completed the pen regimen had more stable blood sugar levels than those who had not.
It was also found that although there were improvements in the primary health care of people who had completed the who Pen intervention, the benefits of the intervention were limited to people who needed insulin therapy or insulin resistance. In other words, this was not intended to be a cost-effective preventative treatment for diabetes. It was designed to target people who are at high risk for noncommunicable diseases but who do not have diabetes, specifically to improve their utilization of secondary means of prevention (for example, physical activity and weight control) by giving them an additional opportunity to reduce their risk for illness and injury. If this primary prevention method is to ever become as important as the primary health care interventions for which it is often substituted, then a lot more research needs to be done in a variety of settings.
This study has several limitations. First, the data used came from an observational study, meaning that there were no random controls in place. Therefore, we cannot determine whether who Pen users are or if the increased use of the pen is related to increased rates of diabetes and heart problems. Second, the number of medical records reviewed was small; therefore, it is difficult to determine whether the pattern of increased use of the pen is stable over time or whether the increased frequency of pen use was due to chance rather than an actual causal relationship. Lastly, the period of the study was not long enough to assess whether the increased frequency of pen use was actually related to diabetes or another disease.
While Whoppers and other similar programs might seem to be great ways to prevent disease and injury in the future, the Whopper study has limitations that outweigh its strengths. The need for long-term studies like those described in this article makes it vitally important for researchers to conduct research using controlled, long-term studies, such as prospective case studies. Using prospective case studies allows researchers to evaluate whether Whoppers really work for people who have Type II diabetes or whether they are just a flash in the pan. For now, there is no good answer. However, the Whopper study offers hope of providing support and encouragement to medical professionals that are concerned with patients who have either diabetes or hypertension.
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