(Tobyotter/flickr)
“It makes sense, because they’re self-medicating with carbohydrates. Carbs do the same thing that stimulant medications do — promote dopamine,” says Hallowell, who wasn’t involved in the latest study. “So you get the gallon of ice cream at midnight.”
With impulse control often a problem for people suffering from the disorder, Hallowell also says that nutrition should be part of an ADHD treatment plan. Continue reading
Here’s a good news/bad story story for men losing it up top.
First the bad: in a new analysis, male baldness is linked to an increased risk of heart disease, the online journal BMJ Open reports.
(world on jan/flickr)
The silver lining: the risk is greatest for men with a “thinning crown” as opposed to a receding hairline, the study finds. Indeed, receding hairlines aren’t linked to a higher risk at all.
Researchers suggest several possible explanations: such baldness may be a sign of insulin resistance (implicated in diabetes); chronic inflammation or a heightened sensitivity to testosterone, “all of which are involved directly or indirectly in promoting cardiovascular disease.”
More from the BMJ news release:
Male pattern baldness is linked to an increased risk of coronary heart disease, but only if it’s on the top/crown of the head, rather than at the front, finds an analysis of published evidence…
A receding hairline is not linked to an increased risk, the analysis indicates.
The researchers trawled the Medline and the Cochrane Library databases for research published on male pattern baldness and coronary heart disease, and came up with 850 possible studies, published between 1950 and 2012.
But only six satisfied all the eligibility criteria and so were included in the analysis. All had been published between 1993 and 2008, and involved just under 40,000 men. Continue reading
Patients facing treatment for prostate cancer expect to be warned of certain dismal side effects: erectile dysfunction and incontinence, for instance. But a new study suggests men should be warned of another possible complication: a shorter penis.
The new report found that a small number of men enrolled in a prostate cancer study complained to their doctors that their penises seemed shorter following treatment (though no actual measurements were taken). Some of the men reported that even this perception of a shortened penis interfered with their intimate, emotional relationships and caused them to regret the type of treatment they chose.
(Wikimedia Commons)
Prostate cancer is the second most common cancer in men, with about 241,740 new cases diagnosed last year, according to the American Cancer Society. Obviously prostate cancer can be serious: it’s the second leading cause of cancer death (behind lung cancer) in American men.
But most men diagnosed with prostate cancer will live — and live with the short- and long-term implications of the type of treatment they choose to undergo. While the problems of erectile dysfunction and incontinence are widely known as possible side effects, few studies have been done on treatment-related penile shortening. But doctors say it can and does happen — though it’s rarely discussed with patients.
In the current study, which was based on surveys completed by physicians treating 948 men with recurrent cancer, a total of 25 patients (2.63%) complained of a shorter penis. Complaints were most common in men who underwent surgery to have their prostate removed (19 of 510 men) and those treated with male hormone-blocking drugs combined with radiation therapy (6 of 225 men), researchers report. None of the men on radiation therapy alone complained of this particular problem.
These numbers are clearly small; but researchers say the phenomenon, due to its intimate nature, is likely underreported. The takeaway from this study, they say, is that the possibility of a slightly shorter penis after treatment should be made clear to patients as they consider their therapeutic options; a frank discussion upfront might minimize later regret. “Physicians should discuss the possibility of this rarely mentioned side effect with their patients to help them make more informed treatment choices,” the study, published in the medical journal Urology, concludes.
From the January issue of the journal Urology
Lead author Paul L. Nguyen, M.D., a radiation oncologist at Dana-Farber Cancer Institute and Brigham and Women’s Cancer Center in Boston, said the novelty of the work is that it shows how even the perception of a shorter penis can profoundly impact a man’s quality of life and lead to regret. “Some people might think this is frivolous — who cares about a slightly shortened penis — but it really does affect people’s lives,” he said in an interview. “If guys [in the study] had this bad result they were much more likely to regret the path they chose. This is important to talk about up front when people are making their decisions.” Continue reading
Preparing for a ritual circumcision (Cheskel Dovid/Wikimedia Commons)
“You realize, of course, this is a purely cosmetic procedure.”
That snarky-toned remark by a neonatologist is imprinted in my memory forever, tinged by the extra distress it caused me. I’d just been through a scary pre-term birth and the anxiety of more than a month of hospital care for my baby son. Now he was finally almost ready to go home, still weighing only a little over five pounds, and the last thing I wanted for him was another procedure.
But the research I’d done persuaded me that circumcision was not just a venerable tradition; it had real health benefits, both shorter-term and when he reached maturity. I knew about the growing movement among men who denounce it. I’d also heard an earful from our babysitter about the penile problems of boys in Europe, where circumcision is rare.
We chose circumcision, but apparently more and more American parents are tipping the other way — and the health results could prove expensive. NPR’s Scott Hensley has just posted an excellent “Shots” piece on the potential tab for the decline in circumcision and its background. Right now, about 55 percent of American boys are circumcised, he notes, down from a peak of 79 percent. But a growing body of research — including this Johns Hopkins study last fall — finds that circumcision has significant health benefits, preventing sexual diseases and urinary infections.
Scott writes about the latest study, on costs:
Johns Hopkins researchers analyzed how declines in circumcision would affect future health care costs, including what would happen if the rate fell to 10 percent, which is the average in Europe. The change — up or down — in HIV infections is the biggest factor. So what’s the tab? If the circumcision rate fell to 10 percent, the annual net increase in health care costs would be about a half-billion dollars a year. The findings appear in the latest issue of Archives of Pediatrics and Adolescent Medicine.
Johns Hopkins pathologist Aaron Tobian, senior author on the paper, tells Shots an increase in health costs tied to less frequent circumcision is already happening. He lays some of the blame on the American Academy of Pediatrics, whose 1999 policy statement says the “data are not sufficient to recommend routine neonatal circumcision.”
Tobian says that data gathered since then show that position is wrong. “The trials were amazingly consistent,” he says. Continue reading
(Anka Grzywacz, Wikimedia Commons)
By David C. Holzman
Guest contributor
David C. Holzman writes from Lexington, Mass., on science, medicine, energy, environment, and cars. He is Journal Highlights editor for the American Society for Microbiology and won a Plain Language Award last year from the National Institutes of Health. This essay began as a response to a CommonHealth post on why people have unsafe sex, and turned into much more.
Caution genes run in my family. My parents put seat belts in the ’57 Chevy in 1960, eight years before they became mandatory. In July, 1975, I bought Bell bicycle helmet serial number 7022. My cycling ensemble also includes one of those lime green jerseys that’s visible from the International Space Station.
And I was asking sex partners about Sexually Transmitted Diseases beginning in the early 1980s, when herpes — not HIV — was the main subject of such conversations. This despite the fact that the first time I did, the woman refused to discuss it, saying I could go to bed with her when I was ready to trust her. Condoms? Of course.
Journalist David C. Holzman
Now, in 2012, I still wouldn’t dream of leaving my seatbelt unbuckled, or biking without my helmet and jersey. I’ve never stopped asking new sex partners about STDs. But recent news reports have suggested that among the middle aged, rates of sexually transmitted diseases are rising while condom use is falling, and I have to confess:
At 59, I’ve worn condoms probably fewer than five times since the millennium, despite having been single for six of those years, during which time I’ve averaged one or two new partners a year, and despite the admonitions of my wonderful primary care doctor. The reason is simple: in my 20s and 30s, sex with a condom felt like getting massaged over a shirt. Now it feels like a massage through a winter overcoat.
I did don a condom last fall, when a new partner made a big deal of it. As a precaution, I took half a Viagra beforehand. (I don’t normally need the pharmaceutical pump; it was left over from earlier, when an antidepressant that I have long since discontinued had turned a Corvette into a Yugo.)
Despite my precaution, our effort to couple resulted in a deflationary event. I couldn’t feel a thing. Actually, I take that back. I did feel the condom squeezing me like a latex boa constrictor, then a softening like a leak in a bicycle tire. And then I felt lost. With that thing on, I would have needed a GPS to find my way in.
I’d like to note here that I take good care of my body. My diet is Michael Pollan-approved, my body mass index is 20, and I run more than 1,000 miles a year. But studies have shown that penile sensitivity declines steadily after the teens and 20s, so that by the 40s and 50s, men require more intense stimulation, says Culley C. Carson, III, Rhodes Distinguished Professor of Urology at the University of North Carolina. “And condoms add to the disability, if you will.”
Female condom (Wikimedia Commons)
I knew that there was an alternative — at least, there had been once. In 1993, I dated a woman who worked on reproductive issues at the National Institutes of Health. We initially used male condoms, but she soon introduced me to something called a female condom, which we used from then on. Then made of polyurethane, it fit inside the vagina, clinging snugly to the walls, held there by an inner and an outer ring. The sensation wasn’t quite as wonderful as using nothing, but for me, the sense of touch was like 20-20 vision rather than the somatosensory blurring that condoms induce. I marveled at the wonder of this device.
Nonetheless, for nearly the next two decades, I never even heard the phrase, “female condom,” nor did I read it, in the mainstream media or any health news outlet. It made few headlines at the major international AIDS conference this week.
Just prior to the date of the deflationary event, knowing that my hydraulics were not what they’d once been, I called a few drug stores to ask if they had female condoms. No one had heard of them.
Soon after, I began seeing news reports with titles like “Seniors’ sex lives are up — and so are STD cases,” and “Condom Use Lowest…Among Adults Over 40?”
In case you missed all that, there were two major sources. One was an editorial last winter in the Student British Medical Journal, written by Rachel von Simson, a medical student at King’s College London, and Ranjababu Kulasegaram, a consultant genitourinary physician at St. Thomas’ Hospital London. The two investigators found that in the UK, new HIV diagnoses in people over 50 had doubled from 2000 to 2009.
How much of that jump comes from unprotected sex? Not clear. They did not break it down by method of transmission, and von Simson says there are no data on condom use in older adults in the UK: “No one was interested in measuring rates until we already had a problem, making past comparison impossible, and still no one has got around to a large study.” Continue reading
Invasive prostate cancer cells
I stand accused (by a man) of paying little heed to recent important prostate news because I lack that particular bit of anatomy myself.
Guilty. But please let me make up for my neglect. Here’s a round-up of the latest wisdom on prostate cancer, and here’s its bottom line: In the prostate cancer field, “watchful waiting” — officially known as “active surveillance” — has never looked better.
Dr. Philip Kantoff, director of the Lank Center for Genitourinary Oncology at Dana Farber Cancer Institute: “This study strongly supports the option of active surveillance in men with good-risk prostate cancer.”
The study he was referring to is just out in The New England Journal of Medicine here, and it’s a high-quality study that randomly assigned 731 men with localized prostate cancer either to surgery or to observation.
Dr. Philip Kantoff” (Courtesy of DFCI)
A decade later, the outcomes of the two groups were strikingly similar: In the prostate surgery group, 171 of 364 men, or 47 percent, died. In the observation group, 183 out of 367, or 49.9 percent, died. “Among men assigned to radical prostatectomy, 21 (5.8%) died from prostate cancer or treatment, as compared with 31 men (8.4%) assigned to observation,” the study reports. How can this be? Prostate cancer is often “indolent;” it can grow very slowly and pose little threat for a long time.
A bit more from Dr. Kantoff: “This is a very important study. It supports what we have known for some time, that there is a great deal of over-treatment of prostate cancer, particularly for men with low risk prostate cancer. More and more physicians and patients are adopting active surveillance as a viable option for men with low risk prostate cancer.” Continue reading
Xiaflex, which could help with Peyronie's Disease. is already approved for a hand-bending problem called Dupuytren's contracture (Photo: Wikimedia Commons)
I first heard of Peyronie’s Disease way back in college, though I didn’t then know its name. A dorm neighbor came back from a big-city sexual adventure with an older man, and when we pressed her for juicy details, she crooked her index finger into a hook and shared the perplexing news that this was the geometry of his arousal.
Years later came Bill Clinton’s sexual scandals, and rumors that his paramours could describe a telltale bend in the president’s erect anatomy. Not long afterward, a new almost-boyfriend bravely sat me down for a well-rehearsed talk: “I have Peyronie’s Disease,” he said, clearly mortified but toughing it through. “My penis was injured during sex and now it just doesn’t straighten or perform the way it used to. It’s gotten shorter, and sometimes it hurts.”
If you’ve never heard of Peyronie’s Disease — which can range from mild curvature to bends so sharp they make intercourse impossible – you’re in the great majority. Not because the disease is uncommon; it’s estimated to affect between 3 and 9 percent of adult men, peaking in their fifties. Rather, Peyronie’s is likely so little known because it is so deeply embarrassing that men just don’t tend to talk about it.
“It’s disabling and deforming in the worst possible place for a guy,” said Dr. Abraham Morgentaler, founder of Men’s Health Boston and an associate clinical professor at Harvard. “A lot of these guys are distressed, distraught, and don’t know what to do. And the treatments we’ve had up to today have not been fantastic.”
This week, however, brought potentially promising news for men with Peyronie’s disease: Two clinical trials for a drug called Xiaflex found that it significantly reduced penile curvature, by a mean of 31 to 38 percent, and tended to lighten their distress.
If you, like me, have trouble computing erection angles in your mind’s eye, look at the chart below from Auxilium Pharmaceuticals, the company that makes Xiaflex. Very roughly, men started the year-long trial just under the 60-degree curvature in the middle, and ended up close to the 30-degree curvature at the bottom.
Xiaflex, which is given by injection, is already FDA-approved for a hand problem called Dupuytren’s contracture, and Auxilium says it aims to apply for Peyronie’s Disease approval by the end of this year. If approved, Xiaflex could start going out to urologists in the second half of next year. Continue reading
(kristykay22/Flickr)
Who knew a vasectomy could make such a great read? But here it is, in GQ, a gripping, hilarious, heart-breakingly honest account of one guy’s decision to take charge of family planning by knife.
As he awaits the surgeon, author Benjamin Percy notices the “walls are busy with gruesome anatomical diagrams, cross sections that make the male genitalia resemble charcuterie.” Then the action begins: “They go to work, flopping back my penis, arranging tools on a tray, positioning a stool between my legs. I squint into the blinding lights while the nurse snaps on latex gloves and my doctor shaves my scrotum. Then it’s time.”
Percy takes us through his decision to get a “v-sec,” noting that he loves, loves, loves his two children. “But a third?” he writes. “Outnumbered, we would have to switch from man-on-man to zone defense, and I can’t help but shudder when I imagine a red-faced baby wailing through the night, the bank statements withering further, the walls crayoned, and the laundry hampers reeking of spit-up and poo. An unexpected pregnancy, in other words, would be a nightmare.”
So he takes the plunge and makes a date with the surgeon:
I don’t scream, but I clamp my jaw so tightly it clicks. I arch my back so much I end up looking behind me at the door. The technique differs from doctor to doctor. Some cut diagonally. Some puncture “keyholes” with a hemostat on either side of the scrotum. Mine scalpels a vertical slash right down the middle. The room is cold, but I am sweating. How I regret not accepting the Valium. The doctor explains the procedure as it progresses. Apparently some men don’t have pronounced enough vas deferens, the tubes that carry sperm outward from the testicles, making the vasectomy impossible. But mine look great, he says. I would tell him thank you if I had a voice.
He will now sever the right vas deferens and excise a length of the tube, making recanalization close to impossible. “Now,” he says, his voice lowering, “you may feel a hot nauseating spike of pain that reaches up your right side.” Nobody I have spoken to, nothing I have read, mentioned anything about hot nauseating spikes of pain. Before I can steel myself to the idea, I hear a snip. The noise of garden shears deadheading geraniums.
I am unable to breathe. I cannot see what the doctor is doing, but he very well might have shoved a furnace-baked length of rebar through my groin and into my torso. I am introduced to vast, intricate networks of pain I never knew existed. Continue reading
Getting an HIV/AIDS test
The Health Department today announced that new HIV data shows a 41% drop in deaths among black persons living with HIV/AIDS between 2001 and 2010. Despite this progress, black New Yorkers – representing 25% of the New York City population – disproportionately accounted for almost half of all new HIV diagnoses (48%) in 2010, a proportion that has remained almost unchanged for the past 5 years. Blacks were, however, more likely than all other racial/ethnic groups in the City to have had an HIV test in the past 12 months. To commemorate the 12th annual National Black HIV/AIDS Awareness Day today, the Health Department reminds all New Yorkers who do not know their HIV status to get tested for HIV, take the necessary precautions to stay negative and protect their partners, and get into treatment if you are positive. Continue reading
Dr. Philip Kantoff
Dr. Philip Kantoff, a leading expert on prostate cancer, is not usually the outspoken public critic type. But this time is different.
The director of Dana-Farber’s Lank Center for Genitourinary Oncology, he is very publicly decrying a federal task force’s recent recommendation against routine prostate screening for healthy men. On the Dana-Farber Cancer Institute’s homepage, he puts it clearly: The panel’s report “is the wrong message.”
So what’s the right message? I asked to speak to him with a particular question in mind: Is “watchful waiting” — officially known as “active surveillance” — the central problem? That is, is the PSA screening test drawing federal fire and causing men to be over-treated for prostate cancer largely because it’s just so hard to be told you have cancer and not do something very interventionist about it? Would PSA screening be more acceptable to medical authorities if we stopped over-reacting to the results?
But the issue is too complex to distill it down to one question. Here’s our conversation, lightly condensed. My takeaway from Dr. Kantoff’s explanations:
Turning thumbs down altogether on the PSA test would set prostate cancer treatment back 25 years. Instead, we need to refine how the test is used. Men with short life expectancies should not be screened at all; some men with elevated PSA levels should not get biopsies. And most of all, more men should opt for restrained ‘active surveillance,’ hard as it may be.
Q: On the Dana-Farber Web page, you say the latest recommendations on prostate screening are the wrong message. What’s the right message?
Let’s begin with a 3-minute overview:
The PSA [Prostate-Specific Antigen] test was developed around 20-plus years ago, and has been used widely in The United States, and it has allowed us to make the diagnosis probably 10 years earlier than before.
It therefore did two things: It pushed back the date of diagnosis — and the stage at the time of diagnosis — so that very few people presented with metastatic disease when they came in the door, as was the case prior to the advent of the PSA.
But at the same time it uncovered a lot of cancers that did not need to be diagnosed, that were non-lethal cancers. However, for quite a number of years in the United States, people treated everything that came their way.
The downsides Continue reading
