Talking About Men's Health™

Last week, Congress passed arguably the most comprehensive health legislation since Medicare. After over a year of passionate debate (and nearly a 100 years in the making), the bill was signed into law. Though not a perfect bill, far from it for many, the legislation establishes a fundamental social precedent where we as a society have decided that basic access to health care is a right and not a privilege. Unfortunately, the political rhetoric has overshadowed many of the benefits in the new law and with it has created large amounts of misinformation. I would like to take the next few paragraphs to explain just a few of the benefits.

The major Pillars of the law (the individual mandate, health insurance exchanges, tax subsidies for individuals, and Medicaid expansion) don’t activate for a number of years, but there are numerous provisions that go into effect much sooner. As soon as the President’s pen(s) signed the bill, small businesses with less than 25 employees became eligible for a 35% tax credit to offer their employees health insurance and seniors in the dreaded Medicare Part D ‘doughnut hole’ became eligible for a rebate to help pay for the costs of prescription drugs. Effective immediately are also a number of new funding streams to improve access to care like appropriations for nurse-managed health clinics ($50 million annually) and the National Health Service Corps (increasing from $320 million annually), and funding to encourage investment in therapies to prevent, diagnose and treat chronic disease ($1 billion over two years). In addition, nearly $500 million will be awarded to the Cure Acceleration Network to pursue many high-need cures with $35 million appropriated annually for mental/behavioral health education and training. The law makes an immediate investment in public health with appropriations for fellowship training grants in the field ($40 million annually) and the creation of the Prevention and Public Health Fund, dedicating $500 million annually (eventually increasing to $2 billion) to expand and sustain public health and prevention programs.

In September, health insurance companies will be forever banned from detrimental actions like dropping coverage for individuals who get sick, denying coverage to children with pre-existing conditions, and placing lifetime and restrictive annual caps on health insurance coverage. New private plans will also be required to cover preventive services and children will be able to stay on their parents’ insurance until their 26th birthday.

In January, primary care physicians will be eligible for a 10% bonus payment in Medicare, new funds will be available for community health centers (increasing from $1 billion annually), and health insurers will be required to cover tobacco cessation programs for pregnant women. Chain restaurants and vending machines will be required to display nutrition information (calories, grams of fat, grams of sodium) with each item, which will begin to help foster a more widespread discussion and strategy regarding the obesity epidemic. The New Year will also produce a $200 million grant program for small businesses to initiate wellness programs, further strengthening a newfound investment in prevention and lifestyle improvement.

These are just a few of the short-term benefits from one health professional’s perspective. No doubt, I take issue with a number of disconcerting provisions such as some of the revenue streams (taxes) as well as cost-containment methods that attempt to address the uncontrolled growth in health care costs. Long-term endeavors to slow the rate of health spending in public and private programs will be needed in order to maintain America’s competitiveness in the global marketplace and will take decades. Though the hard-fought bill was passed, this is truly only the beginning of the reform process. No matter your position of support, it is important to understand that there will be ample opportunity to augment/improve/re-work many of the provisions in the law, especially over the three-year implementation period preceding the 2014 Pillars. The benefits of reform will soon be tangible for millions of working Americans, and we should continue to work together to lay the foundation for a healthier America while improving the value of the investment we make in our health care system with an evidence-based focus on efficiency and care coordination, rewarding quality over quantity, prevention, and wellness.

Richard J. Ablin, research professor of immunobiology at the University of Arizona College of Medicine, has been studying prostate cancer for over 40 years.  After discovering the Prostate-Specific Antigen (PSA), an enzyme made by the prostate, and subsequent approval by the Food and Drug Administration in 1994, the PSA test is the most commonly used tool for detecting prostate cancer in men.  Approximately 30 million American men undergo testing for PSA each year, which Dr. Ablin refers to in a recent New York Times editorial as a “public health disaster¹.”  He states that, although prostate cancer receives a lot of attention, “American men have a 16 percent lifetime chance of receiving a diagnosis of prostate cancer, but only a 3 percent chance of dying from it.”  As a result, he believes that “the medical community must confront reality and stop the inappropriate use of PSA screening” because it could save our ailing health care system billions of dollars from “unnecessary, debilitating treatments.”

Several letters were published in response to Dr. Ablin on March 12².

The president of the American Urological Association (AUA), Anton J. Bueschen, responds with AUA’s recommendation “that men ages 40 and older talk to their doctors about prostate health and the pros and cons of having a PSA test.”

Stephen Teitelbaum, Chief of Urology at the Kings Highway Division of Beth Israel Medical Center, argues that the studies Dr. Albin cites in his article are “too short to draw any conclusions regarding the utility of PSA screening.”  He suggests conclusions be made after a 20-year follow-up period to determine the test’s effectiveness.  In addition, he believes that “prostate-specific antigen testing is our best chance of finding prostate cancer while it’s still curable.”  Furthermore, he places great emphasis on the potential number of lives spared as a result of PSA screening, early detection and treatment, referencing that 3 percent of men “sounds like a lot of men to me.”

Prostate cancer survivor, Lewis H. Miller, Jr., describes his experience and states that “over the last 12 years, I have never regretted my decision, and I have become a proselytizer for yearly PSA testing so long as the primary focus is on acceleration and not merely on a single numerical reading.”  The acceleration Mr. Miller refers to is the change in PSA readings over a short period of time, which can signal abnormal prostate health.

Prostate cancer survivor, Scott Winokur, also describes his experience, “I had no family history of the disease and was utterly asymptomatic nearly 14 years ago when, at age 50, a routine PSA test turned up an aggressive cancer (the disease is often aggressive and therefore especially dangerous in younger men).”  He ends his letter, “But the answer is not to climb aboard the bandwagon and issue a blanket condemnation of the PSA test.  In doing so, authorities like Dr. Ablin condemn tens of thousands of men to early, painful deaths each year.”

Men’s Health Network (MHN), alongside 10 other independent, not-for-profit organizations, collectively known as America’s Prostate Cancer Organizations, issued a joint statement to the House Committee on Oversight and Government Reform on March 4, 2010³.  Relevant excerpts to the debate for screening, early detection and treatment are listed below.

Our shared goal is that all such men should receive the most appropriate advice and care, and that we continue to limit the devastating impact of prostate cancer on men and their families.

The early detection and appropriate treatment of clinically significant and potentially lethal prostate cancer remains a critical priority, especially among men at high risk because of family history, ethnicity, or other factors that define such risk.

Every man has the right to know whether he is at risk for potentially lethal prostate cancer.

Until more accurate tests are available, all health care insurance plans should include coverage of regular testing for prostate cancer (including the prostate-specific antigen or PSA test and the digital rectal exam or DRE) – and its subsequent diagnosis.

Have you or a loved one been affected by prostate cancer?  What are your views about prostate cancer screenings?  Please contact me at ramonl@menshealthnetwork.net and I would love to hear your story.

We also encourage any women who have been affected by prostate cancer to share their stories with Women Against Prostate Cancer, a grassroots organization founded to provide support for women and their families affected by prostate cancer by providing access to resources and supportive programming.  They can be reached at info@womenagainstprostatecancer.org.

References

¹http://www.nytimes.com/2010/03/10/opinion/10Ablin.html?scp=1&sq=the%20great%20prostate%20mistake&st=cse

²http://www.nytimes.com/2010/03/12/opinion/l12prostate.html?scp=4&sq=psa&st=cse

³http://www.menshealthnetwork.org/library/PCagroupshearingstatement030410.pdf

Since it is indeed St. Patrick’s Day and this is a forum for discussing Men’s health you could probably have guessed that the message today would be about the dangers of alcohol consumption.  However, hopefully I can avoid being too stale and provide you with some new information and just enough caution to cause you to not make a complete fool out of yourself and/or die.  As Socrates so succinctly put it and a quote that applies to so many situations in life: “Everything in moderation”.

First, some little known history about this most sophisticated of American holidays.  Today actually marks the 273^rd St. Patrick’s Day celebration in the United States, which began in Boston, Massachusetts in 1737.  It was originally intended to be a religious holiday (as it still is in Ireland) with a feast celebrating the former bishop and patron saint of Ireland, St. Patrick.  The tradition of imbibing alcohol on this day emerged from an old Irish legend that involves St. Patrick and a stingy innkeeper who less than adequately filled the bishop’s glass.  In order to teach the innkeeper a lesson, St. Patrick informed him that a devil in his basement was continually feeding on the man’s dishonesty and that he must turn over a new leaf to rid his establishment of the creature.  Lo and behold, upon his return St. Patrick found the innkeeper filling each glass to the brim.  After swiftly banishing the now-starving devil, the bishop declared that on this day, each person should have a glass of whiskey.

While not on par with the behavioral lessons of Aesop’s Fables or Mother Goose, the story undoubtedly seeks to encourage saintly generosity.  Unfortunately, in the United States you would be hard pressed to find any message attached to St. Patrick’s Day other than “let’s all get hammered” and unlike most other holidays, the celebration’s entire focus revolves around not just drinking, but drinking to excess.  It has been documented in nearly every state that St. Patrick’s Day results in the highest number of traffic-related deaths, as well as the highest levels of arrests for DWI/DUI.  In fact, individuals face a 23% increase in the likelihood of injury or death from drunk drivers on St. Patrick’s Day.

This of course raises the larger issue of alcohol abuse being the third leading cause of preventable death in the U.S.  According to the CDC it results in 75,000 deaths each year and typically steals an average of 30 years of life from those individuals. Additionally, CDC estimates that nearly an additional 41,000 people die each year from alcohol-induced car accidents and other injuries. This is particularly important for men because we account for 72% of these excessive drinkers.  Figures from a study in the UK found that the male alcohol-related death rate in men was 18 in 100,000, which was more than twice that of females. Another sobering finding (no pun intended) is that a further 35,000 deaths occur each year from alcohol-related diseases such as liver cirrhosis and cancer.  Yes, even cancer.  Less commonly known than it’s direct contribution to the death of the liver is the fact that excessive alcohol consumption greatly increases the risk of mouth, throat, esophageal, liver, and colon cancer in men.  If appealing to the preservation of the rest of your body wasn’t enough to give you pause I will risk beating a dead leprechaun by appealing to your own lucky charms.  High levels of alcohol consumption have been shown to result in impotence, infertility, and face and body alopecia by interfering not only with testicular function, but also hormone production.  And we all know the ladies love that.

However, what might prove to be even more dangerous than excessive drinking is the increasing epidemic of binge drinking.  Binge drinking is defined as “drinking heavily over a short period of time with the primary intention of becoming intoxicated” and accounts for a staggering 75% of all alcohol consumed by U.S. adults.  Binge drinking is particularly troublesome because since it is often infrequent, it is not considered to be a problem, yet it carries all the same consequences of regular over-consumption.  In fact, 78% of men who are considered to be frequent binge-drinkers consider themselves to be light or moderate drinkers.  Yet with most other health issues, this is an issue that disproportionately affects men.  Research conducted by the CDC has discovered that men are twice as likely to binge drink and average four times the number of binge drinking sessions per year than women.

This isn’t meant to be an impassioned harangue against alcohol or celebration, especially considering I enjoy the occasional “Irish Car Bomb” myself.  I only preach self-awareness and caution, especially on this most alcoholically indulgent of holidays.  Perhaps try floating a shamrock leaf in your whiskey before drinking, another old custom. At least then you’ll get some vegetables to counteract whatever mystery brew really does make that beer green.  Happy St. Paddy’s Day!

Links for more information:

http://www.cdc.gov/alcohol/quickstats/mens_health.htm

http://www.sdnn.com/sandiego/2010-03-16/lifestyle/beware-binge-drinking-this-st-patricks-day

http://www.msnbc.msn.com/id/6089353/

Remember the last time you did something nice for someone, just because? It probably felt pretty good. Imagine multiplying that good feeling over many times, and it’s bound to have some positive effects on your own health. For those who have a little or a lot of time to give, volunteering for a cause that means something to you has many benefits. It can help you make connections with people, foster new friendships, and give you the chance to learn about the lives of others. Research has also shown that volunteering can bring health benefits such as lower incidence of heart disease and lower levels of depression. These are some of the findings published in a 2007 report from the Corporation for National and Community Service titled The Health Benefits of Volunteering: A Review of Recent Research. You can find the press release and the report itself here (http://www.nationalservice.gov/about/newsroom/releases_detail.asp?tbl_pr_id=687).

It’s not surprising that volunteering can make us healthier. When we give our time to something we care about, we are happy with ourselves and the fact that we are doing something good. In many cases, it is very easy to see that the work we are doing is having a direct and positive impact on others. Staying active through volunteering also keeps our minds and bodies engaged, providing physical and/or mental exercise that is essential for us to thrive. If you find that something is missing from your life, or if you have too much time on your hands, give some thought to an organization or cause that could use your support. Even if it’s just a few hours a month, the time you spend could end up benefiting a lot of people – including yourself.

If you like to volunteer to help the Men’s Health Network, please email Ramon at ramonl@menshealthnetwork.net

On February 24, 2010, Dr. Georges Benjamin, executive director of the American Public Health Association (APHA), announced the Association’s support for the Men’s Health Caucus, which will draw awareness to an emerging and cross-cutting public health concern. Scott Williams, Chair of the newly formed Caucus and Vice President of Men’s Health Network (MHN), explained that “The Men’s Health Caucus is necessary to bring together academic institutions, health departments, non-profit organizations and others with a common interest in improving the health and well-being of men and their families. This field is in desperate need of a diverse, multi-disciplinary, and coordinated approach to better tackle this public health issue within our communities.”

This caucus will allow APHA members and other individuals interested in the field to coalesce around the impact of poor health outcomes and premature death in men as it pertains to public health. Men of all races, on average, live about 5 years less than their female counterparts because they are less proactive and less engaged with the healthcare system, illustrated by CDC reports that women are 100% more likely than men to seek preventive care. Additionally, poor health outcomes in men cause significant financial burdens on the health care system; higher prevalence rates of chronic disease result in premature death and disability which ultimately affect utilization and rates of health care services. Moreover, the ramifications of chronic disease transcend beyond the individual, often affecting immediate family members as well as members of the individual’s social network. As a result, MHN agrees with the following statement from Dr. Benjamin that “protecting and improving the health of men and their families is essential to improving the health of our nation.” It is MHN’s strong belief that strategic and gender-specific outreach can, in fact, improve health outcomes in men. The formation of an official caucus to facilitate dialogue between health professionals, public health practitioners and researchers will create opportunities for progress in the field.

If you are interested in becoming involved with the Men’s Health Caucus, please do not hesitate to contact me at ramonl@menshealthnetwork.net.