tag:theconversation.com,2011:/africa/topics/movember-1847/articlesMovember – The Conversation2020-11-12T18:58:05Ztag:theconversation.com,2011:article/1495972020-11-12T18:58:05Z2020-11-12T18:58:05ZDUDES Club and Movember: Indigenous men taking ownership of their health<figure><img src="https://images.theconversation.com/files/368478/original/file-20201110-14-lpjns.jpg?ixlib=rb-1.1.0&rect=77%2C176%2C1874%2C1278&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">DUDES Club members and research team at a retreat in northern British Columbia.</span> <span class="attribution"><span class="source">(Jeff Topham)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Why do so many men grow moustaches every November? It started in Australia in 2003 <a href="https://ca.movember.com/about/history">when a small group of men grew moustaches</a> to support men’s health and prostate cancer. From humble beginnings, the Movember movement has focused important international attention on issues like men’s mental health and suicide prevention, as well as prostate and testicular cancer. </p>
<p>But can a moustache save a life? According to DUDES Club members, it can.</p>
<p><a href="http://dudesclub.ca/">DUDES Club</a> is an innovative, community-driven men’s health program incorporating Indigenous approaches to healing and wellness. With help from Movember, <a href="https://ca.movember.com/story/view/id/11267/the-dudes-club-a-brotherhood-for-men-s-health">a three-year research project with the DUDES Club</a> demonstrated how a grassroots initiative could be mobilized to work by, for and with Indigenous men. </p>
<h2>Indigenous men’s health</h2>
<p>Research shows that men in general are <a href="https://doi.org/10.5489/cuaj.2308">less likely to seek medical attention than women</a> in addition to being <a href="https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=1310039201#timeframe">three times more likely than women to die by suicide</a>. Indigenous men’s health is further impacted by a lack of research on health services directed <a href="https://doi.org/10.1080/13691058.2020.1722856">specifically at Indigenous men</a>. In addition to the <a href="https://doi.org/10.1016/j.cpr.2016.09.002">impacts of harmful masculine norms</a> such as being “strong and silent,” independent and emotionless, <a href="https://www.cbc.ca/radio/unreserved/indigenous-masculinity-and-the-lasting-impacts-of-colonization-1.5109762/for-indigenous-men-masculinity-can-be-a-glass-ceiling-of-sorts-professor-says-1.5109769">Indigenous men endure the impacts of historical injustices</a> through ongoing <a href="https://www.wellesleyinstitute.com/wp-content/uploads/2015/02/Full-Report-FPSCT-Updated.pdf">experiences of racism, violence and social exclusion</a>.</p>
<p>As an Indigenous health researcher, I am interested in community health and well-being, particularly in urban areas. I study gendered experiences of colonization and their impacts on Indigenous peoples and communities. Through my research with DUDES Club, I worked with community partners, elders, health-care practitioners and DUDES Club members to better understand Indigenous men’s health and extend the model throughout British Columbia. </p>
<p>DUDES Club started in <a href="https://www.youtube.com/watch?v=KVfmAHxrCiU&feature=youtu.be">Vancouver Native Health Society in 2010</a>. It has since grown into a national model for men’s health and well-being with 40 sites throughout B.C. and two nationally.</p>
<p>During weekly “think tanks” at the Vancouver club, members choose topics for bi-weekly sessions. This gives members a sense of ownership over the process and empowers them to take control of their own health. The presence of a health professional at most sites makes health information accessible for men who don’t usually seek out such information. </p>
<h2>Safety, trust and connection</h2>
<p>A survey of 150 men at the Vancouver DUDES Club demonstrated that most came from a context of disenfranchisement, such as <a href="https://www.cfp.ca/content/62/6/e311">unstable housing, unemployment and poverty</a>. In addition, many of the men live with complex histories of trauma, mental health and/or substance use issues. In the face of structural and systemic barriers, the research showed how important community connection and belonging are to mental, physical and emotional health.</p>
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<img alt="On a white table, four black leather vests bearing the DUDES Club insignia and different locations in B.C." src="https://images.theconversation.com/files/368888/original/file-20201111-23-z5u8g5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/368888/original/file-20201111-23-z5u8g5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/368888/original/file-20201111-23-z5u8g5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/368888/original/file-20201111-23-z5u8g5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/368888/original/file-20201111-23-z5u8g5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/368888/original/file-20201111-23-z5u8g5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/368888/original/file-20201111-23-z5u8g5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">DUDES Club has grown into a national model for men’s health and well-being with 40 sites throughout B.C. and two nationally.</span>
<span class="attribution"><span class="source">(Jeff Topham)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Fourteen focus groups were conducted with men in Vancouver, Prince George and Smithers, B.C. In these groups, men described DUDES Club as a place where they can feel purpose and belonging, where they can work together to build peer support networks and engage in community advocacy. The research demonstrated that safety and trust are crucial for men taking ownership over their health. DUDES Club builds safety and trust because it is confidential, includes health professionals who understand member’s reality, and encourages strong peer relationships where respectful listening is the norm. </p>
<p>For men who attend often, the DUDES Club makes them feel more connected to others and improves their quality of life, meaning <a href="https://www.cfp.ca/content/62/6/e311">those who attend more often benefit more from the program</a>. One elder described DUDES Club as a “safe haven.” Its informal motto — “leave your armour at the door” — demonstrates that DUDES Club is a safe space in which to challenge ideas of masculinity that say men have to be the “tough guy.” These ideas have prevented men from seeking health information and created disparities that have persisted for generations.</p>
<h2>The value of grassroots organizing</h2>
<p>While DUDES Club is available to all men, many Indigenous men (63 per cent in the Vancouver DUDES Club) access the program through a <a href="https://www.fnha.ca/wellness/sharing-our-stories/warriors-meet-again">partnership with the First Nations Health Authority</a>. The presence of elders at DUDES Clubs is important, not only for the cultural knowledge they share, but for the humour and love they bring to the gatherings. </p>
<p>Ultimately, the DUDES Club is not just about men’s health and well-being. It is about the health of communities, women, youth, children and elders. DUDES Club reminds men that they are part of a community that values them even as mainstream social supports and health services <a href="https://www.nationalnewswatch.com/2020/11/07/health-experts-urge-ottawa-to-amend-canada-health-act-to-include-anti-racism-pillar/#.X6nlzmhKhEZ">fail them and their communities over and over again</a>.</p>
<p>DUDES Club holds great value as a grassroots health promotion and community wellness model for all people who identify as male. It is a simple yet powerful example of grassroots community organizing that is helping us better understand how intersecting factors (including gender, culture and experiences of colonization) can impact people differently. </p>
<p>So, yes: Moustaches can save lives.</p><img src="https://counter.theconversation.com/content/149597/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lyana Patrick received funding from Movember Canada as part of the research team evaluating the DUDES Club between 2013-2016. She is currently a board member with the DUDES Club Society. </span></em></p>DUDES Club, with a little help from Movember, has shown how a grassroots health and mental health initiative could be mobilized to work by, for and with Indigenous men.Lyana Patrick, Assistant Professor of Indigenous Health, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1071262018-11-23T12:03:18Z2018-11-23T12:03:18ZBeards, business and a history of facial hair in the workplace<figure><img src="https://images.theconversation.com/files/246921/original/file-20181122-182062-8iqj8v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vintage-beard-man-1900-style-fashion-310332725?src=6jI5evJHP4durUuJXOERzw-2-22">By Ysbrand Cosijn / Shutterstock</a></span></figcaption></figure><p>Recording the human face in art is a long-held tradition, from the Roman Bust to the 15th century Dutch painting. The portrait signals power, prestige and wealth. Corporations have also used portraits to depict their leaders. For example, UK retail banks have been collecting images of their founders and chairmen since the 18th century. These paintings remain on proud display in London head offices.</p>
<p>For a company, the portrait provides a public face and identity to an impersonal institution. But portraits can also reveal interesting trends and attitudes towards appearances. Research I carried out on portraits with my colleague Victoria Barnes revealed some interesting results. </p>
<p>One article <a href="https://www.cambridge.org/core/journals/enterprise-and-society/article/constructing-corporate-identity-before-the-corporation-fashioning-the-face-of-the-first-english-joint-stock-banking-companies-through-portraiture/DE8AB45BFEB81F97E3BB93C8C24A1FA1">published in the journal Enterprise and Society</a> analysed the commissioning of bank managers portraits in the early 19th century. The research showed that, from a very early stage, newly formed joint-stock banks realised the value of such art works and used them to successful create a corporate identity and signal their place in the market. </p>
<p>Another article, <a href="https://www.tandfonline.com/doi/full/10.1080/17449359.2018.1431552">published in the Journal of Management and Organisational History</a>, examined how Lloyds Bank began collecting portraits of past bank chairmen in the 1960s and put them on display in their head offices. One thing that stood out to us in this research is the changing patterns in men’s facial whiskers over the decades. Recent fashion has embraced all forms of facial hair, but it has not always been so well accepted. </p>
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<img alt="" src="https://images.theconversation.com/files/246915/original/file-20181122-182062-1aqs1sx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246915/original/file-20181122-182062-1aqs1sx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=474&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246915/original/file-20181122-182062-1aqs1sx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=474&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246915/original/file-20181122-182062-1aqs1sx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=474&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246915/original/file-20181122-182062-1aqs1sx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=595&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246915/original/file-20181122-182062-1aqs1sx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=595&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246915/original/file-20181122-182062-1aqs1sx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=595&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bears were an important part of the Viking warrior uniform.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vikings-their-konung-traditional-warrior-clothes-663600733?src=Z3fFo6fhL5ePxOIbbgnrQw-1-52">Nejron Photo / Shutterstock</a></span>
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</figure>
<p>Ancient Egyptians believed shaving was associated with cleanliness. Greeks were proud of their beards, which symbolised authority and wisdom. Roman whiskers tended to be less luxurious and neater, while Vikings sported large beards and moustaches, their fearsome appearance adding to their formidable reputation in combat. Conversely, later armies often discouraged facial hair as beards could be seized in battle by the enemy to incapacitate a soldier. </p>
<p>Beards thrived in the UK in the Medieval and Tudor periods. Most of Elizabeth I’s key advisers have beards in their portraits. Charles I (1600-1649) famously sported a small and neatly trimmed beard, combined with a moustache. His whiskers may have been famed but they did not prevent his execution. Then, the late 17th and 18th century witnessed the return of the clean shave in Europe, providing abundant work for barbers. </p>
<p>In the early 19th century, beards returned with a flourish. But they were associated with left-wing, anti-capitalist revolutionaries. Just picture Karl Marx.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246910/original/file-20181122-182068-6aqylc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246910/original/file-20181122-182068-6aqylc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246910/original/file-20181122-182068-6aqylc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246910/original/file-20181122-182068-6aqylc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246910/original/file-20181122-182068-6aqylc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246910/original/file-20181122-182068-6aqylc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246910/original/file-20181122-182068-6aqylc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Friedrich Engels and Karl Marx, authors of the Communist Manifesto.</span>
<span class="attribution"><span class="source">Wikipedia</span></span>
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<p>Fashions changed again from the 1850s. As revolutions across Europe were extinguished, in Britain the Victorians enthusiastically embraced beards and muttonchops – big long side burns that connect with a moustache. For them, the beard signaled power, masculinity and status. This was an age when British trade, commerce and industry were in the ascendance. Masculinity was therefore on display during a period of supreme confidence and economic success. This really was a time of “peak beard”. </p>
<h2>Beards and business</h2>
<p>Within companies, the beard has a mixed history, usually depending on contemporary fashions. From 1850 to 1900, British businessmen usually had some form of facial hair. Visit the halls of many UK institutions with a history back to the 19th century and you’ll see a line of portraits of men with beards.<br>
The Edwardians at the turn of the 20th century, in contrast, rejected the full facial hair of their forebears and adopted the moustache. At a practical level, those fighting in World War I shaved off their beards to ensure their gas masks fitted properly. But they often retained their moustaches. The preference for a smooth shave with only a moustache followed thereafter during a period of mixed economic fortunes for British business, interrupted by two world wars and disrupted by the loss of Empire. </p>
<p>As successive generations attempted to move away from the one before them, the beard found favour again in the hippy-influenced 1960s and 1970s. The Beatles led this trend. Facial hair fell out of fashion in the 1980s and 1990s, when trustworthiness in business was signalled by a clean shave. Indeed, companies such as HSBC even had a “clean shave” policy at this time, according to archivists I’ve spoken to there. This was an era of Margaret Thatcher, Ronald Reagan and free-market capitalism. And, of course, more women were visible in both politics and business. </p>
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<img alt="" src="https://images.theconversation.com/files/246912/original/file-20181122-182044-s79m7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/246912/original/file-20181122-182044-s79m7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=762&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246912/original/file-20181122-182044-s79m7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=762&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246912/original/file-20181122-182044-s79m7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=762&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246912/original/file-20181122-182044-s79m7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=958&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246912/original/file-20181122-182044-s79m7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=958&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246912/original/file-20181122-182044-s79m7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=958&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Charles Geach (1808-1854), founder of the Birmingham and Midland Bank, sporting some serious side burns.</span>
<span class="attribution"><span class="source">HBSC Group Archives, 1850. J. Partridge.</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Reflecting the face of corporations, company portraits reflect trends in the appearance of businessmen and women. More recently they also reflect changes in the way that companies project their identity. They are no longer merely a procession of middle-aged, white, senior male managers with beards, as seen in the portraits of 19th-century bankers. Banks now display images that are more diverse – of people from various levels of the company, of women and different ethnicities. Thus, the company portrait survives but reflects progression in the society in which it is embedded.</p>
<p>Changing fashions in facial hair also opens opportunities for business. Barbers’ services and beard products allow men to groom in style. This reinforces the growing trend for men to spend more time and money on their appearance, a trend which shows no sign of abating. A growing popularity of beards is, obviously, less good for those producing razors.</p>
<p>Facial hair has traditionally signalled masculinity. As 21st-century businesses are, of course, gender diverse, facial hair will never be the essential work accessory, but rather a style choice and positive vehicle for charity fundraising through initiatives including <a href="https://uk.movember.com/">Movember</a> and <a href="http://decembeard.co/">Decembeard</a>. </p>
<p>After recent <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/jeb.12958">research in the Journal of Evolutionary Biology</a> found that all women questioned preferred men with facial hair, there may be more than just a business case for men to keep their whiskers. Whatever the motivation for hair growth, it looks like the beard will always be with us.</p><img src="https://counter.theconversation.com/content/107126/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucy Newton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ancient Egyptians believed shaving was associated with cleanliness but Greeks were proud of their beards, which symbolised authority and wisdom.Lucy Newton, Associate Professor in Business History, Henley Business School, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/864342017-11-29T22:41:33Z2017-11-29T22:41:33ZMovember shavedown: Why you should not get your prostate checked<figure><img src="https://images.theconversation.com/files/192585/original/file-20171031-18689-9w3g2o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even if they are not treated, only about three per cent of men will die of prostate cancer over their lifetime, most in their 70s or 80s. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>As Movember comes to a close, and men flaunt or shave the facial hair they have grown, there is something people should know — prostate cancer screening is ineffective and can do more harm than good.</p>
<p><a href="https://ca.movember.com/">Movember is a global charity</a> that raises money for men’s health. One of its key areas for fundraising and awareness is to advocate for prostate cancer testing with a PSA test.</p>
<p>As a family physician and public health researcher, I am not getting a prostate cancer test: Neither a rectal examination nor a PSA blood test. </p>
<p>As a man of a certain age, I am likely to already have prostate cancer, and I know that suffering and even dying from this cancer is on the list of possible fates that await me. My choice is not because I have my head in the sand. It is because, after studying the evidence, I know that a test will likely not improve my outcome.</p>
<h2>Screening is ineffective</h2>
<p>In recent years, the pressure on men to be screened for prostate cancer has been mounting, with organisations encouraging us to “<a href="http://www.prostatecancer.ca/getmedia/b4ce9069-b818-462b-8e17-7cc7b4ec7df1/471_PSA-Know-Your-Number_IG_HiRes_1.jpg.aspx">know your number</a>.” </p>
<p>“It is only a simple blood test,” after all. </p>
<p>Prostate Canada says that <a href="http://www.prostatecancer.ca/Prostate-Cancer/About-Prostate-Cancer/Statistics">one in seven men will have prostate cancer</a>. With the help of screening and then curative surgical treatment, Movember and Prostate Canada claim that <a href="https://ca.movember.com/mens-health/prostate-cancer">prostate cancer now has a cure rate of over 97 per cent</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/196825/original/file-20171128-28899-12zybl6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/196825/original/file-20171128-28899-12zybl6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196825/original/file-20171128-28899-12zybl6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196825/original/file-20171128-28899-12zybl6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196825/original/file-20171128-28899-12zybl6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196825/original/file-20171128-28899-12zybl6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196825/original/file-20171128-28899-12zybl6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is little evidence that PSA screening prevents development of advanced prostate cancer.</span>
<span class="attribution"><span class="source">(Scott White)</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Sadly, these claims give a very false impression of the reality. </p>
<p>Prostate cancer is indeed very common, but <a href="http://dx.doi.org/10.1016/j.eururo.2012.02.054">more so in countries that screen a lot, like the United States and Canada</a>. Death rates have less variation. Studies that examined normal men at different ages found <a href="http://dx.doi.org/10.1002/ijc.29538">many men have small amounts of what looks like cancer in their prostate</a>. Over 30 per cent of men in their 60s have some prostate cancer cells, and in their 80s, over half do. But even if they are not treated, <a href="http://dx.doi.org/10.9778/cmajo.20140079">only about three per cent of men will actually die of prostate cancer</a>, and most of that <a href="http://dx.doi.org/10.3322/caac.20026">will occur at the very end of life</a>, in their 70s or 80s. </p>
<p>If we find cancer many years earlier than we would normally, of course the men will survive five years, though they may still die at the same age as they would have without screening. This is called “lead-time bias.” </p>
<p>Since many prostate cancers grow very slowly many men will die of something else before the cancer can affect them. This is called “overdiagnosis:” Identifying disease that will never be important.</p>
<p>The evidence shows that <a href="http://dx.doi.org/10.3322/caac.20026">if we left men alone we would only recognise prostate cancer in perhaps one in 16 men</a>. The cure rate looks high, because we create false alarms and label many men as having cancer that will never affect them.</p>
<p>Screening is not “just a test.” To take this test is to step into a canoe running down a river with wild and unpredictable rapids. Let me explain….</p>
<h2>Tests are hard to interpret</h2>
<p>The PSA test is a laboratory measurement with errors: Both false positive and false negative. The <a href="http://dx.doi.org/10.5489/cuaj.4888">threshold for abnormality is not clear</a>. Different authorities recommend different levels, and many vary with age.</p>
<p>For men who test positive, the first investigation is usually a prostate biopsy — a needle is poked into the prostate gland multiple times to obtain samples of the gland, to be examined under the microscope. This procedure can carry infection into the gland, and <a href="http://dx.doi.org/10.1016/j.eururo.2016.08.004">results in severe infections in one per cent of patients</a>. Sometimes this becomes septicemia (blood poisoning) that damages kidneys and other organs, or kills the man. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/192592/original/file-20171031-18693-1kyznwa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/192592/original/file-20171031-18693-1kyznwa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=592&fit=crop&dpr=1 600w, https://images.theconversation.com/files/192592/original/file-20171031-18693-1kyznwa.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=592&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/192592/original/file-20171031-18693-1kyznwa.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=592&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/192592/original/file-20171031-18693-1kyznwa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=744&fit=crop&dpr=1 754w, https://images.theconversation.com/files/192592/original/file-20171031-18693-1kyznwa.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=744&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/192592/original/file-20171031-18693-1kyznwa.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=744&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A prostate biopsy.</span>
<span class="attribution"><span class="source">(Wikimedia Commons/Cancer Research UK)</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>The biopsy samples are examined under the microscope by pathologists, who try to predict from their appearance whether this collection of cells is likely to go on to kill the man. </p>
<p>This is difficult: Most cell changes that look like cancer do not develop, spread and kill. Prediction is easier for severe changes than for more frequent minor changes. </p>
<p>Treatment is potentially helpful for the few men with severe changes, but for the majority with minor changes it is unclear how best to proceed.</p>
<h2>Incontinence and erectile difficulty</h2>
<p>Treatment varies and can do more harm than good. Some urologists treat all “cancers.” Others follow a newer approach of surveillance, with regular re-testing, and possibly a repeat biopsy. Thus a well man can be converted into a “possible cancer” patient, getting regular tests, and being reminded that he might have a developing cancer. It is not surprising that many such men decide to have surgery, just to get the gland out, and save the anxiety.</p>
<p>Having surgery to remove the prostate is not a benign process. As with any operation there is a risk of complications. <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/prostate-cancer-screening1">Some men will get infections, blood clots and a few will die</a>. </p>
<p>After recovery, many men have urinary incontinence and erectile difficulty. It is hard to know the actual rates since measuring these is difficult: How much dribbling of urine, or how many embarrassing episodes of urgency should be counted to decide it is important? Measurement of all these outcomes is usually only published by the best centres that are willing to publicly describe their outcomes. There is <a href="http://www.systemperformance.ca/report/prostate-cancer-control-in-canada-a-system-performance-spotlight-report/">wide variation across Canada</a>: It appears that results are worse for many centres.</p>
<p>Everyone assumes that having the operation for early cancer will cure it. </p>
<p>Yes, it does, for a small proportion of men. The few trials available comparing surgery with not treating prostate cancer <a href="https://doi.org/10.1056/NEJMoa1606220">show a very small benefit for surgery</a>. If you had an early cancer that would not develop, then the surgery cured you. (But you never needed the cure.) </p>
<p>On the other hand, most men with severe cancer still die despite screening and treatment.</p>
<h2>Inadequate evidence on screening benefits</h2>
<p>The enthusiasts for PSA screening assert that they are preventing development of advanced prostate cancer. I wish that were true. </p>
<p>Their evidence comes from one project conducted in Europe, where seven centres started running trials on thousands of men aged 55 to 70 years, but <a href="https://doi.org/10.1016/S0140-6736(14)60525-0">only two of the centres showed clear positive results</a>. Even in the trials with positive results, the chance of benefit was small. To prevent each single death from prostate cancer, they had to invite around 800 men. Harms occurred, as over-diagnosis rates were high. And, after 13 years of follow-up, for one less death, six men still died of the disease. So screening does not prevent death from prostate cancer, only reduces it slightly. </p>
<p>Criticism of the trials has also pointed out that these results could be due to the screened men being treated at highly skilled centres, that offered more modern drug treatment. If so, men should simply wait until they get cancer, then obtain high-quality treatment. This choice gives a slightly higher risk of cancer spread, but reduces the chance of over-diagnosis followed by unnecessary treatment. </p>
<p>After the European trial results were published, most evidence-based medical groups including the Canadian Task Force on Preventive Health Care decided that men are more likely to experience harm than benefit from screening. So they <a href="http://dx.doi.org/10.1503/cmaj.140703">warned against screening</a>. Their evidence is summarized in <a href="https://canadiantaskforce.ca/tools-resources/infographic/">decision aids to assist men to understand the risks and benefits</a>. </p>
<h2>What do urology specialists say?</h2>
<p>Urology Associations have a conflict: their members see men dying miserably from the disease, and naturally want to do everything to stop it. However, they too became more cautious after seeing the trial outcome, and now <a href="http://dx.doi.org/10.5489/cuaj.4888">recommend that men should be informed of the risks before they start down the screening pathway</a>. </p>
<p>The American Urology Association recommends that men under age 55 should not be screened. The <a href="https://www.cua.org/en">Canadian Urology Association</a> was in agreement, but recently <a href="http://dx.doi.org/10.5489/cuaj.4888">lowered the age to 50 years</a>, except in special cases of strong family history, where the risk of cancer is higher. It is not clear how well their members follow these recommendations. Many clearly do not. </p>
<p>The <a href="http://www.prostatecancercentre.ca/manvan">Calgary “Man Van”</a> — a mobile men’s health clinic offering PSA testing — recommends testing from the age of 40 and does not inform men of the uncertainties involved. This organisation is advised by urologists, who clearly do not follow their organisation’s policies. The <a href="https://ca.movember.com/mens-health/prostate-cancer">Movember movement says age 50, and 45 for those at high risk</a>. </p>
<p>And for men with higher risk, because of a strong family history, or slightly raised risk because of African ancestry — we have no clear evidence. We simply do not know whether screening is more or less effective among these men, nor whether their risk starts earlier than other men. </p>
<h2>Marketing behind PSA tests.</h2>
<p>The PSA test has been directly marketed to men. The sponsors are not always clear, but appear to be the manufacturers of the tests, and others who profit from screening. They include <a href="http://www.prostatecancer.ca/About-Us/Corporate-Supporters">companies that make surgical equipment and drugs used to treat cancer, and supermarkets that sell incontinence products</a>. For these generous donors, the more men who are diagnosed, the more product they sell.</p>
<p>Prostate screening organisations have also persuaded many men of goodwill that this is a life-saving activity. And they have enlisted other donors who believe in the movement, often after having had a “cancer” removed, persuaded they have been cured by surgery. </p>
<p>It is difficult to tell such survivors that they likely had unnecessary surgery that caused the risks and complications, while most who have severe cancer still die despite the treatment.</p>
<h2>Better ways to improve men’s health</h2>
<p>Men die on average six years earlier than women. For young men, injury and violence including road accidents are the commonest cause, often fuelled by alcohol. In midlife up to age 75, cancer is the most important cause of death. After that, cardiovascular disease dominates. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/196816/original/file-20171128-28917-1arsep0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/196816/original/file-20171128-28917-1arsep0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196816/original/file-20171128-28917-1arsep0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196816/original/file-20171128-28917-1arsep0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196816/original/file-20171128-28917-1arsep0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196816/original/file-20171128-28917-1arsep0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196816/original/file-20171128-28917-1arsep0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lifestyle adaptations such as healthy eating and doing regular exercise may serve most men better than a prostate cancer test.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>But <a href="http://www.cancer.ca/en/cancer-information/cancer-101/canadian-cancer-statistics-publication/?region=on&gclid=EAIaIQobChMI9cnn3fK-1wIVU0sNCh36fwAIEAAYASABEgJUtvD_BwE">prostate cancer only comprises 20 per cent of the cancers</a>. Lung cancer is still the most common fatal cancer in men, largely caused by smoking. Indeed <a href="https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf">more than half of all smokers die of smoking-caused disease</a>, so for them, other causes barely matter.</p>
<p>Many men <a href="http://www.statcan.gc.ca/pub/82-624-x/2014001/article/11922-eng.pdf">are obese, have high blood pressure and diabetes</a> (which are <a href="http://www.phac-aspc.gc.ca/publicat/2009/ndssdic-snsddac-09/pdf/report-2009-eng.pdf">often poorly controlled</a>). All these improve with behavioural change: men need to quit smoking, minimize alcohol, eat healthy food and take regular exercise. Even a small increase in activity, such as walking regularly, will <a href="http://dx.doi.org/10.1186/s12889-016-3021-1%20**https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/aerobic-exercise/art-20045541?p=1**">make a substantial difference to the effect of these diseases and lower the risk of death</a>. It also helps people feel better.</p>
<p>Thus rather than encouraging “a simple blood test,” it is far better for men to encourage one another to change behaviours. This is likely to have far more value — with fewer negative effects — than doing PSA tests.</p><img src="https://counter.theconversation.com/content/86434/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Dickinson was a member of the Canadian Task Force on Preventive Health Care, which is a committee of independent volunteers, with secretariat and meeting costs supported by funding from the Public Health Agency of Canada. </span></em></p>A family physician and public health researcher explains why he isn’t getting a prostate cancer test in Movember or at any time in the near future.James Dickinson, Professor of Family Medicine, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/854432017-10-22T19:03:04Z2017-10-22T19:03:04ZMovember, ice buckets, fun runs and ‘dry’ months: why philanthropy of the body is all the rage<figure><img src="https://images.theconversation.com/files/190750/original/file-20171018-32345-19g5kbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social media is now a major driver of embodied philanthropy because it allows individuals to publicise their involvement through selfies, videos and status updates.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Donating to a charity used to be no more physically arduous then reaching into your wallet. But it is often a much more demanding process now, or at least it can be. </p>
<p>We’ve watched friends trade clean shaves for <a href="https://au.movember.com/">Movember</a> moustaches. We’ve donated when family members have done charity fun runs or <a href="https://www.steptember.org.au/">physical challenge fundraisers</a>. We’ve lived through the craze of the <a href="http://www.mndaust.asn.au/MND-Australia-archive/Ice-Bucket-Challenge-(1)/Ice-Bucket-Challenge-FAQ-s.aspx">Ice Bucket Challenge</a>. We may even do a <a href="https://www.dryjuly.com/">Dry July</a> or a <a href="http://febfast.org.au/">FebFast</a> to do something good for ourselves as much as for a good cause. </p>
<p>Charities are devising new ways to use people’s bodies for philanthropic ends in an ever-growing list of appearance, activity and abstention campaigns. And people are eager to step up to that challenge.</p>
<p>For charities, the body gives on many fronts and it can fulfil multiple objectives around fundraising, publicity and education. For participants, especially <a href="http://onlinelibrary.wiley.com/doi/10.1002/nvsm.1471/full">younger people</a> with less time or money for traditional philanthropy, the body is relatively easy to give. </p>
<p>Researchers, however, are only just starting to grapple with embodied philanthropy as a new kind of pro-social behaviour. They have yet to understand just how many people get involved or how much money charities raise in this way. This is largely because charities don’t tend to be grouped or studied based on <em>how</em> they raise funds.</p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1002/nvsm.1595/abstract">Embodied philanthropy</a>, charitable activity that relies on the body for its core form of engagement, has nonetheless been growing in popularity. From the mid-1980s, event-style fundraisers capitalised on the new preoccupation with health and fitness to get people running, walking and otherwise moving for a cause. </p>
<p>These events spoke to both personal and social motivations to allow participants to simultaneously do something highly <a href="http://onlinelibrary.wiley.com/doi/10.1002/nvsm.1471/abstract">individualistic and something altruistic</a>. In 2004, the quirky style project of <a href="https://au.movember.com/news/11213/">moustache growing took on a charitable inflection</a>, setting the stage for a raft of appearance based imitators.</p>
<p><a href="http://au.wiley.com/WileyCDA/WileyTitle/productCd-0470547979.html">Social media</a> is now a major driver of embodied philanthropy because it allows individuals to publicise their involvement through <a href="ijoc.org/index.php/ijoc/article/download/3143/1400">selfies</a>, videos and status updates, amplifying the charity’s messages and reach. Online platforms, seamlessly integrated into participant profiles, are also increasingly used for <a href="http://www.sciencedirect.com/science/article/pii/S0047272714000036">fundraising</a>. </p>
<p>Although it is difficult to gauge the impact of embodied philanthropy in concrete ways, we understand why the body has become central to modern charities. For charities with goals around fundraising, awareness and even behaviour change, a participant’s single embodied act can be useful in many ways.</p>
<p>The body’s visibility and ability to communicate to others is an important element in raising awareness of a cause. Making a fashion or grooming choice part of a philanthropic signature style can boost publicity and well designed campaigns take full advantage of the high visibility.</p>
<p>Charities can therefore focus attention on making the link between the sign of involvement (a moustache or a shaved head, for instance) and the issues. Participants going about their lives in turn become billboards for the cause. </p>
<p>The body’s ability to suffer and generate empathy is also vital. Donations to those we <a href="http://onlinelibrary.wiley.com/doi/10.1002/bdm.767/full">perceive to be suffering</a> for a cause tend to be higher than for those who fundraise without personal cost. Accordingly, charities have a financial interest in making particpants’ efforts at least appear to be challenging, painful or embarrassing. </p>
<p>Some health-related charities are also eager to have participants learn or model healthier behaviours by compelling changes to diet or activities. Participants who temporarily give up alcohol for charity, for instance, wind up learning about the <a href="http://journals.sagepub.com/doi/abs/10.1177/1363459315600772?journalCode=heaa">important role alcohol plays</a> in many social situations, and practice <a href="https://research-repository.griffith.edu.au/bitstream/handle/10072/49570/84395_1.pdf%3Bsequence=1">strategies for refusing drinks</a>. In turn they become spokespeople for the charity’s larger public health objectives.</p>
<p>Charities get a lot out of embodied philanthropy. They are <a href="https://www.sociologicalscience.com/download/vol-3/march/SocSci_v3_202to238.pdf">peer-to-peer initiatives</a> that rely on participants to do a substantial share of the publicity and fundraising.</p>
<p>For participants, it’s not all about altruism and sacrifice, either: they get something out of it. They might use the campaign as an excuse to try out a new look, or force themselves to exercise more or drink less. </p>
<p>Philanthropists have long held <a href="http://www.jstor.org/stable/2234133?seq=1#page_scan_tab_contents">mixed motives</a> for giving (tax breaks, social acclaim), but it is no coincidence that embodied philanthropy grew exponentially in the era of social media. Daily step totals are logged to encouraging endorsements and photos of changed appearances are hashtagged for the participant’s validation as much as for the cause. </p>
<p>Critics of this phenomenon label it <a href="http://www.ojs.meccsa.org.uk/index.php/netknow/article/view/406">slacktivism</a> and nothing more. </p>
<p>Yet for charities, even those who raise no money but transform their bodies in the ways required are valuable assets. These freeloaders or bandwagoners become part of the collective that endorses the action and the cause. In turn, they can propel unlikely campaigns, such as the Ice Bucket Challenge, to <a href="https://www.nature.com/nm/journal/v20/n10/full/nm1014-1080.html">unexpected successes</a>.</p><img src="https://counter.theconversation.com/content/85443/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Robert does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Physical philanthropy is growing in popularity because it has benefits for the charity and the fundraiser.Julie Robert, Senior Lecturer, School of International Studies, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/108982012-11-29T19:05:50Z2012-11-29T19:05:50ZIs Movember a misguided attempt to do good for middle-aged men?<figure><img src="https://images.theconversation.com/files/18117/original/h3nqf3dx-1354082696.jpg?ixlib=rb-1.1.0&rect=11%2C5%2C543%2C419&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Men would be better off if Movember focussed more on health interventions we know to be effective.</span> <span class="attribution"><span class="source">Anthony Danielle</span></span></figcaption></figure><p>There are no short cuts to improving your health and no magic bullets. Routine handfuls of vitamins will do you no good. In fact, randomised trials have repeatedly shown that people are actually worse off from popping vitamins. </p>
<p>Indeed, there’s no avoiding the fact that eating a wide variety of good food (lots of colours, more vegetables and fruit than dairy and meat) but not too much, keeping physically active, stopping smoking and making sure you don’t drink too much alcohol, are best. Boring, isn’t it?</p>
<p>Still, it’s the best way to avoid illness and disease. And of these, what scares people the most is cancer. </p>
<p>Two gentlemen in the waiting room of a practice I was working at were overheard by our reception staff chatting about a third, who had recently died. </p>
<p>“What did old Bill die of, then?” one asked. “I didn’t even know he was sick.”</p>
<p>“I don’t rightly know,” was the reply. “But I don’t think it was anything serious.”</p>
<p>Behind the apparent ludicrousness of this conversation is the implicit dread of cancer. Bill probably didn’t die of it. We would prefer to die of almost anything else. </p>
<p>The gender-specific cancer affecting women is breast cancer (although a very small number of men also get it). It runs neck and neck with lung cancer in causing more deaths and harm to women than any other. Luckily, we can do something about it because randomised trials have shown breast cancer can be detected by screening at the right age. And early detection and prompt treatment reduces the number of deaths from the disease.</p>
<p>But what about men? Is there something we can do to help them? The obvious contender is prostate cancer (women don’t have a prostate). It’s very common, it’s being diagnosed at increasingly greater rates, and causes a lot of early deaths (and harm).</p>
<p>So promoting screening for it is attractive. And it provides a nice symmetry. Women go off for their breast cancer screening at age 50, and their menfolk follow soon after. Of course, we know that men are much more reluctant to appear before the doctor, so we need something to encourage them. A sort of blokey message, “garn mate, y’know whatcha gotta do.” </p>
<p>Hence Movember. The trouble is we don’t know that screening for prostate cancer works. </p>
<p>That’s right. There’s huge controversy about it. There are advocates for screening (often those doctors who treat prostate cancer) and those who discourage it (especially public health and primary-care doctors). </p>
<p>The huge prostate cancer screening trials, equivalent to those of breast cancer from 20 or 30 years before, have only been published in the last year or two. And the results are ambiguous. </p>
<p>Some find a <a href="https://theconversation.com/giving-men-choice-the-case-for-routine-prostate-cancer-screening-8633">small benefit</a>, and <a href="https://theconversation.com/more-harm-than-good-rethinking-routine-prostate-cancer-screening-8612">others none</a>. It’s such a fine call that the evidence has done little to resolve the issue. Rather, experts are bunkering down to their prior beliefs, with each point of view finding some comfort in their interpretation of the trial data (which, it has to be admitted, is complicated and difficult to sort through).</p>
<p>All this means that one half of <a href="http://au.movember.com/about/">Movember</a>, which aims to increase men’s awareness of prostate cancer and male mental health, is deeply flawed. Sadly, the campaign doesn’t focus on preventive activities we know to be particularly effective – stopping smoking, reducing alcohol consumption down from damaging levels, and doing more physical activity (although its <a href="http://au.movember.com/mens-health/">website does mention them</a>). Health promotion in this area is often unexciting and difficult, but we know it pays dividends in saved lives and avoided misery.</p>
<p>Instead, Movember focuses on something we are not certain is effective.</p>
<p>Worse than that, it might even be doing harm. Detecting cancer in men for whom treatment will confer no benefit is very damaging. Even the diagnosis is damaging. Men are nearly ten times more likely to commit suicide after being told they have prostate cancer. </p>
<p>And the <a href="https://theconversation.com/psa-screening-and-prostate-cancer-over-diagnosis-8568http://au.movember.com/about/">treatment</a> is damaging too. Despite real advances in the definitive treatment (“radical prostatectomy” – for which there are several methods), the chances are that most men will be rendered impotent by the operation, their penises will sink back, and the majority will develop urinary incontinence (temporarily for many – lasting for two years – but for some lasting well after even that).</p>
<p>All this is so counter-intuitive that it’s hard to explain. Surely, if you’ve got cancer, then treating it earlier must be better? Not necessarily. Only if we know that treatment is better than no treatment. And we don’t know that about prostate cancer.</p>
<p>If Movemeber focused more on the things that we know are effective, and steered off controversial areas which divide doctors, men would actually be much better off. </p><img src="https://counter.theconversation.com/content/10898/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Del Mar is a member of the RACGP's Red Book Committee (guidelines for GPs)</span></em></p>There are no short cuts to improving your health and no magic bullets. Routine handfuls of vitamins will do you no good. In fact, randomised trials have repeatedly shown that people are actually worse…Chris Del Mar, Professor of Public Health, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/39882011-11-11T22:08:43Z2011-11-11T22:08:43ZGoing beyond Movember: Facial hair and foreign affairs<figure><img src="https://images.theconversation.com/files/5342/original/Movember_hairspray.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Growing a moustache isn't simply about the style. It could help you win friends and influence people abroad.</span> <span class="attribution"><span class="source">AFP/Wildbird</span></span></figcaption></figure><p>You may notice more than a few of your friends and colleagues are a little more hirsute than normal this month. The annual charity event <a href="http://au.movember.com/">Movember</a> encourages men to grow moustaches to raise money and awareness for men’s health issues, particularly prostate cancer and depression. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/5347/original/Movember_Luna_Park.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/5347/original/Movember_Luna_Park.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=808&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5347/original/Movember_Luna_Park.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=808&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5347/original/Movember_Luna_Park.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=808&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5347/original/Movember_Luna_Park.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1015&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5347/original/Movember_Luna_Park.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1015&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5347/original/Movember_Luna_Park.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1015&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Even Luna Park is adding a little ‘mo to its face this month.</span>
</figcaption>
</figure>
<p>As far as philanthropic gimmicks go, Movember is one of the best in the business. For once it’s cool have a ‘mo. For the other the eleven months of the year moustachioed citizens are subjected to jibes about their facial garb.</p>
<p>But elsewhere in the world, facial hair has deep political and cultural connotations and has featured in international incidents. </p>
<h2>Tradition and modernity</h2>
<p>There’s nothing quite like the moustache to say you are serious in Middle Eastern culture. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/5353/original/Movember_Assad_mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/5353/original/Movember_Assad_mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=807&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5353/original/Movember_Assad_mo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=807&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5353/original/Movember_Assad_mo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=807&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5353/original/Movember_Assad_mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1014&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5353/original/Movember_Assad_mo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1014&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5353/original/Movember_Assad_mo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1014&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">President Assad makes a statement with his facial hair.</span>
<span class="attribution"><span class="source">EPA/Harish Tyagi</span></span>
</figcaption>
</figure>
<p>There the moustache represents the bristly line between tradition and modernity. Pledging reform during the Arab Spring while clean-shaven was a symbolic gesture by Syrian President Assad. He intended to convince the West and his country’s youth that he was serious. </p>
<p>In Iraq, men literally swear by their moustache to seal a deal. Knowing that helps makes sense of an awkward moment in the lead-up to the 2003 Iraq War. </p>
<p>At an international meeting less than a month before the US-led invasion, <a href="http://www.telegraph.co.uk/news/1901519/Saddam-Husseins-ally-Izzat-Ibrahim-al-Duri-captured-in-Iraq.html">Izzat Ibrahim al-Douri</a>, one of Saddam’s key deputies, became infuriated at Kuwait’s decision to allow US troops to gather on its territory. He <a href="http://www.telegraph.co.uk/news/worldnews/middleeast/iraq/1502813/Leading-Saddam-loyalist-is-dead.html">shouted</a> at a member of a Kuwaiti delegation: “Curse be upon your moustache, you traitor!” </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/5352/original/Izzat_Ibrahim_al-Douri.jpg?ixlib=rb-1.1.0&rect=916%2C51%2C698%2C828&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/5352/original/Izzat_Ibrahim_al-Douri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5352/original/Izzat_Ibrahim_al-Douri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5352/original/Izzat_Ibrahim_al-Douri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5352/original/Izzat_Ibrahim_al-Douri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5352/original/Izzat_Ibrahim_al-Douri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5352/original/Izzat_Ibrahim_al-Douri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Izzat Ibrahim al-Douri insulted a Kuwaiti man by cursing his moustache.</span>
<span class="attribution"><span class="source">EPA/Jamal Nasrallah</span></span>
</figcaption>
</figure>
<p>This was read as more than a simple threat. Western journalists <a href="http://www.guardian.co.uk/theguardian/2003/mar/12/theeditorpressreview1">assumed</a> the subtext was that the Kuwaiti representative “wasn’t man enough to deserve the moustache he wore,” and by extension his country’s policy of appeasing the American military was cowardly and without honour.</p>
<h2>The military 'mo</h2>
<p>This lesson on the significance of facial hair in Middle Eastern diplomacy was not lost on the American military. Ever-interested in winning hearts and minds, from 2001 to 2010, the US special ops soldiers in Afghanistan abandoned the <a href="http://www.manbehindthedoll.com/">Ken doll</a> soldier look and cultivated bushy beards as a sign of respect for local culture. </p>
<p>Last year the top brass decided that despite aiding the mission, the look was “unprofessional” and the soldiers were <a href="http://abcnews.go.com/WNT/story?id=130114&page=1">ordered to shave</a>. One Green Beret team leader <a href="http://articles.nydailynews.com/2010-08-08/news/29438834_1_beards-afghan-troops-caps">told a US journalist</a> that “Growing a beard dramatically helps us. Now,” he lamented, “we look no different than the Brits or Russians before us.”</p>
<p>The regular US military also trialled the beard in Iraq. In 2004, soldiers in Fallujah grew beards. But when violence in the area increased, some decided that facial hair diplomacy is outside of a soldier’s job description. <a href="http://www.informationclearinghouse.info/article6036.htm">According to Sergeant Cameron Lefter</a>, “When you go to fight, it’s time to shoot – not to make friends with people.”</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/5348/original/Flickr_The_U.S_Army.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/5348/original/Flickr_The_U.S_Army.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5348/original/Flickr_The_U.S_Army.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5348/original/Flickr_The_U.S_Army.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5348/original/Flickr_The_U.S_Army.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5348/original/Flickr_The_U.S_Army.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5348/original/Flickr_The_U.S_Army.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Growing beards helps foreign forces blend in with the local culture in Afghanistan.</span>
<span class="attribution"><span class="source">Flickr/The US Army</span></span>
</figcaption>
</figure>
<h2>Australians in Afghanistan</h2>
<p>The plight of the beardless soldier has spread to Australian forces in Afghanistan. Despite severe water shortages, soldiers are ordered to shave daily. In fact the commanding officer of Mentoring Task Force 3 in Uruzgan province was so concerned about maintaining shaving standards he insisted that his subordinates sign an order which read: “Be a professional soldier, not a pirate.” The signatories quickly made T-shirts mocking the order. But it’s unlikely our boys in Uruzgan will join Movember this year. </p>
<p>When the objective is to win respect rather than battles, the moustache has proven itself the most unlikely secret weapon in the US arsenal. </p>
<h2>Animal attraction</h2>
<p>More than 200 years ago, one of the few successful diplomats from America’s first conflict with a Muslim nation wrote of how his moustache was crucial in negotiations.</p>
<p>In 1795, poet and diplomat <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1540-6563.1963.tb00208.x/abstract">Joel Barlow</a> was sent to Algiers to secure the freedom more than 150 American sailors who had been captured there.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/5351/original/Flickr_dbking.jpg?ixlib=rb-1.1.0&rect=106%2C50%2C618%2C760&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/5351/original/Flickr_dbking.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=749&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5351/original/Flickr_dbking.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=749&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5351/original/Flickr_dbking.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=749&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5351/original/Flickr_dbking.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=942&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5351/original/Flickr_dbking.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=942&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5351/original/Flickr_dbking.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=942&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Joel Barlow recognised the importance of his moustache in his diplomatic work.</span>
<span class="attribution"><span class="source">Flickr/dbking</span></span>
</figcaption>
</figure>
<p>He wrote the following letter to his wife as he returned to the US after a successful mission in August 1797:</p>
<p>“I am wearing large moustaches, long, beautiful, and black (a little grey however). Do you want me to cut them here, or do you want to see them and cut them yourself? Tell me, and I will obey you without the least resistance. I wager that you will tell me to cut them here, and I wager that you will be right. </p>
<p>"Is it necessary to tell you why I have left them? There is a proverb which is only too true, although very humiliating for humanity, who makes himself the lamb, the wolf eats. No part of this proverb is so useful as in <a href="http://en.wikipedia.org/wiki/Barbary_Coast">Barbary</a>. I was earnest in arriving there, and as I am a lamb at heart, it was necessary to hide this character under the exterior of another animal. And my moustaches give me fairly well the air of a tiger, [a] beast that the wolf does not eat. They have been very useful in my affairs. I attach no price to them except as the sole souvenir of the services which they have rendered me. I put them on your altar, pronounce on their fate…”</p>
<h2>Protest power</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/5343/original/Movember_contest_2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/5343/original/Movember_contest_2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5343/original/Movember_contest_2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5343/original/Movember_contest_2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5343/original/Movember_contest_2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=543&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5343/original/Movember_contest_2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=543&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5343/original/Movember_contest_2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=543&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Moustache culture has been important through the ages.</span>
<span class="attribution"><span class="source">AFP/Wildbird</span></span>
</figcaption>
</figure>
<p>Just as facial hair has been used as a tool to ingratiate oneself with another culture, it has also been used for international, cross-cultural political protest. </p>
<p>In 1953, in an attempt to defuse a political conflict, the British Governor of Uganda exiled the <a href="http://www.britannica.com/EBchecked/topic/399789/Mutesa-II">King of the Buganda region</a>. The King’s male subjects vowed to grow their beards and hair until he was returned.</p>
<p>Some of them were employed in the Ugandan civil service, leading the Governor to complain that the rugged appearance was not befitting of Her Majesty’s civil servants. Nevertheless, the beards stayed. </p>
<p>Within two years this unconventional protest succeeded in ending the King’s exile, and the “band of bearded men” decided to meet at Entebbe Airport and collectively shave their beards as the King’s plane landed. Despite a cultural custom that the King could not touch another man’s hair clippings, the piles of shaven beards were scooped up from the airport floor and used as the stuffing of a cushion, which the King graciously accepted. </p>
<h2>Adding identity</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/5341/original/Movember_Competition_winner.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/5341/original/Movember_Competition_winner.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5341/original/Movember_Competition_winner.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5341/original/Movember_Competition_winner.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5341/original/Movember_Competition_winner.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5341/original/Movember_Competition_winner.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5341/original/Movember_Competition_winner.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Moustache used to be very important to Europeans.</span>
<span class="attribution"><span class="source">AFP/Jonathan Nackstrand</span></span>
</figcaption>
</figure>
<p>Before Christopher Columbus “discovered the Americas” in 1492 Westerners were the bearded ones, and the “exotic foreigners” were clean-shaven. Columbus’ biographer, Bartolomé de las Casas managed to summarise his journal, and revealed a bearded Columbus’ first meeting with the natives of the Bahamas:</p>
<p>“The Indians, who were frightened by [the Spaniard’s] beards, by their whiteness and by their clothing. They went to the bearded men, especially to the Admiral…and they reached out to their beards with their hands, wondering at them as they [the Indians] never have them, and viewing very attentively the whiteness of their hands and faces.”</p>
<p>Thus the beard became a crucial part of European identity, whereas in earlier, and again later centuries it would represent savage cultures. But for a time, the native civilisations stretching from South America to Canada would refer to Europeans as “the ugly bearded ones.” </p>
<p>The politics of facial hair turned violent in the late 1500s, when two Portuguese traders were captured after a battle with Tupinambá Indians in Brazil. The Tupinambá custom was to pluck their hair as soon as it sprouted from every part of their body. After they noticed the significance that the Portuguese attached to their beards, they decided to tear out their prisoners’ beards as a final humiliation before murdering them. </p>
<p>So throughout this Movember, keep in mind the luxuriant international history of facial hair; its embodiment of masculinity and culture, its role in diplomacy, and the shame that it has to end on November 30.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/5344/original/Movember_longest_mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/5344/original/Movember_longest_mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=356&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5344/original/Movember_longest_mo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=356&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5344/original/Movember_longest_mo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=356&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5344/original/Movember_longest_mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=447&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5344/original/Movember_longest_mo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=447&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5344/original/Movember_longest_mo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=447&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">You probably won’t be able to grown this before November 30th. But give it a go. It’s for charity.</span>
<span class="attribution"><span class="source">EPA/Stringer</span></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/3988/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brett Goodin is a participant in Movember.</span></em></p>You may notice more than a few of your friends and colleagues are a little more hirsute than normal this month. The annual charity event Movember encourages men to grow moustaches to raise money and awareness…Brett Goodin, PhD candidate in American history, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.