-
The Big Risk in Just Living With Erectile Dysfunction
Tweet Share on Facebook March 17, 2010 Comment (9)By now, men have probably heard that erectile dysfunction (ED), which the National Institutes of Health defines as the "inability to get or keep an erection firm enough" to do the deed, isn't just an emasculating sexual problem. It's also increasingly being recognized as a sign that something could be amiss in the cardiovascular department. New research adds more.
Research on over 1,500 men published this week in the journal Circulation suggests that for those who have cardiovascular disease, ED is a "potent predictor" of serious trouble ahead: Having both appears to raise the chance of dying from any cause and of dying from cardiovascular disease, and it seems to double the risk of having a heart attack compared with men with cardiovascular disease but no erectile issues. What's more, the researchers reported, the worse the ED, the greater those risks appear to be.
-
Statins for Prevention? Taking a Cholesterol-Lowering Drug When Cholesterol Is Normal
Tweet Share on Facebook March 1, 2010 Comment (17)Everyone's got enemies. But our fiercest foe is heart disease. It's the No. 1 killer of Americans, and while it affects both sexes, it tends to nab men at an earlier age than it does women. Just last month, however, the Food and Drug Administration made a move that many cardiologists call a boon for prevention: The agency OK'd the use of a cholesterol-lowering drug, a statin called Crestor, in folks whose cholesterol levels are normal and whose doctors haven't diagnosed them with heart disease. The move aims to better shield millions more Americans against future heart attacks, strokes, heart procedures, and surgery.
The FDA's decision hinged on the results of a large study, called the Jupiter trial, published in the New England Journal of Medicine in 2008. Jupiter took almost 18,000 middle-aged adults and assigned them to either Crestor or a sugar pill. Under national guidelines, the study participants would not have normally been prescribed a statin because their levels of "bad" LDL cholesterol weren't high enough (all had LDL's below 130 mg/dL), explains Paul Ridker, a cardiologist at the Brigham and Women's Hospital in Boston and lead author of the study, which was funded by AstraZeneca, the drug's maker. But all of the participants had elevated levels of high-sensitivity C-reactive protein (hs-CRP), a measure of inflammation. While inflammation is the body's natural response to infection and injury, it also foments artery-clogging plaque and seems to make that plaque more likely to rupture and cause blood clots that trigger heart attacks and strokes, experts say. Researchers hoped Crestor might lower the risk of cardiovascular problems since statins also reduce CRP.
-
Circumcision: The Flap Over Foreskin Continues
Tweet Share on Facebook January 21, 2010 Comment (58)The flap over a flap of skin—foreskin, to be precise—is heating up again, as two influential groups are re-examining the medical merits of circumcision in light of recent findings and are prepping to release new appraisals of the controversial procedure, a story in the Washington Post points out. Long a cultural and religious given, circumcision has increasingly become a medical issue, as growing evidence suggests that it may offer health gains, and to a greater degree than thought in the past. Opponents of circumcision nevertheless call the procedure unnecessary and compare it to female genital mutilation; many contend that it's child abuse and argue that parents should wait until boys are old enough to decide for themselves.
The Post story noted that the Centers for Disease Control and Prevention, which has never before issued public-health recommendations on circumcision, is expected to release a draft this summer and will most likely weigh in on whether newborns, and even adult males, should get snipped. The final version would serve solely as guidance to parents, individuals, and doctors, according to an agency spokeswoman, and not be a public-health mandate. Meanwhile, the Post added, the American Academy of Pediatrics is mulling over whether it should revise its policy on circumcision, adopted in 1999 and reaffirmed in 2005, which states: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision."
-
Sanjay Gupta Discusses His New Book, 'Cheating Death'
Tweet Share on Facebook December 9, 2009 Comment (42)Sanjay Gupta operates on Mondays and sees patients on Wednesdays. The rest of the week, he leads CNN's medical coverage. Gupta has to be the first (one hopes the last) news reporter to perform brain surgery while on the job in a war zone. He enjoys his weekly responsibilities so much that he turned down President Obama's offer of the surgeon general's position. Cheating Death: The Doctors and Medical Miracles That Are Saving Lives Against All Odds, Gupta's second book, takes a fresh, hard look at assumptions that doctors have accepted for decades: CPR works. You're dead when your heart stops. If your brain looks like mush and the top doctors at a top medical center say you're brain-dead, there's no possibility of coming back. I asked Gupta how the compelling stories he presents should change our ideas about modern medicine and what they might mean for healthcare reform.
Cheating Death and its accompanying CNN specials air some of medicine's basic deficiencies (like how we define death). What's your aim?
I've been thinking about this book since I was a medical student. The way that we pronounce people "dead" and the whole process of death is something that we know more about now than we have ever before. It's not a perfect system. I take some of these concepts that are usually more squarely in the realm of science and the journals and try to make them more approachable for a lay audience. I'm not trying to be controversial or to raise debates. -
Coming: Vaccine That Fights Prostate Cancer
Tweet Share on Facebook December 4, 2009 Comment (11)Women were the beneficiaries of the first cancer vaccine―Gardasil, approved in 2006 to prevent cervical cancer. Several weeks ago, the same drug was made available to young males to prevent genital warts. And now it looks as if the first vaccine approved to fight cancer, by enhancing the body's immune response to cancer cells, will benefit males. Last month the Food and Drug Administration committed to deciding the fate of the prostate cancer vaccine Provenge by May 1, 2010. Prostate cancer is an appealing target because it moves slowly (even men whose cancer comes back after prostate surgery often live for well over a decade). That wide window of opportunity gives a vaccine time to prompt the immune system into fighting the body's own cells when they've become cancerous. (The immune system routinely fends off some tumors on its own, generally tiny cancers that are never detected, much less diagnosed.)
But while Provenge is on track to enter the market first, a less-sexy vaccine that hasn't caught the eye of biotech investors could work just as well at a much lower cost.
-
Video Workouts: Turns Out They're Not So Sweaty
Tweet Share on Facebook November 20, 2009 Comment (5)By getting gamers up on their two feet, Nintendo's Wii workouts are a healthier take on video games than anything that came before (and the cost of the console is dropping). My generation was the first to grow up glued to game graphics, and some of us have the spines to prove it. In medical journals these days, early case reports of "Wii knee" and other orthopedic traumas have been fast followed by serious efforts to understand just how much our bodies stand to gain from Wii workouts. It is already known, as colleague Katherine Hobson reported last year, that in a dual between real and virtual sports, virtual doesn't cut it. But how about basic fitness? Can the Wii give you your daily dose of physical activity? Yes—and no. As it turns out, the Wii offers the real deal for some and little more than virtual exercise for others.
Motohiko Miyachi, a scientist employed by Japan's National Institute of Health and Nutrition, unveiled the latest and most definitive Wii research at the American Heart Association's scientific conference this week. The study was funded by Nintendo, which will use the data in game updates. The report conveniently went public just as the company releases the new edition of its hit exercise program, Wii Fit Plus. Other scientists who have tried to calculate how much energy people burned while playing Wii games didn't use ideal techniques, says Miyachi. Scientists have to measure the oxygen and carbon dioxide players exhale to calculate the energy being burned. That means tying players to cumbersome gas masks, which can limit movement and the degree to which players get into the game.
-
Phthalates Threat: Less Boy, More Girl
Tweet Share on Facebook November 17, 2009 Comment (10)Last week we learned that male factory workers exposed to large amounts of BPA, a chemical in some plastics, had abnormally high rates of erectile dysfunction and other sexual performance problems. This week the news is about phthalates (pronounced THAL-ates). Researchers reported in the International Journal of Andrology that this family of chemicals, used in manufacturing polyvinyl chloride plastics, seems to make little boys behave a bit more like little girls. This small study isn't as worrisome as the headlines suggest. Its main public-health value may be in spurring more pregnant women to avoid processed foods—a worthwhile choice anyway, for other reasons.
The finding hinges on the credibility of a questionnaire—the "Pre-School Activities Inventory" (PSAI), which mothers fill out in describing their child's behavior. It is a psychometric tool, developed in 1993 and considered the most scientific approach available for parsing out masculine boys from feminine boys. Shanna Swan, an epidemiologist at the University of Rochester, led the study, which is part of a series she's conducting on phthalates. Phthalates are plastic softeners found in food-processing plants (hence they're in your food) and in hospitals—and in your carpeting, your wallpaper, and until recently many of your children's toys. Toy companies have already started removing phthalates now that a new federal law goes into effect in February.
-
The PSA Test: 7 Reasons It Still Matters
Tweet Share on Facebook November 13, 2009 Comment (12)The U.S. Preventive Services Task Force asked doctors last year to stop checking PSA levels in elderly men—the very men who are most likely to have prostate cancer. By age 75, the officials reasoned, doctors are more likely to keep tinkering with their patients until they die of treatment side effects or something other than prostate cancer altogether. This spring, the New England Journal of Medicine published two long-term studies that questioned whether knowing a man's PSA level actually helps men survive. Healthcare commentators say that PSAs set off a cascade of overtreatment, endangering patients and tolerating wasteful medicine, and that patients should be wary.
You might expect that the surgical specialists at the center of prostate cancer treatment would have reined in their PSA testing, but they haven't. The American Urological Association actually lowered its recommendation for the age at which doctors should start offering patients the PSA test from 50 to 40. It was the first revision of the guidelines in nearly a decade. The next one, says Kirsten Greene, a urologist who worked on the committee, should take just a year, in light of the accelerating data and heightened public debate.
"The key change is how we react to abnormal tests and to a cancer diagnosis, which is generally less aggressively for some men than in the past," says Gerald Andriole, chief of urologic surgery at Barnes-Jewish Hospital/Washington University School of Medicine in St. Louis. Andriole says that men shouldn't be afraid to get diagnosed; good urologists avoid overtreating less-dangerous cancers. Active surveillance or targeted attacks on very small tumors that spare healthy prostate tissue are both popular options.
-
Sex and BPA Don't Mix, Say Researchers
Tweet Share on Facebook November 11, 2009 Comment (2)Bisphenol-A, better known as BPA, is the building block of polycarbonates and epoxy resins, plastics that have facilitated modern life. (They're in microwave containers, baby bottles, laptops, and even canned foods.) Tiny amounts circulate in the bodies of more than 90 percent of Americans. And now a team of Chinese and U.S. scientists says it has linked the stuff to sexual dysfunction in men. Even before today's news, plenty of people were getting the willies about BPA. Should this news make you feel less virile? Let's take a closer look.
Six years ago, De-Kun Li, a senior scientist at Kaiser Permanente's research arm, and his colleagues were already alarmed about BPA because of a steady stream of studies showing that BPA alters tissues in the reproductive organs and offspring of rats and mice. But there's a heated debate among statisticians, toxicologists, and endocrinologists about which animal models are relevant to human disease and about the paradoxical way BPA seems to work. Unlike typical poisons or carcinogens, more is not always worse and less is not always better. In many of the studies, BPA changes animal tissues only at specific low concentrations and only at particular stages of the life cycle.
-
Prostate Cancer Throws Vitamin E Another Strike
Tweet Share on Facebook October 28, 2008 Comment (8)Some 35,000 men who participated in a major prostate cancer prevention trial are in the process of getting this disheartening—yet not entirely surprising—letter in the mail from the National Cancer Institute. The message: Vitamin E and selenium, long buzzed about for their supposed prostate cancer-fighting properties, have flopped. Flopped hard.
Officials announced this week that they had accumulated enough data to conclude that taking vitamin E or selenium, or even both together, does not prevent prostate cancer. In fact, vitamin E may even slightly increase the risk. Leaders of the trial, called the Selenium and Vitamin E Cancer Prevention Trial, were also concerned to find that slightly more cases of diabetes arose among men who took selenium. And though officials emphasized to reporters that the increased number of prostate cancer and diabetes cases may have been a coincidence, they aren't taking any chances. That's why participants are being told to stop taking the supplements.
