HEALTH / Reel to real: doctors on tape: More and more people feel they get better advice from medical helplines than from their own GP. Annabel Ferriman reports

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The Independent Culture
WHEN Eve Greenwood was told, at the age of 27, that she had Hodgkin's disease, a rare condition about which she knew nothing, she did what most well-educated people do. She went to the public library and looked it up. There she discovered that the disease was a form of cancer, treatment was pretty ineffective and she'd probably be dead within five years.

Now, 20 years later and still very much alive, Eve realises that the library book was at least six years out of date. 'For something like Hodgkin's disease, where medicine is moving fast,' she says, 'that makes a lot of difference. But I did not know that at the time. There was a dearth of information for lay people, and doctors wouldn't discuss it with me. I needed access to some hopeful messages.'

In 1993, such information is easier to come by. If someone discovers they are ill, they can pick up the telephone and find out, in three or four minutes, some of the basic, up-to-date facts about their diagnosis. Dozens of recorded helplines are now advertised in newspapers and magazines, covering everything from Hodgkin's disease to halitosis, from sunburn to sex therapy.

Services range from those run by tabloid newspapers such as the Sun and Daily Star, and women's magazines like Woman and Woman's Own, to those provided by charities and health authorities. Some provide advice on more than 400 medically related subjects. Worried patients, embarrassed adolescents or the idly curious can turn to them for confidential advice on sensitive topics, 24 hours a day, every day of the year.

What has spawned this epidemic of information? The main reason is that helplines have proved to be a profitable way of satisfying consumer demand. Patients want more advice than they get in a five-minute chat with their GP or a 10-minute hospital appointment. They also like the anonymity and privacy of helplines; nobody sees their blushes or discovers their ignorance.

Dr Mike Smith, who provides the recorded telephone helpline for Woman's Own magazine, says: 'People like to use telephone helplines because there is no eye contact and total anonymity. People often tell me that they could never tell their doctor such-and-such because he is too young, or too old, or a man,

or a family friend.'

Dr David Delvin, a writer and broadcaster who provides the telephone helpline for the Daily Star, believes success depends on effective marketing. In particular, he says, providers must never over-estimate people's knowledge - or vocabulary. 'My tapes are advertised in many different magazines and journals under a list of titles. My 'Insomnia' line got hardly any calls until I changed the name to 'Sleeplessness'.'

The first medical helpline in Britain was launched in 1984. Calls were free and the service was run by the non-profitmaking College of Health in London. It provided more than 100 tapes on a variety of topics, but had to rely on editorial coverage in the media for publicity because it couldn't afford to advertise. The helpline was overwhelmed with calls whenever it was featured on a television programme, with quiet periods in between.

Then, in 1986, the newly privatised British Telecom launched its premium rate telephone lines. This meant organisations could provide information to the public and make a profit, as the proceeds are shared 50/50 between BT and the supplier.

The first company to spot the gap in the market was Healthcall, an offshoot of Air Call Medical Services. With great care and the help of an editorial board from the Royal College of General Practitioners, the team drew up scripts for 130 tapes. They used actors of the right age and sex for the condition, and distributed thousands of directories. It was a huge success. The company now receives about 1,000 calls a day and has a directory of 500 tapes, the most popular dealing with sexual topics, depression, anxiety, Aids and constipation. Dr Mike Smith, who has sampled a wide range of medical helplines, thinks they vary more in style than in content. 'I've never heard anyone say a particular helpline peddles a lot of nonsense, but some are more personal than others. The Healthcall ones are competent, professionally prepared and full of reliable information - but they are presented by an anonymous voice, probably an actor's. Where a newspaper or magazine columnist presents his or her own material, it is more interesting than where someone is just reading someone else's words.'

With Dr Smith's comments in mind, I investigated the helplines provided by the Sun, with steamy titles such as 'Exciting Foreplay', 'Spice Up Your Sex Life' and 'Different Sex Drives'. When I dialled the number for 'Is Oral Sex Right For You?', nothing happened. Puzzled, I tried again. Again nothing. Then I found that my husband had taken advantage of British Telecom's offer to bar calls from our phone to 0891 or 0898 numbers. He claimed it was to prevent our children using them.

I cracked the problem by using my Mercury button. I rang 'Is Oral Sex Right For You?' again. To my surprise, I was played a tape on snoring. The Sun has only six helpline numbers and the tapes are changed each day.

Consumers using these services are richer in information, but poorer in pocket. Most commercial helplines cost 48p a minute at peak times and 36p at cheap rates, so the average three-minute tape costs about pounds 1.50. But do not despair. Although the College of Health no longer provides its helpline service, the Department of Health has filled the gap. It now provides a Freefone Health Information Service, giving details of services region by region, your rights under the Patient's Charter, how to complain and how to find out about common conditions and diseases. It operates during office hours, on one free 0800 telephone number (see footnote), from anywhere in the country. Callers are automatically put through to their regional service.

Though the Department of Health did advertise its service in women's magazines and some newspapers earlier this year, you can be forgiven for not knowing about it. A random sample of 20 of my acquaintances had never heard of it either. But there are particularly impressive helplines for the south-east Thames, North West and South West regions.

Arguably the best is operated by North-East Thames Regional Health Authority. Its service now includes the College of Health's tape library, with more than 220 carefully scripted, well-informed messages. Mrs Freda Gorman, a receptionist from Camden, north London, found its tape on migraine extremely helpful: 'I recently started having attacks,' she says, 'seeing flashing lights and feeling dizzy. I was told it sounded like migraine, so I rang the helpline and found its advice useful. The tape explained what caused it - and I learned it was more common among women than men, and that attacks could be triggered by diet. The tape suggested I keep a diary of what I eat to see if there was any connection.'

Mrs Jean Ewing, a teacher from north London, suffers from rosacea, a skin complaint affecting her face. The blood vessels enlarge, giving the cheeks a flushed appearance. She tried two helplines: the free one provided by the Department of Health, and the commercial one provided by Healthcall.

'The free helpline did not have a tape specifically on rosacea,' she says, 'so I phoned the one on acne; rosacea is sometimes thought of as middle-aged acne. The message was down- to-earth and listed the causes clearly. It emphasised what you could do for yourself in terms of diet, general health, types of make-up. There were also warnings about the side- effects of some of the drugs.'

Mrs Ewing then tried the commercial helpline on acne, provided by Healthcall. 'It drove me crazy,' she says. 'It was really chatty, much less professional, and had less detailed information. I checked out the tape on eczema and dermatitis, thinking it might have more useful information. Again, the tape was too chatty for my taste.'

What most of the tapes have in common is an emphasis on what you can do for yourself. But how do helpline users know the information provided is accurate - and objective? Is it biased in favour of conventional medicine rather than complementary therapies?

Dr Mike Smith's helpline for panic attacks in Woman's Own certainly isn't. He recommends yoga, relaxation techniques and meditation. Script authors are nearly always medically trained, but most claim they are not biased against alternative medicine. Dr Delvin says he will suggest complementary therapies when he thinks they will help. He recommends osteopathy and chiropractic in his backache tape.

What characterises all these helplines most strongly is their positive attitude. Whether they are about depression or infertility, cancer or anxiety, the message is always one of hope - help is at hand, there is always something you can do, someone you can turn to.

'That would have made a difference to me,' says Eve Greenwood. 'When you first discover you are ill, you need something to take away the fear. A positive message can give you the courage to seek further help.'

Department of Health Information Service: 0800 66 55 44 (10am-5pm, Mon-Fri). Healthcall: free directory available on 0898 600 600.