Tag Archives for MD

Putting the Brakes on Testosterone Prescriptions

Published in Pawtucket Times on March 30, 2015

Sophisticated mass marketing pitching testosterone to combat age-related complaints combined with lax medical guidelines for testosterone prescribing can be hazardous to your physical health, even leading to strokes and death, warns an editorial in this month’s Journal of the American Geriatrics Society.
The March 2015 editorial coauthored by Dr. Thomas Perls, MD, MPH, Geriatrics Section, Department of Medicine, Boston Medical Center in Boston, and Dr. David Handelsman, MBBS, Ph.D., ANZAC Research Institute, in New South Wales, Australia, expressed concern over commercial-driven sales of testosterone, effectively increasing from “$324 million in 2002 to a whopping $2 billion in 2012, and the number of testosterone doses prescribed climbing from “100 million in 2007 to half a billion in 2012.”

Pitting Patients Against Patients

The editorial authors see the “40 fold” increase of testosterone sales as the result of “disease mongering,” the practice of widening the diagnostic boundaries of an illness and aggressively promoting the disease and its treatment in order to expand the markets for the drug. Glitzy medical terms, like “low T” and “andropause,” showcased in direct-to-consumer product advertising pit aging baby boomers against their physicians, who demand the prescriptions, say the authors.

“Clearly, previous attempts to warn doctors and the public of this disease mongering that is potentially medically harmful and costly have not been effective, says co-author Dr. Perls.

The epidemic of testosterone prescribing over the last decade has been primarily the proposing of testosterone as a tonic for sexual dysfunction and/or reduced energy in middle-aged men, neither of which are genuine testosterone deficiency states,” observes Dr. Handelsman.

According to the National Institutes on Aging (NIA), the nation’s media has increasingly reported about “male menopause,” a condition supposedly caused by diminishing testosterone levels in aging men. “There is very little scientific evidence that this condition, also called andropause or viropause, exists. The likelihood that an aging man will experience a major shutdown of testosterone production similar to a woman’s menopause is very remote.”

The authors agree with the NIA’s assessment, but go further. They point out in their editorial that for many men, testosterone does not decline with age among men retaining excellent general health, and if it does, the decline is often due to common underlying problems such as obesity and poor fitness. Those who hawk testosterone have developed advertising that focus on common complaints among older men such as decreased energy, feeling sad, sleep problems, decreased physical performance or increased fat.

But, many times a testosterone level won’t even be obtained and the patient is told that, simply based on these common symptoms alone or with minor reductions in serum testosterone, they have “late onset hypogonadism” or that their erectile dysfunction may be improved with testosterone treatment, say the authors. But the authors also point out the true hypogonadism is the cause in fewer than 10% of men with erectile dysfunction.

FDA Enters Debate

The U.S. Food and Drug Administration’s (FDA) recent dual commission findings concluded that testosterone treatment (marketed as ‘low T’) is not indicated for age-associated decline. The benefits of this “deceptive practice” remain unproven with the risks far outweighing the perceived benefits,” says the agency. Pharmaceutical companies are now required to include warning information about the possibility of an increased risk of heart attacks and stroke on all testosterone product labels.

Health Canada, Canada’s FDA, recently echoed the FDA’s committee findings that age-related hypogonadism has not been proven to be a disease-justifying treatment with testosterone. Both agencies warn of an increased risk of blood clots in the legs and lungs and the possibility of increased risk for heart attack associated with testosterone use.

In a statement, James McDonald, the chief administration officer for the Board of Medical Licensure and Discipline, says: “There is a concern in healthcare regarding direct-to-consumer prescribing of medication. At times, the prescription is not evidence-based, and can lead to misuse. There is concern with Testosterone, a schedule 3 controlled substance,that can be used as a performance-enhancing drug. The Rhode Island Board of Medical Licensure (BMLD) investigates complaints regarding all types of misuse of prescription medications as well as complaints regarding over-prescribing.”

Drs. Handelsman and Perls also warn about another drug commonly hawked for anti-aging, growth hormone. The FDA requires that doctors perform a test to demonstrate that the body does not produce enough growth hormone. “Those who market and sell HGH for these common symptoms nearly never perform the test because if they did a properly performed test, it would almost never be positive because the diseases that cause growth hormone deficiency in adults, such as pituitary gland tumors, are very rare,” said Perls. Growth hormone is well known for its side effects, including joint swelling and pain and diabetes. Ironically, opposite of anti-aging claims, growth hormone accelerates aging, increases cancer risk and shortens life span in animal studies.

In the editorial, Perls and Handelsman call upon professional medical societies and governmental agencies to take definitive steps to stop disease mongering of growth hormone and testosterone for conjured-up deficiencies.
“These steps include the banning of ‘educational’ and product advertising of testosterone for these contrived indications,” said Perls. “Furthermore, the FDA and Health Canada should require a physician’s demonstration of a disease process proven to benefit from testosterone administration in order to fill a lawful prescription for testosterone.”

Tightening Up Prescription Guidelines

The issue of prescribing testosterone is firmly on the medical profession’s radar screen with the FDA’s recent committee’s findings and Perls and Handelsman’s pointed editorial calling for the medical profession to seriously tighten up the lax consensus guidelines in order to stop the medically inappropriate prescribing of testosterone.
Rather than pushing testosterone, wouldn’t it be a “mitzvah – a good deed- if the nation’s pharmaceutical companies ran public service commercials stressing the importance of losing weight, exercising and eating nutritious meals as a way to effectively combat age-related problems, like low libido. But, this won’t happen because it is not a revenue generator or good for the company’s bottom line.

Herb Weiss, LRI ’12 is a Pawtucket-based writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.

It Takes a Village to Age in Place

Published in Senior Digest, February 2015

The simple act of joining his good friend, Reverend James Ishmael Ford, of the First Unitarian Church of Providence, for a quick cup of coffees piqued Cy O’Neil’s curiosity and led him on a journey to learn more about a new care option popping up around the nation, one that allows aging baby boomers to age in place right in the comfort of their home.

During their coffee chats, Ford, a native of California, began talking about his upcoming retirement, planning to return to his home state to be near his children.  But, he stressed the importance that his new California community must be located near a village.

O’Neil was intrigued and began Googling for information on specific villages, one was the The Beacon Hill Village.  He quickly got the concept.  Villages are created by membership-driven grass-roots organizations, with volunteers and paid staff, who coordinate access to affordable services, transportation, health and wellness programs, home repairs, social and educational activities, and other day-to-day needs enabling older persons to remain connected to their neighborhood community throughout the aging process.

According to Village to Village Network, there are now over 120 villages operating across the nation, in Canada, Australia and the Netherlands, with over a 100 additional Villages being developed.

Like many aging baby boomers, sixty-five-year old O’Neill did not want to leave his comfortable home in his later years, but stay put in his long-time Oakhill neighborhood.  The Village on Providence’s Eastside might just be the way to assist neighbors working together to successfully keep each other right in their homes, far away from assisted living facilities or nursing homes.

Creating Providence Village

Last February, O’Neill and several friends, over pot luck dinners, began  brainstorming how the Village concept could be brought to the Ocean State. One of the oldest Village organizations, The Beacon Hill Village, was established in Boston in 2001.  Why couldn’t the successfully run, The Beacon Hill Village, be replicated right here in Rhode Island, they asked.

Three pot luck dinners along with a larger event that drew over 30 attendees, resulted in a group of nine people who decided to launch an effort to create what they call the Providence Village.  This group consisted of a writer, editor, a geriatrician, college educators and administrators, people with business backgrounds, and artists.

“Rhode Island is the only state that does not have a village yet,” quips O’Neil.  There have been other attempts to bring The Village concept to Rhode Island but the failed,” he believes.

O’Neil, Boston College’s associate director for long-range planning and capital, notes that the Providence Village is still in the exploratory phase, gathering information.  The Steering Group is reaching out to Eastside Community in Providence through a survey on its website (http://providencevillageri.org/take-our-survey/) to identify the types of programs and services needed and identifying potential partners.  When completed, the Steering Group will move the organization into development phase where “serious planning begins to take place,” adds O’Neil.  At this phase, member benefits will be determined, organizational partners identified, and an operational, business and marketing plan developed.  .

“So far our responses have been very positive,” observes O’Neil.  “We’re energized by these responses and are very committed to rolling up our sleeves to make Village Providence work,” he says, noting that the Steering Group wants to create more opportunities to get more people involved to make Providence Village a reality.

Thoughts From Steering Group Members

Pat Gifford, MD, a retired geriatrician who is certified in hospice and palliative care who has practiced for over 30 years, brings her medical expertise and understanding of aging issues to the Steering Group.  The sixty-six year old Laurel Mead resident sees the village movement targeted to aging baby boomers.  “The Village is not a social service agency to take care of frail people,” she notes, but a “way of organizing people to take care of each other, often involving volunteering and a measure of paying-it-forward.”

Gifford, who brings extensive experience about the Village movement to the Steering Group, would like to write and teach on health and wellness issues for the members of the Providence Village, especially providing support to self-supportive groups for those with chronic diseases.  “It’s up to the Board of Village members if they are interested in these efforts,” she says.

According to Gifford, the key to Providence Village being a success is garnering strong grass roots support.  “It is important for people to go to visit our web site and complete our survey, so that we can understand the needs and desires of our unique community,” she adds.

A Final Note…

“The village movement is one of many approaches to senior living that AARP encourages,” said AARP State Director Kathleen Connell. “It’s impractical for many people to simply remain in the family homestead forever. It’s not ‘Aging in Place’ if the place isn’t right for you. Most people talk about downsizing as if it is all there is to be said about housing options. It’s not true, and we’re happy to see growing awareness that less house to maintain is really only part of the solution.

“One’s house and one’s home are two different things. You can choose another house, but people are most comfortable when they make a new home in an environment where they feel comfortable and live in proximity to the services and support they require as they age. AARP calls these livable communities and they are aligned with the thinking behind the village movement.

“Rhode Island does not have unlimited space to build new retirement communities. We need a balance of traditional senior housing development and the creative thinking and the adaptive use of existing housing.“

For more details about Providence Village go to http://providencevillageri.org/.

Herb Weiss, LRI ’12, is a Pawtucket writer covering aging, health care and medical issues.  He can be reached at hweissri@aol.com.

 

Prominent Oncologist’s Death Wish at Age 75

Published in Pawtucket Times, December 12, 2014

Dr. Ezekiel Emanuel, MD, Ph.D., a nationally-recognized oncologist and bioethicist, definitely marches to a different drummer.  While millions of older Americans pop Vitamins and supplements like M&M Candy, regularly exercise at their local gym, religiously jog and carefully watch what they eat to increase their life span, the chair of medical bioethics and health policy at the University of Pennsylvania, says living past the ripe old age of 75 is not on his bucket list.  We would be doing both society and our loved ones a favor by agreeing with this belief, he says.

When I am 75…

Why not age 80 or even 85?  Emanuel admits that his 75th birthday day was just a randomly chosen number, but the year was selected because scientific studies indicate that increases in physical and mental disability occur around this age, as well as a decline in both creativity and productivity.

The renowned 57-year old breast oncologist is at the top of his professional game.  Emanuel has received dozens of awards from organizations such as the National Institutes of Health and the American Cancer Society, including being elected to the Institute of Medicine (IOM) of the National Academy of Science, the Association of American Physicians, and the Royal College of Medicine (UK). Hippocrates Magazine even selected him as Doctor of the Year in Ethics.

Emanuel is a prolific writer, editing 9 books and penning over 200 scientific articles. He is currently a columnist for the New York Times and appears regularly on television shows including Morning Joe and Hardball with Chris Matthews.  .

The prominent physician, is also considered a key designer of the Affordable Care Act (commonly called Obamacare).  At a personal level, he has two well-known brothers, Chicago mayor Rahm Emanuel, former White House chief of staff, and Hollywood agent Ari Emanuel.

With this prominence, Emanuel’s death wish to die at 75, (the year 2032) before the onset of Alzheimer’s disease and other dementias, and decreased physical stamina (it’s harder to walk a quarter of a mile, even to climb 10 stairs) is drawing the ire of critics who charge that he advocates for health care rationing and legalized euthanasia.

But Emanuel claims that these charges are not true.  Setting his death at 75 is just his personal preference, he says, leaving his mortal coil. In his writings and media interviews he notes that setting the age when he hopes to die just drives his daughters and brothers crazy.

Last October, at the BBC Future’s World-Changing Ideas Summit in Manhattan, Emanuel’s prop, a full-page AARP ad from a newspaper, featuring an older couple hiking above a line of text that read, “When the view goes on forever, I feel like I can, too. Go long.”  Reinforcing his point, Emanuel is not buying AARP’s message pushing the positives of living an extended life.  For him, he doesn’t buy it and most definitely, seventy is not the new 50.

Sharing a Death Wish on the Air Ways

On Dec. 7, on CBC Radio Canada’s Sunday Edition, Emanuel, discussed his controversial October 21, 2014 article published in the The Atlantic, “Why I Hope to Die at 75.”  His Sunday interview detailed his unconventional and controversial stance, especially to AARP, the nation’s largest aging advocacy group, and aging organizations who strongly oppose this type of thinking.

Throughout the 28.12 minute interview with Michael Enright, Emanuel, he warns listeners, “Don’t focus on years, and focus on quality.”

“A good life is not just about stacking up the years and living as long as possible. People need to focus on quality of life,” says Emanuel, noting that “Setting an actual date for a good time to die helps you focus on what is important in your life.”

“It is really about what you are doing to contributing and enriching the world.  I want people to stop focusing on just more years, focusing on quality,” he says.

Emanuel says that you need to be realistic on living forever, your body and mind doesn’t  go on forever.  You should just be satisfied with living a complete life, he says.

By age 75, people will have gone through all stages of life, says Emanuel.  As a child you begin to develop skills and figuring out your place in the world. You go to college, raise a family, work to hone your skills and talents. At the later stages of your life you give advice and mentor people, he says, noting that in your mid-seventies, physical deterioration and mental slowing along with loss of creativity, begin to be felt.

During his radio interview, Emanuel claimed he is very active, recently climbing Mount Kilimanjaro with is two nephews, stressing that he is in relatively good health and doesn’t have a terminal illness and has no plans to commit suicide.   As a matter of fact, the physician even condemned physician-assisted suicide and euthanasia, in a 1997 article published in The Atlantic, a policy allowed in the states of Oregon, Vermont and Washington.  His philosophical view of ending one’s life is to allow the body to age naturally, he stresses.

In eighteen years, Emanuel pledges to refuse all medical procedures and treatments, including taking medications such as statins, cholesterol lowing drugs, and antibiotics that could prevent life-threatening illnesses or extend his life.  He notes that his last colonoscopy will be at 65, to screen for cancer.  No more colonoscopies after 75.  And, he’ll only accept palliative care after that milestone age, too.

“I’m not suggesting people kill themselves at 75 but, rather, let nature take its course,” Emanuel says.

How Others See it

Emanuel’s personal preference not to seek medical procedures or to use medications at age 75 that might lead to his death is not the same as physician assisted suicide, says Rev. Christopher M. Mahar, S.T.L., of the Providence Catholic Diocese, noting that this choice has always been respected by the Catholic Church.

“He is not actively choosing to take his life, and as long as he is not rejecting any of the ordinary means necessary for the preservation of life, such as nutrition and hydration, and is not intentionally destroying his body, he is free to decide for himself, says Mahar.

As Emanuel says, there is a downside to aging.  My 88-year-old mother died after a 14 year battle with Alzheimer’s disease.  At age 89, my father, whose quality of life declined over his later years, died suddenly, by having a pulmonary embolism.

For me, 89 is the year I choose to meet my maker, hanging up my spurs.  Yes, I will let nature take its course, but I will most continue to take Vitamins and antibiotics, even my Lisinopril, for high blood pressure.  I will not turn my back on medical procedures or technology that might enhance the quality of my life, even lengthen it.

I agree with the statement of late Actress Betty Davis stated, “Old age ain’t no place for sissies.”   There is no alternatives, you can only hope for nature to ultimately take its course, and it will.  And so, we all are inclined to pick our own magic number.

Herb Weiss, LRI ’12, is a Pawtucket writer who covers aging, health care and medical issues.