Man flu is real

“Man flu” may be real, according to a study published in the British Medical Journal.

The study, written by health scientist Kyle Sue of the Memorial University of Newfoundland in Canada – and who is, it should be noted, a man – links lab studies, epidemiological findings and evolutionary theory to conclude that weaker immune responses among men compared to women are statistically significant.

Furthermore, he concludes, the diminution of care that arises upon a diagnosis of man flu is “unjust”.

Sue cites several mouse-based studies, stretching back as far as the Seventeenth Century, which found that females have higher immune responses than males, leading to the idea that sex-dependent hormones play a significant role in reactions to influenza infection.

Turning to human data, he notes that the World Health Organisation recommends that gender be considered when evaluating potential outcomes from influenza infection. He cites Hong Kong epidemiological records covering flu seasons from 2004 to 2010, showing that adult men had a higher incidence of hospital admission.

Among other studies, he also points to a 1993 paper in the journal Social Science & Medicine, in which data from a US hospital Common Cold Unit was used to show that “clinical observers … under-rate men’s symptoms”.

It could be said, however, that in this instance Sue is cherry-picking the findings of the source paper, which also found that “men were significantly more likely to ‘over-rate’ their symptoms in comparison with the clinical observer than were women”.

(For what’s worth it should be noted that the study author, Sally Macintyre, of the Medical Sociology Unit in Glasgow, Scotland, is not a man.)

Sue’s arguments perhaps find their most robust footing when he turns to comparative biology and evolutionary theory for evidence.

He notes a wide range of studies across mammal species that indicate males have weaker immune responses than females.

This, he suggests, is because males have greater investment in short-term gains – such as holding territory and passing on genes – than long-term success.

“Across species,” he writes, “the male strategy of ‘live hard, die young’ arising from stronger intra-sexual competition than among females has led to less investment in immunity.” 

He quotes a 2011 study into sex differences in influenza responses which finds that male inactivity while ill may be important because “it promotes energy conservation and reduces the risk of encountering predators.”

In other species, so also in humans. 

Sue writes: “Classic modes of energy conservation may include lying on the couch, not getting out of bed, or receiving assistance with basic activities of daily living, which could all be effective for avoiding predators.”

In calling for the condition of man flu to be reassessed and the stigma attached to it removed, Sue suggests the creation of dedicated treatment facilities.

“Perhaps,” he concludes, “now is the time for male friendly spaces, 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.”