Of mice and “man flu”

Alan Cassels says he rarely gets the flu. But he’s happy to have a research-based pretext to begin construction of a man-cave. All in the name of health, of course.

Spreading like a virus on steroids, a BMJ feature article about the “man flu” shows there is now “science” behind the claim that men seem to have worse symptoms–and may be justified in complaining about them more vocally and persistently than women–when suffering from colds or the flu.  

Generating stories in Newsweek, CNN, LA Times, US News, USA Today, and CTV, this article is further proof that no matter how implausible the premise, almost nothing will stop clickbait-y research topics from getting picked up by news outlets and spread to readers across the globe without critical evaluation or context. 

Who was in on the joke?

Some savvy health reporters were attuned to the playful spirit of BMJ’s Christmas edition, which is known for its humorous medical studies. The UK’s Guardian notably cautioned high up in its coverage that the research was “somewhat tongue-in-cheek.” The LA Times also cued readers into the “whimsical” nature of the research early on. 

It’s clear, however, that some media outlets weren’t in on the joke. They earnestly reported the “facts” from this so-called “study” as, well, facts.

In his article, Canadian researcher Kyle Sue, MD casts a wide net for available evidence, trolling the world’s literature on sex differences in response to the cold or flu. He captures a ragtag haul of theories, hypotheses, mouse studies and test tube research, highlighting whatever might explain the stereotype that men whine and whinge excessively when they have a cold or a flu — and reporting almost nothing that cuts the other way. 

He maintains that “the concept of man flu, as commonly defined, is potentially unjust. Men may not be exaggerating symptoms but have weaker immune responses to viral respiratory viruses, leading to greater morbidity and mortality than seen in women.” 

How about that mice connection?

We’ve cautioned before against drawing conclusions about human health from animal research and decried coverage that asserts links between various mouse-applied “treatments” and memory loss, obesity, vision loss, and fertility, among other issues. Yet here, few reporters seemed inclined to step back and question Dr. Sue’s nose-stretching mouse studies, or acknowledge that the cheeky British journal might be having a laugh at readers’ expense. Newsweek reported earnestly that “The language in the Christmas issue of The BMJ is traditionally tongue-in-cheek, but the science is held to the same rigorous standards it would be any other time of the year.” 

But was this actually “science”? While most news outlets reporting on Sue’s article described the paper as a “study,” the heading at the top reveals that this actually was a “feature” article, which this description of the BMJ Christmas issue clearly classifies as “non-research.”

In fact, a careful look at the methods suggests that this was just one man dredging the literature for studies that would support his hypothesis. It’s fine to have an opinion and to marshal an argument in support of it, but let’s not pretend that such selective cherry-picking amounts to a “study” or “rigorous” science.

Sue, it must be said, does an excellent job of selling his argument to reporters, telling CTV that he was “tired of being accused of over-reacting” when he fell ill.

Whether this is true belief or deadpan genius is admittedly difficult to untangle.

“I’ve been told to ‘man up,'” he told the Canadian news outlet, “But if ‘manning up’ means having a weaker immune system, I would probably prefer to say ‘woman up.'”

Like Newsweek, CTV claims the BMJ Christmas issue “is meant to be a more humorous edition of the journal, though still featuring legitimate research.”

A veneer of plausibility is all it takes

Sue backs up his hypothesis by asserting that the hormone estradiol, which is found in higher levels in women, is “immunoprotective” and testosterone, meanwhile, is “immunosuppressive.”  While this has the veneer of plausibility, few news outlets entertained any question of the teeny-weeny fact that men are not mice. And fewer still cautioned that what happens in test tubes frequently stays in test tubes.

Apparently, some research shows that when you infect nose cells with the flu, then expose them to estradiol, there is more of an effect on female nose cells than male nose cells. But really, can this be called reliable evidence that the “man flu” is a thing?

Sue does cite a handful of human studies that demonstrate possible sex-related differences in response to the flu. But those observational studies were also susceptible to bias. CNN does a good job of honing in on those problems, noting that the studies didn’t account for smoking and drinking rates that might have influenced the results.

Should we be laughing or crying?

Many journalists seemed to catch the whiff of parody with the conclusion of Sue’s article. It makes the case for special male-friendly spaces where “men can recover from the debilitating effects of man flu in safety and comfort.” These man caves, he suggests, could be “equipped with enormous televisions and reclining chairs.”

But by the time there’s any hint of a joke, many readers will have already swallowed the premise that reporters also seemed eager to gulp down. And in that sense, the coverage mirrors so much of what we see day in and day out — where almost laughably weak research is enthusiastically touted as the next “breakthrough” or “gamechanger,” and key caveats and context are relegated to the bottom of the text, as afterthoughts.

If laughter is the best medicine, this BMJ article is a fine tonic. It might help if journalists could better inform us when we should be laughing with such an article, versus when we should be laughing at it.  

Addendum: If you are still wondering if ‘man flu” is real, then watch this hilarious parody from the BBC sketch comedy “Man stroke woman.”

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Comments (3)

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Carolyn Thomas

December 13, 2017 at 6:10 pm

This man flu coverage requires a mindset somewhat like that needed when reading The Onion: the BMJ’s famously oddball Christmas issue is required reading for those of us who tire of all those bleak, indecipherable academic tomes that will be refuted at this time next year (or month). I LOVE the Christmas issue each year (e.g. this year, the lexicon comparing UK and US medical terminology was also delightful – and oh-so-non-scientific!)

But perhaps the BMJ needs to spell out the fun in a seriously worded disclaimer for the benefit of amateur journalists at Newsweek, CNN, CTV et al who aren’t in on the joke!

Charles L Carter

December 13, 2017 at 8:12 pm

It’s high time all this misandry comes to an end!!!
I’d never heard of “man flu”, so I scanned one of the news reports. After one sentence I a) knew what they were talking and 2) literally laughed out loud. Like so much else in our lives , all we really want is for wives and girlfriends and maybe doctors to be extra nice for a couple of days!

Bob Roehr

December 14, 2017 at 4:16 pm

There is a bit more to the data than mouse studies. It is well accepted that the immune systems of males and females differ in all mammals, including humans, with the female being stronger. That plays out in things like higher incidence of autoimmune disease in females. Several studies have shown a stronger response to vaccination in women than in men.