No man's land: men, illness, and the NHS
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7320.1058 (Published 03 November 2001) Cite this as: BMJ 2001;323:1058
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Editor,
It is a pity to see someone in the vanguard of Men’s Health promoting
nonsense. Ian Banks states that, “Only 29% of doctors routinely provide
age appropriate instruction on testicular self examination, compared with
86% who provide instruction to women on breast self examination”.1
There is no evidence that routine testicular self examination (TSE)
is beneficial - and there never will be, as the disease is so rare that
the number of patients required for a proper trial would be prohibitive.2
Furthermore, TSE is a screening test and fails miserably when measured
against standard screening test criteria.3 There is, however, evidence
that the activity may cause harm by revealing irrelevant abnormalities
which cause anxiety and result in unnecessary intervention.4 Promoting
routine TSE wastes NHS resources, turns our nation’s blokes into ball-
watching neurotics and distracts from the real issue, which is the need to
encourage men to avoid delay in seeking medical advice when a problem
arises.
It is ironic that Banks seems impressed by the comparatively large
number of doctors who provide instruction on breast self examination in
females - it has been known for some time that this activity does no good
and causes some harm, and so should no longer be encouraged.5 Doctors in
general, and men’s health enthusiasts in particular, should have learned
the lesson that what seems at first sight intuitively sensible might turn
out to be not such a good idea.
Men’s Health might be taken more seriously if it was grounded in a
mixture of evidence and common sense and avoided advocating nonsense in
its rush to bang the Men’s Health drum. Perhaps the blinkered individual
in the picture used to illustrate the piece represents the Men’s Health
movement rather than men themselves.
Keith Hopcroft
GP, Laindon Health Centre,
Basildon,
Essex SS15 5TR
Editorial Adviser, Doctor Magazine
Medical Editor, Men’s Health magazine.
1 Banks I. No man’s land: men, illness, and the NHS. BMJ
2001;323:1058-60.
2 Morris J. Should testicular self examination be recommended? Journal of
Medical Screening 1996; 3(1):2
3 Buetow S. Testicular cancer: to screen or not to screen? Journal of
Medical Screening 1996; 3(1): 3-6.
4 Austoker J Cancer Prevention in Primary Care: Screening for ovarian,
prostatic, and testicular cancers BMJ 1994;309:315-320.
5 Canadian Medical Association Journal 2001;164:1837-46.
Competing interests: No competing interests
Dr Banks' article is timely and he makes some excellent points.
But he has not addressed the issue of access to health - not just for
men, but for all working people. How many surgeries are open outside
working hours?
Most of us, with the customary hour's commute, lose a huge chunk of
our working day to visit a GP. I also have to make up the hours.
There is also a significant loss of privacy, with employers and
colleagues having to know that one has a health problem.
I have recently raised this issue with the Department of Health,
which referred me to the NHS Direct clinics. But these are staffed by
nurses, not doctors.
Please - more evening/weekend clinics and/or the possiblity of
registering near work!
Competing interests: No competing interests
Men and the NHS
Dear Sir
I was rather disappointed by the BMJ issue on mens health. I did,
however, enjoy the contribution from Ian Banks and would like to add a few
comments.
First, I strongly agree with Banks's observations on the
unfriendliness to men of the GP's surgery. May I add another unfriendly
item to the list. Usually the magazines available to the waiting patient
are exclusively for women. Furthermore, these magazines often include
publications (such as "Cosmopolitan") which are potentially offensive to
some older men. Can you imagine any waiting room with copies of "Playboy"
lying around? Not likely!!
I take issue with the description of training of medical students.
Banks's comments are entirely valid for the late 1950's when I was a
medical student, but we are doing better on all scores now - at least in
Oxford!
I would also like to comment on the statements about breast and
testicular self examination. Neither of these procedures has been shown
to be beneficial and both are potentially harmful because their use is
associated with high rates of false positivity, unnecessary medical
intervention and anxiety. Rather, people should be introduced to the
concepts of breast awareness and testicular awareness. This implies the
acquisition of knowledge about normal shape and feel of the breasts or
testes during bathing and showering for example, but the avoidance of
ritualistic self examination at rigidly fixed intervals which can become
obsessive in some people.
I think the BMJ issue generally missed out on the depressing
situation in which men today find themselves. Wherever one looks, men are
losing ground to women and many feminists are not backward in making full
mileage out of this. Indeed, Doris Lessing has condemned the female
culture that revels in humiliating men. She has said "the most stupid and
nasty woman can rubbish the kindest and most intelligent man and no-one
protests". Women are protected by the concepts of political correctness,
often backed by law, which can render men powerless. This is not the
climate in which men are more likely to take interest in their health and
to make use of services. Rather, they are encouraged to conclude "the
only safe place is in my head"!
A final point along the same lines. Our society for some reason
delights in ridiculing men and the more this is done, the less likely are
men to take themselves and their health seriously. Any one viewing
popular television programmes and advertisements will be aware of this
issue which has indeed often been pointed out and decried by women. Even
the mens health issue of the BMJ is guilty on this score. This is
evidenced by the image on the front cover, the illustration accompanying
Banks's article and the photograph accompanying the comment about the
latest bit of rubbish put on at the National Theatre. To improve mens
health, society has to begin by taking men seriously.
Yours sincerely
Martin Vessey
Competing interests: No competing interests