Published: 30/06/2005, Volume II5, No. 5962 Page 17
I had an awful day earlier this month. I had to fly from London to Belfast and back within a few hours, and it caused me extreme anxiety.
Why? Because I am afraid of flying, and in particular of taking off and landing. So two short-haul flights in one day made me stressed.
But I have to fly for my work, so I bite my nails, grab hold of the armrest, opt for an aisle seat so I can't see out of the window, and just do it through gritted teeth. It is the only solution to my unwarranted anxiety.
Some might say I would also benefit from attending fear of flying therapy (there is such a thing), but I do not think anyone would recommend any other course of action.
In particular, I do not think anyone would sensibly suggest as a response to my irrational fear that I should just stop flying, thereby reducing the imagined risk. In fact, as we all - even I in my heart - know, flying is by far the safest form of transport, and it is getting safer and safer.
A sensible approach to my flying phobia would be to inform me that it is unfounded, and explain why. As one captain said as I landed at Heathrow from a transatlantic flight:
'You're now coming to the end of the safest part of your journey. Please take care driving home.' So why are people's irrational, unfounded fears for their health treated in an entirely different way?
Why are they seen as providing a reason to act on the supposed health risk, rather than providing a need to counteract the unfounded fear?
A recent example is found in research released last month by Cancer Research UK, claiming that 60 per cent of women in the UK - more than in any other country - are terrified of developing breast cancer.
The charity's response was to take the opportunity provided by this research to promote the trial of anastrozole, a drug currently used to prevent the recurrence of breast cancer but which could, possibly, be taken as a daily dose to reduce the risk of developing the disease in the first place.
Almost half of the fearful women in the survey said they would swallow such a pill.
Cancer Research UK said the survey highlighted not only the need for preventive measures to reduce women's risk of developing cancer, but also the importance of reassuring them. So are drugs now being developed not only for the purpose of curing diseases, but also to counter fears?
Reducing real risk is not at all the same as providing reassurance, especially if the anxieties in the first place are so out of proportion.
What if a survey showed that one in four men aged 18-25 were also afraid of developing breast cancer, when male sufferers of the disease are extremely rare?
Does that mean we should prescribe them a preventive drug, which would counter the negligible risk of developing the disease, just to make them feel less afraid? Of course not.
A responsible health service should tell them that they simply should not be so worried. Any other course of action is unfair to the would-be patient, not to mention being a real waste of resources.
There are tried and tested ways to reduce the likelihood of developing breast cancer which Cancer Research UK promotes.
These include tackling obesity and reducing alcohol intake. Given that we should all do these things, to our broad benefit, wouldn't public money be better spent on public health campaigns around these issues rather than on preventive drugs?
Of course, breast cancer should be of real concern to everyone, even though it is still overwhelmingly found in post-menopausal women.
But as Cancer Research UK itself points out in a separate document to the survey, we should be becoming less and less afraid.
Breast cancer survival rates are gradually increasing due to earlier detection and improved treatment.
So why is not Cancer Research UK countering the picture of doom and gloom emerging from its survey with sound facts and figures filled with optimism?
It is not only breast cancer that stresses us out. Heart disease is another area of increased public concern.
We all get so worried about it that you can now get your cholesterol tested at most corner chemists. Yet these tests have little purpose.
Despite its death-inducing image, a simple high cholesterol-level reading does not say very much about how likely you are to develop heart disease. Such a reading is far more likely to lead to high anxiety than a cardiac arrest.
But with heart failure, there is a supposed preventive drug as well:
the all-pervasive aspirin. Taking aspirin, however, is no sure-fire guarantee to prolonged good health.
Eating oily fish and taking regular exercise more may do the job just as well.
If nothing else, there would be fewer real risks. A recent, rather controversial study showed that lowdosage aspirin treatment in healthy over 70-year-olds may lead to lifethreatening bleeding.
It is sad when pioneering, innovative medical charities pander to panic.
It is sadder still if the health service follows this lead and makes fear a catalyst for providing care.
Instead, tell patients the truth. We may never have been more concerned about our health, but we have never been healthier. Let's exploit any widespread concerns to reassure and re-educate through public health campaigns.
That is far better than using those fears to promote preventive drugs. .
Dea Birkett is a writer on health and social care issues. She can be contacted through www. deabirkett. com. Next week's columnist is Simon Stevens, president of UnitedHealth Europe and the prime minister's health adviser from 1997 to 2004.
HSJ is holding a conference on Delivery Choosing Health in London on 12 July. For details visit www. hsjchoosinghealth. co. uk