How health campaigns may make us MORE ill

AFEW months ago, the NHS issued a guide to doctors, nurses and other clinical staff listing planned health awareness campaigns it knew of for the year ahead — no fewer than 81.

The campaigns, often run and funded by charities, Government departments or drug companies, included high-profile ones, such as Dry January and world Cancer Day, on february 4. But they also featured less wellknown initiatives such as world Thrombosis Day (October), Nutrition and Hydration week (March), and functional Neurological Disorder Awareness Day (April).

Awareness campaigns such as these — using TV, radio, print and social media — are an increasingly popular tool for educating the public. The theory is they will be more likely to recognise the symptoms and seek medical help sooner, improving the chances of a full recovery. But some doctors are casting doubt on whether certain projects are beneficial.

The fear is that prompting millions of people who generally feel fine to focus on symptoms of often quite rare illnesses will make some begin to experience those symptoms, even when there is no underlying disease present. This phenomenon is known as the nocebo effect.

for example, studies show that about 60 per cent of cancer patients undergoing chemotherapy feel sick before treatment even begins, such is the negative expectation about the side-effects.

Last year, the president of the Royal Society of Medicine and former leader of the Royal College of Psychiatrists, Sir Simon wessely, called for an end to public awareness campaigning about mental health problems. He said he feared such initiatives could result in already over-stretched NHS mental health services being overrun by patients convinced they are ill.

In a BMJ interview, Sir Simon said: ‘we don’t need to be more aware. we can’t deal with the ones who already are aware.’

He said alarm bells rang when a National Union of Students survey suggested 78 per cent of students had mental health problems — ‘which seems unlikely’.

His concerns have been backed up by a report in the Journal of Medical ethics by scientists at flinders University in Adelaide in Australia. One initiative focused on neuropathic pain, a burning, stabbing or shooting pain that affects feet or hands. Designed to encourage patients to see a doctor, it used graphic images to represent the pain — fire for the burning feeling, and stabbing.

The researchers say these icons ‘reinforce the idea of the sensation in the viewer’s mind and increase the likelihood of a nocebo effect’.

Some awareness drives are instigated by companies that make drugs for the illness in question.

In the UK, firms are barred from advertising prescription medicines, but through funding awareness campaigns they increase the chances of undiagnosed patients seeking help and being put on their medication. As the Australian researchers put it: ‘The aim is to increase demand for the therapy produced by the pharmaceutical company that sponsored the campaign.’

Research by Peter Tyrer, an emeritus professor of community psychiatry at Imperial College London, suggests one in five patients seeing a doctor has abnormally high levels of anxiety. He worries that the barrage of campaigns is making it worse.

Professor Tyrer says problems mostly arise when awareness campaigns emphasise symptoms that are non-specific and could be caused by something innocuous. ‘Take twitching muscles, which is very common — I’ve seen numerous patients worried they have motor neurone disease because they read a leaflet that said this was one of the signs,’ he says.

Twitching muscles are usually due to tiredness (when muscles are tired, nerve fibres release abnormal electrical impulses).

Professor Tyrer stresses that some awareness campaigns are justified — such as cancer initiatives, for instance bowel cancer, which encourage patients to act quickly if they suspect a problem. early treatment boosts their chances of survival.

BUT Dr John Cosgrove, a GP in north warwickshire, has been especially critical of the Government’s lung cancer awareness campaign, which urges people to see a GP if a cough lasts three weeks.

He says many self-limiting coughs (those that get better on their own without treatment) last around four weeks, and one senior lung specialist he knows has complained her clinics are overrun with demand for chest X-rays as a result of the campaign.

Professor Tyrer estimates the annual cost to the NHS of dealing with patients who undergo unnecessary tests could be as high as £56 million. But the Association of the British Pharmaceutical Industry, which represents drug companies, insists campaigns can have a positive effect on patients’ health.

Deputy chief scientific officer Sheuli Porkess says: ‘ These campaigns can help people start a conversation about what help might be available.’