Thursday 31 October 2013

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. 


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.

Friday 25 October 2013

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.

Thursday 24 October 2013


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.”

Wednesday 23 October 2013


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

Sunday 20 October 2013


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.

Friday 18 October 2013

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.



Thursday 17 October 2013


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.  

Wednesday 16 October 2013



The mystery of Movember’s mission

I worry about Movember, the forthcoming moustaches-for-men’s-health fest. You’ll have read earlier in this blog about fears that the charity markets itself better than it markets men’s health issues. But I also worry that this global campaign, with an increasingly impressive UK profile involving the likes of Gary Lineker and Stephen Fry, is not as transparent as it could be. 
I think that the British public – who go out and raise millions of pounds for Movember every year – is getting pretty poor information about what the charity does with that money to improve men’s health in the UK.
Let me explain. Way back at the start of April this year, I contacted Movember UK about an article I wanted to write for The Times – a piece about the men’s health issues that really needed addressing in the UK. I thought I could base the piece around examples of current Movember initiatives. If I followed the £27 million people raised for Movember in 2012, saw how it was carved up into different areas of men’s health, I would have the shape of a piece that could take Movember initiatives as examples of areas that required action.
Sounds simple, but Movember found the question difficult to answer. Which was difficult for me too because it was the basis of my projected piece. So I persisted. They explained that UK annual figures weren’t to hand because Movember was a global organisation and many of its objectives were strategic and long-term. Not all funds were spent straight away, and some funds were as yet unallocated. They told me that they’d get something together for me, and then later in the year they’d have global report cards available which would provide absolute transparency about where all the UK Movember funds went. 
Nearly two months after my initial enquiry, Movember came back with some “top line notes” of Movember’s funds in action in the UK, without any figures or proportions attached. If I looked up each individual project on their website, I could perhaps work out (if I had a spare week) how much the totals were. 
Surely, I said, even given the difficulties, you must have a general idea of fund allocation each year. Movember says that its focus is on men’s health, prostate cancer, testicular cancer and mental health; it says its main programme areas are awareness and education, living with and beyond cancer, staying mentally healthy and research. So roughly, out of every pound raised by a mo, how much went into each area?
Movember continued to be charming. But it was not until 28th June, nearly three months after my initial enquiry, that they sent me a breakdown of Movember’s current activity in the UK.
Here it is. You won’t find these figures anywhere else – not even in the now published, much-vaunted global report cards now on their website (which still only give a global picture, and still tell you about projects rather than funding priorities). Movember told me these figures were preliminary.

2011 and 2012 
Movember raised a total of £48.9 million in the UK.
£3.2 million goes to awareness and education
Movember explains: “The delivery of the annual Movember campaign which gets men to grow moustaches and the community to support them leading to conversations about men’s health. This leads to greater awareness and understanding...”
£3.9 million goes to Movember’s Global Action Plan
Movember explains: “By bringing together international researchers, GAP facilitates a new and unprecedented level of global research collaboration, not previously seen within the prostate cancer community.” 
£15 million goes to Prostate Cancer UK for research
Movember explains: “Prostate Cancer UK’s new research strategy focuses attention on effectively identifying those men more at risk, detecting the aggressiveness of the disease and developing more effective treatments.”
£14.5 million goes to Prostate Cancer UK for projects supporting men with prostate cancer
Movember explains: “Working with Prostate Cancer UK, Movember is funding survivorship programmes aiming to ensure that men living with prostate cancer have the care needed to be physically and mentally well.”
£3.8 million goes to Prostate Cancer UK for policy and influencing
Movember explains: “Movember funds some policy, evaluation and education activities thorough Prostate Cancer UK to ensure that activities are being delivered effectively with the intended outcomes.”
£0.9 million goes to the Institute of Cancer Research
Movember explains: “The ICR’s Movember funded work focuses on a world class testicular cancer research programme which studies the genetic basis of testicular cancer.” 
(You can see where non-programme funds went here

Knowing the proportion of UK Movember funds spends on different programmes is important. When a charity reaches the size of Movember, transparency becomes more and more of an issue. Movember are doing nothing legally wrong in not making the information above widely available: their accounts are audited, public, and lodged with the Charity Commission. Charities are not required to break down their total figure for charitable activities into individual projects. So Movember are fulfilling all their obligations.
But for an organisation that claims on its website to be “committed to best practice levels of transparency, accountability and governance”, it is, as a senior figure in the charity world told me, lagging way behind many other UK charities that are making a point of demonstrating to fundraisers exactly where the money goes. 
These new figures are also important because they make clear that:
  1. Movember’s awareness and education work attracts a small proportion of its funds. This work in the UK consists almost entirely of “inspiring literally billions of conversations” through moustache growing, and posting health information on its website. Its advice on prostate checks has been criticised as unhelpful by some UK doctors. Margaret McCartney wrote eloquently on this in the British Medical Journal. 
  2. More than £33 million of the £41.3 million allocated funds go to one charity, Prostate Cancer UK. 
  3. 90% of the allocated funds are spent on prostate cancer (currently the Global Action Plan concentrates on prostate cancer). Movember UK insists it is not a prostate cancer organisation, but a men’s health organisation. Peter Baker, until last year Chief Executive of the Men’s Health Forum, has pointed out the difficulty of claiming (as Movember does) that you are “changing the face of men’s health” if nearly all your funds go towards a condition that causes just 4% of all male deaths. 
  4. No funds are currently allocated to mental health in the UK, even though throughout its UK website Movember says men with mos “raise vital funds and awareness for prostate and testicular cancer and mental health”. Movember UK told me there will be more emphasis on mental health in the coming years.
So the question raised itself: does Movember know which men’s health issues in the UK need addressing most? My feature, as I planned it, was scuppered. I went to talk to Sarah Coghlan, Movember’s UK Director, to explore things further, and will report on that conversation in a future post. 

Monday 14 October 2013


Episode 5: on the trail of Kolotov

The story so far: Athlete, intellectual and secret agent John Drake has a few things on his mind: his health, his job and the fact that his doctor won't leave him alone... 
The Austin Healey certainly wasn’t designed for reconnaissance. Rain thudded down on the rag-top, and ran in trickles down the insides of the windows. A wave of cold air wrapped itself around Drake’s legs. He felt weary, wearier than he could ever remember feeling before.
“The tiredness could be some transient side-effects of your new medicines,” Dr Sixsmith had told him. “But I’d stick with it. Lesser of two evils and all that. And you said it yourself Mr Drake: you’ve been very stressed by work. Your tiredness, headaches, your sleeplessness – they’re all classic symptoms of anxiety. I can prescribe you something for that if you like.”
Drake peered through the smeared windscreen. Still no sign of Kolotov. He’d gone into the Kingsway building two hours ago clutching a large tied parcel, and he hadn’t emerged from the front entrance yet. Maybe he should go in and check for other exits. Give it five more minutes...
He reached over to the passenger seat for his sandwich, and started to unwrap it. Sardines and lettuce, no butter, wholemeal bread. Low in cholesterol. Good for his heart. He took a bite, chewed without relish, wrapped it up again, and put it under his seat. His hand found a bottle there, and he drew it up. French brandy, bought from Swiss duty-free two weeks ago. He took a small swig and it felt good. It was the only thing in the world that could dent his headache.
Still no Kolotov. Drake’s mind turned to work. It was true he was worried. Every mission seemed to start with an argument with his superiors: robotic civil servants who expected him to be as blindly obedient as they were. Killing solved nothing. Brains, diplomacy and cunning did. But they didn’t want a brain, they wanted a bloodthirsty automaton, and he wasn’t sure how much longer he could play their game.
Drake’s reverie was broken by the sight of Kolotov stepping through the glass doors onto the steps. Simultaneously, calamitously, the phone in the red public box just feet from Drake’s car started to ring loudly. Drake cursed quietly as he saw Kolotov look over to ringing phone. He was looking right at Drake. Drake could see Kolotov’s mind working, wondering what a man was doing just sitting in a sports car, doing nothing. Kolotov paused to light a cigarette, and Drake made a split-second decision. He got out of the car and went to the answer the phone as if it were the call he’d been waiting for.
“Hello,” said Drake into the receiver, turning to check if Kolotov was still there. He was, struggling with his matches in the wind. “Who is this?”
“Hello, is that Mr Drake?” It was a woman’s voice.
Drake was astonished to hear his name. “Who is this?”
“Oh hello Mr Drake. It’s the hospital here. I’m just phoning to check why you haven’t attended for your biopsy. It’s due in ten minutes.”
“What... Do you... But I’m in the middle of something. A matter of international security.”
“I’m afraid if you miss your appointment you’ll have to wait another two months, but if you come now...”
“But Kolotov...” Drake looked round again.
“I can’t see what’s more important than your health...” the woman burbled on.
Kolotov was gone. No trace, not even a whisp of cigarette smoke.
Drake sighed, deeply. He felt in his jacket for the reassuring bottle of valium. “Give me fifteen minutes,” he said.

Sunday 13 October 2013

Forgotten gurus: F Meredith Clease


In 1909, with advertisements surrounding him advocating tobacco, patent remedies and astrology as a means to health and happiness, F Meredith Clease was offering something truly radical: exercise. Clease said his system of stretching not only cured obesity and “prominent hips” but also “Slackness, Out of Breath, Puffiness, or Can’t-be-bothered Condition.” 
If only people had listened. Was he a crank, a quack or a visionary? It’s still so hard to tell the difference.

Friday 11 October 2013


The happy countdown: top ten reasons to be cheerful

Top ten lists: don’t we love them. Journalists know how to get people to look at stuff, and you only need to look at how they permeate lad’s mag and men’s page to get an idea of how effective countdowns are with a male audience.
Where did it all start? Yes, lists are blessedly brief. But did Victorian adolescents sit down outside the blacking factory to jot down a run-down of the best ever paddle steamers? I’ve looked through a fair number of Edwardian magazines, and though there are plenty of articles listing heroes of the Albert Medal and interesting things to do with a tiger pelt, there are precious few numbered lists.
My theory is that men’s current appetite is borne of an era of exciting countdowns in the sixties, seventies and eighties –  the opening credits of Thunderbirds, the start of every space mission, the end of Radio One’s chart show. Countdowns make us expectant.
So, aware that my last post might have sounded a little old and grumpy, I’ve put together my own top ten list, of good things about men’s health. The mere mention of “health” usually brings visions of physical decline and misery, which doesn’t really help anyone. So I’m trying to reclaim the high ground of positivity here.
  1. Men’s death rates are down. Between 1980 and 2010, mortality rates for men declined by 39 per cent.
  2. Male mortality is declining quicker than women’s (not that we’re happy about the women situation)
  3. Life expectancy is up. Over the past 50 years, male life expectancy has increased by 10 years (compared to eight for a woman).
  4. Men get happier. There’s evidence that overall happiness in men increases over the age of 30. 
Okay, I lied. I couldn’t manage ten (suggestions gratefully received). And there are lots of bad things happening too. But there are reasons to be cheerful about being a bloke, and on average we aren’t doing so bad when it comes to looking after ourselves.

Wednesday 9 October 2013


Movember: not talking about my generation

Last night I was at the big, noisy, grungey launch of Movember at Camden’s Koko night club. Movember, as I’m sure you will be aware, is the month formerly known as November, now a global campaign for men’s health which revolves around growing moustaches.
I came away clutching my goodie bag (Mo razor, Mo HP sauce, Mo wristband, Mo plectrum, Mo badges... you get the idea), ears ringing and mind full of the slogans flashed at me on posters, on screens and in speeches from Movember’s founders. I must have been the oldest person there and it is clear that at 53 I do not belong to Generation Mo. Which is odd, since 6 in 10 cases of prostate cancer are found in men over 65. But it may also explain why I left feeling less than euphoric.
Here are this year’s Movember campaign slogans, portrayed in stark black and white, alongside pictures of snakes and wolves:
  • If you don’t like our moustaches, we don’t like your laws
  • Give respect, get respect
  • We are generation moustache
  • Gen Mo
  • Swift silent hairy
  • 13

The words are macho, like the launch: confrontational, even aggressive. I don’t know what they mean, but they are not meant for me. They have been chosen to create a sense of unity, mission, rebellion among the 20-30 year olds that Movember sees as key fundraisers.  
Adam Garone, Movember’s CEO and co-founder (who was at the launch with fellow co-founder JC aka Justin Coghlan) told Marketing Week yesterday that the new branding was “to target a new generation of fundraisers and drive positive change.” He said that “fun is the trojan horse to get guys engaged”. How, exactly, all the marketing drives “positive change” as opposed to fundraising is still a mystery, however.
A report from Precise Brand Insight analysing Movember’s social media reactions in 2012 concluded: “While more and more people are clearly aware of and excited by Movember, the original aim of the movement seems at risk of being overtaken by the excitement about growing moustaches.” It found that only 10 per cent of social media mentions about Movember related to raising awareness.
Movember has become an extremely effective, marketing-savvy fundraising machine. Whether it is actually achieving what its founders say is its core objective – “change” – is open to question. 
What do you think? Have a look at the video clip of acolytes taking the Movember pledge at Tuesday’s launch.


Tuesday 8 October 2013


Episode 4: Danger Man and the mystery of the plasma-free PSA

The story so far: John Drake, a seemingly healthy 40 year old, has grappled an intruder to the ground in his hotel room. He discovers it is Dr Sixsmith, his GP.
“I have to say that your devotion to my health is well beyond the call of duty,” said Drake, pouring his doctor a glass of water. “So let’s get this straight. You phoned my home with my test results, and my wife told you I was in Lisbon. You happened to be coming to Lisbon anyway for the International Blood Pressure Society meeting, so you called in to my hotel. Is that correct?”
Dr Sixsmith was sitting hunched on the sofa, pressing a damp towel to his bleeding head. “That’s right,” he said.
“So why were you behind the curtain?”
“It’s a strange thing,” said Sixsmith, sipping the water as if it were Scotch. “When I told the receptionist who I was, and showed her my identification, she suggested I wait for you in your room. I waited for an hour and then heard someone scratching at the lock of the door. I assumed it was you and was about to let you in when someone clearly put their shoulder against the door. Twice, three times they slammed against it, and I’m ashamed to say I was frightened. So I hid. It wasn’t you was it?”
“No.”
“It stopped, but then someone tried the key again, so I stayed where I was. It turned out to be you.”
Drake paced back and forth between the window and the coffee table, deep in thought.
“I’d recommend a biopsy,” said Sixsmith.
“Hmm? What?”
“Your PSA test results Mr Drake. Its why I’m here. Let me explain. A normal level of PSA in the blood would be below a reading of three. Your reading is four. That’s not worrying in itself, but your plasma free PSA looks rather low.”
“What does that mean?” Drake had stopped his pacing. He looked pale.
“I’m afraid I can’t explain that for reasons of dramatic brevity,” said Sixsmith. “But to be on the safe side, I think you ought to go to hospital for further tests. Nothing to worry about.”
Drake reached into his pocket, drew out a pill bottle, tipped two into his hand and flung them into his mouth. Sixsmith looked disapproving.
“What are those?” he snapped.
“Blood pressure tablets,” said Drake. “You should know. You prescribed them.”

Monday 7 October 2013


Live with it

Today I’ve been interviewing Professor Roger Stupp in Zurich. He’s an important man because nearly ten years ago he discovered a combination of radiotherapy and chemotherapy that significantly extended the life expectancy of people with brain tumours.
But interestingly, he told me that looking for “cures” for all cancers was the wrong priority for researchers. Many potentially other life-threatening conditions that people live with every day are not curable, and few live in the expectation of cure. Heart disease, high blood pressure, diabetes, he pointed out, are all conditions that are controlled not cured with drugs, or lifestyle modification. The priority, said Stupp, should be to give people the maximum quality of life, while controlling the conditions to extend life.
Most ailments either go away by themselves or stick around, often unnoticed, sometimes thankfully held in check by treatments. Cures don’t come round that often, so when you think about it, it’s remarkable that so many cancers are now effectively curable. When it comes to most illness – whether it be damaged arteries, heart disease, waterworks problems, piles or persistent athletes foot – men have to live with it. 

Sunday 6 October 2013


In praise of the inane

Psychologist Averil Leimon told the BBC’s Today programme that men bond with each other by quoting from films, whereas women start revealing intimate details to each other.
"Quoting lines from a film is a quick and quite clever shorthand way for men to bond with people without achieving any intimacy at all,” she said. "But it's also quite a clever personality test. You suss out who is part of your tribe.”
I think it’s true – at least that men bond by doing what might superficially seem mundane, stupid. Ah yes, those adolescent sessions reciting Monty Python’s parrot sketch, those pub evenings putting together lists of top ten movie deaths, those annual golf gatherings repeating jokes you’ve told every year. 
It’s refreshing to hear men’s natural propensity for triviality, inanity and gaining pleasure from simple things not being actively mocked (though there’s plenty of room for that too). We do things – and important things like bonding, resolving problems, dealing with stress – very differently than women. Understanding the way we approach problems, rather than comparing it unfavourably with the way women do things, is a good way forward when it comes to health issues.
Studies are always finding out that women are better at disclosing how they feel about their health, and more likely to visit the doctor. And in response, doctors are constantly urging men to be more like women.
It’s not going to happen. Some men are okay with baring their souls and talking openly to GPs but many are not. If you want to help all men lead happier, healthier lives, you have to work from that starting point and not “if only” world. If you do, you might find that being blithe and inane has many benefits.
Or as I always say:  “I'm a lumberjack, and I'm okay. I sleep all night and I work all day. I cut down trees. I skip and jump. I like to press wild flowers. I put on women's clothing. And hang around in bars.”

Friday 4 October 2013


It's the quality, not just the length

Today's British Medical Journal publishes an important review indicating that exercise is just as effective as drugs in helping people who have had stroke, heart failure, heart disease or are at risk of diabetes. They live just as long if exercise is prescribed rather than drugs, and in the case of stroke longer.
Which is quite a stunning conclusion, particularly since 305 randomised controlled trials informed the study. What makes it all the more remarkable is that this study looked at length of life, not quality of life. 
What would be the results of a study that also took into consideration the life-inhibiting side effects of the drugs here being compared with exercise? The drugs most commonly used to prevent heart attack, heart failure and stroke – beta blockers, ACE-inhibitors, anticoagulants, diuretics, statins – are pretty blunt instruments which are not easily tolerated. GPs often struggle to find the right dosages and combinations that enable people to lives not feeling woozy, sick, worried or rushing to the toilet every few minutes. Exercise, on the other hand, usually improves quality of life.
The conclusion to be drawn isn’t that we stop using drugs, and get everyone to run round the block instead. It’s that drugs, particularly those known to have problematic side effects, should not always be the first port of call. Length of life doesn’t necessarily suffer if you put quality of life first.

Thursday 3 October 2013


Episode 3: Danger Man gets into a bit of a scuffle

The story so far. Having been found to have raised cholesterol and above average blood pressure, John Drake has reluctantly agreed to further tests.

There was a man behind the curtain: no doubt about it. The purple fabric quivered unmistakably at head height, heaved in and out by the intruder’s deep breaths. Drake froze, and glanced round the hotel room. There, that would do: a heavy-bottomed glass vase, containing a single orchid stem. In one long feline movement, Drake swooped for the vase, and hurled himself at the fluid spot in the curtain, bringing the vase down hard where he judged the top of the intruder’s head to be.
There was a muffled yelp as Drake pulled the man towards him, enfolding him in the curtain, pulling it off its rings – ping, ping, ping – as he drew him to the floor, and launched five sharp blows to his body, two to the head. The intruder’s resistance ebbed, his stifled protestations changed to groans.
Drake began unwrapping the unsavoury bundle. As the head appeared, its words became clear: “Stop it, for God’s sake stop hitting me!”
Drake put his hands round the man’s throat: “Tell me who you’re working for,” he spat. “Who is the Cairo operative? And what did you do with the microfilm?”
“Stop it!” the man gurgled. “It’s me. Stop it.”
Drake was troubled, and his grasp slackened on the throat. There was something familiar about that sweaty, bloodied head. It looked like, like...
“Dr Sixsmith!” Drake let go, and started back as if hit by an electric shock.
“Ughh.”
“But what, what on earth are you doing here?”
Sixsmith managed to prop himself up on his elbows, and gently felt his reddened neck. His voice came out as a croak.
“Mist..Uggh Mr Drake. I.... I came to give you the results of your PSA test.”

Tuesday 1 October 2013


Money up in smoke


From a godforsaken corner of the BBC website comes an interesting news story. A review for Public Health Wales has concluded that £1.5m of public money was spent in the past year on 10 projects that were unlikely to bring any health benefits at all. 
A smoking helpline, a scheme to raise awareness about skin cancer and a cooking bus to promote healthy eating all bombed.
How can this come about? Very easily. Projects to improve public health are bound to be useless unless they are grounded in an understanding of why people behave the way they do. Most are not. Our understanding of health behaviour is poor, mainly because there’s so little research happening in these areas.
A month ago I interviewed David Cameron – no, not that one: Professor David Cameron, Director of Cancer Services for NHS Lothian and the man in charge of moulding the new national cancer research networks between 2006 and 2010. He’s infuriated at how little hard facts informs what happens in health services.
He told me about the number of political initiatives to try and improve health in the UK where evaluation wasn’t even part of the process. “The attitude is: ‘Come up with a better way of doing things, and we’ll give you the money.’ But if you respond that you need to have the data to show you the best way, the answer is: ‘No, sorry, you have to know the answer or you don’t get the money.’”
The idea for a project all too often comes before the reason for doing it.
Why do particular groupings of men smoke, drink too much, eat unhealthily and indulge in risky behaviours? We have very little evidence. Until we do, and until we know whom to target with what help, many projects urging them to conform are doomed to failure.

A new beardy campaign

With reference to my first post on this blog, it has been pointed out to me that a men’s health website is the ideal place to start a Campaign for Real Broccoli.