Opinion: the trouble with single-issue campaigns

It is crucial to appreciate the unintended harmful consequences of single-issue campaigns, argues Dr Mohammed Razai.

Single-issue campaigning and advocacy about health conditions are rising. With a clear agenda, clarity and purpose, activists campaign for more awareness, better care and prevention, and increased resources and funding for their cause on diverse health problems including prostate cancer and menopause.

Thanks to the internet, social media platforms and 24-hour TV news, there are many effective ways and markets for the campaigners’ views, emotive stories and perspectives. Many celebrities, politicians and influencers are then using their large public platforms to amplify those messages.

Undoubtedly, many campaigners, including professionals, laypeople and celebrities, are well meaning. The health conditions are important, and the suffering of individuals is undeniable.

However, we rarely hear about the unintended consequences of such campaigns for better access, greater resources and more awareness.

At the outset, it is crucial to distinguish genuine health campaign groups from ‘Astroturfing’ – fake grassroots campaigns to mask the real sponsors (corporate and political) of a message or organisation and make it appear a legitimate group. The purpose is to give credibility to the message (such as the promotion of a particular product) without full disclosure of who is behind it.

But even genuine single-issue campaigns with noble goals and lofty ambitions are not without problems. Every advocacy group wants its own message and agenda promoted and prioritised. Where GP care is concerned, this would mean more convenient and better access for a patient cohort, more time spent caring for them, better diagnosis, treatment, follow-up and referral.

In an ideal world of infinite resources and time, this would not be an impossible task. However, even under ideal circumstances, GPs’ time, attention and resources are limited and they must balance innumerable and sometimes competing demands. General practice, especially now, is going through a crisis in funding, workforce and morale. With each extra item that is added to the workload, something else has to give, including diversion of resources from another patient cohort.

This raises further ethical dilemmas, tensions and conflicts about ensuring justice and equitable access to resources for all, including those without an advocacy group supporting them. This becomes particularly concerning if the demands of one group get statutory priority over others, such as mandatory health checks for a particular age group.

The campaign groups may raise awareness about a condition without any mechanism to ensure its subsequent safe and appropriate management through the health service. They may also demand interventions that are not supported by evidence or are not practical.

Despite the good intentions of the prostate cancer awareness campaign Movember, its effects probably result in a large number of healthy individuals requesting tests, investigations and further referrals that probably lead to harm. A major systematic review in 2018 concluded that PSA testing did not affect overall mortality and warned against the long-term harms of screening, ‘including complications from biopsies and subsequent treatment, as well as the risk of overdiagnosis and overtreatment’.

Many awareness campaigns are either started or taken up by well-heeled journalists and celebrities without a nuanced understanding of the issues, proper context or balanced discussion. The impact of high-profile campaigns, especially when led by a celebrity, such as the TV documentary Sex, Myths and Menopause, can be enormous and they usually lead to an outcry about the poor standard of care with a particular emphasis on lack of awareness, poor diagnosis and treatment by GPs.

In 2019, a template letter for patients who had been refused HRT to send to their GPs,written by a menopause campaigner who runs a private menopause clinic, was criticised for its ‘threatening and unprofessional’ language. As a BMJ article highlighted, the author of the letter previously had financial relationships with big pharma companies including Pfizer, Meda, Mylan and Besins. It is therefore essential to be aware of the vulnerabilities of campaign groups to financial interests, including those of the drug companies, as well as the dangers of overdiagnosis and overmedicalisation.

Then there is the issue of widening health inequalities – in particular racial health inequalities as a result of preferential treatment of some health conditions and services. Which campaign groups gain prominence depends on a number of factors, including celebrity backing, media attention and funding. The implication is that the health concerns of a white celebrity are likely to be taken more seriously than those of others not fortunate enough to have a platform.

It is crucial to appreciate the unintended harmful consequences of single-issue campaigns. It is more important than ever to allocate our limited resources according to ethically justifiable and publicly defensible principles. The focus of GP care should be on the health needs of the whole population, not just who has the most effective campaign and advocacy.

Dr Mohammad Razai is a salaried GP in south-west London and an NIHR in-practice fellow in primary care at St George’s, University of London

Competing interests: None
Acknowledgements: The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.