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Beyond 'Man Flu': There May Be Real Differences In How Men And Women Respond To Infection

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(Tomas/Flickr)

"Man flu" is real, and it’s time to make accommodations for the men who suffer inequitably from it, according to an article published this month in the esteemed British medical journal, the BMJ.

“Perhaps now is the time for male-friendly spaces,” writes Dr. Kyle Sue, “equipped with enormous televisions and reclining chairs, to be set up where men can recover from the debilitating effects of man flu in safety and comfort.”

Before you take to your recliners, men, know this: It’s a joke — mostly.

Sue’s article is part of the medical journal’s Christmas edition, traditionally full of tongue-in-cheek reports. And while much of the article is pure buildup to a punchline, Sue does offer a semi-serious review of the scientific literature on how men and women respond differently to flu in particular, and to respiratory infections more broadly.

“Man flu” has lately become a term — generally used by women, and with a subtext of snark — to describe men’s perceived exaggeration of symptoms. The implication is that the flu is the flu, but some men just can’t handle it.

Danish naval personnel suffering from Asian flu occupy beds in temporary sick quarters set up in a gym in Copenhagen's navy shipyard to handle the large number of patients, Oct. 12, 1957. Reports indicated that between 15 and 25 percent of the men were down with the flu. (AP)
Danish naval personnel suffering from Asian flu occupy beds in temporary sick quarters set up in a gym in Copenhagen's navy shipyard to handle the large number of patients, Oct. 12, 1957. Reports indicated that between 15 and 25 percent of the men were down with the flu. (AP)

As evidence that men may in fact suffer more than women, Sue cites mouse studies that found stronger immune responses in female mice than in males, linked to sex-specific hormones. He notes human studies that suggest women have a stronger immune response to the flu vaccine, sometimes with more severe side effects, and that men are more likely to die from flu and other respiratory infections — though that could be in part because they are also more likely to smoke and less likely to seek preventive care.

Sue began reading about man flu when he was a graduate student at McMaster University, recovering from the flu himself, and he was asked to make a two-minute presentation on any topic.

“I was actually quite surprised that there was already so much on the topic,” he said in a phone interview. “I just dived in headfirst and thought, I’ll do what no one’s done before, actually put all of these studies together into a summary, a review, with the bonus that if I did find that 'man flu' was indeed a real phenomenon, then men around the world would have some mechanism of defense next time they are criticized for exaggerating their symptoms.”

The review led Sue to conclude that using the term “man flu” pejoratively “is potentially unjust.” He calls seriously for more research on the sex-specific differences in immune responses, something actual experts on the topic agree is needed. But Sue, who is now the sole doctor for 3,100 people in the remote — no running water, fly-in only — Canadian Arctic town of Arviat, also has fun with the topic.

“An example of future research,” Sue writes, “may include a controlled trial in which men are infected with a respiratory virus, then subjected to rigorous research conditions in which all their requests are met by a healthy designated caregiver or they are left to fend for themselves.”

The World Health Organization published a report in 2010 describing how the H1N1 flu outbreak of 2009 hit women of reproductive age hardest. It explored how flu has affected men and women differently through their lifespan and throughout history. More men died in the 1918 flu outbreak, for example, possibly because of co-infection with tuberculosis. “Significantly more research is required” to understand the effects of sex and gender on flu virulence and vaccination, the report concludes.

Elsewhere, researchers have called for more attention to sex as a variable in immune responses more broadly.

The matter is a legitimate public health issue, one that could help tailor prevention and treatment to each sex for better outcomes overall. But too often, the conversation devolves into a debate that causes women roll their eyes and men to reach for their video game controllers.

Take this study out of the U.K. last year: Researchers at the Royal Holloway University of London hypothesized that some viruses have evolved to be less virulent in women than in men, so that they have a greater chance of being passed from mother to child.

More than one media outlet  reported that the new study confirmed the existence of "man flu," despite the fact that the study authors themselves said their findings were not relevant to influenza, which does not rely on mother-to-child transmission.

“That was a little bit frustrating,” said biologist and co-author Francisco Úbeda. “We’re not talking about 'man flu.' Most of the models actually wouldn’t apply to 'man flu.' ”

Úbeda conceded that any attention drawn to the topic of sex and immunology may be beneficial in the long-run, “as long as it’s not frivolous.”

Many reporters seemed not to get Sue’s joke, writes Alan Cassels in a critique for HealthNewsReview.org, “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." The Boston Globe published a story Thursday saying that Sue's "scientific report" throws doubt on "one of wifehood’s most treasured truths: that men, who would be unable to withstand labor pains, can’t handle the common cold, either."

Sue says he has been overwhelmed by the response to his article, including interview requests from 120 reporters around the world.

Humor aside, “This is serious research," he said, “and I really think there is a place for it.”

Here's one thing we don't need research to tell us: Man or woman, the flu is miserable.

Chelsea Conaboy is a freelancer who writes often about health care. Find her at chelseaconaboy.com and on Twitter @cconaboy.

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