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Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
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There is a Women's Health Specialty, should there be a Men's Health Specialty?
In response to a previous blog "The 10 Real Reasons Men Don't Go to the Doctor," I have received emails from men suggesting that men's issues are underrepresented in medicine. This has brought up an issue worth raising: should there be a men's health specialty and are we paying too much attention to women's health?
First, until very recently, studies done on stroke and heart disease prevention and treatment DIDN'T enroll women at all or women were represented in very limited numbers. Even today it is well known in academic medicine that women are underrepresented in studies on heart disease (whether it is aspirin for prevention of heart disease, the use of ace inhibitors, immediate coronary angiogram intervention for unstable angina, etc). Now that we have clinics with a women's health emphasis are we pouring too many resources into women and ignoring the needs of men? Should there be Men's Health Clinics? I'll be honest, I have always felt that in the field of medicine men were highly represented and taken care of. Maybe they feel they are not?
1) Women's Health is not a recognized subspecialty of medicine as is cardiology, oncology, endocrinology, and pulmonary for example. Women's health clinics were started with the idea of combining OB/GYN issues and preventative care for women. Women's health clinics are usually Primary Care Doctors (Internal Medicine doctors, family medicine doctors) who take care of serving the needs of women that men don't need: menopause, contraception, breast cancer screening, cervical cancer, etc.
2) It has been proposed that Men's Health Centers, if they did exist, focus on prostate and erectile dysfunction issues. The question here is whether these issues are being properly addressed by primary care providers without having separate dedicated Men's Health Centers.
3) What needs are not being met for men in Primary Care clinics? Screening for cholesterol, blood pressure, blood sugar, weight and exercise regimen are all part of a General Internal Medicine Practice so this should meet the needs of men for preventative care.
4) How we are different other than the obvious ways: Heart disease prevention and treatment are different for men and women. There are significant differences between men and women in the epidemiology, diagnosis, treatment and prognosis of coronary heart disease that should be taken into account in the care of women with known or suspected disease. Unfortunately, data from clinical trials about the management of women with an acute coronary syndrome (myocardial infarction or unstable angina) are limited, since women are generally underrepresented in randomized controlled studies. A repeating theme in the literature is that unadjusted outcomes are often worse in women than men; for example 30 day mortality after bypass surgery is higher in women than men. We should all know this: recommendations for screening and treatment of heart disease are largely based on data conducted predominately on men so the needs of men should be served here by their Internal Medicine or Family Medicine doctor.
5) Screening for Prostate cancer. I heard complaints that relatively little is spent on men's health as compared to women's health. I have lost several patients close to me from complications due to prostate cancer or surgery for it but certainly don't think prostate cancer is being ignored. In fact it appears we may be over-treating and over-screening, performing too many surgeries for prostate cancer when there is no single trial that shows screening for prostate cancer with PSA prevents death from prostate cancer. As many of you have heard recently in the press, in March 2009 the results of two large studies were released and after these the consensus is that there are many patients who are diagnosed with prostate cancer that do not need to be treated, can be observed safely, and will not die of their cancer. Yet most of them are being treated with surgery.
6) What are the real downsides of PSA screening resulting in prostate biopsies and surgeries? The real issue here is that aggressive screening, biopsies and surgery results in immediate effects for men: incontinence and erectile dysfunction among them. This is real, and distressing, and if we aren't preventing mortality or morbidity from these surgeries we should think long and hard about it.
7) Are the needs of men being overshadowed by research into breast cancer, hormone replacement therapy and other women's health issues? There is huge funding in cardiology research (with most studies still enrolling a higher percentage of men) as well as prostate cancer. I'll be honest this is not an argument I hear often in academic medicine but maybe there are many out there who feel this to be true? Let me hear your voice.
Dr O.
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Still hoping we will get a response from Dr. Orrange, and hoping she will make a honest effort to get some feed back from some non-partisan males about her articles. I think an unbiased read by many men will point out the problems with the thinking that drives these kind of posts, again not saying she is bad or intentionally prejudiced, but the posts certainly read that way...in the past I am sure if you asked men if they were sexist or prejudiced when they oppressed women, they would not have recognized it either...as a kid I heard a lot of racist jokes from basically good people who didn't even realize the harm in what they were doing..it was humor, and seperate but equal...now we see how unequal it was...didn't at the time...but now...think we have the same thing going on here
Congressman Tim Murphy has proposed a bill establishing an office of men's health. Worthy of support.
Thanks to ESF for this link
http://murphy.house.gov/News/Docum...
There are men's clinics already, mostly as part of larger institutions. Very few are standalone.
The point of having them is to attract more men to seek attention earlier. If the existing clinics could prove that they did that, it would be a lot easier to push for them. As I've said, I don't know what the results of such a study would be. Possibly they wouldn't attract more men, but I think they certainly have potential if done right.
And by the way, I don't know why you emphasize that the president's of all those societies are men. Are you suggesting that no woman could be sympathetic to improving men's health? If so, I don't believe it.
Joel Sherman MD
Dr. Orrange, I realize it probably seems like you are being unfairly attacked. I for one do not think you provide any less care, nor care less for your male patients. My point is your posts exemplify the biais that men face in the medical system. To be honest it seems many Doctors are unwilling to openly discuss this with us choosing to either change the subject or simply not respond. My feeling is that you do care about your male patients, but you fail to understand the issue at hand from a male perspective.
I truely felt the 10 reasons post was demeaning to men from the point that making light of DRE's, Testicular exams, and ED indicates how medical care including embaressment and modesty for men is not recognized or at least undervalued compared to females. It was stated by several posters had a male GYN done a similar post making light of female pelvic exams, he would have been roasted. The fact that you would feel comfortable making those statements doesn't mean you dislike or don't care about your male patients...it does however indicate you do not recognize men are being treated as if their health issues are less serious. this includes and perhaps especially is true of the non physical aspects of their care. We are careful to create environments that are female friendly both in womens clinics and within general care. We not only do not do so for men...we, as indicated in your 10 reason post feel it is ok to make light of them, to joke about them...
On the issue of specialty clinics. The point I was trying to make was if you read your post. You pose a question, Should there be mens specialy, and through out your post site all the reasons seem to indicate you don't think men should. To me your post seems so one sided, so defensive of womens clinics while downplaying the need for mens clinics when the exact same reasons exist for men. You end with let me hear your voice. Perhaps we were a little to exuberent in doing so...but the fact that you seem to not recognize how the need/benefit is similar between male and female seems to indicate you really don't understand your male patients. I think we are trying to provide male health care from a female perspective. Providers act like Men think its funny if you joke about sticking a finger in their butts, that it is alright to do this, providers seem to think men can get care for male specific issues in the general care but females need specialty centers that not only treat female issues...but in a female friendly manner. The fact that this seems so obvious to other males, and you do not see it...doesn't make you bad, doesn't mean you don't care...but neither does it make you right and seems to indicate you do not understand male mentality.
Just for kicks I took your articles and gave them to a couple friends and said read these and tell me what you think...a couple females were more likely to think they were funny or a little off where men thought they were way off. I would suggest if you provided them to 10 random people who were completly nuetral...you would find they are for lack of a better term prejudiced against male patients and seem to follow stereotyping.
Long post, if you would just do me a favor and answer a couple questions I will try to step out and let this one go. If you would just answer the following:
1) Do you agree that if a male practioner had made comments about sticking a finger in a female patients butt or feeling her tits or P*ssy (I really hate that word) that he would have recieved a very negative reaction...that it would have been less acceptable.
2) I still fail to see where you feel that thinking Womens Clinics are if not needed, at least justified for female specific issues as well as screening....but male specific issues and screenings do not warrent male clinics as they can be handled in the general medical setting...I just don't see how you can feel this is not skewed to placing a higher priority for womens needs...not nesecarily their health..but needs...If you could please just explain that...
I apologize if my posts made you feel persecuted or unfairly accused. I assumed you were not going to reply to these posts...it seems that is a common experience with providers male and female. I would appreciate a reply and would appreciate some discussion on this. I could be wrong, but I don't think you realize how what you are posting at a minimum is interpeted by men or possibly indicates you may not realize your own biais in how your view mens health care...not saying you care less for them...but just as I can not truely understand what women think and feel....I think you are showing the same to a high degree toward your male patients...thanks, hope to hear from you soon
And Dr. Sherman is correct in his criticisms of you: you ask if men should receive comparable specialty care that women receive, when anyone with half a heart or brain knows that men should receive the same focus and expenditures that women do. For you to even raise such a point as question is outrageous: it is like asking, "Should we let the Jews out of Auschwitz?"
You only focus on prostate cancer, when anyone with a modicum of intelligence knows that there are far more male health issues than prostate cancer.
You also failed to acknowledge the points I raised about the fraud perpetrated by the Congressional Women's Caucus in the early 1990s. I pointed out their misleading claim that women's health issues received 15% of the NIH budget - but they ignored the fact that male health issues received only half of that.
I daresay that if men are hesitant to visit the doctor, it is precisely because they have so frequently encountered the mindset that you ably demonstrated here.