Why aren't apples more tempting? Adam speaks

It’s so simple if you look at the research. An Oxford University study, published in the British Medical Journal, has concluded that eating an apple a day could save as many lives in the over 50s as a daily statin.

Regular readers of Danger Man’s Doctor will already be aware of our interest in brocolli, and apple is as noble a variety of vegetation. Readers will also be aware of our curiosity that, while everyone bemoans the nation’s stubborn refusal to eat more of said brassicas and fruits, no one stops to ask why we won’t do as we’re told. 

The Oxford University study is a case in point. “We could all benefit from simply eating more fruit,” says study author Dr Adam Brook wistfully, in the face of evidence that one in ten of us can’t even manage one portion of fruit and veg a day.

If people did ask why we aren’t listening, they might find some answers quite quickly. Strong clues came in two news stories published in the past fortnight.

First, a study in the Journal of Consumer Research found that we remember the least when we feel most threatened. If information makes us worried, our brain’s first response is to blank it. 

The researchers used the example of breast cancer awareness campaigns: an advertisement dwelling on women’s vulnerability to the disease is likely to make them feel threatened, and the prevention message is more likely to be forgotten.

As we’ve said before on this blog, scaring people about health doesn’t work. We freeze like rabbits in the glaring headlights of our impending mortality, and can only move on by forgetting we ever heard the message.

The second enlightening news story was that drug giant GlaxoSmithKline has announced it will stop paying doctors to promote its drugs at medical conferences. Amazing that it ever happened at all isn’t it? 

What this tells us is that getting an accurate picture of what’s good for us – not a simple prospect in itself – is made much more difficult by commerce weighting the answers we get. Industry funds research about industry’s products – which is why there’s a wealth of evidence showing the benefits of statins, but hardly any research showing the benefits of apples. Why would drug companies fund research into apples? Why would multinational food companies for that matter? Until someone comes up with a body of research about apples that compares with the vast amount invested in for statins, doctors are not going to be prescribing fruit.

It’s not really our fault that we don’t behave sensibly when it comes to our health. It’s the result of health information campaigns being based on how we’d like humans to be, rather than how we actually are. And it’s the result of industry simply having too much clout in determining what doctors tell us and what foods are allowed to seduce us.  

Bad gen on the antigen

I’m a loyal follower of The Times: I worked for it for 14 years. I’m also a great supporter of prostate cancer support and research: my father died of the condition.

So you’d have thought I’d be rejoicing about the fact that this year The Times Christmas Appeal is supporting Prostate Cancer UK. But I’m not. Why?

Because it seems the charity is using this wonderful opportunity to raise money for research, to promote messages about prostate cancer which are unhelpful and possibly damaging.

This week the journal Biomarkers in Medicine pointed to the shortcomings of the PSA (prostate specific antigen) test in diagnosing prostate cancer or indicating its aggression. It highlighted the need to find new biomarkers that would provide doctors with a genuinely useful test – one that wouldn’t throw up vast numbers of false positives, and expose men to tests and treatments that could leave them unnecessarily impotent, incontinent or in pain. Such a test currently does not exist.

The prostate specific antigen. Pic: EAS 

Yet here in the same week is Owen Sharp, Chief Executive of Prostate Cancer UK, quoted in an article in The Times to launch the appeal:

“Low awareness of the PSA test means that lives may be lost every single day because men don’t know what is already available to them,” he said.

“We know that GPs are turning men away and talking them out of it. It’s not the majority but it’s about one in eight. Some of them don’t believe in the PSA test. We have calls from men about this all the time and I spoke to a man last week who had a stand-up row with his GP to get the test. We need to be very clear that having had the conversation, it is men’s choice and they shouldn’t be turning men away.”

A more responsible approach might be to support GPs who are not rushing men into having a potentially damaging test; to make clear that the PSA test is the bluntest of instruments; to stress that this is exactly why all of us need to support the quest for a new test.

Thankfully, Rosemary Bennett, the Times journalist who wrote the piece, had the sense to put Sharp’s words into context with comment from GPs about the dangers of PSA testing.

And they say it’s journalists who over-simplify... 

Men's health in proportion 2: the God Doctor

You will remember that in a recent post I looked at a crowd of 100,000 men in one of the world’s largest football stadiums, and asked what they’d all eventually die of. The surprising answer was that around a fifth of them would die from heart disease and stroke, less than a 20th of them would die from prostate cancer, and around 40% of them would die from dozens and dozens of less common conditions that we rarely think about when it comes to men’s health.

Photo credit: Dieter Drescher / Foter.com / CC BY-NC-ND

Let’s take another look at this crowd, this time from the perspective of a psychic doctor who has the power to see one year into the future. Let’s call him the God Doctor (some believe he exists). When he looks down on the football crowd at a game being played in May, he can see who is going to be diagnosed with a new condition before the following May.

What he’ll find is this. Out of the crowd of 100,000 men:

• 500 (that's one in 200) will be told they have heart disease

• 250 will have a heart attack

• 180 will have a stroke

• 105 will be told they have prostate cancer 

• 58 will be told they have lung cancer

• 58 will be told they have bowel cancer

(The figures aren’t exact, because sadly disease incidence figures aren’t easily comparable, but it provides a rough idea).

You may look at such statistics, as I do, and draw some simple conclusions. You may say...

“Getting to grips with how I can avoid disease/keep alive, isn’t simple.”

“If I’m going to live by the law of averages on what’s going to kill me, then I’m going to concentrate on reducing my risk of stroke and heart disease. If I exercise properly, eat a varied diet and stop smoking, I’ll definitely be reducing my risk of conditions that definitely kill a lot of men – heart disease and stroke.”

“If I do that, it’s very likely that I’ll reduce my risk of all those other conditions, like many cancers, where smoking, diet and exercise may play a part.” All good thinking so far. Entirely sensible.

But then you might think some more about these statistics and the statistics about mortality in the previous post and start to get confused. With prostate cancer, for example, it looks as if there’s a reasonable chance of me getting it, but much less of a chance of me dying from it. And you might start to wonder whether statistics can be used from many perspectives, according to what message you want to give the public.

Most of all, your confusion might result in one big question. What about me? It’s all very well having these averages for populations, but what if you’re my age, with my parents, in my country, with my background? What if some diseases actually hold more fears for you: should that be ignored?

Good point. I’d like to talk about that some more, because in this age of “personalised medicine”, we’re absolutely rubbish at personalising information to make it useful. More in another post.

Mental disintegration: the unacceptable face of cricket

Well done then, Australian cricketer David Warner. There you are sporting your Movember moustache, supposedly declaring your allegiance to the cause of men’s health, supporting men who are struggling with physical and mental health problems.

And then, after the Aussies paste England in the first Ashes test match, you gleefully declare that the performance of England cricketer Jonathan Trott was “poor and weak” and that he had “scared eyes”. You promise him there will be more “sledging” (the cricketing art of heaping abuse on batsmen with the aim of causing “mental disintegration” – a term coined by one Australian captain ). 

“Disrespectful” is how the cricketing community has condemned Warner’s words. For those who care about mental health, the condemnation should be stronger – particularly after the news that Jonathan Trott has now had to withdraw from the Ashes tour “because of a long-standing stress-related condition”.

In some machismo circles, it is seen as a necessary part of being a competitive male that you should put those down who can be labelled weak or mentally frail.  In school, such behaviour is called bullying.

Can it have any long-term effect? You bet. More and more studies are showing that bullying leads to mental health problems. A study published in one of the most respected psychiatric journals this year found that victims of bullying were nearly five times as likely to have anxiety and panic attacks than those who weren’t bullied.

It’s pretty clear that David Warner’s comments didn’t cause Trott’s stress-related problems, but they didn’t help. Anyone who really wanted to help the cause of men’s health wouldn’t be attempting to cause mental disintegration. Perhaps David Warner needs to be told that nearly 10% of premature male deaths are the result of suicide, self-harm and accidents. 

Hairs come easy. Actions don’t. 

Men's health in proportion: the football ground

Welcome to the Nou Camp stadium. It’s the Champions League final 2015 between Manchester United and Chelsea. The ground is massive – it has a 100,000 capacity. Today it’s full at the seams with a crowd is entirely made up of British men and boys – of all ages from five to 90. The women have something better to do.

Let’s look at this crowd of men, with the eye of an all-seeing God who can look into the future. And let’s bear in mind that this is an unusual crowd, because as it represents a cross-section of the entire British male population – one in six is over the age of 65. Quite a few will be there in wheelchairs.

The God view of the crowd 

Out of that enormous crowd of 100,000 men, 847 will die in the coming year. Nearly half of them over the age of 80.  

What will they die of? I’ve scrawled over the nice picture of the Nou Camp to give you a general idea (below) but here are the figures (based on data from National Statistics).

136 of them will die of heart disease (16.1% of the deaths)

61 of them will die of lung cancer (7.2%) 

52 of them will die of a stroke (6.1%)

49 will die of respiratory disease (5.8%) 

43 will die of dementia (5.1%) 

39 will die of influenza and pneumonia (4.7%)

40 will die of accidents, suicide and self harm (4.7%)

34 will die of prostate cancer (4.1%) 

27 will die of bowel cancer (3.2%) 

Picture: Oh-Barcelona.com/Foter.com/CC BY

You’ll be wondering what all the others died of. Other types of cancers, liver disease, and dozens of other conditions that affect a smaller number of men across all age ranges.

What does this show? Well, it shows first of all that people die, even if they’ve just been to the football. You’re not “unlucky”, you’re just human. You’re part of the football crowd.

What else does it show? It shows that an awful lot of men die of heart disease, and not that many from “male specific” conditions like prostate cancer.

It’s one way of getting our health, and the things we should worry about, in proportion. There are others... coming soon.

Getting health in proportion: the No I'm Not Lost Effect

So you’re a practical, generally responsible chap – most of us are. You’re concerned about your health, in a vague sort of way. Most of us are. You don’t want to die, you don’t want to burden to your family, you don’t want to be useless. Most of us don’t.

But you also find the whole health thing a bit of a pain. You’re fed up with everyone telling you to start doing this, and stop doing that. You frankly don’t want to spend your life at the doctor’s surgery: it seems dull, dependent, confusing and might confront you with something that makes your life more complicated than it already is. 

This is what I call the No I’m Not Lost Effect. It’s a cliché, but still perfectly true, that most men would rather have their toenails pulled out with molegrips than stop the car and ask someone for directions if they’re lost. The invention of satnav may have saved men a haranging from women passengers only too willing to acknowledge failure to passers by, but the problem persists in health. 

"For God's sake Amanda, don't ask that man
for directions!"

Men want to find their own way when it comes to keeping healthy. We’d rather do our own own groundwork, find ways of doing things that fit our own lives, decide our own routes and not have to stick what some so-called “expert” says is the proper way.

There’s another cliché about men which is relevant: that we can’t multitask. We like to focus on one thing at a time. The truth is that it is impossible for the average male to absorb, assimilate and implement all the health information fired at us by doctors, health education campaigns, or the media. There’s just too much – or even if there isn’t too much, it seems too much. We don’t want our brains cluttered with stuff which may or may not be relevant to us. 

Clearly, ignoring the opinions of others and concentrating on one thing at a time has its hazards. But I don’t think it’s stupid. I’d say it has its advantages.

What if we built on men's need to control and focus?  Men need to be helped to work out for ourselves what we’re most likely to die of – doctors could do more to help us do that. Because frankly we’re currently being told to worry about too many things that will never, ever effect us.

Each of us will die of something nasty: a single condition. Before that happens, it is possible we will be affected by anything between none (if we’re very lucky) and 20 (if we’re very unlucky) potentially serious conditions. Some of the conditions we get will be completely unpredictable – against the odds and possibly obscure – so there’s little point in trying to predict them. 

But some, and particularly the ones we are likely to die of, are much more predictable.  This is either because of our family history, or because simple statistics reveal how common they are in men.

As a society, we’re very bad at helping men get things into proportion in this way. I’ll be trying to help in posts that follow.

Men and women: one size doesn't fit all

So which is the sneezier gender? New research from the American College of Allergy, Asthma and Immunology shows that women are more at risk from allergies, asthma and other diseases that affect the body’s immune system.

The researcher, Renata Engler, has also found that the pattern of which gender is most susceptible to allergies changes over time – in childhood, it’s boys who suffer more.

Why is such research important? Because it joins a growing body of evidence that men and women have radical differences when it comes to physiology and health. For example,  it’s only in the past decade that doctors have begun to realise that heart attacks manifest themselves very differently in women than men. Women are less likely to get classic chest pain, and more likely to have indigestion-like symptoms.

It's increasingly clear that lumping everyone together in terms of typical symptoms, likely diagnoses, optimal treatments is not only unhelpful, but also potentially dangerous. In this supposed age of personalised medicine, one size won’t fit all. Which is particularly obvious (if you stop to think about it) when it comes to big hulking men and less than big and hulking women. 

Episode 7: Admission

The world gradually congealed into view. Drake was looking at a fluorescent light on a polystyrene tiled ceiling. Around him were curtains and above him stood a man with a benign smile on his face, wearing white.

“Where am I?” asked Drake.

“In the Hospital” said the man.

Drake was confused. “What do you want with me?”

“Well, we don’t want anything, apart from to make you well.”

Drake was trying to work out how he could be in a hospital, when he was clearly in a reeling ship. The room was swaying and he felt sick. Altogether he felt extremely strange, disconnected, and he didn’t like the look of the man in white now bending over and looking into his eyes. 

“Whose side are you on?” Drake demanded, but his words seemed slow and delayed. He tried to focus: the face had something of Kolotov about it.

The man looked puzzled, and then impatient.

“Look, you’re here because you had a nasty turn. We want to make sure you’re alright so we’re running a few checks. Now just relax, and we’ll soon have you as right as rain.”

You must be joking, thought Drake, and leapt out of the bed. Except he didn’t. He couldn’t. His legs didn’t move at all. He tried to heave himself over the bed rail with his arms, but the man in white stood in his way.

“I’m afraid you don’t have use of your legs at the moment,” said the man in white. “We’re not quite sure what’s happened yet, but it’s possible you’ve had some kind of small stroke, so we’re running some tests.”

Drake tried to think back. What was the last thing he remembered? He’d gone to see Dr Sixsmith, stormed out of the surgery, driven home... That’s right. Mrs Drake was out – she’d left a note to say she was meeting a friend in town. He’d gone to start packing for his trip to Zagreb and then... that was where his memory ended. He must have lost consciousness then.

“I’m going to leave you in the capable hands of nurse Cooper now,” said the man in white. He drew back the curtain and called to the other side of the room. “Nurse Cooper, will you attend to Bed Number 6”?

Movember: a response from the Head HonchMo

Last week I talked to Movember’s Head Honcho Paul Villanti. He’d seen my earlier blog posts, raising questions about Movember’s aims and transparency. 

What he said clarified some of the muddy waters surrounding Movember, although some areas remain opaque. He acknowledged that there had been mistakes, and that the organisation had not always been clear in communicating what it aimed to achieve. 

In particular, he made clear that:

• Movember never set out to transform men’s health in its broadest sense
• Movember will finally be considering moving into UK mental health projects next year
• Movember has some regrets about some of the men’s health advice it has put out in the past.

About Paul Villanti

Paul Villanti has a say in every aspect of Movember, overseeing its investments in health initiatives globally. He is not one of the charity’s original founders, but joined from a business background four years after Movember was established in 2003. Today he is Executive Director of Programmes, and a member of the Board, the Global Scientific Committee and the Global Leadership Team. He is also Director of Movember Europe, a Director on the Boards of the Prostate Cancer Foundation (USA) and Prostate Cancer Canada and is an Associate Director of Prostate Cancer UK.

That’s a lot of responsibility. 

The prostate question

I asked Paul Villanti about Movember’s focus on prostate cancer, even though the disease accounts for only 3% of premature male death in the UK. In some countries with lower male life expectancy the disease hardly features as a problem at all. “Changing the face of men’s health” surely involves tackling more than that?

He said that from the start Movember had been “results-focused”. 

“In deciding the areas to invest in, we’ve challenged ourselves to make a significant impact on men’s lives,” he said. “Strategically the decision was made a long time ago that we wanted to focus on areas where we could make a significant impact on men’s lives rather than having a Santa Claus strategy where you sprinkle a bit of money everywhere but actually not make much of a difference.” 

In the long-term, he said, Movember was all about building strong partnerships with specific organisations across many sectors, he said, and if funds allowed it wanted to expand beyond core areas: prostate cancer, testicular cancer and mental health. 

“I don’t think there’s any organisation in the world capable of solving all the problems in men’s health,” he said. “I fully accept that we aren’t tackling every men’s health issue, and I think it’s really important to be transparent about what we do raise funds for.”  

The initial decision to focus on prostate cancer was driven by the fact that investment in this field had been historically very low. There are complex and pressing issues to be resolved, such as the need for effective screening and overtreatment. “It is expected to be the most common cancer by 2030. It is a significant challenge facing men and under-invested in in every country,” said Villanti. 

The expertise question

So what research and professional expertise informs Movember’s decision-making and health advice? The Movember Board, which decides strategy, is dominated by Australian businessmen and Movember’s founders, and has only one representative with any health expertise (in prostate cancer). Its Global Scientific Committee is almost exclusively prostate cancer experts.

Villanti explained that in each country, programmes are decided on and overseen by panels of national experts in particular fields (for example mental health). These groups, he said, do not feature on the Movember website but are working behind the scenes. I asked him what expertise informs Movember’s decisions on a higher strategic level to help change men’s health. Villanti assured me that there are a large number of experts that guide strategic direction, and then moved the subject back to the specifics of programme development again. 

The mental health question

In this blog I’ve pointed to my concern that Movember UK donated no money to mental health projects in the UK in 2011 and 2012, even though its website claims it raises “vital funds and awareness for prostate cancer and testicular cancer and mental health”. 

Paul Villanti reassured me that in March 2014, the Movember Board will be looking at ways to “expand investment” in the UK beyond prostate and testicular cancer. 

“We had always planned to review our options at this stage,” he said. It will be engaging independent experts in men’s health to inform this process, and will seek advice from mental health groups. “We expect the advice we get to inform the process,” he said. 

The health awareness question

I explained to Paul Villanti my reservations about Movember’s much-vaunted “awareness and education” work in the UK, which seems to consist entirely of hoping men will talk more about their health as a result of growing moustaches. There’s little evidence that talking about health, or going to the doctor for check-ups, will result in men living longer, I pointed out.

He acknowledged that there is much we don’t know about men’s health behaviour. However, it is clear that men have lower levels of health literacy than women, and this results in poor health outcomes, he said. “Step one obviously is to increase their levels of education and awareness, and the Movember campaign is respected across prostate cancer and mental health because it uses the unorthodox concept of using fun to increase men’s awareness of the risks they face, try and educate them and encourage them to take action when they’re sick.”

The screening advice question

Over the past two years, doctors in the UK and elsewhere have criticised Movember’s health education advice. Until late last year, its website advised men over the age of 50 to get a PSA test – even though the test is very contentious because of the dangers of over-diagnosis and incorrect diagnosis. 

Until last month, its website advice on colon screening and aortic aneurysm was at odds with NHS recommendations. The website still said that prostate screening at age 40 was “reasonable” and its information on mental health problems suggested they went no wider than depression. 

Villanti told me that Movember hadn’t recommended the PSA test since 2011 – it had instead encouraged conversations about screening with GPs. But he acknowledged that its attempts to take a global position on men’s health last year – including a recommendation on its website last year that men should have an annual health check and specific checks at different stages of their lives – had not succeeded.

“With the benefit of hindsight, there were a number of weaknesses with that approach which we have taken on board,” he said. Much of the advice Movember put on its website had been based on information from the Australian College of General Practitioners and other Australian health bodies. “What we realised was that there are major disparities in what professional health bodies say from country to country. To us, that seemed incredible: it’s supposed to be based on the best evidence out there. We can’t understand why one country recommends one thing, and another recommends another approach.” 

He emphasised that the organisation did have serious concerns about over-diagnosis and over-treatment, and the problem was being investigated in various Movember programmes. I told Villanti that his concern about over-treatment was not reflected in the messages that Movember pushes out.

“One of my big frustrations is that we don’t know at a population level how bad some of these issues are, and how different treatment modalities relate to poor outcomes, so we are investing in a national cancer registry in Australia. We see that as a powerful vehicle for improving the quality of treatment, and we’re hoping to do something similar in the UK.”

With Movember now in full flow, and millions already donated by members of the public, it’s surely right that those who oversee it are kept on their toes – something that, up until now, hasn’t been done in the media. We all love the story of how Movember grew from small beginnings, but it isn’t the only story. 

It’s good that Paul Villanti is prepared to respond to comment and concerns, and I hope that there are messages the organisation will take on board, because it has too good an opportunity to waste.

Movember needs to be more open about its strategy – even if that makes it appear more limited in its scope than it would like.

Movember needs to draw in a wider range of evidence and expertise when setting strategies and goals, and providing health advice.

Movember needs to be global in outlook, as well as activity – not taking Australia as a template for what the rest of the world needs.

Most of all, Movember needs to step up its game. It started as a group of Aussie blokes in a pub with an idea to change the world and the skills to bring it off, but with very little understanding of health or its global dimensions. Mistakes are bound to happen as long as Movember’s tight-knit structures and decision-making continue to reflect that historic and naive starting point.

Forgotten gurus: George R Sims

In this, the first week of Movember, let’s celebrate a true guru of male hair growth: George R Sims, journalist, dramatist, novelist, social reformer, gambler, sportsman, bulldog breeder and inventor of Tatcho hair restorer. 

Sims made a fortune from his diverse activities, and became a Victorian celebrity. By 1898 he earned £150,000 a year. Late in his career, he invented a hair tonic to prevent “inevitable” loss of hair, and the money continued to flow in. The bad news is that it didn’t do anything to improve his own receding hairline, and he lost virtually all the money he made through gambling.

In 1902, the British Medical Journal published an analysis of the content of Tatcho. It turned out to be mainly borax, glycerine, formaldehyde, alcohol, colouring and perfume: more cleaning product than growth-promoter. 

But as this 1909 advertisement shows, that didn’t stop Tatcho continuing to be a cultural phenomenon: “It will bring back the hair of your youth, make a new being of you, and give you a new grip upon life,” said the eternally reassuring advertisements. In an age when hair equalled vigour, men wanted to believe. And who knows, many may indeed have felt more confident in themselves having this slimy, semi-caustic blackening on their heads.

Man-size broccoli recipes

Inspired by the news from the Men’s Health Forum that it will shortly be publishing a booklet on healthy eating for men, I thought it high time I returned to the subject of broccoli. You may remember that, given research indicating that broccoli protects your bones, skin and heart and reduces cancer risk, I previously proposed a Campaign for Real Broccoli. Since then, I have been considering other ways we might be able to make this miracle food appeal to men.

• Deep fried battered broccoli
• Doner broccoli kebab
• Broccoli Pops cereal (with added vitamins, only 12% sugar)
• Broccoli in the basket
• Broccoli and tonic 

I would appreciate further suggestions before packaging up my ideas for restaurants, food manufacturers and the Men’s Health Forum. 

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.

What's the beef on cholesterol?

Oh the difficulties of getting a straight story. Particularly on cholesterol

Last week the news splash was on statins. The Daily Mail and Daily Telegraph authoriatively told us that new research had revealed that “Strokes fall by 40% due to statin use”. Great news for manufacturers of cholesterol-lowering statins and the government that has been encouraging their prescription. Apart from the fact that the research being reported said nothing of the kind. 

Yes, the research in the journal Stroke found that stroke incidence fell by 39.5% between 1995 and 2010. But exactly why it happened is still a matter of conjecture: the paper pointed to improvements in prevention and healthier lifestyle as possibilities, as well as the introduction of statins.

So strokes don’t fall by 40% due to statin use: no evidence there at all I’m afraid.

This week came a bold but sensible paper in the British Medical Journal, designed to open a debate. A young heart specialist, Aseem Malthotra, tried to take a fresh look at the research on cholesterol, and concluded we were wrong to demonise foods high in saturated fat to the exclusion of processed foods packed with sugar and trans fats. At least as far as heart disease is concerned.

The result? Today I get a press release from the Meat Advisory Panel claiming “Red meat may be beneficial after all”. The headlines ring “Butter is better”. No message about a balanced diet, which is what all the experts agree on. 

Sadly, the appearance of new evidence often turns out not to be a step towards knowledge, but an opportunity for a group or industry to promote their agenda.

Former pharma: Dr Williams’ Pink Pills

Here we are in 1946, three years after penicillin was introduced, and popular magazines are still running advertisements for Dr Williams’ Pink pills “to build up the blood, enriching and purifying it” – adverts that first appeared in Victorian times. This sample is from that magnificent publication Family Star (“You’ll enjoy – Married to a Glamour Girl” – long chapter inside”), price twopence.

Dr Williams’ miraculous pInk pills first appeared as far back as the 1850s, and were originally known as Pink Pills for Pale People. Originating in Canada, they arrived in Britain in 1893. In their long history these glorified iron supplements were marketed for everything from lumbago to palpitations, paralysis to headache, sallow complexion to “all forms of weakness in male or female.”

But in 1946, Dr Williams was concerned about all that worry readers of Family Star suffered reading those tense romantic stories.

“The new rich blood which these pills help to create supplies to the starved nerves just the elements they need. In this way these pills have banished nervous trouble in many thousands of cases.”

Movember: we moustache you some questions

If you’ve read my past posts, you’ll know that I’ve been asking questions of Movember. I think the charity should be more accountable.

Having finally obtained some information about where the UK Movember money goes, I wanted to get to the bottom of what Movember actually wants to achieve with it. 

I’m not the only one. Some influential commentators in the UK and Australia (where the organisation was founded) have expressed unease about Movember’s objectives. Chris De Mar, Professor of Public Health at Bond University, recently wrote that Movember’s campaigning activity was “deeply flawed” because it focused on health check-ups which show no evidence of benefit to men. Last week, Peter Baker, until last year Chief Executive of the Men’s Health Forum, wrote of his concern about Movember’s pre-occupation with prostate cancer and its outdated view that men’s health is about male-specific disease.

A few weeks back, I went to Movember’s UK headquarters in Clerkenwell, London, to put my questions to Sarah Coghlan, Chief Executive of Movember UK and wife of Justin Coghlan (known in the Movember movement as “JC”), one of the original founders of Movember. There were four areas I wanted to talk to her about:

• Since around 90% of their allocated funds go to prostate cancer projects, isn’t Movember a prostate cancer charity rather than a men’s health charity?

• Does Movember’s men’s health awareness work in the UK consist of more than putting health information on its website and promoting conversations by getting people to grow moustaches?

• Can Movember UK justify its claim that it raises “vital funds and awareness for prostate cancer and testicular cancer and mental health”, when no UK money went to mental health in 2011 and 2012?

• Why is it difficult to get annual figures on how Movember UK’s money is used?

Here is what I was told.

What does Movember want to achieve?

Movember’s stated objective is “To have an everlasting impact on the face of men’s health”. So why, I ask Sarah Coghlan, do nearly all of its allocated funds go towards a condition that causes just 3% of premature male deaths? “That’s interesting,” says Sarah Coghlan. “It’s certainly our vision to change the face of men’s health, but I certainly wouldn’t say we’re doing it in this instance in 2013.  That’s where we want to get to.”

She explains that Movember has “just landed” in the UK in 2008, and its international model is to have a big charity partner in prostate cancer as things start up. “Now, going into 2013, we can take a broader stance and start to look at – and we are certainly starting to look at – what does men’s health mean.”

This year, she says, is the first when all the Movember campaigns across the world are focusing on the “pillars” of prostate cancer, testicular cancer and mental health. In the UK, she says, campaigning is going to broaden to encourage men to “know their numbers” (blood pressure, cholesterol etc) and to be more active. 

“We see it as a longer-term programme to get to that men’s health space you’re talking about,” she says. 

I ask her about Movember’s key objectives. After all, the website information about Movember’s aims and objectives is woolly. It says its “campaign strategy and goals” are “to get men to grow moustaches and the community to support them”. That’s not really a concrete goal for men’s health. So what is?

“To change men’s health behaviour,” she says.

But if you want to change behaviour, why is the bulk of Movember money going to a condition which cannot be prevented and where lifestyle is not a factor?

“It’ll be less to prostate cancer and more to other things this year, and that will start to shift more in the coming years,” she says.

Changing behaviour: what does Movember’s awareness work consist of?

I ask Sarah Coghlan about how Movember wants to change behaviour.

“Creating conversations is a big part of what we believe the awareness part is,” she says. “Giving men the right tools to educate each other. That information is really important to be shared and men aren’t very good at that. That’s the sort of conversation that women would have over a coffee – “I’ve found a lump” or “My period’s not quite right”. It comes quite naturally for women, but not for men. So having men, even for one month, becoming comfortable enough to say to their dad ‘Hey Dad, have you had a prostate check?’ can lead to changes in behaviour.”

I tell her there is no evidence that doing any of these things have a positive effect on men’s health.

“Yet anecdotally you would think that all those things are logical,” she says.

You would, I say. But it’s quite a leap to allocate 8% of your spending on creating conversations in the vague hope that this will change the face of men’s health. She tells me that this year’s Know your Numbers and Move campaigns will have a more specific impact, and suggests that I talk to Paul Villanti, Movember’s global Director of Programmes, who has a more overarching understanding of Movember’s objectives.

Why does no money currently go to mental health in the UK?

Mental health moves more onto the agenda when Movember has established itself in a country, Sarah Coghlan explains, and “that kind of investment” will be coming to the UK shortly. “The investment we’ve made in mental health in Australia is significant over the last eight to nine years and we can start to point to some of those initiatives that we’ve funded having behaviour change attached to and around them.” Again, she suggests I talk to Paul Villanti, and says an interview will be arranged. That hadn’t happened until yesterday, when Movember phoned me to arrange an interview.

Why is it difficult to get annual figures on how Movember’s money is used?

I discuss with Sarah Coghlan my difficulties in finding out how the money raised in any one year was actually spent.  Sarah Coghlan assures me that the new report cards on their website will show all the money coming in, and all the money going out. “Transparency is one of our core values, because we think we can do a brilliant job of setting a benchmark in that space,” she says.

“You will be able to go right back to 2007 and say in this year the money went on that, that and that. It’s just taken us time to get to that point.”

Since my interview, the report cards have gone live on the Movember website. They are a definite improvement. But I am still unable (and this may be a mark of my own ineptitude) to see how they provide a break-down the UK figures annually, or how income and outgoings relate.

Sarah Coghlan’s answers continue to raise questions, and I will be pursuing them with Paul Villanti shortly. 

In the meantime, do post comments here, and follow the debate about Movember in the UK. There is continuing discussion on Twitter at #MoDiscuss, comments on Peter Baker’s blog and Chris Hiley’s blog. 

Danger Man episode 6: The cornered dog

The story so far: John Drake has had a biopsy to see whether he has prostate cancer. He has just received the results of the test from his GP, Dr Sixsmith.

Drake shifted around in the surgery chair, trying unsuccessfully to get comfortable. Dr Sixsmith sat in front of him, signing a series of prescriptions.

“There you are Mr Drake, that should keep you going for a few weeks. I think you’ll find there are fewer side effects with these, but if there’s any problem, just come back to me and we’ll try something else.” He pushed the prescriptions over his desk towards Drake.

“And the discomfort? There’s nothing to be done about that?”

“You mean after the prostate biopsy? It should settle down. You can try paracetamol for the time-being.”

Drake fixed Sixsmith with hard, steel-blue eyes. His jaw was clenched. 

“Have you any idea?”

“I’m sorry? About what?"

“About the biopsy.” Drake’s already pallid face turned white. “I mean you sit there, you hand out leaflets about what the procedure involves, and what the effects might be, but how everything’s alright in the end, and then afterwards you tell me to take a paracetamol. I mean seriously. Have you any idea?”

Sixsmith looked concerned. He leaned forward and nodded. “I can see you feel angry about this Mr Drake.”

Drake’s brain whirred. Was it anger? Was it pain? Or was it those damned statins? His emotions no longer seemed his own to control.

“Dr Sixsmith, I am as you know a secretive man. But at this point in my life I can tell you that during my work I have been sliced, pierced, burned, pummeled and half-drowned. I have been tortured by no end of ingenious devices. But nothing, nothing, has been as unpleasant, as undignified, nor as continually uncomfortable and unsettling afterwards as the medical procedure you have recently subjected me to.”

Dr Sixsmith nodded. “I’m sorry your experience of prostate biopsy has been a bad one Mr Drake, but having had it, perhaps we should be grateful for the good news that you do not have cancer. And let me assure you, that research has indicated most men do not have serious complications and...”

Drake stood and leaned on Sixsmith’s desk, causing the doctor to sit back in his chair. “Dr Sixsmith, I am not most men. I am an individual. And for this man...” Even as he was saying the words part of Drake felt embarrassed by his behaviour. This wasn’t like him. He imagined himself to be cool, clever, calculated, not a hot-head. But now he felt cornered, injured, like a baited dog.

“... for this man, enough is enough,” he hissed, as the doctor cowered in front of him. “When I came into your office eight months ago Dr Sixsmith, I was a well man. I fenced, sparred, ran and lived my life to the full. And today, following your very close attentions, I can do none of those things. Even sitting down is a difficult experience.”

Drake reached into his breast pocket, pulled out an envelope, and slapped it down onto the doctor’s desk. “That is a letter requesting a transfer to another practice. I wish to be left alone. Goodbye Dr Sixsmith."

He turned, marched to the door and slammed it behind him. Sixsmith sat looking at the door, trying to work out what had happened. Had he dealt with the situation badly? The air conditioning whirred. 

Then the handle of the door turned. Drake’s face appeared round the door.

“Sorry,” he said, padding over to the doctor’s desk and picking up his prescriptions. “Forgot these.”

He tiptoed back to the door and closed it gently behind him.

Something else to worry about: health anxiety

Today’s edition of medical journal The Lancet includes fascinating research on health anxiety. A study from Imperial College London found that cognitive behavioural therapy (CBT) – a kind of talking therapy that helps people change unhelpful thinking patterns – is very effective at reducing anxiety among hospital patients.

It backs up earlier studies that found that CBT and related mindfulness techniques are really good at helping worrying patients. 

Just as interesting, however, is the fact that such papers talk about patient anxiety, not hypochondria (though they are theoretically the same thing). The word hypochondria has comic associations: they may have started with Jerome K Jerome’s Three Men in a Boat, written in 1889, whose narrator concluded after looking through a medical dictionary that he was “a hospital in myself”.

But today’s hypochondria deserves a less trivialising name. According to the new Lancet research, 5% of people worry obsessively about their health, and up to 20% of people who attend hospitals have abnormal health anxiety. These aren’t odd bods who casually think they have every condition under the sun. They are people – often elderly – made unhappy and sometimes ill by the fear that they have something seriously wrong with them.  According to Peter Tyrer, the author of the Lancet paper, health anxiety is a hidden epidemic. 

British Medical Journal 1864

What’s behind this epidemic? Being confronted with endless information about disease doesn’t help. A paper published this week in the journal Cyberpsychology, Behaviour and Social Networking finds (not surprisingly) that online health information seems to worsen worriers’ anxiety. 

But also at play is our society’s increasing obsession with perfect health and constant messaging from government and charities that we should go to the doctor regularly and have health checks. The NHS’s new health checks programme for 40-74 year olds will only add to the toll of unnecessary worry – with little evidence that anyone’s health will actually benefit.

Forgotten gurus: Z P Zazra

Thank goodness for the recommendation from the estimable “Dr Cooper”, otherwise you might have feared that the exotic Professor Z P Zazra’s skin looked a little too artificially dusky, his features a little too public school. For a shilling, Zazra offered an account of correspondents’ current lives and a prediction of their future on the basis of a single fingerprint. That was in the early 1900s. Today, there’s an app for that.