[tombone12]

"What’s the biggest single factor that puts you at risk for ignoring your health? Being a man.

Sociologist Lisa Wade, interviewed in New York Magazine, says that 'some scholars argue that being male is the single strongest predictor of whether a person will take health risks.'

Men like risk it turns out. Most of them also hate putting lotion on their skin (too girly) and being afraid of things (not manly). They are also more likely to have outdoor jobs and do household tasks that involve being outside the house. Think lawn mowing and BBQ-ing. They also pay less attention to their skin and so don’t catch early warning signs.

Women, generally speaking, don’t mind lotions, do pay attention to changes in our skin, wear sunscreen to avoid premature aging and wrinkles, and often also wear make up year round that contains ingredients that protect skin from the sun."

"[...] part of the reason that married men, or men with female partners anyway, live longer. They’re nagged into healthy habits and visit the doctor more often."

https://fitisafeministissue.com/2014/08/16/men-and-skin-canc...

[ganley]

About a decade ago, I got a physical after having not set foot in a doctor's office in about 12 years. The doctor asked what made me come to get a physical after so long, and when I said nothing in particular, he pretended to write on his clipboard "Wife made me come here."

He said middle-aged guys with no obvious health problems pretty much only come to the doctor for one (or both) of two reasons: Their wife made them, or they want Viagra.

[thaumaturgy]

It's not just a macho thing.

I pretty severely injured an ankle back in September, at MMA, and for the first time in my life (at 38) it doesn't seem to be healing up very well. I keep finding new little movements that cause it to feel pretty wrong ("popping", "pulling", cold sensation, mild short-term pain, weakness).

One of these happened in front of my girlfriend, who ordered me to see a doctor, so I did. I filled out new copies of all the paperwork I filled out a year ago when I was grievously ill, sat around for a bit, got into the doctor's office, his assistant appeared and asked me a couple of questions, then the doctor appeared after a bit and asked me the same questions again. He palpated my ankle for a few seconds, told me to get a brace, and then left the room without another word.

Unless you're wealthy enough to afford a dedicated physician, there's just really no point in seeing a doctor for anything less than "I might be about to die".

...which sucks, because I'm a huge proponent of preventative medical care. It's just not available for most people.

[barsonme]

> Unless you're wealthy enough to afford a dedicated physician

I think it depends on your doctor.

My GP is fantastic. He's always running late because the company he works for slots patients in 30 minute intervals, but he takes as long as is needed for his patients.

I'm not even close to wealthy ($50k/year) I can go to him for anything from the flu to broken bones to high cholesterol without thinking, "this is pointless".

[ganley]

No idea which of us is more typical, but my doctor is awesome. Preventative care is deductible-waived, so there's really no good reason other than laziness for me not to get a regular annual physical.

[walshemj]

But you don't know if that of pain is going to kill you or not

[eon1]

The whole "getting a physical" annually is purely an old school American thing anyway. I don't know anyone in my country who does this - although apparently nowadays US med associations recommended you go visit a doctor every 5 years or so if you're under 40.

Still, if I walked into a doctor and said "is anything wrong with me?" with no symptoms or obvious indication that this might be so, they would probably take blood pressure, do a breathing test, ask me if anything was actually wrong, and then wonder why I was wasting their time (or maybe ask if I was looking for a medical certificate cos I didn't feel like going to work, heh).

[derefr]

Personally, I kind of wish my GP was there to help me optimize my health, rather than just to diagnose illness.

Like, all those dietary restrictions they give to people who've had heart attacks? Why not give them to me before I have a heart attack, so I won't ever get one? Make my life more of a hassle, so that I live longer!

I want to have someone in my life who plays the same role that a dental hygienist plays a dentist visit, but for my general physical health.

[eon1]

Okay.. so that kind of sounds like you need a dietician, which is someone you can ask your GP for a referral for, or in many cases just book an appointment with. Your GP doesn't send you to the dentist unless there's something so wrong with your teeth it's impacting the rest of your health; why would it be any different for your diet?

[DaUR]

> I want to have someone in my life who plays the same role that a dental hygienist plays a dentist visit, but for my general physical health.

You better not expect doctors to be that. Most of them still believe cholesterol causes heart disease, for example, or that you need 50% carbs in your diet.

[DanBC]

> He said middle-aged guys with no obvious health problems

Why would anyone see a doctor unless they had a health problem? (Or wanted health advice?)

[fencepost]

> Why would anyone see a doctor unless they had a health problem? (Or wanted health advice?)

Because "sedentary middle-aged American eating a typical American diet" (possibly including "fat" as well) might as well be considered a preexisting condition all by itself, and a simple checkup may catch something that can be addressed before it becomes a hospital visit. Most notable as things to watch out for are high blood pressure, high/poorly balanced cholesterol and diabetes or early signs of it. Two of those you can do some checking for at home fairly inexpensively, but cholesterol not so much.

Despite having health insurance (Thanks Obama! while it lasts) I haven't actually had a checkup in probably 5+ years, but after this I'm going to see about getting in and at the least getting bloodwork, etc. which I've been thinking about anyway. Clearly Jason Scott can't be called all that sedentary given all the walking he did during his heart attack, which is why this is a bit of a wakeup call.

Edit:

I'll throw in a surgeon's commentary from when my wife had her gallbladder out: "Men are stupid."

Context: He was noting that most gallbladder problems are in women, that 90% of gallbladders are removed laparoscopically as outpatient procedures, and that of the other 10% where people end up hospitalized most are men because "Men are stupid." Men will try to tough it out and won't go see a doctor until they're in so much pain that they end up in the ER, and the ER isn't going to dink around with a laparoscope for investigation - if things are that bad, they may well slice you open so they can see what's going on and yank it right then and there leaving a nice scar, at least one overnight in the hospital, and some significant movement restrictions while you're healing.

[Frondo]

Interesting. I was one of those stupid men who was immobilized with pain from acute cholecystitis, I went to the ER, and they still did it laparoscopically.

I did spend two nights in the hospital (one before the surgery, one after), but I'm surprised that surgery would be considered outpatient under any circumstances. Do they really send people home immediately after putting them under and rooting around in their chest cavities?

[fencepost]

The only reason my wife's involved an overnight stay was dehydration since she'd been unable to keep much of anything down for a couple days. That said, her surgery was scheduled after a pretty short series of doctor, ultrasound, surgeon, weekend, surgery.

[DanBC]

Your last paragraph - about men not seeing a doctor when they are in pain - doesn't seem to fit the context of people seeing a doctor when they have no symptoms.

And how many of those women needed surgery?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679744/

[fencepost]

Based on my reading of that, a very significant majority.

From a quick read before I dash out the door, it looks like at most ~21% had surgery based on indefinite or vague symptoms. I'd say that there's a good chance that many or most of those cases should have received at the least other treatment before surgery and that some physicians started resorting to surgery too soon once that surgery became easier, cheaper and safer.

That still leaves the other 79%.

[nommm-nommm]

Annual physical exam (AKA annual wellness visit, annual preventive exam, periodic health exam, and routine checkup) - http://www.webmd.com/a-to-z-guides/annual-physical-examinati...

Last I knew though they weren't evidence based.

[PeterisP]

Regular preventive checkups are (or should be?) a thing.

Quite a few deadly things need to be caught before they become obvious problems. As a crude example, prostate cancer is one of diseases causing death for men; and has the "nice" property that if it's detected early in a screening then it's (usually) treatable with minor side effects, but by the time it causes symptoms serious enough to seek a fix for the symptoms, it generally has grown enough to be lethal.

[js2]

Should they?

In 2012, the Cochrane Collaboration, an international group of medical researchers who systematically review the world’s biomedical research, analyzed 14 randomized controlled trials with over 182,000 people followed for a median of nine years that sought to evaluate the benefits of routine, general health checkups — that is, visits to the physician for general health and not prompted by any particular symptom or complaint.

The unequivocal conclusion: the appointments are unlikely to be beneficial.

From https://www.nytimes.com/2015/01/09/opinion/skip-your-annual-...

[nommm-nommm]

What you say about prostate cancer is wrong/misleading/outdated. The side effects of prostate cancer treatment can absolutely not be described as "minor." Routine screening of asymptomatic average risk men have caused more harm than good.

https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

>Prostate cancer is very common but isn’t always harmful. It is found in 80% of autopsies where the men died of something else. Many more men die with prostate cancer than because of it.

>The screening test for prostate cancer is a blood test for prostate-specific antigen (PSA). This is not a yes-or-no test. It must be interpreted in the context of the patient’s age and risk factors and the rate of rise, and any cut-off level is arbitrary and will miss some small percentage of cancers. If the PSA test is positive, the next step is biopsy. Typically, 12 needle biopsies are done, 6 on each side. They find cancer in 25% of patients. But if you go back and do more biopsies, you’ll find cancer in 25% more patients. Theoretically, if you could see every cell in the prostate, you might be able to find a cancer cell or two in almost everyone, most of which would never progress or kill the patient. So you have to decide how many biopsies are reasonable. If you find cancer on a biopsy, the next step is treatment, and treatments for prostate cancer are not benign.

>In a large European study, screening resulted in an absolute reduction in deaths from prostate cancer of 7 per 10,000 men screened. We can look at this in terms of number needed to screen (NNS) and number needed to treat (NNT). To prevent one death from prostate cancer, 1,068 men would have to be screened and 48 treated. But here’s the kicker: there was no reduction in all-cause mortality. The overall death rate was the same in the screened group as in the unscreened group.

>If a prostate cancer is localized and low grade, it is reasonable to observe the patient and not treat unless he develops signs of progression. A recent study compared surgery to watchful waiting and found no reduction in deaths. Within 30 days of surgery, 1/5 of the patients had complications including deaths. 2 years after surgery, these long term complications were present:

    17% were incontinent
    81% had erectile dysfunction
    12% had bowel dysfunction

>Popular advice has been “Get tested; it could save your life” but current expert advice is “Don’t get tested; it does more harm than good.” (Mainly from impotence and incontinence.) Emotional anecdotes abound. One doctor wrote an article titled “The New York Times Killed My Patient.” His patient refused PSA testing because he had read that it was not recommended; he developed invasive prostate cancer and died. Another doctor wrote about the opposite experience: his patient had insisted on testing. He was diagnosed with low-grade localized cancer, the kind that can be observed without treating. But he couldn’t face living with the knowledge that he was harboring an untreated cancer. He was afraid of surgery and opted for radiation treatment. He developed radiation proctitis and had rectal pain and bleeding for years. He became impotent and lost bladder control. He told his doctor he would rather be dead than live wearing adult diapers.

>The American Urological Association initially disagreed with the recommendation not to screen, but they have re-considered and issued these new recommendations:

    Don’t screen men under 40 or over 70
    Don’t screen men with a life expectancy of less than 10-15 years
    Don’t screen men age 40-50 who are at average risk
    Consider screening men age 55-69 who are at average risk
    Consider screening high risk men of any age
    Before any screening, doctor should discuss risks and benefits with patient

The U.S. Preventive Services Task Force concludes:

https://www.uspreventiveservicestaskforce.org/Page/Document/...

>Although the precise, long-term effect of PSA screening on prostate cancer–specific mortality remains uncertain, existing studies adequately demonstrate that the reduction in prostate cancer mortality after 10 to 14 years is, at most, very small, even for men in what seems to be the optimal age range of 55 to 69 years. There is no apparent reduction in all-cause mortality. In contrast, the harms associated with the diagnosis and treatment of screen-detected cancer are common, occur early, often persist, and include a small but real risk for premature death. Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit. The inevitability of overdiagnosis and overtreatment of prostate cancer as a result of screening means that many men will experience the adverse effects of diagnosis and treatment of a disease that would have remained asymptomatic throughout their lives. Assessing the balance of benefits and harms requires weighing a moderate to high probability of early and persistent harm from treatment against the very low probability of preventing a death from prostate cancer in the long term. The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.

We are slowly learning to do much less asymptomatic screening, though charities and celebrities are fighting against it. Joe Torre still comes on my TV saying "get screened early and often." The generic advice about "always catching cancer early" being an unequivocal good thing is false. Over-diagnosis and over-treatment are huge problems. For another example, thyroid cancer screening in South Korea has resulted in a massive increase in thyroid cancer diagnosis and treatment but not any decrease in thyroid cancer mortality.

I can go on about this topic, but I won't. I suggest reading that blog I linked to, its fantastic.

[ganley]

A health problem that you are aware of. You're supposed to see a doctor periodically because they might catch health problems that haven't yet advanced to the point that you know they're happening.

[DanBC]

It's not surprising that the US has such a problem of overdiagnosis and overtreatment.

http://www.bmj.com/content/349/bmj.g5432

[jstalin]

Preventive maintenance.

[Tepix]

If you are middle-aged (or older): to get a checkup

[ergothus]

I can't deny the conclusion, and I agree that men are socialized to not show weakness ("macho"), but for me, I tend to avoid going to the doctor because, as a general rule, it rarely helps and it always costs money. (macho-ness may make more sensitive to that, hard to really know)

I was very sickly as a child. Every doctor's visit did nothing to change this (it wasn't even "Hmm, you have a trend", it was "oh, you have a cold/bonchitis/etc.) It wasn't until I was 30 that I learned I was allergic to pollen, molds, dustmites, cats, dogs, and rats - basically everything that won't kill you (no food allergies I've nailed down) - and that discovery was made when my symptoms suddenly got dramatically worse for months, and I pinned down the only three things that had changed in that time and went to an allergist myself.

Each winter for several years since then I would get bronchitis, and the coughing and shortness of breath would last for months. Every doctor told me to take some Delsym and wait 4-8 weeks. I eventually pieced together that this is my allergies (which, while treated, aren't gone) draining into lungs overnight and slowly being coughed up during the day. Some anti-inflammatory treatment that is now legal in Washington turns out to have stopped that for the last few winters.

I've had two rounds of kidney stones in the last 5 years (each involving at least two stones, because apparently the inflammation from a kidney stone tends to "shake more loose") - Doctors couldn't do much beyond painmeds and flowmax. (First time though, I had a $1000 CT scan (I think it was CT - I get CT and MRI mixed up) because the doc suggested it.)

I had pneumonia once - didn't realize it, it was just a bad cold/cough that got dramatically worse. Calling my doctor for an appt gave me something in 3 days. Day of, I wasn't sure I would be breathing by the time of the appt, so I was going to go to the ER. (which would have been ridiculously expensive). My wife took me to a local urgent care clinic (PatientFirst in VA) because she was worried about the wait time at the ER. They were awesome, saw me immediately as I walked in (they could hear me breathing), did in-house xray of my lungs and o2 sensor. Now that I'm in Seattle, the local clinics work differently - they REALLY want you to have a primary care physician. I recall a doctor there once saying that's because they want someone to coordinate your care, maintain a big picture view, and proactively look into potential issues. I told her I'd never had a PCP do any of those things)

I'm not knocking medical science - it's a near impossible job: "Debug this program to which you don't have the source code, can't control or even know all the environment and inputs, and if you crash it someone dies". It's amazing they can do what they can, and in certain circumstances they are responsible for saving and improving a lot of lives (see above having pneumonia).

But the reality is that if I went to the doctor every time some part of me hurt (and now that I'm 40, that's a lot of parts) based on my past experiences, I'd just spend a lot of time and money and be not much better off. So I'm all for being cautious on big things like chest pains. I'm all for knowing the warning signs of stroke, heart attack, and the like. But going to the doctor for every little thing? Seems a waste.

[DaUR]

Sociologists and feminists like to chalk everything up to gender roles, as the author does here, and offer feminism as a solution, but this is dogmatic.

There's a difference between taking risks (if you take risks, and bad things happen as a result, that's often outside of your control; e.g. sharks when swimming in the ocean, there's always a risk) and self-neglect, which is within your control. Self-neglect is a consequence of low self-esteem, and has nothing to do with masculinity. This may be uncouth, but: think of the men who you think are least masculine, and ask yourself if they nurture themselves more, go more to the gym, and eat better. If anything, the opposite is true.

The real problem is self-neglect, whose root cause is low self-esteem.

I don't think women's average self-esteem is any higher or lower than men's, but theirs manifests itself in different ways, which explains why women would be more conscientious of their physical health, and push men to do the same. Still doesn't change the nature of the problem, or its real solution.

[derefr]

> The real problem is self-neglect, whose root cause is low self-esteem.

I'm not sure if I disagree with you, or if my perspective is this same perspective from a different angle, but: I would say that it's more that men tend to (expect to) derive their self-esteem from things they do, rather than things they are—so they invest much more time in doing things, and much less time in being things.

In order to "be" beautiful or to "be" athletic, it's usually a pre-requisite to be healthy—to take care of your body. In order to do things like building a successful business or finding cures for diseases, you don't have to be anything in particular, other than, perhaps, stubborn. So you tend to see things like your own physical health as distractions from "doing."

[DaUR]

> I'm not sure if I disagree with you, or if my perspective is this same perspective from a different angle, but: I would say that it's more that men tend to (expect to) derive their self-esteem from things they do, rather than things they are—so they invest much more time in doing things, and much less time in being things.

I agree, but that seems tangential to the point. It's a gender difference that has been constant throughout history, and seems arbitrary to want to change. It also doesn't fix the main problem. Making men more feminine will not make them more self-nurturing.

To illustrate, putting on makeup isn't self-nurturing, anymore than getting a haircut. It's not something that depends on your self-esteem, everyone does it. Binge-dieting is self-neglectful (the opposite of nurturing), and so obviously doesn't come from a position of high self-esteem. Being more obsessed about your appearance doesn't make you more nurturing of yourself physically. Again, women don't nurture themselves more than men. You could chalk up wives' willingness to go to the doctor as higher fear of potential negative consequences, rather than self-nourishment.

The question is how do you get men to care more about their health, remember. And changing society or "gender roles" isn't the solution.

> In order to "be" beautiful or to "be" athletic, it's usually a pre-requisite to be healthy

The assumption here is that women nurture themselves because they want to look good, I don't believe that at all. You'll nurture yourself because you'll want to do it, instinctively, without needing any willpower. A necessary condition for that is high self-esteem.

Put another way: if you want to learn better eye contact, you have two ways. 1st: practice better eye contact. 2nd: increase your self-respect. The 1st won't work. The 2nd, will, because it addresses the actual cause. I'm arguing that the same is true for men's health.

[derefr]

> The assumption here is that women nurture themselves because they want to look good, I don't believe that at all. You'll nurture yourself because you'll want to do it, instinctively, without needing any willpower.

That wasn't what I was trying to communicate at all. My intended meaning was that women—by wanting to look good, or to seem happy, or to put on one of the numerous other faces people expect women to present to the world—are forced to pay attention to their own bodies. At which point they will notice if-and-when they're bodily unhealthy. (And in many of the other major roles women play, they're expected to be caregivers: people who pay attention to others, and are paid attention to in turn. Women in such roles have support networks who will notice if-and-when they are unhealthy.)

Men, meanwhile, usually are expected to strive toward goals that involve paying solely external attention—and often abstract attention, to things or systems or concepts more than to people. Their attention will almost never need to be on their own bodies to achieve their goals; and nor will anyone around them (in a professional capacity) pay attention to their state of being, as long as their work is getting done.

The stereotype is at its strongest in war narratives: "valor" is ignoring the bullet in your calf and the stab-wound in your left side and marching on to finish the battle. Because, relative to winning the battle, the state of your body is immaterial. All other stories of "heroism" tend to have some form of this—the mathematician who abuses drugs to find the answer, the entrepreneur who gives a thousand sleepless nights to their cause, etc.

Put women in those roles, and the immediate evaluation (in our culture) changes from "heroism" to "self-neglect." Which tells you a lot more about how our culture thinks of men, than how it thinks of women, since the evaluation for women is clearly factual.

[DaUR]

> That wasn't what I was trying to communicate at all. My intended meaning was that women—by wanting to look good, or to seem happy, or to put on one of the numerous other faces people expect women to present to the world—are forced to pay attention to their own bodies.

I misunderstood that, you're right.

About your wider point: you seem to put a lot of importance on societal roles ("expected to", "narratives"), and I don't think much of this (if at all) is caused by society rather than self-directed. You're arguing that women are more physically nurturing than men (which could well be true), I'm arguing that it's inconsequential as to how to make men more self-nurturing.

[mbrock]

> About your wider point: you seem to put a lot of importance on societal roles ("expected to", "narratives"), and I don't think much of this (if at all) is caused by society rather than self-directed.

Why do you think so?

[pmarreck]

With the disclaimer that this is gender stereotyping (and my doubts have been increasing as to the utility of this way of thinking about people), this does seem like an insightful observation

[derefr]

Hmm, sex stereotyping is usually wrong, but I'm not sure what's wrong with gender stereotyping—as in, predicting that people will behave a certain way when (voluntarily, self-identifyingly) playing a defined gender role in a culture with clear gender-segregated role-scripts.

It's in the "Western man" role-script to "do" things—and to be expected to "do" things by others; it's in the "Western woman" role-script to "be" things—and to be expected to "be" things by others. As long as you "put on the mask", the people around you will generally push you toward playing your part. (This is what a large part of gender dysphoria is about: being pushed by society to play a part you don't identify with, because of what you present as.)

If you don't strongly identify with either of the roles of "Western man" or "Western woman", then the likelihood of you taking care of yourself isn't predictable. But if you do (and a lot of people do), it generally is.

[hubert123]

It has nothing to do with risk taking, quite the opposite. This is all pop culture. Going to the doctor is a risk. You cannot and dont want to take that risk if you have to go to work. Most of the time if you dont have an issue that's stopping you from working, it's not an important issue worth risking work over. To call men who dont want to go to the doctor basically "emotional pansies" is a very.. i dont know, maybe a very uninformed way to look at it.

[jstalin]

It's not popular these days to claim that there are differences between men and women.

[ergothus]

Is it? I know it's not popular to say things like "women can't do this" or "women aren't as good at this", but I've not actually heard someone say that men and women don't have differences. A great many of those differences are socialization, not biology, but even then there are physical differences.

For example, I know lots of people that want women to be able to be in combat roles in the military. I've not heard anyone suggest that any qualification standard that actually applies to fitness to do so be lowered. Given the biological range of the genders, this would mean that:

* there would be women who physically qualify * that number would be less than men that physically qualify

...and everyone seems okay with this.

Frankly, I've heard far more people get angry about some theoretical upset person than I've ever seen actual upset persons.

[goatlover]

It's funny though, because I've heard tons of women, many of them progressive, from 20s to 60s, who eagerly acknowledge differences between men and women.

I have to think hard to recall otherwise. Usually it would be in context of a specific argument. Maybe I just don't know any hard core feminists.

[Shendare]

Of course, acknowledging and appreciating differences differs greatly from enforcing differences.

[comicjk]

I have traveled in some of the most socially liberal circles in the US, and I have to disagree with you about what's popular - or at least make it much more specific. It's not popular to claim that there are significant, biologically-determined, mental differences between men and women. Small differences, cultural differences, and corporeal differences are all accepted. This zeitgeist may still be incorrect, but it's not terrible as a heuristic.

[robertk]

Popularity and truth are correlated but sometimes orthogonal.