The ill-American male
David Nolan reports on America's unhealthy obsession with men's health - a sickness that is now spreading across the Atlantic
If a nation the size and diversity of the USA could be said to be obsessed with anything for longer than it takes to find and cremate a Kennedy, one major contender would be its health. From Boston, MA to San Diego, CA it is difficult to walk a block without passing a gym or being threatened by rollerbladers, joggers and cyclists hell-bent on ditching calories and gaining muscle bulk. America's neurosis about fitness and health might be vaguely understandable, if so many people did not eat so much food. So while the USA may have the highest per capita gym membership figures in the world, it is way up there in the obesity league as well.
An analysis of the nation's love/hate relationship with its own health - from an admittedly disinterested perspective - reveals a lot about what underscores this unhealthy fixation. Take National Men's Health Week early this summer. A blast of TV advertising promoted a free action pack; a website was established; and media coverage was extensive. Each day of the week had a theme. Monday - why men avoid the doctor; Tuesday - lifestyles; Wednesday - the male 'menopause'; Thursday - impotence and infertility; Friday - domestic violence from the battered husbands' point of view. For the weekend we had cancers, of the prostate on Saturday and the testes on Sunday.
Pennsylvania recently hosted the country's first National Men's Health and Fitness Conference. It was addressed by failed Republican presidential candidate Bob Dole, who told America in graphic detail about a little problem that affects himself and 'millions of men and their partners' - impotence. The main thrust of the conference publicity focused on the fact that one third of American men have not had a check-up in the previous year and nine million men had not seen a doctor for five years. The response? Get into a 'relationship' with your doctor - even if you don't need to.
You cannot even mail a letter here without being reminded of 'men's health problems'. Following the hugely successful breast cancer awareness stamp issued in July 1998, the United States Postal Service decided to issue a stamp advising men to have annual check-ups and tests for prostate cancer.
Concern about some of these issues seems bizarre. Why do men avoid the doctor? Could the answer be that we are generally healthy - and certainly more so than at any other time in history? Or that it is a pain to get time off work for no reason? Or that we don't want to be told that we eat, drink and smoke too much and exercise too little? Maybe most men simply do not go to the doctor because they are not ill, and so they have no reason.
Much is made of the fact that women consult medical professionals far more than men do. Women visit doctors 30 percent more than men - overall, seven out of 11 adults visiting doctors are women. But women have problems we don't have to worry about, like periods, contraception and pregnancy. Women, particularly those with young children, have easier points of contact with doctors - the opportunity to consult them is there, so they 'opportunistically consult'. Maybe we should conclude that some women spend more time than is healthy pestering physicians.
Just because women have certain needs does not mean that men have to mirror them. Yet this is exactly what much of the imaginatively constructed high-profile men's health issues that dominate discussion in the USA are doing.
Take the male menopause. The female menopause is clearly a 'health issue'. At some time, usually between the ages of 45 and 55, a woman stops ovulating and menstruating. Her hormone balance changes in a way that can have a deleterious effect on her physical health. Women experiencing the menopause can get relief from unpleasant symptoms and benefit their long-term health by seeking medical advice and treatment. But a 'male menopause'?
The Greek basis of the word menopause itself means menses (periods) pausis (stop). Men, of course, do not have periods to start with. But semantics aside, there is no evidence of sudden hormone changes or any other form of biological causality for male depression, loss of sex drive, weight gain or any of the other supposed male menopause symptoms. Sure, lots of men have mid-life crises. But they are more likely to be caused by the psychosocial frustrations of work, family life and facing up to middle age than something that a physician can fix. The existence of the 'male menopause' is hotly contested and it is weird that it should feature as a theme for any national initiative.
As for battered husbands: even if we were to accept that significant numbers of men are trapped in abusive relationships with their wives, it is hard to see how this fits into the health model. A man who is battered by his wife does not have a health problem, but a relationship problem.
National Men's Health Week is a prism through which American men are being asked to examine not just their bodies, but their personal problems and behaviour. Health professionals are being promoted as mentors who are needed to help us get our bodies, minds and relationships in order. Men, according to the health establishment over here, are simply not worried enough, insecure enough or neurotic enough. Not worried about your health? You should be. Not experiencing symptoms of illness? Don't assume you are healthy - assume you simply haven't noticed yet.
Fortunately this recent flurry of dubious campaigns has had its critics. While many in the medical profession clearly relish their status as life-guides, others with a more straightforward interest in biomedical problems are irritated by what they see as bad advice posing as health promotion. The prostate cancer postage stamp caused a mini-furore, with a number of respected doctors arguing that the postal service should concentrate on delivering the mail rather than delivering ill-founded male health advice.
Writing in the New England Journal of Medicine, Drs Steven Woloshin and Lisa Schwartz, who work at a veterans' hospital in Vermont, argue that far from merely 'raising awareness' as is claimed, initiatives such as the prostate cancer stamps risk causing 'confusion, anxiety and an unhealthy preoccupation with illness'. Citing the Congressional Office of Technology Assessment, the US Preventive Services Taskforce and the Federal Centers for Disease Control and Prevention, the doctors point out that there is no reason for annual check-ups or tests, that the cure can often be worse than the prostate cancer itself, and that the thinking behind the stamp was wrong. Indeed the US Preventive Services Taskforce recently concluded that 'there is fair evidence to support the recommendation that [prostate cancer] be excluded from consideration in a periodic health review'.
Not that this criticism has discouraged the US postal service's interest in men's genitals. It made much of the fact that Lance Armstrong, a member of the USPS-sponsored cycling team, won the Tour de France with one testicle, the other having fallen victim to a rather virulent form of testicular cancer that spread to his brain. No opportunity was lost to repeat the mantra that regular check-ups were required, whatever your age. The fact that Armstrong ignored some pretty grotesque swelling and pain that would send most men running for help was conveniently ignored.
The result of campaigns such as these will not be to ensure that everybody receives the healthcare they need, when they need it. The only consequence will be to flood doctors' surgeries with men reporting every minor ailment and tiny ache as a life-threatening incident, adding to an already unhealthy obsession with health and personal lifestyle.
Men need healthcare when we are sick. When we are well, we only need to be left alone.
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Reproduced from LM issue 123, September 1999