Why I won’t be growing a moustache for “Movember”

Flickr photo by Joel Washig 

It’s not that I don’t like moustaches. “Free moustache rides” is still one of my favourite lines ever. And I can totally get behind publicizing men’s health issues. (The statistics are shocking, especially in mental health and suicide.) But there are two big reasons I don’t do Movember: I don’t want to unwittingly promote controversial cancer screening to the male masses, nor do I wish to be a cause-marketing dupe for companies (and industries) that do not reflect my values. 

The key message that I hear from Movember is that men (ALL men) need to get themselves to the doctor for P.S.A. testing as soon as possible. This is the Movember rallying cry that gets amplified through their moustachio’d membership. “Get tested — early detection saves lives!” is the soundbite bouncing across Facebook, Twitter and throughout offices and workplaces. The belief behind this micro-message is that P.S.A. testing is an unequivocal success when it comes to saving lives.
If this were true, it would be a no-brainer. But it isn’t true. In fact, the U.S. Preventive Services Task Force recently recommended against PSA testing for asymptomatic men.  
David Newman, a director of clinical research at Mount Sinai School of Medicine in Manhattan puts it this way in a recent New York Times article:
 
“Imagine you are one of 100 men in a room,” [Newman] says. “Seventeen of you will be diagnosed with prostate cancer and three are destined to die from it. But nobody knows which ones.” Now imagine there is a man wearing a white coat on the other side of the door. In his hand are 17 pills, one of which will save the life of one of the men with prostate cancer. “You’d probably want to invite him into the room to deliver the pill, wouldn’t you?” Newman says.
 
Statistics for the effects of P.S.A. testing are often represented this way — only in terms of possible benefit. But Newman says that to completely convey the P.S.A. screening story, you have to extend the metaphor. After handing out the pills, the man in the white coat randomly shoots one of the 17 men dead. Then he shoots 10 more in the groin, leaving them impotent or incontinent.
 
Newman pauses. “Now would you open that door?” He argues that the only way to measure any screening test or treatment accurately is to examine overall mortality. That means researchers must look not just at the number of deaths from the disease, but also at the number of deaths caused by treatment.
 
So why is Movember apparently choosing to ignore the science and continue the “early detection saves lives” rhetoric? In a charitable mood, I might say it’s complicated. That it’s an emotional issue and those emotions cloud reason. We want to believe there’s a simple test that will go a long way to saving the lives of the men we love. And P.S.A. testing clearly does save lives, it’s just that it also claims them. It’s a matter of emphasis. But that isn’t how the issue is framed via Movember.
 
If I was feeling cynical, I might say that at a board level it isn’t complicated at all. Cancer screening is big money. It’s the top of the sales funnel for the cancer-treatment industry, which includes medical trade organizations like The American Urological Association as well the drug companies that are always looking to grow their market. When men are tested en masse, many of those men will be treated (whether they need it or not.) From this perspective, Movember, with its staunch pro-P.S.A. stance, is at risk of appearing like a PR arm for the cancer biz. 
 
Movember also acts as a cause-marketing juggernaut for some very big companies, some of which have dubious connections to the cause. Schick, for example, advertises on the Movember Canada website. The Environmental Working Group (EWG) provides an online cosmetics database where consumers can research the health hazards of common ingredients in personal-care products.
 
Unfortunately, many of these chemical ingredients are unregulated and unlisted on packages, despite scientifically backed concerns about exposure. One of the main concerns that shows up again and again? Cancer.
 
 Movember reminds me a lot of the pink-ribbon campaign for breast cancer, right down to the screening controversies and questionable corporate ties. Which is probably no accident. Movember appears to be modeled after Pink Ribbon. But unlike the Pink Ribbon campaign, which has earned its fair number of critically thinking detractors, critics of Movember are virtually impossible to find ... so far.
 

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Comments

soil remediation

i'm growing a moustache to raise money for a grass roots soil remediation and land reclamation project in industrial east vancouver. i feel that detoxifying urban soil and providing more biodiversity in the city is a good preventative strategy that can help to address chronic health issues for both men and women. all money raised will go to a youth collective operating out of the purple thistle. i'm going to help as part of this collective, together we're hoping to restore a wetland and continue expanding a local food forest.

not all moustaches have to serve the same agenda.

I shave my head and my

I shave my head and my eyebrows, so i'd look silly with a moustache.

Thanks Matthew

matthew kemshaw wrote:

i'm growing a moustache to raise money for a grass roots soil remediation and land reclamation project in industrial east vancouver. i feel that detoxifying urban soil and providing more biodiversity in the city is a good preventative strategy that can help to address chronic health issues for both men and women. all money raised will go to a youth collective operating out of the purple thistle. i'm going to help as part of this collective, together we're hoping to restore a wetland and continue expanding a local food forest.

not all moustaches have to serve the same agenda.

 

Thanks for your illuminating perspective Matthew. Best wishes with your project.

Lack of credibility & information

I think it's a horrible article. Why didn't he outline WHY the screening takes lives? Completely incoherent writing without that information.

Hold on: Let me put it in a metaphor. "You think a phone book is reilable information? I will blow your mind. Imagine a phone book, with numbers and information in it. But hold on! Imagine a phone book where three pages get torn out. Now it's not reliable!"

... So what. There's three less pages. Where's the why ? Uninformative, specultively and seemingly contrarian otherwise.

Re: Lack of credibility & information

Hi Bob,

Simply put - Screening takes lives because it can lead to treatment which can lead to death. The research suggests that some men will die without treatment, some men will die in spite of treatment, and some men will die because of treatment. Untangling the data in a meaningful and objective way seems to be the challenge.

I didn't get too explicit about the research because I thought the reference links in the article provided enough of that background. 

Perhaps an oversight on my part.

see: http://www.nytimes.com/2011/10/09/magazine/can-cancer-ever-be-ignored.html?pagewanted=4&ref=health

Be well.

Justice, excellent written

Justice, excellent written article!

Justice Marshall's Movember article

Right on, Justice!! FINALLY someone is starting to intelligently question the dangerous trend of over-diagnosis. Even Wikipedia has listed it as a problem. See: http://en.wikipedia.org/wiki/Overdiagnosis

I think that our medical model is based disproportionately on the diagnose and treatment of  symptoms of disease but we need to find out WHY so many of us of ALL ages are getting cancer in the first place.

"Without the Cause, what Hope the Cure?"

Thanks for bring this to the examination table Justice.

 

"Without the Cause, what Hope the Cure?"

RE: "I think that our medical model is based disproportionately on the diagnose and treatment of  symptoms of disease but we need to find out WHY so many of us of ALL ages are getting cancer in the first place."

Despite years of cancer "awareness campaigns" I just recently discovered that 80-90% of all cancers are believed to be caused by environmental factors. Makes the emphasis on a magic bullet "cure" seem a little absurd to me.

see http://www.davidsuzuki.org/blogs/docs-talk/2010/04/environmental-chemicals-and-cancer/

and http://www.ens-newswire.com/ens/jun2004/2004-06-28-02.html

Um. No. Just no.

This article doesn't even explain its objections properly. You had to do (something like) that in the comments. There's a clue as to the strength of your approach, writer. You may want to keep this in your back pocket for the next time you whip something up for publication. Now, to the point: Get tested. If you find out the have the disease, then you can research and discuss treatment options (as the husband of a friend of mine--he just 44--is now doing). This notion that sticking your head in the sand is good idea is incredibly foolish. But hey, if you want to _wait_ until you have cancer advanced enough to present symptoms, knock yourself out. It's your "right". Ridiculous. Just ridiculous.

Grow get screened

I thought the money was going toward funding research. Is it going toward probing instead?

Ridiculous? Um. No.

Anyone wrote:
This article doesn't even explain its objections properly. You had to do (something like) that in the comments. There's a clue as to the strength of your approach, writer. You may want to keep this in your back pocket for the next time you whip something up for publication. Now, to the point: Get tested. If you find out the have the disease, then you can research and discuss treatment options (as the husband of a friend of mine--he just 44--is now doing). This notion that sticking your head in the sand is good idea is incredibly foolish. But hey, if you want to _wait_ until you have cancer advanced enough to present symptoms, knock yourself out. It's your "right". Ridiculous. Just ridiculous.

I sometimes wish I could indeed "whip something up for publication." Alas, writing doesn't come that easy for me. I work hard at communicating ideas clearly and in a compelling way. I research my points and provide reference links for readers who wants more context or background. I even engage readers who take me to task and provide additional followup in the comments.

Now to the point: The data indicates that "getting tested" may do as much harm as good. Clearly this counters your personal ideology. That's fine. But with all due respect, you may want to go a little further in explaining your objections. And perhaps examine the strength of your approach. As for sticking my head in the sand, it can be argued that it beats sticking it in a hornet's nest.

Ridiculous? Only to a true believer. For some of us wearing our critical thinking caps, weighing the risk/benefit of screening actually seems quite reasonable. 

 

Thank You

Unfortunately it seems that critical thinking goes out the window when the word 'cancer' is raised. My first sense that there was a problem with blanket prostate screening was when I visited my doctor in the UK. He asked me if I had any symptoms or a family history (I didn't), so he asked why I wanted screening (I explained that my Canadian wife thought I should). He sat down and explained a few things to me:

1. Non of the screening is actually that good at detecting cancer.

2. If it detects something it could be either: a) Not cancer, b) A slow growing cancer that will not kill the patient and may not even cause symptoms (my doctor pointed out that lots of men have prostate cancer, but that it is only discovered when they die of something else), c) A fast growing cancer that is very likely to kill the patient, even with treatment.

3. Once there is a concern that 'something' is there, treatment is very likely the next step, and treatment carries its own problems.

Since this conversation I have seen more and more doctors raising concerns about over-diagnosis of prostate cancer.

Like your article, the challenge is in how to raise this when conversations about prostate cancer, Movember, or screening begin. Individuals will attack you and say, "My dad/brother/husband was treated for prostate cancer once it was diagnozed and he's fine now." What they miss is: a) The treatment may have been absolutely unnecessary (the undiagnozed cancer may have been the type that would never have caused a problem), b) Some men die, or are maimed by the treatment (and some of these are men who would not have been killed by the cancer).

I have come to the current conclusion: Blanket screening for some cancers may be desireable, but at the moment it doesn't appear to work for prostate cancer (over-diagnosis and over-treatment can be as bad or worse than under-diagnosis and under-treatment).

Re: Thank You

Thank you Philip for sharing your insights. It's heartening to hear that your UK doctor fulfilled his responsibility to help you make an informed decision.

I welcome more stories from men -

Has your doctor informed you about the risks associated with psa screening? Please share...

yes, health is a pretty loaded topic.

I am fully supportive of keeping critical awareness about our own health options in the public eye, and not suggesting that one "answer" is for everyone. It becomes complex if, for example, a guy's grandfather had prostate cancer so there's "family history", but he doesn't think it should be an issue for him and is concerned about the risks associated with screening. How to know if it is time, eventually, to go get screened? Oof. Stressful.

I noticed that part of the support for your viewpoint, Justice, was questioning why Movember doesn't speak about getting off your butt and exercising - general lifestyle changes. Maybe it's a recent update, but (albeit briefly) it does appear on the website: http://ca.movember.com/mens-health/

This does not change the fact that the focus of this page is clearly on cancer, although this is no surprise in our modern society. I'm actually impressed that the page also touches on mental health and suicide rates.

Moreover, the wording on the Prostate Cancer-related pages, interestingly, does not seem to force the point that screening and treatment are the only options, though they are the only options listed (very sneaky). It actually says this: "The question of screening is a personal and complex one. It’s important for every man to talk with his doctor about whether prostate cancer screening is right for him." http://ca.movember.com/mens-health/prostate-cancer/

And there is discussion of the risks of screening linked to the Navigating Prostate Cancer page: http://prostatecancer.ca/getmedia/314c5c7c-32d1-4ad0-b1fe-f386d845926c/2...

Overall, I think it's worded quite clearly that it's up to the individual and getting screened is a choice. Of course there is social pressure through the medical community. Further links about preventative lifestyle changes and complementary and alternative therapies would be made available in an ideal world. But we already know that biases about prevention and treatment in the medical community are connected to training and finances, and the more people know that and talk well with their doctors (go Philip Solman!), the better we can avoid that bullshit. I think putting all of this on the table for critical discussion via whatever medium you've prefer, moustache or article (money-raising Movember campaigns aside) could actually be a good thing.

Thank you for the article!

Shunned when not supporting a cause

What is also interesting is the fact that people who decide not to support Movember or Pink Ribbon or whatever cause is being championed, are looked down upon by the masses who follow this things.  When did we all have to have the same opinion, and if we don't there is someone there telling you things like, "I hope you don't ever get prostate cancer".  You have the right to grow whatever you want for whatever reason, but it doesn't mean that people who don't want to support it don't have a valid point of view.

I did the Movember thing last year, I did my research and compared to many other charities out there they seemed to be legitimate and genuine in their mission and forthright about where their money goes. Yes, over-diagnosis is a problem and should be addressed but I feel like blaming an organization like Movember for for over-diagnosis is like blaming a person for telling a kid to go buy a slingshot because they are fun and then the kid does and kills the neighbours cat (see I can use inexplicable and poorly placed metaphors too!).

 

Movember is about starting a much needed conversation about mens health with other men which will hopefully lead to them having an informed discussion with their respective health professionals who (if they are worth their salt) will recommend an appropriate course of action. Instead of taking issue with a charitable organization who is actually trying to make a difference perhaps some of (y)our (passive) agression should be focussed towards the ACTUAL PEOPLE AND COMPANIES WHO BENEFIT FROM OVER-DIAGNOSING A PATIENT.

 

Also, instead of backing up your shotty opinions and worse metaphors with 'linformative links' try just standing up for what you say in the form of research based proof instead of simply making statements and doing a lot of back pedaling. I learned how to do that in grade ten English, my friend.

People can speculate about

People can speculate about this issue all they want. Whether your argument is the organization states it is an individual's choice or that it's the best one out there But regardless, if the money is going for the screening process and not the research itself, that is a huge problem. I have trouble with other cancer charities as well; struggling with the idea that my money would just be going chemo equipment orpharmaceuticals.

I think people have the misconception that corruption hasn't hit cancer 'research'. Rather, it's become a profitable industry.

Anyways, this article was well written and has swayed me for the most part.

 

Corporate Collusion

Thanks for pointing out the bitter irony that many of the companies that align themselves with these cancer awareness campaigns are complicit in creating dangerous products. Cancer is big business and there's no money in the cure.  

Overscreening...among men?

Take your point, however obscurely it was presented, that overscreening and testing can be detrimental. But step back here and think about who we're talking about. Most men I know (eductated professionals in their 40s and 50s with families) are lucky if they get to the doctor for checkup once a decade. Somehow I don't think over-diagnosis is going to be a problem.

you are wrong.

Really dude? Movember does so much more than what you're talking about? Hey you know what I hate? Pink during breast cancer month, it's so annoying!! get a life, become a man and then grow a moustache.

 

Contrarianism sure is easy

Boo!  Trouble with being a devil's advocate if that devil's advocates are the last to notice that being the contrarian is always the easiest voice.  Go ahead and skip the fun - thanks to most thinking people just wanting to help each other out Movember remains a huge success despite uninformed, fear-mongering hair growth Grinchies like you.  :D

comment

the guy who wrote that probably can't grow facial hair at all

Prostate screening oversold

As a practising family physician, and a close follower of the data stream around primary care, I can affirm that this article is entirely accurate. It is easy to rally the troops (especially the corporate troops) for end-of-pipe, product-heavy care for manifest disease. On the other hand, it's is hard to advocate for prevention, and the promotion of good health -- especially at the government policy level, and especially with the governments we have today at both federal and provincial level! The latest evidence-informed guidelines state clearly: no prostate testing in the absence of relevant symptoms -- something I've personally advocated for some years. Our honeymoon with the PSA (prostate specific antigen) test is over, and reality has set in. Yes, PSA testing (coupled with the far less popular digital rectal exam, which doesn't get nearly as much press!) is now a test for guys with or excessive worries, or strong familial histories of aggressive prostate cancer, or suggestive symptoms. That's what it should have been since it was first introduced into clinical practice in the early 1980s.

prostate cancer movember

Thanks to PSA testing I have survived the killer type of prostate cancer twice. For the first time I am growing a mustache this movember.

it boils down to awareness

it boils down to awareness and education. don't oversimplify the issue. screening is important and individuals should be aware of their hereditary conditions and other susceptabilities. 

breast cancer and prostate cancer- we should have access to screening if we want it, and awareness of these threats should be kept in the front of our minds. thats what movember and pink ribbon and all that is about. too bad about the corporate sponsorship but just ignore it then, there is so much of it out there. 

PSA testing

This is interesting. I'm no "mo sister" for some of the reasons you mention. But I hadn't heard any bolstering for regular or frequent PSA testing and I don't think this is regular practice in Canada. I believe they check PSA IF there is a physical finding and/or symptoms. Am I wrong? Is this changing? or is this "mo bros" spreading fear and talking about things they don't know about?

In fact, one of the reasons I'm annoyed with "Movember" is that I don't hear nearly enough about the health issues. And from your account, it sounds like some of them don't even really know what they are talking about. The websites tell you all about Movember and less about the actual issues it is supposedly all about (this seems a little better this year than last). The official poster last year was nothing to do with health and all to do with moustaches. That, and lots of that money goes right back to promoting Movember itself. But even if the money does go to R&D... I don't want to fund big business pharma companies if that is the plan.

P.S. Sounds like you're doing your part to promote disscussion on men's health topics... moustache or not.

 

PSA Testing

When you state that "The key message that I hear from Movember is that men (ALL men) need to get themselves to the doctor for P.S.A. testing as soon as possible", where did you see/read/hear this?  Movember's stance on PSA testing is that it has both advantages and disadvantages, and that men interested in testing should consult with a doctor first.  Not sure where you are getting this info.

 

//

//

YIKES!

There are weak arguments, but the premise of this article is anemic at best. I understand the interest to base speculation on how much of the Movember message is dedicated to encouraging lifestyles that help to prevent cancer. However, this entire article is built upon the conjectural antecedent that PSA testing, in the States, is not an unequivocal success for asymptomatic men. To this my retort would be, "DUH!"

Speaking from experience this year, your PSA test goes hand in hand with your physical exam. Which is then followed by ultrasound, which then, if need be, is confirmed by biopsy. I can only assume the author chose to ignore this info about the "science" in order to further another false supposition, that the message "early detection saves lives"  is some how misinformed rhetoric. Wow, really, wow!

Then the rest of the article is couched around negative inferences on "cause marketing" and corporate interests. Hell, I'm all for conspiracy theories, subverting the dominant paradigm, or the right for a person to maintain their non-joiner status, but not in the case of forsaking your own, or others, health. Yikes, this is ignorance at its best. I don't care if you grow a moustache or not, or, but if you're a guy at the age of 30 or above, get to a doctor and get a finger in your ass, at least on a yearly basis; then tell your loved ones to do the same.

horrible article

this article is interesting, but ultimately misguided.  i could write a lot here, but since time is short, i will just say this -- the purpose of "movember" is NOT to just go for a PSA test, as the author suggests.  the purpose of movember is to bring awareness to men's health issues, so that men (#1) go for prostate cancer screening, which entails multiple things: complete medical and family history, physical exam (incl DRE), and bloodwork (incl PSA), and (#2) go see a doctor for regular checkups in general, which most men are lothe to do.

Clarity

Thank you Philip. And thank you also to the writer for tackling this subject. Movember is clearly a trend event which is easily harnessed by marketing ploys, if not fabricated by them in the first place. The major shortfall of this article was not clearly explaining the detriments of screening. I really did not understand what your objections were despite my guy instinct to avoid the Movember craze. Philip did a good job of clarifying the issue. It is not enough to cite—a reader must be able to understand the fundamentals of your argument without chasing down references. Not to discredit your argument—just to encourage a more thorough approach.

 

Re: Lack of credibility & informationJustice Marshall November 9th 2011 | 7:19 PM

Hi Bob,

Simply put - Screening takes lives because it can lead to treatment which can lead to death. The research suggests that some men will die without treatment, some men will die in spite of treatment, and some men will die because of treatment. Untangling the data in a meaningful and objective way seems to be the challenge.

I didn't get too explicit about the research because I thought the reference links in the article provided enough of that background. 

Perhaps an oversight on my part.

see: http://www.nytimes.com/2011/10/09/magazine/can-cancer-ever-be-ignored.html?pagewanted=4&ref=health

Be well.

I Agree (31) I Disagree (26)  

 chasing 

 

Philip Solman wrote:

Unfortunately it seems that critical thinking goes out the window when the word 'cancer' is raised. My first sense that there was a problem with blanket prostate screening was when I visited my doctor in the UK. He asked me if I had any symptoms or a family history (I didn't), so he asked why I wanted screening (I explained that my Canadian wife thought I should). He sat down and explained a few things to me:

1. Non of the screening is actually that good at detecting cancer.

2. If it detects something it could be either: a) Not cancer, b) A slow growing cancer that will not kill the patient and may not even cause symptoms (my doctor pointed out that lots of men have prostate cancer, but that it is only discovered when they die of something else), c) A fast growing cancer that is very likely to kill the patient, even with treatment.

3. Once there is a concern that 'something' is there, treatment is very likely the next step, and treatment carries its own problems.

Since this conversation I have seen more and more doctors raising concerns about over-diagnosis of prostate cancer.

Like your article, the challenge is in how to raise this when conversations about prostate cancer, Movember, or screening begin. Individuals will attack you and say, "My dad/brother/husband was treated for prostate cancer once it was diagnozed and he's fine now." What they miss is: a) The treatment may have been absolutely unnecessary (the undiagnozed cancer may have been the type that would never have caused a problem), b) Some men die, or are maimed by the treatment (and some of these are men who would not have been killed by the cancer).

I have come to the current conclusion: Blanket screening for some cancers may be desireable, but at the moment it doesn't appear to work for prostate cancer (over-diagnosis and over-treatment can be as bad or worse than under-diagnosis and under-treatment).

PSA testing

My father died from undiagnosed prostate cancer from a physician who said to my then 63 year old father who was having some issues...what to you expect from a man your age??...he never suggested the PSA test....18 months later my dad was dead from secondary liver cancer and primary prostate cancer......I support Movember....I support research.....I support the cause....Ask questions, don't take no for an answer....do your due diligence.

misleading article

I am aware of the statistical interpretation problem the author is refering to, though I'd caution that this guy might be drawing the wrong conclusions by cherry picking a quote from one report. The problem goes like this: doctors claim pre screen test detects cancer with 80% accuracy so everyone should pre screen. However, the true statistics are that prescreen detects cancer in 80% of patients who actually have it, and in, say, 5% of those who don't. The author of the article then goes on to assume that these patients with false positives are given dangerous drugs with extremely high liklihoods of severse adverse effects, administered without biopsy confirmation and ruining the lives of countless individuals. In reality there is a wait and see approach that is common when unidentified tumors appear but do not point to cancer. Unnecessary treatment does not happen often, but do sometimes happen, and this is what we should be focussing on. It is not testing that hurts people, but unnecessary elective medicine, which, I should point out, is much more common in the US.  You are making an argument that horribly misleading and dangerous.  I would refrain from blogging about medicine and science unless you are willing to do some due diligence beyond reading a couple articles.

actually yes...

Anyone wrote:
This article doesn't even explain its objections properly. You had to do (something like) that in the comments. There's a clue as to the strength of your approach, writer. You may want to keep this in your back pocket for the next time you whip something up for publication. Now, to the point: Get tested. If you find out the have the disease, then you can research and discuss treatment options (as the husband of a friend of mine--he just 44--is now doing). This notion that sticking your head in the sand is good idea is incredibly foolish. But hey, if you want to _wait_ until you have cancer advanced enough to present symptoms, knock yourself out. It's your "right". Ridiculous. Just ridiculous.

 

Seems that "writer" has facts straight and you are acting emotionally. Enough people agree with the views herein that it makes worthwhile to discuss processes that don't include slurping up donations from the very self-proclaimed-entities that produce the problem in the first place.

Movemeber does a lot more good than harm

While I of course agree that over-zealous testing and paranoia can do more harm than good, I think it's foolish to say that the Movember movement is contributing to these things.  Movember is about raising awareness about men's health issues, and encouraging men to maintain healthy lifestyles, and that includes regular check-ups with a doctor.  Regular digital rectal exams and, if necessary, blood testing for PSA levels are the two most effective ways to ensure early detection and full recovery from prostate cancer.  As many other commenters have noted, I have seen nothing in Movember's literature\propaganda that encourage over-zealous, unnecessary testing.  Rather, they do a great deal to make a lot of people who would otherwise ignore their health to start thinking seriously about it, and, ultimately, taking affirmative action to maintain their health.