Tuesday, 29 October 2013

Why do men get ill? Really

Some of you who’ve read my previous posts will be surprised that I have worries about Movember. So let’s make it clear that in many ways I’m full of admiration: Movember has been genuinely innovative and successful at raising money, and has transformed the prostate cancer agenda as a result. That is no small achievement.

What concerns me is that Movember, like many other health projects, doesn’t get down to basics –  doesn’t ask some very fundamental questions about why they are doing what they do. The danger of not asking those questions is that efforts to improve health are based on unproved assumptions that can be unhelpful or even dangerous.

When it comes to men’s health, and in particular Movember’s messages, there’s the assumption that if men behaved a bit more women, talked about health and went to the doctor regularly, they would live longer, happier lives. But we don’t know that. In fact, there’s now a significant body of doctors who believe that getting your health checked when you have no symptoms is likely to lead to unnecessary treatments that could in turn make you ill.

So let me ask a controversial question. Why do men get ill? People rarely ask it, because we don’t know the answer. And if we don’t know the answer, we can end up looking stupid. So we just ignore it and hope no-one notices. By we, I mainly mean politicians, policy makers, doctors, academics, charities and yes, sometimes journalists.

There are bits of evidence that you can add together into a general picture, but little that's authoritative, coherent and global. And there aren’t obvious funders for complicated research on something so fundamental. Most statements about “the problem” of men’s health are little more than an educated guess on why we get ill. 

Here’s my own reasonably evidence-based guess:
  • Because of our genes: we’re born susceptible to some conditions.
  • Because we get a kick out of some risky activities because they’re risky: driving fast, drinking beer and eating pork pies spring to mind.
  • Because we get anxious, sad and scared: so we lose respect for our bodies, copy what others do, delay going to the doctor, get into bad habits and addictions that seem to make us feel better.
  • Because we’re given unhelpful information, or unnecessary tests and treatments, which  can lead to all sorts of physical and mental problems.

I’ll come back to all these points and expand them in posts to follow. I certainly don’t have all the answers. But you’ll note I’m not saying the problem is that men don’t talk enough. The answer to the question “Why do men get ill?” is far, far more complicated that. 

Movember – if they really want to change the face of men’s health – would best achieve it by spending some of their substantial funds on research that goes beyond prostate cancer, and into these difficult and vitally important fields.