An open letter to the organisers of #Movember

Dear Movember,

I have been encouraged to write to you by a friend and colleague after having a conversation with her about my reasons for growing a charity moustache this year (which is now a full handlebar, having trimmed from full beard, rather than starting clean shaven – see photo). She felt it was important that I told you what I told her.

This is the first year I have participated in moustache growing, sculpting and curling. I first heard about Movember three years ago when working as a palliative care doctor in a specialist unit during my training to be a General Practitioner. One of the specialist nurses drew our attention to it as a way of raising money for and awareness of cancer in men. Having several men in my care at the time with advanced palliative prostate cancer, I thought this was an ingenious idea and extremely important.

Alas, I moved on and forgot about it and didn’t get round to it until now. What inspired me this year was your press release in September that you were adding men’s mental health to the agenda. This was for a couple of reasons. Firstly, mental health is my passion and special interest. Secondly, in recent years I had become concerned that fund and awareness raising for certain physical illnesses had eclipsed the far greater need to deal with the consequences of psychological illness. As a practising GP, I had become concerned that the vast majority of our time and resources were going to healthy people, whereas those who were in acute distress (for example, someone with severe depression having suicidal ideas) were having to wait extraordinary lengths of time to be seen.

The closer it came to November, the more time I spent on the Movember website and the greater my concerns grew. Far from allaying my concerns, the website seemed to suggest screening healthy people above and beyond what is currently considered appropriate by NHS screening. The suggestion that men as young as 40 should have their cholesterol and PSA checked, when their is not a shred of evidence to suggest that such testing would improve their outcome (see the Cochrane reviews on the subject) seemed at best a worrying diversion of resources from the important practice of treating sick people, and at worse, potentially harming healthy young men by potentially putting them on a lifetime of medication from which they are likely not to achieve benefit, or sending them for invasive tests which had the potential to leave them incontinent or impotent, from which they may not receive any benefit. Effectively it seemed to be about making healthy people into patients by adopting an aggressive preventative health strategy

I was also concerned that there seemed to be no suggestion on the site that any money raised would go towards men’s mental health, despite the fact that:

– 10 times as many men will die annually from suicide than testicular cancer.

– Mental health problems create more morbidity than prostate cancer and is likely to do so at a much younger age.

– Whereas a diagnosis of cancer triggers contact with numerous professionals, support groups etc. a diagnosis of a mental illness is often suffered alone, with patchy access to evidence based treatments, widespread stigma, misunderstanding and denial.

This is why I have continued with my moustache growing efforts but have decided to donate the money raised to a local mental health charity, Hafal, which assists in finding affordable housing, sustained employment, psychological support and battles stigma and misunderstanding.

I would love to support Movember in future years. To help me do so I would ask that you change your campaign to:

– Focus on the issues that cause men the greatest burden of disease, especially mental health issues, and focus on treating illness, not turning healthy people into patients.

– Ensure the advice given on the site is in keeping with the best evidence available, particularly Cochrane reviews, and does not promote patterns of testing or screening that may cause more harm than good.

– Ensure that when screening tests are discussed, the harms in terms of over-diagnosis, false positive rates and harms from treatments are discussed alongside the benefits, and that the information encourages the reader to make an informed decision, rather than promote a single best course of action.

I very hope to be growing a moustache for Movember next year, providing the website, campaign and recipients of funding are such that I can be sure that I am taking part in something that is clearly going to improve the state of Men’s Health in the UK and worldwide.

Sincerely yours,

Dr Simon Braybrook BSc. (Pub Health) MB BCh. MRCGP
Associate Academic Fellow and General Practitioner
Cochrane Institute of Primary Care and Public Health
Cardiff University
Health Park
CF14 4XW


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