celebrity effects on health-seeking behaviour. from BMA news 12.4.14

This post has now been put up on the BMA Blog website here


Much a tattoo about nothing – a doctor’s perspective

ben's tatto

Someone I know and love has recently had another tattoo etched (or is it drawn?) over their left shoulder, the most recent of at least 16 tattoos that I know about, about their person. Perhaps, it is a symptom of growing older but there seems to be more and more people in more walks of life with tattoos. I have a number of unanswered questions about tattoos:

  • Why exactly do people get tattoos?
  • Just how many people get tattoos these days?
  • Do just young people get tattoos?
  • Are there associations with tattoos that we make as doctors?
  • Are these associations in fact a form of prejudice against those who choose to decorate their body permanently with ink figures, symbols and pictures?

Although the cultural significance to young people in the UK today of tattoos may be a subject for sociologists to ponder I find it interesting to consider the relationship of the tattoo with medicine. The prevalence of tattoos is perhaps something for our public health colleagues to consider but I do wonder if my perception of it is accurate?

In order to try to answer my questions I carried out a brief search of the NCBI database [1] for articles including the words “prevalence” and “tattoo”, or “perception” and “tattoo” or with the MESH term “Tattooing/psychology”  as applied to humans and in the English language. This non-exhaustive, but handy search revealed approximately 50 publications since I graduated as a doctor 7 years ago and began taking notice of tattoos.

Of these only 3 were carried out in the UK. One was a touching anecdote about a patient who tattooed the name of his rare medical condition onto his body [2], another was about the effect of tattoos on body image and self-perception of the recipient [3]. The same author had carried out research which closest answers one of my questions 4 years earlier when a study of 160 undergraduates resulted in the provocatively titled article “Unattractive, promiscuous and heavy drinkers: perceptions of women with tattoos” [4].

Since I have graduated it seems that tattoos are no longer confined to rock stars, sailors, soldiers and drug addicts. Even watching football highlights over the last few years has made me realise that more and more people younger than me are getting tattoos, and more elaborate and extensive tattoos at that.

It seems a shame that the only recent piece of research in the UK draws on the opinion of university students and comes up with such a negative connotation of tattoos [3]. I wonder if this feeling pervades amongst the medical profession? Do we use phrases such as “tramp stamp” – a derogatory term for a tattoo in the lumbar region that seems popular, especially amongst women? Do we associate tattoos, perhaps wrongly with increased risks of blood borne viruses, where the majority of the research seems to focus?

If one is to rely on the evidence base about tattoos, you could be led to believe that doctors perception of those with tattoos are those with risky behaviour, certain occupations, with hepatitis B/C or some other weird and rare disease contracted from Chinese ink [5]. Our older patients fall into the categories of criminal or regretful.

My search didn’t really answer my questions, but made me examine myself. It made me examine what I thought of people with tattoos, questioning whether my observations of ink-stained flesh slip into judgements and whether there is anything I could do to change this, if that were the case. I also realised that there is a massive gap in knowledge about tattoos. If tattoos are a risk factor for both physical and psychological illness, then perhaps we should at least have a handle on who is getting tattoos, where they’re getting them, why they are getting them and how it affects us as doctors when we see and treat them.

bens tattoo2


  1. Pubmed. http://www.ncbi.nlm.nih.gov/pubmed/ [accessed 8 June 2012]
  2. Whittaker RG, Turnbull DM, 2009. A diagnostic tattoo. Clin Genet. 75(1):37-8.
  3. Swami V, 2011. Marked for life? A prospective study of tattoos on appearance anxiety and dissatisfaction, perceptions of uniqueness, and self-esteem. Body Image. 8(3):237-44.
  4. Swami V and Fyrnham A, 2007. Unattractive, promiscuous and heavy drinkers: perceptions of women with tattoos. Body Image 4(4):343-52.
  5. Hamsch C, Hartschuh W, Enk A, Flux K, 2011. A Chinese tattoo paint as a vector of atypical mycobacteria outbreak in 7 patients in Germany. Acta Derm Vernereol. 91(1):63-64.

Caring and the community

Two of my heroes are Shane Claiborne and Anthony Watt. The first is famous in a Christian celebrity kind of way, the second probably only known by a few thousand Christians outside of his native New Zealand. The thing they have in common is the formation of intentional communities. That is, clusters of open households that share a daily and weekly rhythm of prayer and worship, as well as involvement is social projects.

They have both extended their families by allowing both needy strangers and friends to come live with them, share their houses, their space, their meals and their lives. They speak and write of the love that is fostered between people as they struggle to love God, each other, the world and themselves. They move me with accounts of the suffering that they can’t help but hold close to their heart as they give up more of their lives to express their love as God tangibly as love for those around them.

But where does that leave me as a father and husband who has re-discovered God in the last 3 years? Once my family and household had already been established.

Much as I would love to be able to be part of such a community, perhaps start a community like the ones that Shane and Ants are part of, I have a strong suspicion that this will not happen for a variety of reasons. Some of these are under my control, others are not. Simple inertia, comfortable living, possessiveness, children issues and the perhaps less need in a country where there is still social welfare to sustain the most needy at least at a financial level.

So I am slowly and reluctantly accepting that I won’t be a part of an intentional community in the next 20 years at least. I’ve almost gone through the frustration stage; every now and then it flares. And I’m working through the childish strops of “well if I can’t do this, then I just won’t bother at all and live my life like everyone else I know…” But that doesn’t quite sit right with me either.

I want so much more and so much less than how everyone at my workplace, on my street at my church lives with. I want so much more of God, his love and his suffering and I want so much less attachment to my worldly possessions and ambitions. I want to take seriously the commandment to love my neighbour and in that learn to love myself, through the experience of loving God and knowing I’m loved.

So, I’ve reached the point of resigning myself to “normal” family living, but carefully seeking and searching the principles of intentional living to see what aspects of it are helpful applications of the expression of God’s love that can be put in to practice in my family. After all, my family is an intentional community of sorts. I have chosen to share my life with a woman and two small people who daily expose my capacity to love, my inability to have patience, my weaknesses and strengths. And I grow closer to God as  I share their joys, wonders and sufferings. It’s just intentional living in a slightly smaller package.

I’m left asking myself if my family community is simply a place where I unwind after a day’s work or a place that I seek to love others, love the world and love God and through that learn to appreciate that I am needed and loved. Although we don’t have the space (at the moment) to invite anyone to share in that, I have the hope that wherever we are a small bit of what we grow here rubs off onto those we meet and those who enter our house.

Perhaps I need to accept that this is not a “watered down” intentional community, just one that looks and feels slightly different to the ones that my heroes so eloquently communicate. Not lesser, simply different. Not lesser, simply different. Repeat as required until my mind understands this and my heart believes.

Humbug of sorts

I took my two children to a school fayre yesterday. The wanted to see Santa Claus. He asked them what they wanted for Christmas and then asked me if they had been good enough to deserve their desired Christmas gifts. Of course I said yes, what else could I say in that situation, but I couldn’t help but think that yet another white lie was being drummed in to my 5 year old and 2 year old children. Namely, that we only get what we deserve.

Surely the whole message of Christmas is that Jesus, the son of God, became a human child and went on to become a man that would die in order that we would get what what we didn’t deserve – a relationship with a living God. If Jesus had asked God, “Well have they been good enough for the first Christmas gift?” I’m certain of the answer…

And it’s the little lies around Christmas that I dislike the most – because they disguise themselves as something that feels good and right, like only giving presents to children who’ve been good. Like singing about the colour of the nose of a mythological character that led him to be an outcast. Only for his acceptance to depend on him doing something worthwhile – again, his worth was in what he did, not who he was, poor Rudolph.

A few days to be tolerant and kind towards your extended family, so you don’t have to make quite such an effort for the rest of the year. A few weeks to think about the poor and homeless and give to charity, to absolve oneself from year-round compassion. A few days for me to work out what on earth Jesus has got to do with Christmas trees, Christmas cards, turkey, sprouts, mulled wine, mince pies, Christmas crackers, Santa Claus, commercialism, materialism, indulgence. If this is life in all it’s fullness then I’ve got it all wrong.

So I just smile weakly and bear it. Bear it for the sake of the little ones and hope that their little souls and mine don’t get crushed by the enormity of the Christmas monster. That one day they’ll forgive their parents for letting them believe in Santa Claus (and the tooth fairy). And I hope that on every day of the year I remember that the greatest gift of life that I have received was not dependent on how good I was and that I can show my children they are loved for who they are and not what they do.

Authentic community

This is an attempt to crystallise the thoughts that have been going around my mind for ages. The proposals and thoughts are all couched in the proviso that I have no formal theological training. So I apologise in advance if I have misinterpreted the message of the Gospel and I am more than willing to be corrected. I am also well aware that I am more than likely going to be hypocritical in the comments that I make.


What I would like to come up with is a short essay outlining the basis for the necessity for young Christians, all Christians, to be involved in social action and community. Perhaps this project could be called “Authentic Community” or “Authentic Action” for ease of reference, but it is really just working out how to make the Gospel real and relevant. So for the sake of clarity I’ll refer to this project as “Authentic Community” in this essay. It would be great to come up with the following statements:

· Mission

· Vision

· Values

But perhaps we need the young people to do that?

The crux of the problem

Put simply, how do you balance the following bible verses against one another:

“As the body without the spirit is dead, so faith without deeds is dead.” James 2v26


“For it is with your heart that you believe and are justified, and it is with your mouth that you confess and are saved” Rom 10v10.

The latter verse is part of a section in the Bible that explains that we can do nothing to earn the love of God and that we are simply to accept hi grace, but the passage in the letter from James rebukes believers who fail to live out that grace and fail to show it to others. Their faith is described as dead, meaningless, worthless. Despite that we know that nothing can separate us from the love of God, so once we have accepted his love and grace through Christ Jesus why do we need to bother to love others?

Back to Basics

Loving others is quite simply what Jesus commanded us to do. He said: ” ‘Love the Lord your God with all your heart and with all your soul and with all your mind.’This is the first and greatest commandment. And the second is like it: ‘Love your neighbour as yourself.’” (Matt 22v37-39).

I believe that this is the action that James is referring to. He is referring to the sharing of God’s love with other people, our neighbours, our families, strangers (remember the Good Samaritan?). If the recipients of James’ letter were not keeping the greatest and simplest commandments of Jesus then how could they claim to have faith in Him?

Jesus makes it clear who we are supposed to love. He also has something to say on how we are supposed to love other people:

· Clothe the naked

· Feed the hungry

· Give a drink to the thirsty

· Care for the sick

· Visit those in prison

· Selling all we own and giving the money to the poor

· Give away our clothes is someone asks for our coats

All seems a bit extreme, doesn’t it…?

Especially when we live in the suburbs and don’t often come across sick, naked, thirsty people in the street. How do you live up to that kind of thing when you’re not yet 16 and can’t join a community scheme because of daft child protection issues? When you can’t visit old people in a care home as they would have to be CRB-checked? When you can’t accompany adults on a soup run because it is perceived to be dangerous? As an aside, I’m sure Jesus said he would look after us as He cares for us even more than He cares for the birds in the sky; and they do OK the majority of the time. If we believe we are doing what God wants then surely we should be able to trust that He will look after us?

Who can we help?

In Paul’s letter to the Galatians (a misbehaving church) he says:

“Therefore, whenever we have the opportunity, we should do good to everyone—especially to those in the family of faith” Gal 6v10

This is really a call to keep up the old saying that “charity starts at home” – that is we should concentrate on showing love and doing acts of kindness for other members of the church./ After all when we are “born again” they become our spiritual brothers and sisters as they are all born again of the same Father, God.

So perhaps that is the safest and most biblical place to start. Rather than looking for a “cause” or and “issue” to raise funds for or get involved in, young people need to find people to care about and get involved with. Shane Claiborne says “Don’t choose issues; choose people”. And for young people who are yearning to live out the gospel then caring about people within the church could and should be the start of them learning how to love their neighbours next-door, their neighbours in school, their neighbours at the margins of society that have no-one else to speak up for and care about them.

I would hope that this would lead to young people coming to the church leadership and saying “It’s great loving and caring for people, but Jesus said we should also be inviting people to our parties that normally get ignored – I want to reach out to the sick, the homeless, the poor, the oppressed. Help me to care for these people. Help me see Jesus; not just lifted high, but I simply want to see Jesus in other people and show my love for Him by loving them”; or words to that effect… It’s not something that can be forced upon them. I’m hoping that we can provide the spark and ask the Holy Spirit to breathe upon it and burn up the young people with love and passion.

But what about grace?

Love that comes from a sense of guilt, service or debt will not be sustainable. The challenge will be to present these opportunities to young people and let their imaginations run away with the ideas. The best and most sustainable projects will come from them. God does not impose his will on us and so this project should not be imposed on anyone. A sense of conviction is healthy but not guilt. Furthermore love for someone else that is an overflow of grace received from God is the goal. We are to love people as we love ourselves, which means we have to love ourselves and want to have a deeper understanding and knowledge of God’s love for us and His grace and mercy. We can only share that which is a reality for us.

Imagine a see-saw. The see-saw itself is your faith. The pivot on which it balances is God. The weight on the right hand side (where you are) is the grace of God. The movement on the left hand side is action or good deeds. Grace causes good deeds through faith, which is resting on God. If we try to do good works alone, pushing down on the left hand side of the see saw then God’s grace gets pushed up in the air, away from us. If we are closer to God then a small amount of grace has the chance to cause more good deeds (more movement on the left hand side). If we have more faith, we have a longer see-saw and so it moves more and more good comes of that too. It’s dynamic. A still see-saw is no longer a see-saw, it’s just a useless bit of modern sculpture that doesn’t hold the attention.

So, authentic action needs to be underpinned by faith, grace and an experience of God’s love. Wth a desire to get to know Jesus, the Holy spirit, the Bible and a passion for praise and prayer which will fuel it.

The nuts and bolts

“In this life we cannot do great things. We can only do small things with great love.”

Mother Theresa

So what can we do?

I propose that we start really, really small. Miniscule, in fact. The first question to ask is “who are the needy people in church that young people could help?” The short list I would come up with would be:

· The elderly

· Young parents

· The unwell


One of the biggest problems with elderly people is loneliness. Perhaps we could use Catriona Foster to find out which of the older members of the congregation would like someone to come to chat with them once in a while. And if it will make the church feel better to CRB check them, then let’s do that. Let’s get consent forms and make sure that we know when and where the young people are going to be – to start off with. But as an aside how absurd does it sound that we need to be informed of all random and not-so-random acts of kindness motivated by the love of Jesus?

Young parents

There seems to be a baby boom going on. And all is not light and sweetness with very young children. There’s the fatigue. And although everyone is smiles on a Sunday I know for a fact that some young parents with children don’t eat properly – let’s cook for them. Some can’t find time to clean the house properly – let’s clean for them. Some may find it hard going to the park with 2 children – lets go with them to help push one of the swings. We just need to follow our ears and our noses and ask the mums and dads if there is anything a young person could do to help.

And given the age of young parents they are often don’t belong to the generation of the young people or to that of their parents. So, unless they do youth ministry work they won’t normally form relationships with young people. This kind of project would help to foster an interdependence and a sense of family between members of the church. It would also help the young person to see how God works in other people’s lives and relationships. Again, absurd as it may sounds why not CRB check new parents – just to check that it would be safe for a young person to spend time with them (hang on they’ve just become a parent…!).


Get the church service sheet. Look at the names. Pray. Pick one. Look up their name in the church phone book. Call them or their family and see you can help. Simple.

YOUth Ministry – living by example

I’ve always been intrigued by the bit in the bible about the right hand not knowing what the left hand is doing. I think that means you shouldn’t do something if you expect to be rewarded for it (that’s why you should invite tramps and beggars to your birthday party – they’ll eat everything and won’t bring you cool presents). However, we are supposed to bring things to gatherings that will comfort, encourage and strengthen each other and I think the youth ministry and other members of the church could encourage the young people with examples of what they do to share the love of Jesus. Not for the benefit of getting praise but to MAKE IT REAL and more than just a two thousand word essay on why we should help young people to love each other and other people.

And who knows where it might lead? Inviting homeless people for lunch? Giving out presents to children in the waiting room at the Children’s Hospital? Handing out our spare coats to homeless people and asking if we can pray for them? Mentoring young students from Harborne Hill? Visiting elderly people as they are discharged from hospital? Visiting dying children in the Acorns Hospice? Holding open air barbeques in the street to tell the neighbours that God loves them?


Much of the teaching of Authentic is about words (not all, but quite a lot). It has been a time of explaining where the kingdom of God is, how to get there. Perhaps the next step is showing young people how to actually live in the Kingdom of God, to explain the “do’s” and not just the “don’ts”. The foundation of knowledge is there and we all need to move from being to believers in Jesus (even the demons believe in Jesus) to being followers. If the young people catch this vision and it is fuelled by the gifts and fruit of the Holy Spirit then there will undoubtedly be revival. They will cross the River Jordan into the promised land of life in the Kingdom of God and will be shouting to the rest of the church “Come on over – it’s not safe, but God is good and this is amazing!”