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Should men worry more about their health?

Paul Colbert and Dr Michael Fitzpatrick exchange views

Why men need to feel, too

Paul Colbert, editor of ZM magazine, thinks that men need to adopt a more feminised approach to health advice and self-help

Launching a new health magazine - especially one for men - gives you a fascinating insight into how different men and women's attitudes are towards advice.

Men don't like it.

Give them 'opportunities to learn' or 'information to collect' and they'll gleefully absorb the facts until closing time. But deliver anything that smacks of an instruction and their attention will swizzle back to the footie faster than you can say 'hand me the remote'.

How men come to terms with this educational reticence will have greater repercussions on their health in the next millennium than any number of medical initiatives.

Look at the different approach the sexes have towards breast and prostrate cancers. There are more than 100 charities and organisations dealing with breast cancer, and while the annual death rate is still in the thousands, it's continuing to fall. At last count prostrate cancer had just three charities. Death rates are lower than for breast cancer, but still in the thousands - and rising speedily enough to make it one of the fastest growing male killers in the country.

I think this says as much about men's inability to communicate as it does about their disposition towards their health.

Over recent decades women have successfully mobilised their shared concerns about health and made it a joint force for good. They seem to have an innate ability to share experiences in a positive way. 'I've got a cold.' 'I had one last week and I tried taking zinc. It worked brilliantly for me.'

For a man the only reason you would share a health tale with a mate would be to make him gag on his beer with a medical horror story. All such tales have three rules. They have to be painful: 'my testicles resembled a golf ball and a King Edward in a pair of tights;' bizarre: 'usually it's something only bats catch;' and must conclude with a piece of voyeuristic triumphalism: 'three of the cooks came to have a look because they'd heard the nurses talking about it in the canteen.'

Also men are a particularly strange breed of hypochondriac. They're always sicker than their women, but they won't go to the doctor, and they never take drugs. Perhaps it's because we think trooping off to the GP is a girlie thing to do, and real men just tough it out until the bleeding stops. At least that's the traditional view. Now I'm not so sure. I think there's a much stronger element of fear in there than men are ready to confess to - the dread that there might actually be something wrong.

Lately men's magazines - even the drinking and leering varieties - have been telling men to feel around for signs of testicular cancer while they're in the bath. But the number of men I know who do it can, in fact, be counted on the testicles of one scrotum. We're too scared of finding something.

While our overall interest in our own health and fitness is thankfully on the increase, there are still two big trigger points that bring our mortality emphatically home to us. 1) when we turn 30, 2) when we have kids.

For men no birthday is ever as bad as 30. It's the first one where we have to come to terms with no longer being as fit as we once were. The trend has turned downwards. And kids make us realise more than anything that exercise is our body's pension. We're no longer working out in order to have a flat stomach for the summer, we're working out so we can still play football with our son at 14, when we're aged - er, well, let's not go into that.

At ZM we've decided that our mission is to be the best health insurance a man can buy. And that insurance is information. Our job, as we move into the next millennium, is to find a way of delivering it that makes men pay attention, take action and not get scared.

But if there has been one question we've been asked during the making of ZM that's revealed the average man's true attitude towards his health and fitness it's this. 'You know those electronic pad things that you strap on to exercise your muscles while you're sitting still?' Yesss...'Do they work?'

It's going to be an interesting future.

ZM, the men's health, fitness and lifestyle magazine, was launched by National Magazines in October

Straw men

Dr Michael Fitzpatrick sees the booming men's health industry as a symptom of an unhealthy obsession

In the world of men's health magazines the stereotypical male is reticent, stoical and haughtily indifferent to exhortations to live a healthy lifestyle and to submit regularly to medical inspection. My first response is to wish that a few more like this would turn up at my surgery, in place of the intensely disease-aware and health-obsessed young men currently shuffling through the waiting-room doors.

Indeed I was beginning to think that the hard man who haunts the men's magazines had become extinct, when one turned up last month. He is a patient who comes very occasionally, when he thinks he needs some particular treatment. Now 75, he had a stroke some 10 years ago, leaving him paralysed down one side and scarcely able to speak. Though he is virtually confined to a wheelchair, he still insists on coming up to the surgery, assisted by his wife.

The effort required for such an outing - always complete with collar and tie and polished shoes - is clearly enormous. When I say that I would be happy to visit him, his wife just says, 'he likes to come'. Yet so unusual has such an outlook become that he now seems to be a visitor from the distant past, if not from another planet.

For today's promoters of men's health, my patient manifests seriously disturbed behaviour. His reluctance to parade his distress indicates denial of his deeper emotional needs, and his insistence on getting dressed up and going out suggests an unhealthy perfectionist mentality, if not outright obsessional compulsive disorder. He is clearly in dire need of counselling.

As recently as 10 years ago, males between the ages of five and 65 were rarely seen in general practice. We mostly saw women and children, and old people, who are, of course, predominantly female. Now men, particularly young men, are frequent attendees (and earnest articles in the medical press suggest methods of persuading adolescents that they should join the queue).

The men's magazines often claim that they are following the trail blazed by the women's movement and demanding that health services become more responsive to their particular needs. In fact, in its early radical phase, the women's movement regarded the world of medicine as patriarchal and oppressive and attempted to organise key aspects of women's healthcare autonomously. However, once the radical moment passed, this movement was rapidly incorporated by the medical establishment: the former samizdat handbook Our Bodies Ourselves can now be found on many GPs' shelves. What started out as a challenge to medical authority over women contributed to the evolution of a more comprehensive system for the medical regulation of women's lives - notably in the spheres of contraception, pregnancy, childbirth and in the promotion of screening tests of dubious efficacy such as cervical smears and mammography.

Lacking any radical impulse, the men's health magazines have taken the degraded end product of the women's health movement as their model. Far from challenging medical authority, they urge men to submit themselves to it on a greater scale than ever before. In choosing campaigning issues, advocates of men's health have proceeded by analogy with the feminists: they had cervical smears - we demand prostate examinations; they can do breast self-examination - we can play pocket billiards.

The parallel between screening tests for cervical and prostatic cancer is richly symbolic. Just as the smear test exposes women not merely to the medical gaze, but also to vaginal penetration, so the palpation of the prostate involves digital penetration of the male rectum. The slippery finger may be less impressive than the metal speculum, but it is no less significant as an instrument of symbolic domination.

It is striking that long after medical authorities have accepted the uselessness of both breast and testicular self-examination, the popular health magazines continue to promote them. The extent of popular approval of these techniques - out of all proportion to any value they might have in reducing the impact of cancer - is a potent indicator of the pathological preoccupation with health in modern society.

When it's time for my old patient to go, he looks me in the eye and shakes hands - with the left because his right is paralysed. Here too the contrast with the modern male is striking. Modern man slouches out, in his shabby black and grey, his eyes cast downwards, avoiding a handshake or offering a feeble gesture in response. It strikes me that as the hard men die out, the new men have become rather like old women.

Reproduced from LM issue 116, December 1998/January 1999



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