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November 2, 2001

Men going the way of the dodo, journal surmises

Tom Spears -- Ottawa Citizen
National Post

Men's health has fallen so far behind women's that the new issue of the British Medical Journal asks: "Are men in danger of extinction?"

Men should be kings of the hill in health as they are in society, the journal says.

Yet somehow, life is not working out that way.

"Despite having had most of the social determinants of health in their favour, men have higher mortality rates for all 15 leading causes of death and a life expectancy about seven years shorter than women's," says the lead editorial in the journal's Nov. 3 issue, which is dedicated to men's health.

The journal expects the gap between the sexes to widen.

Much of the blame is pinned on men's behaviour.

They start and wage wars, drink too much and stupidly accept risks ranging from fast cars to sexually transmitted diseases.

The journal warns of growing dangers as well from increasing midlife crisis and domestic violence among men, "while men's increasing aggression also remains an unsolved health and societal problem."

Men have been killing themselves and each other for millennia, and haven't died out yet. But for all their history they've had one indispensable role: maintaining the species.

Kiss goodbye to that too, says the journal.

"With the advent of sperm banks, in-vitro fertilization, sex- sorting techniques, sperm-independent fertilization of eggs with somatic [non-sperm] cells, human cloning, and same-sex marriages, it is reasonable to wonder about the future role of men in society," the journal writes.

One British men's health expert calls for major reforms of the health system to serve men as well as it serves women.

The health system is a "no-man's land," Dr. Ian Banks, president of the European Men's Health Forum, says in the journal. Among its problems:

- Men don't know much about health to start with, and there is almost no health material written for teenaged boys and young men.

- Doctors can be anti-male from the start: "Training in medical school has been described as sado-masochistic, and much of it is imbued with the macho male culture."

- Men who go to a family physician "receive significantly less of a doctor's time" than women. Women get advice on examining their breasts for lumps but men are not told how to examine their testicles for signs of cancer.

- Men tend to wait longer after an illness begins before they go to the doctor, especially working-class men who feel it's not manly to ask for help. Men would rather suffer in silence than ask for help, even from their friends.

This lack of medical treatment is killing men, Dr. Banks concludes. "For instance, deaths from melanoma [skin cancer] are 50% higher in men than women despite a 50% lower incidence of the disease."

- Even the doctor's office is a threatening place for men, he says. The receptionist and nurse are mostly women, and the waiting room is filled with information on women's health issues alone.

The journal also publishes new evidence that men suffer as frequently as women from "body polymorphic disorder" -- a perception that their bodies are misshapen, carried to such a severe extent that it's a psychiatric problem.

Most often men are worried about baldness or the shape of their noses, but also about the size or shape of their genitals and the perception that their muscles are too puny even if they are actually large and muscular.

Katharine Phillips, a psychiatrist at Brown University, says in the study that this worry can take up hours of time every day for men who tried to hide the supposed defect.

Men can become housebound for fear people will see them. They can seek needless surgery or take dangerous steroids to bulk up. They sometimes commit suicide.

"Body image isn't just a woman's problem," she says. Forty-three per cent of American men are dissatisfied with the way they look, three times the number found 25 years ago.

She says men are as likely as women to be so upset by a perceived imperfection that they can't function normally in daily life. It is, she says, "a relatively common but severe psychiatric problem" that affect 12% of patients who consult dermatologists, and 7% to 15% who want cosmetic surgery.

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