as facial hair now sprouts forth, let us examine the health advice that Movember is offering on its website.
here, they give a good rundown on what you can do to reduce your risk of avoidable premature death or illness; essentially it is this. Don’t smoke, keep to a healthy weight, do some exercise you enjoy – preferably, social and preferably daily; eat a varied diet, mainly plants, and have work you like.
Not at all useful is this webpage, a ‘health checklist by age’.
Last year, @petedeveson wrote this article about the lack of evidence for the health checks they advocate. I was especially concerned about last years advocating of PSA screening, and took up his offer to speak to the PR department of Movember on a joint phone call. I offered evidence based information, such as the complex nature of most screening tests and the problems of overdiagnosis, overtreatment and the need for fair information. I said I’d be happy to speak to them again. No luck!
They have now produced a document suggesting that men aged 40 and above have a baseline PSA test. They do not mention any of the problems with PSA testing – namely that it doesn’t work well as a screening test, and is not part of an NHS Screening programme. PSA screening means that men who would never have been maimed by an indolent prostate ‘cancer’ are, however, harmed by treatment for it. Movember present PSA testing as something a good citizen would do, not something which performs very poorly. Nor do they link to information such as decision aids for PSA screening (which, incidentally, tend to lead to more men not wanting the test.)
There are lots of other problems with Movembers’ screening information. They advise a blood pressure to be measured every 2 years. The NHS says men over 40 should have it checked every 5 years. They say mens’ cholesterol should be checked from age 20. The NHS says from age 40 in someone otherwise well, and even then, cholesterol is only one factor of a cardiovascular risk assessment – which includes things like smoking. I think – I’m not sure from their wording – that they are recommending flu vaccination in men aged 20 and above, again, this isn’t recommended by the NHS unless there are other health problems such as asthma. (There is also the additional ‘problem’ of Cochrane but we will leave that meantime). There is good information about what the NHS recommends in terms of vaccination, here. From age 50, Movember recommend diabetes screening, again, despite the lack of the NHS recommending this and this recent large RCT.) They also recommend annual bowel screening, although the NHS offers it every 2 years from age 60 (not because the NHS is stingy, but because this is where the balance of risk and harm is most favourable.) As for aortic aneurysm screening, they say this is ‘only relevant for men who have smoked’ – in fact the NHS invites all men aged 65, smokers or not.
In other words, their advice is contrary to NHS advice. This is unfair on men, and on the NHS, who have to use their resources to mop up this kind of poor information.
I urge Movember to pull their health check ups page, use evidence based advice, and concentrate on some of the real unmet health needs of men – what about suicide, alcohol, and car crashes, for example. Not as sexy as proactive (unnecessary and potentially harmful) health checkups – but likely to be of far greater benefit if properly addressed.