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

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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.
 

(35) Comments

matthew kemshaw November 8th 2011 | 6:18 PM

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.

Bobbie Bees November 8th 2011 | 10:22 PM

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

Justice Marshall November 9th 2011 | 1:13 PM
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.

Bob Smith November 9th 2011 | 4:16 PM

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.

Justice 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.

Chuck Chamberlain November 10th 2011 | 12:12 PM

Justice, excellent written article!

Lucretia Schanfarber November 10th 2011 | 4:16 PM

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.

 

Justice Marshall November 10th 2011 | 8:20 PM

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

Anyone November 18th 2011 | 10:10 AM
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.
SDan November 19th 2011 | 7:07 AM
I thought the money was going toward funding research. Is it going toward probing instead?
Justice Marshall November 23rd 2011 | 8:20 PM

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. 

 

Philip Solman February 3rd 2012 | 12:12 PM

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).

Justice Marshall February 4th 2012 | 8:20 PM

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...

hk November 2nd 2012 | 7:07 AM

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!

Seba November 2nd 2012 | 10:10 AM

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.

M November 3rd 2012 | 10:10 AM

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.

 

Lori Paul November 4th 2012 | 8:08 AM

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.  

TheYear3000 November 5th 2012 | 11:11 AM

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.

Steve King November 5th 2012 | 11:11 AM

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.

 

Let Guys Help November 5th 2012 | 7:19 PM

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

Matt November 5th 2012 | 8:20 PM

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

Warren Bell November 6th 2012 | 8:08 AM
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.
Harold Steves November 7th 2012 | 1:01 AM
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.
kb November 7th 2012 | 10:22 PM

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. 

Eliza November 9th 2012 | 5:17 PM

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.

 

Provember November 17th 2012 | 11:11 AM

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.

 

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Alex Hamilton November 18th 2012 | 4:16 PM

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.

Dr. Anish Patel November 18th 2012 | 7:19 PM

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.