Talking About Men's Health™

The opening moniker for any of my lectures on men’s health, “Being a man is harmful to one’s health”, Continue Reading

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/

Men’s Health issues are featured in an article by Teddi Dineley Johnson in the current issue of The Nation’s Health, a print and online publication of the American Public Health Association.  You can access the article here: http://TheNationsHealth.AphaPublications.org/content/40/1/28.full.  This piece, which quotes both MHN Vice President Scott Williams and Advisory Board member Dr. Perry Karfunkel, is a call to action for men to consider and improve their health.  It’s also a reminder that men’s health issues do not always show up on the radar in discussions about national health in general.

One of the key points in the article is the gap of 2-3 decades in which a large percentage of men have very little contact with health professionals.  Having passed through high school and possibly college, men in their 20s, 30s and even 40s become alienated from the healthcare system.  This can be attributed to a combination of factors, including fear and the classic tough-guy belief that you don’t need to see a doctor unless you’re in extreme pain.  Also, unlike women, men have much less frequent contact with doctors during their adolescence for routine care and never get into a healthy habit of regular check-ups to detect potential problems.  When men finally do present themselves in a medical facility, perhaps years after developing mild pain or a nagging health condition, many have missed the chance to catch a serious ailment early.

If this sounds like you, don’t wait any longer to see a professional about any health issues that are bothering you.  And if you know someone who is struggling with an ailment, let them know you care enough about them to ensure they get the help they need.  Finally, be sure to share information like this article with those you know, and to advocate for more coverage of men’s health issues in both publications and public policy debates.  MHN is excited to see this article published in The Nation’s Health and looks forward to engaging in more educational activities about men’s health around the country.

The American Pubic Health Association’s Annual Meeting is next week (Nov. 7-11). The conference will be in Philadelphia, PA where you can find the MHN staff members hosting informative oral presentations and poster sessions. Of course,  the TAMH Blog writers and the awesome MHN staff will be at the Men’s Health Network’s booth (#1415) in the Exhibition Hall throughout the entire conference. Please come visit and mention TAMH Blog to be in the running for a prize being given out at end of the conference!

Things to make sure to visit:

MHN’s Booth#  1415 - Location: PCC Hall

Oral Session 4306.0 An Epidemic of Suicide among US Veterans: A Myth or a Reality
Tuesday, November 10,2009: 2:30 PM – 4:00 PM – Location: Loews: Adam

Poster Session 212387 Moving forward or backward: History, culture, and transition to private health care in Turkey
Monday, November 9, 2009: 2:30 PM – 3:30 PM – Location: PCC Hall AB

We will try to update short blurbs during the conference, but you can find MHN throughout the APHA conference or anytime by following MHN on twitter:  http://twitter.com/MensHlthNetwork

-Sonny S. Patel
Chief Editor of TAMH

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I pose the question of  ”What is your favorite part of APHA conference?” to the TAMH writing staff.

Here’s one of the best responses I received below:

“Looking forward to this year’s APHA Conference. My favorite part of
the event is wandering around the Exhibition hall, networking with
various organization’s booths and answering any and all questions
about our hard work as men’s health advocates. It’s always motivating
to hear people say things like, “You know, I haven’t heard a lot about
efforts geared specifically to men, and I’d love to learn more. It’s
so important because of my father/uncle/son….” Congrats also to all
those involved in the creation of the new APHA Men’s Health Caucus! ”

-Adam Dougherty, MPH
TAMH Writer

Since June I have participated in several health fairs and I consistently notice a clear trend: Men by-passing our tables like one would do with a slow car on the highway.  Men would most likely ignore our table and all the valuable information we have to offer like the plague if we fail to catch their attention with incentives, giveaways, and our genuine caring personalities.  To illustrate my perspective even further, I offer an analogy:

Picture a guy in a mall walking by a lingerie store.  As he walks by, he slyly takes a peek or two into the store, long enough to check out the scene, but quickly enough to maintain his cool, just in case anyone was watching him.

This is exactly what I see at health fairs.  Men continually refuse to engage with our knowledgeable staff to learn about men’s health.  This is the sad reality.  How can men be expected to make informed decisions on health issues when they are generally uninformed and unwilling to take the initiative?

Men’s reluctance to engage in health-seeking behaviors are deeply rooted in socially accepted norms that men should always be “macho,” “powerful,” “confident,” and “impervious to health problems.”  Additionally, these norms have been institutionalized.  Male health screenings, such as the Prostate Specific Antigen (PSA) test, which screen for prostate cancer, remain as an out-of-pocket health service for many providers, including government agencies.  Females, on the other hand, have been conditioned to seek routine health care.  A prime example is the annual reproductive examination as soon as females reach puberty.  Interestingly enough, the female reproductive examination includes a variety of other preventive components, including a discussion on various health topics such as allergies, a previous medical history, family history, social history and a review of systems, among others¹.  As a result, Robert Alt, MD, argues that males should be conditioned in a similar fashion.  By using the annual female reproductive examination as a model, the next generation of males would have preventive health-seeking behaviors instilled at younger ages and as a result, they would be more likely to carry that same proactive philosophy throughout their lifetime.

If you have any comments or suggestions to improve men’s health in your community or on a national level, please do not hesitate to contact me at ramonl@menshealthnetwork.net.

References:

1. Alt, Robert L., MD. (2002). Where the Boys Are Not: A Brief Overview of Male Preventive Health. Wisconsin Medical Journal: V101(4):22-27.