Dr. Sharon Orrange
Primary Care Physician
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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LOCATION: Santa Monica, CA, USA
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  • Assistant Professor of Clinical Medicine, Division of Geriatric, Hospital and General Internal Medicine, Keck School of Medicine, University of Southern California
YEARS IN PRACTICE: 11
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There is a Women's Health Specialty, should there be a Men's Health Specialty?
55
Posted in Abstinence & Ce... by Dr. Sharon Orrange on May 02, 2009

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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Ever notice how providers want to hear your opinion...unless you don't agree with them???
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Well, does not appear Dr Orrange intends to return to comment on the issues and comments brought forth. This seems to be fairly common with many providers. The have their opinions, and they don't really want to discuss or debate. There were valid points brought forth here, granted some were pretty "emotionally charged", but then the comments on 10 reasons and this presented by the good Dr. would hardly lead one to think she was the sensitive type. Perhaps this is a whole different issue the fact that Dr.'s are not open to listening to people who have different views. It probably contributes to exactly what we are talking here, the failure to understand issues that do not ring home to them, male modesty and equality being one of them....I tried to give the benefit of the doubt but when you don't see the need to respond to issues you have put forth....won't debate.......silence says a lot
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I am replying to Norma who posted a comment on the Breast cancer thread about how men are complaining to much about unequal treatment. Well Norma, what exactly bothers some women when men have a legit complaint. Do you feel it takes away from womens issues, do you feel as the oppressed victim it is impossible for men to be discriminated against or is it a in the past your fathers discriminated so now it is our turn. A wrong is a wrong, some women seem to feel so threatened when a male addresses inequality that can't even see the obvious. They (you) are so caught up in the fact that it isn't your gender you won't even recognize facts. 16.6% of all new reported cancer is prostate cancer yet it recieves 7.1% of cancer funding, the national cancer Institute budgeted twice as much for breast cancer as prostate (715 to 376), 49 states mandate insurance carriers cover breast cancer screening, 28 mandate covering prostate screening, media coverage was 2.6 stories on breast cancer for every one on prostate, there are 7 new drugs on the market for breast cancer for every one for prostate. I understand this is an emotional issue, and there is no doubt sexism was heavily a male transgression in the past and it was wrong then, and it is still an issue now, but reverse sexism is no different and no better. Whether some people want to admit it or not,,,men can be the victim of discrimination and sexism. Sometimes in our enthusiasim to correct past wrongs the pendulem swings to far. In our society it has become accepted for women to cry foul, cry discrimination and sexism becasue it was so obvious and prevelant in the past, so its easy to understand how giving up that position of perpetual victim may be difficult, but...things are a lot closer, not equal, still have aways to go...but it doesn't mean pointing out inequality on the other side is wrong....
By doalan  May 12, 2009
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ESF outstanding, thanks for the link I am going to spread it to other sites.
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
By doalan  May 12, 2009
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