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Are we aware of the consequences of raising awareness?

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There was an interesting discussion on Radio 5 Live recently between Glasgow GP Dr Margaret McCartney and Kris Hallenga, the founder of the CoppaFeel breast cancer awareness charity.

The interview was arranged in relation to an article Dr McCartney wrote for the BMJ in the first of her new weekly columns for the journal, which criticised The Sun newspaper’s rather hypocritical page 3campaign to encourage young women to regularly check their breasts for lumps. Whatever you might think of the piece, you have to admire Dr McCartney’s boldness for taking on both a national newspaper, and debating the emotive power of the Pink Ribbon for her first article.

The interview exposes how screening for disease and responding to symptoms are so often blurred in the media and by health campaigners – whether this is due to simple ignorance or a deliberate ploy to increase the power of the campaigns is uncertain, but that it is helpful is without doubt.

The Sun’s campaign calls for the screening of asymptomatic women through regular breast self-examination, and Dr McCartney asserts is that the benefits and harms of this strategy are not sufficiently understood to be able to promote such advice - and what evidence we do have suggests it may do more harm than good.

Ms Hallenga says that she ‘ignored her symptoms for so long’. However, ignoring the symptoms is not the same as failing to remember to check yourself when you don’t have symptoms – there is something more going on here, which brings me to a fundamental problem with ‘awareness-raising’ health campaigns.

The logic of raising awareness goes like this: people aren’t seeing their doctor quickly enough about a certain disease and this must be due to a lack of knowledge, understanding and awareness of the condition; there should be a campaign to raise awareness so that people will be better informed and see their doctor more quickly; lives and money will be saved.

If we were all computer programmes and responded in a predictable way to data input this would work a treat, but people are far more complicated than that.

There are many reasons why someone may choose not to see their doctor when they have significant symptoms. Ignorance may be one of them, but in this day and age of instant health information courtesy of Google, it is surely less of a factor than it used to be – the danger is now the converse, that too much information may be having a detrimental effect. If a woman finds a breast lump - by chance or checks - she is likely to be aware that breast cancer is a possibility, and yet some will delay seeing their GP despite this knowledge.

Other factors must play a part: fear of treatment; complex self-denial; embarrassment; being too busy. These attitudes might be improved by an awareness-raising health campaign, or might just be hardened by it.

Awareness-raising is usually championed by politicians whose motive is to improve a statistic or – for understandable reasons – by those with an emotional connection with the disease in question. The problem with this is that the focus is heavily biased towards those with the disease, with little consideration given to the potential harm to others who may be caught up in the campaign.

The justification is often that it reassures those who are checked out and found to be OK. But we should question the merit of a campaign which brings peace of mind to those who have been made anxious by the same campaign in the first place.

The ‘cough for three weeks could be cancer’ strategy is a good case in point. I have seen more patients with a cough since the adverts appeared – usually non-smokers who are conscious of their health and would never ignore symptoms for very long – and I am also aware of smokers who have been put off seeing their GP by this very campaign because they don’t want to be given bad news.

There is rarely any attempt to see how people will respond to these health messages and little consideration given to the fact that the same message might harden the resistance of those who should seek advice while unhelpfully altering the health-seeking behaviour of those who should not. We need to be bolder in challenging this, even if, like Dr McCartney, we end up being accused of acting ‘dangerously’.

Sometimes, though, if you can’t beat them you have to join them, and so I would like to launch my own awareness-raising campaign.

It’s simple and it goes like this: ‘Health awareness campaigns can do more harm than good – use with caution, apply common sense, and trust your instincts’.

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.

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