Are ribbon campaigns making us loopy?

Michael Fitzpatrick, a general practitioner, claims that disease awareness increases anxiety--and newspaper and magazine circulations--much more than it increases diagnosis

"And finally, today is colorectal cancer awareness day so here's our health correspondent--wearing the campaign's distinctive melaena coloured ribbon--to tell us about a new 'do it yourself' colonoscopy technique."

Perhaps not this week, but it can only be a matter of time before every day of the year is allocated to some disease or disorder and every news bulletin concludes with an awareness raising feature. But when does public enlightenment become morbid preoccupation? Are we in danger of becoming so obsessed with the threat of disease that our quality of life is diminished?

Ovarian cancer

Powerful forces drive campaigns to raise public recognition of disease. Doctors seeking to raise the profile of their specialty or special interest sponsor voluntary organisations to attract funds and promote research. For politicians worried about their loss of influence and respect, health promotion activities offer a means of making contact with an atomised electorate.

Breast cancer

Pharmaceutical companies have notoriously promoted conditions--firstly, the menopause, now osteoporosis, anxiety and depression, erectile dysfunction, and childhood hyperactivity--as a means of stimulating demand for pharmaceutical products. Corporations whose products are blamed for encouraging obesity and causing heart disease are only too keen to improve their image by sponsoring life enhancing fun runs and marathons. Even television soap operas that are not based in hospitals or surgeries earnestly include public health messages about screening tests and healthy lifestyles. The vogue for exposures of doctors who are incompetent or corrupt has not displaced reports of research breakthroughs and novel therapies. Disease sells newspapers, magazines, novels, and autobiographies.

ME/chronic fatigue syndrome

There is no sign that the public regards the barrage of health-related propaganda as intrusive or oppressive. Indeed it seems that people can't get enough of it. The quest for information about matters of health and disease is--after pornography--the most common reason for logging on to the internet. In an anxious age, people fear disease more than ever and, feeling isolated and vulnerable, seek reassurance from doctors and other professionals--and from readily available sources of information such as NHS Direct. At a time when traditional forms of collective activity, from churches to trade unions and political parties, are in steep decline, the cancer research road race or the hospice charity event provide an alternative focus.

Although campaigners claim that their activities increase public knowledge about diseases and raise money for research, heightened awareness is not without its dangers.

Promoting disease awareness inevitably tends to inflate the problem of disease. Enthusiasts in any specialty always claim that the prevalence of the disease that is their particular interest is much higher than was previously thought. This tendency is most marked in the sphere of psychiatry, where the vagueness of diagnostic categories creates enormous scope for both the expansion of existing categories and for the creation of new disorders. Thus the campaign to "defeat depression" claims that this condition afflicts one in four of the population and the autistic spectrum has stretched to include every absent minded professor and trainspotter. Novel conditions like post-traumatic stress disorder and attention deficit hyperactivity disorder bring a widening range of normal experience within the framework of disease. Growing awareness of these conditions is likely to result in a growing scale of disability.

Disease awareness increases anxiety much more than diagnosis. It is striking that publicity about cancer tends to have its greatest impact on the media savvy young middle classes--those at lowest risk. In recent years doctors' surgeries have been flooded with victims of the vogue for men's health magazines, young men who have followed detailed instructions on testicular self examination, only to break into a cold sweat on discovering a tiny epididymal cyst or varicocele. Popular accounts of angina have encouraged an epidemic of "atypical chest pain" and thousands of "worried well" consultations.

Isn't it only common sense that greater awareness leads to earlier diagnosis, prompt treatment, and a better outcome? This notion has a powerful appeal, but unfortunately, like much commonsense wisdom, when subjected to cold scientific scrutiny it turns out to be a big disappointment. The problem is that in relation to the major killer diseases of our time--heart disease and cancer--the evidence for this proposition is equivocal. There is also considerable evidence that early detection--for example, of prostate cancer or of ductal carcinoma in situ of the breast--may lead to aggressive treatment with a high risk of adverse consequences, without prolonging life.

It is a sad comment on contemporary society that, at a time when we live longer and healthier lives than at any time in human history, so many young people pass their days worrying about the diseases that may befall them. In the form of disease awareness, death casts a long shadow over life.

Michael Fitzpatrick general practitioner, London
Email: fitz@easynet.co.uk


studentBMJ 2004;12:133-176 April ISSN 0966-6494