Medical Health Center

Philadelphia Inquirer Columnist Discusses Depression Among Black Men

Stigma “continues to surround mental illness,” particularly in the black community, Philadelphia Inquirer columnist Annette John-Hall writes. She notes that according to John Head, author of “Standing in the Shadows: Understanding and Overcoming Depression in Black Men,” the stigma around mental illness in black men is “even worse.”

According to John-Hall, Arthur Evans, director of the Philadelphia Department of Behavioral and Mental Retardation Services, said that studies indicate that signs of depression show up in the form of aggression. “So it shouldn’t come as much of a surprise that the overwhelming number of victims and perpetrators of violence are black men,” John-Hall writes.

A recent “admission” by National Football League player Shawn Andrews that he has depression should “lift the veil of shame and encourage other young African-Americans to confront their depression and really understand that they can actually take steps to feel better,” John-Hall writes.

“Fact is, depression favors no one. Multimillion-dollar contracts can’t protect you from it. Nor can celebrity,” John-Hall says, adding that Andrews’ case should show other black men that “depression doesn’t make you weak, stupid or to blame. And it sure doesn’t make you less of a man.” She continues, “If anything, it should force” black men to accept the possibility that they could be depressed, seek treatment and get “on a path to healing” (John-Hall, Philadelphia Inquirer, 8/8).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Online Pharmacy Safety Providing Erectile Dysfunction Drugs

Should you buy erectile dysfunction and impotence treatment drugs online?

Online Internet shopping today offers many benefits. You can research a product in the privacy of your own home and purchase most anything by clicking a mouse. But should we be allowed to buy prescription drugs via the Internet, bypassing a traditional office visit or conversation with a physician? In the August issue of Mayo Clinic Proceedings, researchers from Utah and several colleagues compare the relative safety of two systems — an online prescribing service versus traditional physician consultation - for patients seeking medication to treat erectile dysfunction.

Online prescribing, also called e-medicine prescribing, is relatively new in the United States. Patient demand for these services appears to be growing, but the researchers acknowledge that the health care industry “has appropriately raised serious concerns about the safety of prescribing over the Internet.” In 2002, the state of Utah signed a contract with an Internet prescribing service to prescribe erectile dysfunction drugs called PDE-5 inhibitors. Erectile dysfunction (ED) is the inability of a man to maintain a firm erection long enough to have sex.

The researchers randomly selected 1,000 patient medical records from patients seeking ED treatment from Jan. 1, 2001 to Dec. 31, 2005. Half (500) of these patients used the online prescriber (the e-medicine group), and 500 consulted a physician (the traditional medicine group) for treatment.

Using statistical analyses, the researchers compared the safety of both approaches — e-medicine versus traditional medicine — in treating patients who have ED. The safety comparisons looked at a number of criteria, including prescription appropriateness, how often the prescribers used a diagnostic tool called the International Index of Erectile Questions (IIEQs) and the level of patient education provided by prescribers.

Evaluating both systems for these safety criteria, the researchers concluded that the e-medicine system “outperformed the traditional system in most of the safety variables tested.” One area the e-medicine system appeared to excel was patient education. The authors noted that 100 percent of the e-medicine clients received written manufacturer product information, and 75.2 percent of e-medicine clients received tailored electronic messages. In comparison, study data showed that no medication instructions were recorded for 51.8 percent of patients who received prescriptions via a traditional physician consultation.

“Innovation, technology and current medical practice all factor into the outcome of this study,” note the authors. “Application of an expert interview system specifically targeted to erectile dysfunction along with a continuous platform for patient client-physician communications make this particular Internet system comparable to traditional medical practice.”

The researchers acknowledge that additional research is needed to confirm these results. They also recommend that state regulatory agencies “consider using the regulatory model of oversight protections implemented by the state of Utah to license Internet prescribing companies.”

More Men Should Undergo Prostate Cancer Screening Tests

Analysis has shown that more men need to undergo prostate cancer screening tests, especially black males who are at higher risk.

A team of researchers from Duke University in Durham, North Carolina examined data from a 2002 survey involving 58511 U.S. men aged 40 and over.

Results showed that 1 out of 5 white men and 1 out of 3 black men had undergone prostate-specific antigen (PSA) screening during the past year. Hispanic men were found to be more likely to take the screening on time. Overall, study reported that 22.5% men aged from 40 to 49 and 53.7% of men over 50 have got PSA tests.

Researchers still think that the prostate cancer screening rates are extremely low. Those at higher risk for prostate cancer must be more attentive and not to wait for their older ages. If they are at higher risk, they need to keep an eye on the disease to make it curable.

According to American Cancer Society recommendations, men over 50 must undergo prostate cancer screenings to identify the disease as early as possible. African Americans are found to be at higher risk, this is why they are recommended to undergo screening at their 45s. If they have strong family history, they should take the screening in their 40s.

“Our study is the first to specifically examine PSA screening in younger men, which provides an important assessment of quality of care, especially for high-risk groups,” wrote study authors. “Further investigation will be required to understand the impact of new risk-stratification strategies, with particular focus on the policy implications of potentially large increases in health-care resource use.”

Swimmer Eric Shanteau Fights Testicular Cancer, Inspires Victims

There is an Olympic athlete with testicular cancer who still competes. Eric Shanteau is not doing this to raise money for testicular cancer, but he actually is putting off treatment to compete, despite the fatigue and pain from the growing cancer.

“While I don’t agree with Eric Shanteau’s decision since he’s 24 years old and the quicker he gets treatment, the better his chances of survival are, you have to admire what he’s doing,” writes Jamie from EG Citizen Cancer Blog.

Eric Shanteau is diagnosed with the testicular cancer a week before leaving for the U.S. Olympic trials, but the swimmer says cancer relieves competition pressure.

We wish Eric quick recovery and treatment from testicular cancer, as well as good competition in Olympics.

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One In 5 Young Men Has Had Prostate Cancer Test

A new analysis finds that one in five men in their 40s has had a prostate specific antigen (PSA) test within the previous year and that young black men are more likely than young white men to have undergone the test. The study, published in the September 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society, provides valuable information as experts discuss possible changes to prostate cancer screening recommendations.

Currently, major medical organizations say evidence is insufficient to recommend routine prostate cancer screening using PSA or digital rectal exam (DRE). Rather, most group recommended men at average risk discuss with their doctor starting at age 50 whether to get tested. The American Cancer Society does though recommend that African Americans and men with a first degree relative with prostate cancer should , have screening every year, begin at age 45, and that men with two or more first degree relatives with prostate cancer begin testing at age 40.

To shed light on current PSA screening practices in young men, Dr. Judd Moul and Dr. Charles Scales, of Duke Prostate Center and Urologic Surgery at Duke University and colleagues obtained data from the 2002 Behavioral Risk Factor Surveillance System, an annual, population-based survey of civilian, non-institutionalized adults in the United States. The final sample for this study consisted of 58,511 men ages 40 and above.

The investigators found that one in five of them men had undergone screening in the previous year. Several sociodemographic characteristics were associated with PSA screening in younger men. In particular, young, black, non-Hispanic men were more likely than young white, non-Hispanic men to report having a PSA test in the previous year. This finding was independent of income, education and access to care. The authors noted that these results are reassuring, showing that physicians are more likely to recommend screening among black men due to this group’s elevated risk for prostate cancer. However, they also noted that PSA screening in this group remains potentially suboptimal; only about one in three African American men reported having a PSA test in the previous year.

The survey also revealed that younger Hispanic men were more likely to undergo PSA testing than younger white, non-Hispanic men. The probability of undergoing a PSA test was also higher with increasing obesity, as well as with higher household income and education level. Health insurance coverage and an ongoing relationship with a physician were also strongly associated with having had a recent PSA test.

“Our study is the first to specifically examine PSA screening in younger men, which provides an important assessment of quality of care, especially for high-risk groups,” the authors write. “Further investigation will be required to understand the impact of new risk-stratification strategies, with particular focus on the policy implications of potentially large increases in health care resource use”.

Men Older 75 Should Not Be Screened For Prostate Cancer

Men age 75 and older should not be screened for prostate cancer, and younger men should discuss the benefits and harms of the prostate-specific antigen (PSA) test with their clinicians before being tested, according to a new recommendation from the U.S. Preventive Services Task Force. The recommendation and accompanying evidence summary appear in the August 5 issue of the Annals of Internal Medicine.

The Task Force found evidence that screening for prostate cancer provided few health benefits but led to substantial physical harms and some psychological harms in men age 75 and older. In men younger than 75, the Task Force concluded that current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening. An estimated 218,890 U.S. men were diagnosed with prostate cancer in 2007, and one in six men will be diagnosed in his lifetime.

Screening for prostate cancer is most often performed using PSA tests and digital rectal exams. The PSA test is more likely to detect prostate cancer than the digital rectal exam. However, prostate cancers that are found with a PSA test take years to affect health; most prostate cancers that grow serious enough to cause death take more than 10 years to do so. Since a 75-year-old man has an average life expectancy of about 10 years and is more likely to die from other causes such as heart disease or stroke, prostate cancer screening is unlikely to help men over 75 live longer.

For the same reasons, men younger than 75 with chronic medical problems and a life expectancy of fewer than 10 years are also unlikely to benefit from screening. There are also harms associated with prostate cancer screening, which include biopsies, unnecessary treatment and false-positive results that may lead to anxiety. Complications often result from treating prostate cancer and may include urinary incontinence and impotence. These slow-growing cancers may never have affected a patient’s health or well-being had they not been detected by screening.

“Because many prostate cancers grow slowly, early detection may not benefit a patient’s health and in some cases may even cause harm,” said Task Force Chair Ned Calonge, M.D., M.P.H., who is also chief medical officer for the Colorado Department of Public Health and Environment. “We encourage men younger than 75 to discuss with their clinicians the potential—but uncertain—benefits and the possible harms of getting the PSA test before they decide to be screened.”

Current data show that one-third of all men in the United States over 75 are receiving PSA testing. Although most major medical organizations suggest that prostate cancer screening may be discontinued in men with a life expectancy of fewer than 10 years, the Task Force is the first group to define an explicit age cutoff above which screening is likely to be ineffective or harmful. The results of two ongoing clinical trials—the National Cancer Institute’s Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial and the European Study of Screening for Prostate Cancer—should help to clarify the potential benefits of screening in men under the age of 75.

The Task Force is the leading independent panel of experts in prevention and primary care. The Task Force, which is supported by AHRQ, conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the gold standard for clinical preventive services.

Researchers Identify Promising Prostate Cancer Drug Target

Scientists at Dana-Farber Cancer Institute report they have blocked the development of prostate tumors in cancer-prone mice by knocking out a molecular unit they described as a “powerhouse” that drives runaway cell growth.

In an article that is being published as an advanced online publication by the journal Nature, the researchers said the growth-stimulating molecule called p110beta – part of a cellular signaling network disrupted in several common cancers – is a promising target for novel cancer therapies designed to shut it down. Lead authors of the report are Shidong Jia, MD, PhD, Zhenning Liu, PhD, Sen Zhang PhD, and Pixu Liu, MD, PhD.

The p110beta molecule and a counterpart, p110alpha, are “isoforms” – slightly different forms – of an enzyme called PI(3)K that is an intense focus of cancer research and drug development. PI(3)K is the linchpin of a cell-signal pathway that responds to growth factor signals from outside the cell.

When activated by growth factor receptors, PI(3)K turns on a cascade of genes and proteins that drives cells to divide and grow. The molecular accelerator is normally kept under control by a tumor-suppressor protein, PTEN, which acts like a brake to curb excess cell growth that could lead to cancer.

Mutations that inactivate PTEN – in effect releasing the brake on growth signals – are found in a significant proportion of prostate, breast and brain tumors. The senior authors of the new report, Jean Zhao, PhD, and Thomas Roberts, PhD, previously showed that blocking p110alpha protein inhibits cancerous growth induced by various cancer-causing proteins, such as Her2 and EGFR. With that knowledge in hand, the researchers, in collaboration with pharmaceutical companies, are developing p110alpha blockers.

P110beta, by contrast, was thought to be a relatively insignificant player in tumors. However, “the surprise in this paper is that p110beta has been found to be a bigger player than p110alpha in tumors that result from PTEN loss,” noted Zhao. “Now the drug companies, which have been focusing on p110alpha, will have to think about making p110beta inhibitors as well.”

Both forms of the p110 molecule have dual tasks: they are involved in responding to insulin signals – a metabolic function – as well as relaying growth signals from outside the cell. But the importance of 110beta had been vastly underestimated, the researchers said, for reasons they don’t entirely understand.

“We knew that when cells are stimulated with growth factor signals, the activity of p110alpha, but not p110beta, rises rapidly and sharply in triggering excess cell growth,” Zhao said. “We speculate that 110beta may be providing a low-level but steady growth stimulus and when PTEN is lost, it becomes an important source of cell proliferation signals.”

The new findings stem from experiments in which the scientists disabled the p110beta protein in mice as a way of exploring its normal functions. In one of the experiments, the researchers “knocked out” p110beta in mice that also lacked the PTEN tumor suppressor protein and were therefore highly prone to prostate cancer. Mice that lacked PTEN but had functioning p110beta proteins all developed early prostate cancers by 12 weeks of age. In contrast, the “knockout” mice with no p110beta function remained free of prostate cancer even though the PTEN “brake” had been disabled.

The scientists concluded, as a result, that p110beta becomes a “powerhouse” to drive cancerous cell growth when PTEN function is missing.

In light of the new findings, there is likely to be great interest in finding drugs or other tools to block the p110beta protein in cancers where mutations in PTEN have unleashed the overactive growth signals, said Zhao, who is also an assistant professor of surgery at Harvard Medical School.

The task is made somewhat easier, said Roberts, by the fact that “we know what the inhibitor should look like because of our work on p110alpha inhibitors.”

Roberts, who is also a professor of pathology at Harvard Medical School, said that drugs designed to block the p110alpha form are on their way to clinical testing, but he could not predict when p110beta inhibitors might become available for clinical testing.

New prostate recommendations - new lessons for journalists

Just four days ago, in response to an NBC News story in which reporter George Lewis recommended that all men over age 50 get annual prostate exams including the PSA blood test, I cited the statement of the U.S. Preventive Services Task Force to show that Lewis’ advice was not based in evidence:

“The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE). Although the Task Force found evidence that screening can find prostate cancer early and that some cancers benefit from treatment, the Task Force is uncertain whether the potential benefits of prostate cancer screening justify the potential harms.

“The potential harms of prostate cancer screening include fairly frequent false-positive results from PSA screening, which may lead to unnecessary anxiety and biopsies. In addition, early detection and treatment may result in complications from treating some cancers that may never have affected a patient’s health.”

Yesterday the USPSTF updated its recommendation and it makes Lewis’ on-the-air statement to all of NBC’s viewers all the more problematic in its crusading advocacy that is not supported by evidence:

“In men younger than age 75 years, the USPSTF found inadequate evidence to determine whether treatment for prostate cancer detected by screening improves health outcomes compared with treatment after clinical detection.

“In men age 75 years or older, the USPSTF found adequate evidence that the incremental benefits of treatment for prostate cancer detected by screening are small to none.

“The USPSTF found convincing evidence that treatment for prostate cancer detected by screening causes moderate-to-substantial harms, such as erectile dysfunction, urinary incontinence, bowel dysfunction, and death. These harms are especially important because some men with prostate cancer who are treated would never have developed symptoms related to cancer during their lifetime.

“There is also adequate evidence that the screening process produces at least small harms, including pain and discomfort associated with prostate biopsy and psychological effects of false-positive test results.

“The USPSTF concludes that for men younger than age 75 years, the benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined.

“For men 75 years or older, there is moderate certainty that the harms of screening for prostate cancer outweigh the benefits.

“Older men, African-American men, and men with a family history of prostate cancer are at increased risk for diagnosis of and death from prostate cancer.1 Unfortunately, the previously described gaps in the evidence regarding potential benefits of screening also apply to these men.

“The yield of screening in terms of cancer cases detected declines rapidly with repeated annual testing. If screening were to reduce deaths, PSA screening as infrequently as every 4 years could yield as much of a benefit as annual screening.

Journalism is supposed to be about evidence and facts, not crusading advocacy.

“We don’t have any studies that show prostate cancer screening saves lives,” explains Dr. Otis Brawley, chief medical officer for the American Cancer Society.

Prostate Cancer in Vietnam Veterans Linked To Agent Orange Exposure

UC Davis Cancer Center physicians today released results of research showing that Vietnam War veterans exposed to Agent Orange have greatly increased risks of prostate cancer and even greater risks of getting the most aggressive form of the disease as compared to those who were not exposed.

The findings, which appear online now and will be published in the September 15 issue of the journal Cancer, are the first to link the herbicide with this form of cancer. The research is also the first to utilize a large population of men in their 60s and the prostate-specific antigen (PSA) test to screen for the disease.

“While others have linked Agent Orange to cancers such as soft-tissue sarcomas, Hodgkin’s disease and non-Hodgkin’s lymphoma, there is limited evidence so far associating it with prostate cancer,” said Karim Chamie, lead author of the study and resident physician with the UC Davis Department of Urology and the VA Northern California Health Care System. “Here we report on the largest study to date of Vietnam War veterans exposed to Agent Orange and the incidence of prostate cancer.”

Chamie also said that, unlike previous studies that were either too small or conducted on men who were too young, patients in the current study were entering their prime years for developing prostate cancer. There was also the added advantage that it was conducted entirely during the era of PSA screening, providing a powerful tool for early diagnosis and tracking of prostate cancer.

More than 13,000 Vietnam veterans enrolled in the VA Northern California Health Care System were stratified into two groups — exposed or not exposed to Agent Orange between 1962 and 1971. Based on medical evaluations conducted between 1998 and 2006, the study revealed that twice as many men exposed to Agent Orange were identified with prostate cancer. In addition, Agent Orange-exposed men were diagnosed two-and-a-half years younger and were nearly four times more likely to present with metastatic disease. Other prostate cancer risk factors — race, body-mass index and smoking — were not statistically different between the two groups.

“Our country’s veterans deserve the best possible health care, and this study clearly confirms that Agent Orange exposure during service in Vietnam is associated with a higher risk of prostate cancer later in life,” said Ralph deVere White, UC Davis Cancer Center director and a study co-author. “Just as those with a family history of prostate cancer or who are of African-American heritage are screened more frequently, so too should men with Agent Orange exposure be given priority consideration for all the screening and diagnostic tools we have at our disposal in the hopes of early detection and treatment of this disease.”

Now a banned chemical, Agent Orange is a combination of two synthetic compounds known to be contaminated with the dioxin tetrachlorodibenzo-para-dioxin (TCDD) during the manufacturing process. Named for the color of the barrel in which it was stored, Agent Orange was one of many broad-leaf defoliants used in Vietnam to destroy dense forests in order to better visualize enemy activity.

It is estimated that more than 20 million gallons of the chemicals, also known as “rainbow herbicides,” were sprayed between 1962 and 1971, contaminating both ground cover and ground troops. Most of the rainbow herbicide used during this time was Agent Orange. In 1997, the International Agency for Research on Cancer reclassified TCDD as a group 1 carcinogen, a classification that includes arsenic, asbestos and gamma radiation.

Experts Question Prostate Cancer Screening Benefits

A report published in the August 5, 2008 issue of Annals of Internal Medicine says that the U.S. Preventive Services Task Force (USPSTF) has played down the benefits of prostate cancer screening for men above the age of 75.

According to the report, the U.S. Preventive Services Task Force is updating its 2002 report on prostate cancer screening recommendations.

The latest recommendation warns against routine prostate cancer screening for men over the age of 75 and USPSTF also says that further research and evidence is needed to establish if men under the age of 75 could benefit from prostate cancer screening.

Figures show that prostrate cancer is the second leading cause of cancer death in men in the United States. One in six American men is affected by prostrate cancer which is also common non-skin cancer in America.

Whereas the Measurement of prostate-specific antigen (PSA) in the blood can detect prostate cancer before symptoms develop, the Task Force says that there is no satisfactory evidence which shows that the tests give long term health benefits.

The USPSTF chair Ned Calonge said that they had “carefully reviewed the available evidence to measure the benefits and harms of screening for prostate cancer and could not find adequate proof that early detection leads to fewer men dying of the disease.”

The report also quoted Ned as saying “At this point, we recommend that men concerned about prostate cancer talk with their health care providers to make a decision based on their individual risk factors and personal preference.”

The full recommendations of the report are published in the August 5, 2008 issue of Annals of Internal Medicine which is one of the most cited peer-reviewed medical journals in the whole world.

Prostate Cancer Screening Risks - Provided by National Cancer Institute

Risks of Prostate Cancer Screening

Key Points for This Section

* Screening tests have risks.
* The risks of prostate screening include the following:
o Finding prostate cancer may not improve health or help a man live longer.
o Follow-up tests, such as a biopsy, may be done to diagnose cancer.
o False-negative test results can occur.
o False-positive test results can occur.

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.

The risks of prostate screening include the following:

Finding prostate cancer may not improve health or help a man live longer.

Screening may not improve your health or help you live longer if you have cancer that has already spread to the area outside of the prostate or to other places in your body.

Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. It is not known if treatment of these cancers would help you live longer than if no treatment were given, and treatments for cancer may have serious side effects.

Follow-up tests, such as a biopsy, may be done to diagnose cancer.

If a PSA test is higher than normal, a biopsy of the prostate may be done. Complications from a biopsy of the prostate may include fever, pain, blood in the urine or semen, and urinary tract infection. Even if a biopsy shows that a patient does not have prostate cancer, he may worry more about developing prostate cancer in the future.

False-negative test results can occur.

Screening test results may appear to be normal even though prostate cancer is present. A man who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if he has symptoms.

False-positive test results can occur.

Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn’t) can cause anxiety and is usually followed by more tests, (such as biopsy) which also have risks.

Your doctor can advise you about your risk for prostate cancer and your need for screening tests.