Inferior preventative health care
There is a general impression that in some aspects of health care men are disadvantaged compared to women. The lack of Well-Men clinics, and of out-reach or out-of-hours clinics convenient for men, comes to mind. Funding and research on male-specific diseases has starkly lagged that directed at female-specific diseases. Similarly for male osteoporosis. Although physical fitness is important to many men, men are generally less health minded than women. More reluctant to see a medic if they have a problem, more likely to put up with routine health problems. Medical services have not been overly male-friendly, and there are now more women than men entering general practice. Less than 8% of nurses in general nursing are male, which has a bearing on male privacy. How many times have you seen a male receptionist in a doctor’s surgery or in a NHS hospital?
It is not all one-sided, however. Current policies on preventing cardio-vascular disease, which affects twice as many men as women, are directed equally at men and women. Screening tests for cardio-vascular risk factors exist and therapies also exist to control them. If used, these effectively reduce the burden of cardio-vascular disease. The problem is that many men do not bother to make use of them.
An out-reach screening service would help many such men who otherwise would not seek medical advice. Instead of men seeking a screening service at their local surgery, the screening service would seek them, by touring those places where the least health-conscious men tend to congregate, eg. sports events and workplaces. This would provide the normal screening for blood pressure, blood lipids, blood sugar and smoking history, alcohol consumption, and obesity, as in the local surgery, but with more time and conducted by men. Such facility would save many more premature deaths and disabilities in men, and is thus likely to be highly cost-effective.
Sex specific diseases
In the case of sex-specific diseases, however, sexual politics has no doubt played a part in driving priorities in spending and health care towards women rather than men. Until comparatively recently, research into male specific diseases, such as prostate cancer, has been minimal. A more accurate and reliable diagnostic test for active prostate cancer is still awaited and more effective treatments with less serious side-effects are needed. One relatively new treatment, brachytherapy, in which radioactive seeds are implanted in the prostate gland, appears to meet the objective of lower side effects, but its long-term efficacy is still unproven. The treatment was given approval in 2005 by the National Institute for Health and Clinical Excellence, but its use is available in only a few areas of the country because of financial pressures on Primary Care Trusts (PCTs). In other words, its availability is rationed in many areas.
The reality is that different cancers are given different funding priorities by the National Health Service (NHS). Breast cancer currently receives ten times more funding than prostate cancer. This is a huge disparity. It reflects not only the higher profile of breast cancer gained over the past two decades or so, but also a medical and financial hesitation in the case of prostate cancer in committing resources to routine diagnostic procedures which are unreliable and treatments which to date research has not all been shown to prolong life or prevent disability sufficiently to justify the side effects. These include pain, incontinence, erectile dysfunction, loss of libido and energy, and the feminisation that the some treatments may produce. Clearly, a substantial increase in funding is required for prostate cancer research to tackle such uncertainties.