tag:blogger.com,1999:blog-4261616759637452562024-03-05T08:25:55.737-08:00urology updateDr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.comBlogger28125tag:blogger.com,1999:blog-426161675963745256.post-11873729904579208382019-02-20T12:58:00.000-08:002019-02-20T12:59:56.653-08:00Deregulation and the Healthcare sectorThere has been an inordinate amount of discussion about deregulation and our flourishing economy. Unfortunately, none of this deregulation has entered the healthcare sector. Medicine has become an over regulated conglomerate fueled by the forces of large hospital systems, the pharmaceutical and insurance industries and government regulations, all of which are suffocating healthcare providers<br />
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There was a time when the provider was actually allowed to practice medicine with latitude and genuine decision-making entered into the equation. Nowadays, the burden of restrictions dictates case-making decisions with the erroneous belief that this is all for the better. <br />
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Patient care is mandated by algorithms, EMR (electronic medical records) documentation, insurance industry restrictions for prescribing medications and diagnostic tests and a mound of preauthorizations. The physician lacks autonomy and is left with relatively no say in the process of true decision-making without asking ‘Big Brother’. Practicing medicine is not any easier than navigating a complicated maze riddled with obstacles. Some might say that it’s easier to practice medicine because everyone else, except the physician, has already decided what is good for the patient. I see it a bit differently. Physicians are over-regulated, overburdened and part of a broken profession. It’s no wonder that burnout is at an all-time high<br />
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Let’s encourage our goverment to ‘loosen the reins’on the healthcare sector and restore some dignity to a demoralized profession which is on the brink. I can only imagine how some degree of deregulation might add a breath of fresh air for a profession which once took pride in their endeavors and were committed to the forgotten “Art of Medicine”.<br />
<br />
Ronald G. Frank, MD FACS<br />
Urologist<br />
West Orange, New JerseyDr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com1tag:blogger.com,1999:blog-426161675963745256.post-85708745432514407002017-06-01T12:00:00.003-07:002017-06-01T14:30:58.656-07:00A New Trend Among Trendsetters: The Hamptons Vasectomy<a href="http://nypost.com/2017/05/27/hamptons-bachelors-are-getting-vasectomies-so-golddiggers-cant-trap-them/" target="_blank"><img style="width: 80%; margin: 0 auto; display: block; margin-bottom: 15px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsbL1dHHMpcjxedGF3FH9fMFxyhr7n-ge-5l7kCol5gsi6au0grzrKGXUzXNTVq1Umhmdi1fQtGpHFg0xzLWjVpNddbBpLiseyxfrUpBEebVPH3EaVCaUcWX6v4eM_uxUT-qwNW-vwwdI/s320/18086956_l.jpg" /></a>
<span style="background-color: white; color: #222222; font-family: "arial" , sans-serif; font-size: 12.8px;">A page one article from <a href="http://nypost.com/2017/05/27/hamptons-bachelors-are-getting-vasectomies-so-golddiggers-cant-trap-them/" target="_blank">Today's New York Post</a> confirms what Dr. Ronald Frank sees at his office - an increase in the number of young, successful man who come in for a simple, minimally invasive vasectomy.<br><br>According to the report, affluent bachelors who visit The Hamptons on weekends are worried of women who have sex with them in order to get pregnant. These men prefer to minimize potential complications by undergoing the procedure, which removes sperm from a man's semen.<br><br>Dr. Frank's no-scalpel vasectomy with local anesthesia is designed to minimize discomfort and provide men with a safe, quick form of vasectomy. Visit the website or call (973) 731-6600 to schedule an appointment. For NYC patients, we arrange for transportation to and from NJ.</span>Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com1tag:blogger.com,1999:blog-426161675963745256.post-90793829902456109752016-05-27T11:47:00.002-07:002016-05-27T11:47:44.593-07:00Elevated Prostate Specific Antigen<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 12.8px;">A recent article in the <a href="http://www.drronaldfrank.com/wp-content/uploads/2016/05/NYTimes.pdf">NYTimes</a>, shows a shift in early-stage prostate cancer treatment. Over the past few years, treatment for men with early-stage prostate cancer has dramatically shifted from surgery to surveillance. In the past, most early-stage prostate cancer patients chose to remove or treat the cancer with surgery or radiation. Only 15% of patients left their cancers alone and had regular monitoring or active surveillance to make sure the tumor was not growing. Now, about 40-50% of patients are choosing active surveillance of their prostate cancer. In 2011, the National Institutes of Health concluded that active surveillance is a good choice for patients with small non-threatening tumors. Active surveillance requires regular <a href="http://www.drronaldfrank.com/elevated-prostate-specific-antigen.html">PSA blood tests</a> to determine the state of the cancer. Though active surveillance is helpful, it is not for everyone. Speak to a medical professional about the best treatment for you. </span>Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-58272273785411304402015-07-10T17:53:00.002-07:002015-07-10T17:53:26.462-07:00PROSTATE CANCER AND EJACULATIONS<b>Recent data from the American Urologic Association(AUA) meeting reported a decreased incidence of prostate cancer with increased monthly ejaculations. This data is not altogether surprising since certain cancers are associated with chronic inflammatory conditions . Frequent ejaculations will decrease gland engorgement and the associated inflammation. This is clearly good news as a proactive measure to help ensure a healthy prostate.</b><br />
<b><br /></b>Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-65170576099899305532014-08-12T12:49:00.000-07:002014-08-12T12:49:35.959-07:00XIAFLEX and Peyronie's diseaseXiaflex is the first FDA-approved drug for the treatment of Peyronie's disease. The drug, collagenase clostridium histolyticum, had previously been approved as a treatment for Dupuytren's contracture. Xiaflex acts by breaking up the collagen scar tissue and allowing for remodeling of the scar with improvement of the penile curvature. Candidates for Xiaflex injection would be a man with stable disease, Peyronie's disease for at least 12 months and a curvature of 30 degrees or more. Xiaflex is a product of Auxilium pharmaceuticals. Xiaflex is available through urologists participating in the REMS program for Peyronie's Disease.Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-12167318684023452492014-01-14T11:45:00.001-08:002014-01-14T11:45:32.276-08:00More on EMRIn the NYT article<strong>-"A Busy Doctor's Right Hand"-</strong>1/14/14, I am amazed how the burden of EMR is magically solved in some corporate boardroom or home garage. <br />
The result is the absurd entity known as a "scribe". A non-professional hired to shadow and assist the physician by insinuating and infiltrating the private domain of Medicine. While assisting the physician with cumbersome tasks of entering data, the scribe will only further fracture the personal doctor-patient relationship which is already severely damaged. Shame on those in the corporate world who concocted this pathetic entity and to those who subscribe to this service. Yes, the problems of EMR were answered with this "Band-Aid" of a solution. Yet, the root of the problem is once again ignored.Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-47114438454534331982013-11-06T10:04:00.000-08:002013-11-06T10:04:10.216-08:00Prostate exams go live on TODAY showIn an effort to publicize awareness for men's health, Matt Lauer and Al Roker are to undergo prostate exams on live TV. How about that? Might this be a little too personal!! There are other more discrete ways to convey the message. I will wait and see the result of this demonstration.Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-74956985298218786952013-10-06T21:17:00.000-07:002013-10-08T16:11:51.964-07:00 EMR(electronic medical record)=Medical texting while "driving"It is clearly evident that the push for EMR(electronic medical records)continues. The national healthcare community fueled by goverment incentives continues to drive this trend. We are enamored by this technology whether we like it or not.
As I walk down the corridors of a major New Jersey medical center, I cannot help but notice rows of medical professionals transfixed to computer screens as if they were seduced by the data before them. It consumes their attention. The patients are awaiting to be seen or have recently been evaluated. The professionals peruse the data and robotically configure the information into a medical "note". We cannot deny that this is a laborious process even for the most adept typists. I often thank God that I paid attention in Ms. McGillicutty's high school typing class not knowing then how important this skill would prove to be at this stage in my career!
In all seriousness, I can reasonably understand the rationale and motivation to adopt this technology. The consolidation of data would certainly avoid the duplication of unnecessary services which could have astronomical savings in the context of an exorbitant and escalating national healthcare bill. But, let us not forget, first and foremost, the PATIENT. The number of hours in the day is unchanged and the additional computer tasks certainly extracts time from the traditional doctor-patient encounter. Futhermore, It's unfortunate that many physicians have resigned themselves to enter data using computer tablets during the patient encounter and avoiding any direct eye contact with the patient. It's very easy for the patient to feel distant and ignored from such an encounter leading to further erosion of the doctor-patient relationship.
There was a time not too long ago when texting while driving was not regarded as hazardous. That was soon to change and the penalties are currently steep for those committing this act. For that matter, any distraction while driving is dangerous. EMR, can easily be equated to medical texting while "driving". While not recognized now, it may not be very long before we realize the detrimental effects on the quality of patient care and the doctor-patient relationship. Only time will tell whether this technology has irreparable damages.Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-84828813849979789322012-07-20T07:44:00.000-07:002012-07-20T07:44:47.706-07:00Study questions value of prostate cancer surgeryToday's New York Times article about the PIVOT study(Prostate Cancer Intervention Versus Observation Trial)presents important data and once again reiterates the role of watchful waiting in early prostate cancer. The role of PSA testing and intense counseling of early newly diagnosed prostate is of the utmost importance. The need for surgical management needs to be individualized.Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com1tag:blogger.com,1999:blog-426161675963745256.post-51826518151796348882012-03-19T11:07:00.002-07:002012-03-19T11:15:56.998-07:00ZYTIGA(abiraterone acetate)An exciting new oral agent has recently become available to treat patients with metastatic castration-resistant prostate cancer (mCRPC) who have received prior chemotherapy containing docetaxel. <br /><br />Abiraterone is an androgen biosynthesis inhibitor which acts at 3 sources of testosterone production: the testes, adrenal glands and prostate tumor tissue.<br /><br />Hopefully, the indications for this once daily 250mg tablet will be expanded to include other patients who never received chemotherapy.Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com3tag:blogger.com,1999:blog-426161675963745256.post-76374975734221582872011-12-10T10:17:00.000-08:002011-12-10T10:27:13.940-08:00We're movingWe are looking forward to moving our office just 1 mile down Northfield to the Atkin's Building at 1500 Pleasant Valley Way in West Orange. The office will be ready for occupancy in early 2012!!Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-9776704407633574962011-07-06T06:56:00.000-07:002011-07-06T07:15:05.730-07:00IMMUNOTHERAPY for prostate cancerA number of articles in the NYT and WSJ have addressed the treatment of prostate cancer using immunotherapy. Provenge (Dendreon Corp) has recently received the most publicity particularly in reference to Medicare's decision to cover this costly drug. <br /><br /><br /><span style="color: rgb(255, 0, 0);">How does immunotherapy work?</span><br /><br />Certain immune cells are collected from a patient's blood in a procedure known as leukapheresis. The immune cells are processed to combine with a protein found in most prostate cancers and another compound that stimulates the immune system to make Provenge. When given intravenously, the drug is believed to activate other immune cells to see the cancer as a threat and attack it.<br /><br />Several companies are exploring this modality for the treatment of other solid tumors. More to come.Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com2tag:blogger.com,1999:blog-426161675963745256.post-13550728201195979962011-07-06T06:48:00.000-07:002011-07-06T06:56:15.959-07:00AVODART warningAs with Proscar (finasteride), new warnings have been released regarding the incidence of high grade prostate cancers in men taking Avodart and the combination drug Jalyn (avodart +flomax). The incidence is 1% with avodart versus placebo of 0.5%. This data was presented in the 4 year REDUCE (reduction by dutasteride of prostate cancer events study). The data for for proscar was slightly higher at 1.8% versus placebo of 1.1%).<br /><br />Therefore, close monitoring of PSA is important in this group of patients taking Avodart as well as Proscar in those patients who require these medications for the treatment of symptomatic benign prostatic hyperplasia (BPH).Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com3tag:blogger.com,1999:blog-426161675963745256.post-4768894767529399052011-01-24T09:24:00.000-08:002011-01-24T10:20:29.795-08:00DIET, HEALTH AND FITNESSI was saddened to hear of the death of Jack LaLanne at the age of 96. I vividly remember his black and white television shows during my childhood. Although, he was fanatical and regimental in his daily exercise routines and obviously had a good genetic make-up, there is a lot to learn from his habits. In his obituary in the New York Times 1/24/2011, he outlined his eating habits..."he ate two meals a day and shunned snacks. Breakfast, following his morning workout, usually included several hard-boiled egg whites, a cup of broth, oatmeal with soy milk and seasonal fruit. For dinner he took his wife, Elaine, to restaurants that knew what he wanted: a salad with raw vegetables and egg whites along with fish-often salmon-and a mixture of red and white wine. He sometimes allowed himself a roast turkey sandwich, but never a cup of coffee." He was definitely a forward thinker way ahead of his time.<br />He would famously like to say. "I can't die, it would ruin my image."<br />He was a true icon.Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com1tag:blogger.com,1999:blog-426161675963745256.post-44121574705842741002010-11-30T09:10:00.001-08:002010-11-30T09:17:03.716-08:00Vitamin D and calcium supplementsIt didn't surprise me one bit when an article appearing on the front page of the <span style="font-weight: bold;">New York Times </span>nixed the benefits of megadoses of vitamin supplements. Out of nowhere everyone seems to be getting bloodwork for vitamin D levels and prescribed supplements for low levels. Today's article makes us reconsider whether all these supplements are indicated. It's been known for some time now that megadoses of calcium contribute to kidney stones. <br /><br />Report: <span style="font-weight: bold;">Skip the Megadose of Vitamin D</span><div class="postTop clrFx"><div class="artHeadline"> </div> <div class="postTime"> <abbr class="published updated" title="2010-11-30T09:25:28-05:00"><br /></abbr> </div> </div> <div class="addthisToolbarTop"><br /></div> <div class="writerProfile"> <a href="http://www.aolnews.com/team/lisa-flam"> <img src="http://o.aolcdn.com/os/news/art/lisa-flam" alt="Lisa Flam" /></a><p class="author vcard"><b class="fn"> <a href="http://www.aolnews.com/team/lisa-flam">Lisa Flam</a></b> <span class="blogtitle">Contributor</span></p> <span class="source-org vcard"><span class="org fn" style="display: none;">AOL News</span></span> </div> <div class="entry-content" id="article-entry-content"> (Nov. 30) -- Dietary guidelines being released today call for a slight increase in the amount of vitamin D people need every day for good health but warn against megadoses of the "sunshine vitamin," saying there's no proof they prevent cancer and that they could in fact be harmful.<br /><br />"More is not necessarily better," Dr. Joann Manson of Harvard Medical School, who co-authored the report, <a target="_blank" href="http://www.miamiherald.com/2010/11/30/1949400/report-a-bit-more-vitamin-d-is.html">told The Associated Press.</a><br /><br />The report from the prestigious <a target="_blank" href="http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx">Institute of Medicine</a> says most people in the U.S. and Canada from ages 1 to 70 need 600 international units of vitamin D daily. That's up from the 400 IUs under today's government-required food labels and above the 1997 guidelines from the institute that called for 200 to 600 IUs, AP noted.<br /><br />Most people are getting the amount of calcium they need from their diets, the report found, and supplements are not needed, <a target="_blank" href="http://www.nytimes.com/2010/11/30/health/30vitamin.html?hp">The New York Times reported</a>. Calcium and vitamin D work together to help build strong bones.<br /><br />"For most people, taking extra calcium and vitamin D supplements is not indicated," Dr. Clifford J. Rosen, a member of the panel, told The Times.<br /><br />The guidelines could slow the vitamin D craze. The sale of supplements has soared as some scientists recommend 2,000 IUs a day amid studies suggesting low vitamin D levels increase the risk of cancer and heart disease, AP said. The report out today suggests an upper limit of 4,000 a day.<br /><br />"This is a stunning disappointment," Dr. Cedric Garland of the University of California, San Diego, who was not part of the study, told AP. The risk of colon cancer could be cut if people got enough vitamin D, he said.<br /><br />Low levels of vitamin D have also been linked to stroke, diabetes, breast cancer, auto-immune diseases, infections and depression, and studies have suggested many Americans don't get enough vitamin D because they spend time inside and wear sunscreen when they go out, <a target="_blank" href="http://online.wsj.com/article/SB10001424052748704584804575645023841631864.html">according to The Wall Street Journal.</a><br /><br />But the institute didn't find enough evidence to prove a link to those chronic diseases, the newspaper said. The new guideline was created solely to promote bone health, the Journal said.<br /><br />The new guidelines will affect the recommended daily allowances listed on food packages and the makeup of school lunches and other federal nutrition programs, according to the newspaper.<br /><br />Some experts were disappointed.<br /><br />The recommended 600 IUs of vitamin D is "way too low," Creighton University professor of medicine Robert Heaney <a target="_blank" href="http://www.usatoday.com/yourlife/food/diet-nutrition/2010-11-30-calciumvitaD30_ST_N.htm">told USA Today</a>. Heaney, who has studied the benefits of D, says people should consider getting about 4,000 IUs daily.<br /><br />"For me, it's a no-brainer," he told the newspaper. "There is a large body of evidence for benefit at intakes above the IOM recommendations. There is no risk, and very little cost, so why not take a chance of a benefit if there's any possibility?"<br /><br />The latest study to report no cancer protection from vitamin D, and the possibility of a greater risk of pancreatic cancer, came last summer from the National Cancer Institute, AP said. A megadose of more than 10,000 IUs daily is known to cause kidney problems, AP said.<br /><br /><div style="color: rgb(192, 0, 0);" class="inContent"><span>Sponsored Links</span> </div>These days, more people are taking vitamin D supplements and know their vitamin D levels through tests at medical checkups. Sales of vitamin D have risen from $40 million in 2001 to $425 million last year, the Journal said.<br /><br />"Everyone was hoping vitamin D would be kind of a panacea," Dennis Black, a University of California, San Francisco, professor of epidemiology and biostatistics, told the Times.<br /><br />The guidelines may dampen enthusiasm for the vitamin, he said. "I think this will have an impact on a lot of primary care providers," he told the paper.<br /><br />For calcium, the report recommended the levels that are already accepted, about 1,000 milligrams for most adults, 700 to 1,000 mg for children, and 1,300 mg for teens and menopausal women, AP said.</div>Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com3tag:blogger.com,1999:blog-426161675963745256.post-58871731141491965212010-11-02T05:26:00.001-07:002010-11-02T05:29:04.615-07:00New FDA warnings about Lupron and related meds<a target="_blank" style="color: rgb(0, 0, 0);" name="S1"><h3 style="margin: 15px 0px 5px; font-size: 17px; color: rgb(0, 0, 0);">FDA Requiring GnRH Agonists To Carry Warnings About Potential Risk For Heart Disease, Diabetes.</h3> </a> <p style="margin: 0px;"> The <a target="_blank" style="color: rgb(14, 77, 150); text-decoration: underline;" href="http://mailview.custombriefings.com/mailview.aspx?m=2010102101aua&r=3043208-edfc&l=001-d94&t=c"><u>Wall Street Journal</u></a> /Dow Jones Newswire (10/21, Dooren) reports that to shrink prostate tumors, the medical community relies on a group of products that reduce male hormone levels, but these gonadotropin-releasing hormone (GnRH) agonists may also increase the risk of diabetes and cardiovascular problems. Thus, the FDA is now requiring the drugs, marketed under generic and brand names like Zoladex (goserelin), Lupron (leuprolide), Trelstar (triptorelin), Vantas (histrelin), and Synarel (nafarelin), carry labels that highlight the potential risks. </p> <p style="margin: 0px;"> In February, "the American Heart Association, the American Urological Association, and the American Cancer Society issued a joint advisory warning of the increased risks of diabetes, myocardial infarction, stroke, and sudden death among men who use androgen deprivation therapy (ADT) to treat prostate cancer," <a target="_blank" style="color: rgb(14, 77, 150); text-decoration: underline;" href="http://mailview.custombriefings.com/mailview.aspx?m=2010102101aua&r=3043208-edfc&l=002-168&t=c"><u>MedPage Today</u></a> (10/20, Walker) reported. "GnRH is the most common form of ADT. However, the groups did not offer specific guidelines for clinicians on when to employ ADT therapy or when to avoid it." </p> <p style="margin: 0px;"> Thus, the FDA stepped in May and "announced...that it was reviewing the" GnRH agonists, <a target="_blank" style="color: rgb(14, 77, 150); text-decoration: underline;" href="http://mailview.custombriefings.com/mailview.aspx?m=2010102101aua&r=3043208-edfc&l=003-14e&t=c"><u>HealthDay</u></a> (10/20, Reinberg) reported. "Speaking after the FDA's announcement earlier this spring," Dr. Nelson Neal Stone, of the Mount Sinai School of Medicine, "said studies have shown that men with advanced prostate cancer who take hormone therapy face a twofold increased risk of developing metabolic syndrome, a cluster of symptoms tied to the development of heart disease." And, "once patients understand that, Stone hopes they will be motivated to watch their diet and exercise." For the time being, however, "men should not stop taking their hormone therapy, but do everything they can to reduce their risk of developing cardiovascular disease and diabetes with lifestyle changes, he said." </p> <p style="margin: 0px;"> Still, the "relationship between heart disease risk, diabetes, and androgen deprivation therapy has not been without controversy," <a target="_blank" style="color: rgb(14, 77, 150); text-decoration: underline;" href="http://mailview.custombriefings.com/mailview.aspx?m=2010102101aua&r=3043208-edfc&l=004-e59&t=c"><u>Medscape</u></a> (10/20, Mulcahy) pointed out. "A medical oncologist specializing in prostate cancer treatment recently defended the safety of the therapeutic approach in an interview with Medscape Medical News." Mark Scholz, MD, of the California-based Prostate Cancer Research Institute, said, "There is no convincing evidence that hormone blockade shortens life or causes excess heart attacks if weight gain is attended to and blood sugar levels are kept in check." </p> <p style="margin: 0px;"> Nevertheless, even though "all of the drugs will stay on the market," they "will be required to carry new label warnings," <a target="_blank" style="color: rgb(14, 77, 150); text-decoration: underline;" href="http://mailview.custombriefings.com/mailview.aspx?m=2010102101aua&r=3043208-edfc&l=005-3e1&t=c"><u>WebMD</u></a> (10/20, DeNoon) reported. "The risk that the drugs will trigger diabetes or heart disease/stroke appears small, the FDA says," but again, "recent studies suggest that doctors should monitor blood sugar levels and watch for signs of heart disease in men taking these drugs." <a target="_blank" style="color: rgb(14, 77, 150); text-decoration: underline;" href="http://mailview.custombriefings.com/mailview.aspx?m=2010102101aua&r=3043208-edfc&l=006-cd9&t=c"><u>Reuters</u></a> (10/21, Richwine) also covers the story. </p> <div style="border: 1px solid rgb(203, 218, 235); margin-top: 15px; margin-bottom: 15px;"> <table cellspacing="0"> <tbody><tr> <td style="margin: 0px; padding: 4px 20px; background: none repeat scroll 0% 0% rgb(203, 218, 235); color: rgb(1, 52, 116); font-family: georgia,times new roman,serif; font-size: 18px; font-weight: bolder;">From the AUA</td> </tr> <tr> <td style="margin: 0pt; padding: 16px 20px; line-height: 15px; background-color: rgb(241, 246, 251); color: rgb(85, 85, 85);font-size:12px;"><span style="font-size:85%;"><b>Claim Your AUA2010 Credits Online </b><br /></span><span style="font-size:85%;">Attendees of the 2010 AUA Annual Meeting may claim their credits and/or print a CME certificate by clicking <a style="color: rgb(14, 77, 150); text-decoration: underline;" href="http://mailview.custombriefings.com/mailview.aspx?m=2010102101aua&r=3043208-edfc&l=007-dfd&t=c" target="_blank">here</a>. All 2010 Annual Meeting credits must be claimed by December 31, 201</span></td></tr></tbody></table></div>Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com5tag:blogger.com,1999:blog-426161675963745256.post-72753385916826242272010-10-12T14:19:00.000-07:002010-10-13T08:51:46.157-07:00Testosterone replacementIt is clear that we still don't have all the answers regarding the risks and benefits of replacement therapy. More studies are needed to clarify the issues. See the following article from the New York Times Science section.<br /> <h6 class="kicker">Personal Health</h6> <h1 class="articleHeadline">Hormone Replacement for Men? Perhaps</h1> <h6 class="byline">By <a href="http://topics.nytimes.com/top/reference/timestopics/people/b/jane_e_brody/index.html?inline=nyt-per" title="More Articles by Jane E. Brody" class="meta-per">JANE E. BRODY</a></h6> <h6 class="dateline">Published: October 11, 2010</h6> <div class="articleTools"> <div class="box"> <div class="inset"> <ul id="toolsList" class="toolsList wrap"><li id="facebook_item"> <a id="facebook_button"> <span>Recommend</span> </a> </li><li id="twitter_item"> <a id="twitter_button"> <span>Twitter</span> </a> </li><li class="email"> <a id="emailThis">Sign In to E-Mail</a> </li><li class="print"> <a href="http://www.nytimes.com/2010/10/12/health/12brody.html?_r=1&ref=jane_e_brody&pagewanted=print">Print</a> </li><li class="reprints"> <form name="cccform" action="https://s100.copyright.com/CommonApp/LoadingApplication.jsp" target="_Icon"> <input name="Title" value="Hormone Replacement for Men? Perhaps" type="hidden"> <input name="Author" value="By JANE E. BRODY " type="hidden"> <input name="ContentID" value="http://www.nytimes.com/2010/10/12/health/12brody.html" type="hidden"> <input name="FormatType" value="default" type="hidden"> <input name="PublicationDate" value="October 12, 2010" type="hidden"> <input name="PublisherName" value="The New York Times" type="hidden"> <input name="Publication" value="nytimes.com" type="hidden"> <input name="wordCount" value="12" type="hidden"> </form> <a href="http://www.nytimes.com/2010/10/12/health/12brody.html?_r=1&ref=jane_e_brody#">Reprints</a> </li><li style="width: 168px;" class="closed last" id="shareMenu"><a class="shareButton" href="http://www.nytimes.com/2010/10/12/health/12brody.html?_r=1&ref=jane_e_brody#">Share</a><a style="opacity: 0;" class="hidden" href="http://www.nytimes.com/2010/10/12/health/12brody.html?_r=1&ref=jane_e_brody#">Close</a><ul style="opacity: 0;" class="hidden" id="shareList"><li class="linkedin"><a style="background-image: url("http://graphics8.nytimes.com/images/article/functions/linkedin.gif");" href="http://www.nytimes.com/2010/10/12/health/12brody.html?_r=1&ref=jane_e_brody#">Linkedin</a></li><li class="digg"><a style="background-image: url("http://graphics8.nytimes.com/images/article/functions/digg.gif");" href="http://www.nytimes.com/2010/10/12/health/12brody.html?_r=1&ref=jane_e_brody#">Digg</a></li><li class="mixx"><a style="background-image: url("http://graphics8.nytimes.com/images/article/functions/mixx.gif");" href="http://www.nytimes.com/2010/10/12/health/12brody.html?_r=1&ref=jane_e_brody#">Mixx</a></li><li class="myspace"><a style="background-image: url("http://graphics8.nytimes.com/images/article/functions/myspace.gif");" href="http://www.nytimes.com/2010/10/12/health/12brody.html?_r=1&ref=jane_e_brody#">MySpace</a></li><li class="yahoobuzz"><a style="background-image: url("http://graphics8.nytimes.com/images/article/functions/yahoobuzz.gif");" href="http://www.nytimes.com/2010/10/12/health/12brody.html?_r=1&ref=jane_e_brody#">Yahoo! Buzz</a></li><li class="permalink"><a style="background-image: url("http://graphics8.nytimes.com/images/article/functions/permalink.gif");" href="http://www.nytimes.com/2010/10/12/health/12brody.html?_r=1&ref=jane_e_brody#">Permalink</a></li><li id="shareMenuAd"><br /></li></ul></li></ul> <div class="articleToolsSponsor" id="Frame4A"><a href="http://www.nytimes.com/adx/bin/adx_click.html?type=goto&opzn&page=www.nytimes.com/yr/mo/day/health&pos=Frame4A&sn2=18af8609/8623460a&sn1=9359d1fa/659afedb&camp=foxsearch2010_emailtools_1225556c_nyt5&ad=127hrs_120x60_08.25&goto=http%3A%2F%2Fwww%2Efoxsearchlight%2Ecom%2F127hours" target="_blank"> <img src="http://graphics8.nytimes.com/adx/images/ADS/24/04/ad.240479/127hrs_120x60_8kanim.gif" border="0" width="120" height="60" /></a> </div> </div> </div> </div> <div class="articleBody"> <p> Women are way ahead of men in knowing the benefits and risks of hormone replacement. There has yet to be a large study spanning years, comparable to the Women’s Health Initiative, of the safety and effectiveness of hormone therapy for aging men who have signs and symptoms of <a href="http://health.nytimes.com/health/guides/test/testosterone/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Testosterone." class="meta-classifier">testosterone</a> deficiency. </p> </div> <div class="articleInline runaroundLeft"> <div class="inlineImage module"> <div class="image"> <div class="icon enlargeThis"><a>Enlarge This Image</a></div> <a> <img src="http://graphics8.nytimes.com/images/2010/10/12/science/12brody/12brody-articleInline.jpg" alt="" width="190" height="260" /> </a> </div> <h6 class="credit">Yvetta Fedorova</h6> <p> </p> </div> <div class="columnGroup doubleRule"> <h3 class="sectionHeader">Related</h3> <ul class="headlinesOnly multiline flush"><li><h6>Times Topic: <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/testosterone/index.html">Testosterone</a></h6></li><li><h6><a href="http://www.nytimes.com/top/news/health/columns/personalhealth/index.html">More Personal Health Columns</a></h6></li></ul> </div> </div> <p> Despite beliefs based on observational evidence that <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/estrogen/index.html?inline=nyt-classifier" title="Recent and archival health news about estrogen." class="meta-classifier">estrogen</a> therapy enhanced the health and well-being of menopausal women, when a definitive study was finally done, clinicians and researchers were shocked to discover that the risks of long-term hormone replacement could outweigh its benefits. </p><p> Would a similar study of testosterone therapy for men experiencing “andropause” likewise reveal more hazard than help? The answer would be welcomed by an estimated four million men in the United States who have subnormal levels of this important hormone, a common result of advancing age. </p><p> But these men, as well as those already receiving testosterone therapy and the baby boomers who may soon develop symptoms of low testosterone, may never know whether adding to their bodies’ waning supply will improve or detract from the quality and length of their lives. Rather, they may have to base a decision about therapy on confusing and conflicting evidence. </p><p> Late last year, for example, a six-month federally financed study of a testosterone gel put a surprising hitch in efforts to improve the lives of aging men who experience a decline in energy, mood, vitality and sexuality as a result of low testosterone levels. The study, conducted among 209 men 65 and older who had difficulty walking, was abruptly halted when those using the hormone had an unexpectedly high rate of cardiac problems. </p><p> The researchers, who <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1000485" title="Study abstract.">published their findings</a> in The <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/n/new_england_journal_of_medicine/index.html?inline=nyt-org" title="More articles about New England Journal of Medicine" class="meta-org">New England Journal of Medicine</a>, noted that the deck might have been stacked in favor of a hazardous outcome because study participants, especially the group that received testosterone, had high rates of <a href="http://health.nytimes.com/health/guides/disease/hypertension/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Hypertension." class="meta-classifier">high blood pressure</a>, <a href="http://health.nytimes.com/health/guides/disease/diabetes/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Diabetes." class="meta-classifier">diabetes</a>, <a href="http://www.nytimes.com/info/obesity?inline=nyt-classifier" title="In-depth reference and news articles about Obesity." class="meta-classifier">obesity</a> and elevated blood <a href="http://health.nytimes.com/health/guides/nutrition/fat/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Fat." class="meta-classifier">lipids</a>. Then again, this may be a realistic population to study, given that many candidates for hormone therapy are likely to have such health issues. </p><p> <strong>Advisement ‘in Limbo’</strong> </p><p> A $45 million study financed by the National Institute on Aging is under way at 12 medical centers to see if a year of treatment with testosterone will help 800 men aged 65 and older with low levels of the hormone and problems with physical functioning, fatigue and sexual or cognitive performance. The study, in which the men are being randomly assigned to receive the hormone or a look-alike placebo, will also evaluate the hormone’s effects on cardiac risk factors. </p><p> Still, this study will not answer the question of whether it is safe to use the hormone for years, even decades, which would be necessary to maintain any benefits. A major concern is whether long-term use would promote the growth of <a href="http://health.nytimes.com/health/guides/disease/prostate-cancer/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Prostate Cancer." class="meta-classifier">prostate cancer</a>, which is present but hidden in as many as half of older men. </p><p> “There are not many good studies of testosterone in older men,” Dr. William J. Bremner, a urologist at the <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/u/university_of_washington/index.html?inline=nyt-org" title="More articles about University of Washington" class="meta-org">University of Washington</a> in Seattle, said in an interview. “The studies are small and the longest of them lasted only three years. We need the same kind of study for testosterone as the Women’s Health Initiative — several thousand men followed for maybe 10 years. Currently, we’re in limbo as to how to advise patients.” </p><p> He acknowledged that the need for such a study for men is “less compelling” because, in contrast to women, who experience an abrupt drop in estrogen at <a href="http://health.nytimes.com/health/guides/disease/menopause/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Menopause." class="meta-classifier">menopause</a>, often with disruptive symptoms, hormone decline in aging men is far more gradual, and symptoms, when they occur, are commonly viewed as normal signs of aging, not hormone deficiency. </p><p> A <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa0911101" title="Study abstract.">large European study</a> published in the same issue of the journal sought to better determine who, among middle-aged and elderly men, might be candidates for testosterone replacement. Among a sample of 3,369 men aged 40 to 79, researchers at eight European medical centers found that “limited physical vigor” and three sexual symptoms — diminished sexual thoughts and morning erections and <a href="http://health.nytimes.com/health/guides/symptoms/erection-problems/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Erection problems." class="meta-classifier">erectile dysfunction</a> — were most closely linked to low levels of testosterone. </p><p> Although low hormone levels are widely thought to increase a man’s risk of depression, the researchers found that “psychological symptoms had little or no association with the testosterone level.” </p><p> There are four main approaches to testosterone therapy available in this country: intramuscular injections every one to three weeks; skin applications through a patch or gel; and pellets implanted under the skin that last for months. The patch can cause skin irritation, and the gel can be transferred to others through skin contact unless care is taken to cover the area where it is applied. But oral administration is rarely used because of toxic effects on the liver. </p><p> <strong>Weighing Help vs. Harm</strong> </p><p> The most common reason men seek testosterone therapy is waning sexual desire or performance, although the ability of the hormone to relieve sexual symptoms is unpredictable. More than one-quarter of men with normal testosterone levels have such symptoms, and many men with subnormal levels do not. Dr. Bremner said he typically suggests a trial of therapy for up to a year to see if sexual function or other symptoms improve. </p><p> Citing the results of many small studies, Dr. Bremner said, “There is good evidence that testosterone administration can improve muscle mass and strength and increase bone density” in men with subnormal levels. Dr. Abraham Morgentaler, a urologist at Harvard Medical School and author of “Testosterone for Life” (McGraw-Hill, 2009), said in an interview that other noted benefits include a decrease in body fat and <a href="http://health.nytimes.com/health/guides/test/cholesterol-test/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Cholesterol test." class="meta-classifier">total cholesterol</a> and improved blood sugar metabolism. </p><p> In <a href="http://www.nejm.org/doi/pdf/10.1056/NEJMra022251" title="Study excerpt.">a report on the risks of testosterone therapy</a>, written with Dr. Ernani Luis Rhoden and published in 2004 in The New England Journal of Medicine, Dr. Morgentaler noted that testosterone has widespread effects throughout the body, but he and Dr. Rhoden concluded that with proper monitoring, any looming hazards can be readily detected. </p><p> Before the most recent study, at doses considered normal, the testosterone gel showed little or no effect on cardiovascular risk, the two doctors reported. Injections could result in harmful thickening of the blood, however, especially if above-normal blood levels of the hormone result. </p> Although testosterone can cause overgrowth of the prostate, studies have not shown harm to urinary function, Dr. Morgentaler said. The risk of prostate cancer is of greater concern, given that suppressing the body’s natural production of testosterone can cause this <a href="http://health.nytimes.com/health/guides/disease/cancer/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Cancer." class="meta-classifier">cancer</a> to regress. Men considering treatment should first undergo a full prostate exam and <a href="http://health.nytimes.com/health/guides/test/psa/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about PSA." class="meta-classifier">PSA</a>Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-16257861324080066502010-09-07T09:49:00.000-07:002010-09-07T09:58:45.219-07:00BRCA2 gene mutation and prostate cancerA recently reported study in the <strong>British Journal of Cancer </strong>reported a higher rate of survival in prostate cancer patients who are non-carriers of the BRCA2 gene mutation compared to carriers. These findings may have important prognostic decision-making implications in stratifying patients for treatment once diagnosed with prostate cancer. Those expressing the gene mutation would not be advised to proceed with surveillance because of the poorer prognosis. Genetic testing for BRCA2 gene may become important part of the evaluation in patients with newly diagnosed prostate cancer.<br /><br />Breast cancer is the cancer most commonly linked to BRCA1 and BRCA2 gene mutations.Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-77465182314522727372010-09-06T05:30:00.000-07:002010-09-06T05:41:07.991-07:00Concierge medicine. Will urology or specialty services move in this direction?I found an interesting article debating the pros and cons of "concierge" medical care. It is clear that the delivery of medical services is rapidly evolving. I was wondering whether this model might move into the specialty services realm. The following article from the New York Times looks at some of these issues.<br /><h6 class="kicker">Doctor and Patient</h6> <h1 class="articleHeadline"><nyt_headline version="1.0" type=" ">Can Concierge Medicine for the Few Benefit the Many?</nyt_headline></h1> <nyt_byline> <h6 class="byline">By PAULINE W. CHEN, M.D.</h6> </nyt_byline> <h6 class="dateline">Published: August 26, 2010</h6> <script type="text/javascript"> var articleToolsShareData = {"url":"http:\/\/www.nytimes.com\/2010\/08\/26\/health\/26pauline-chen.html","headline":"Can Concierge Medicine for the Few Benefit the Many?","description":"At a boutique practice at Tufts Medical Center, retainer fees support the general practice, teaching and free health care.","keywords":"Doctors,Medicine and Health,Health Insurance and Managed Care,Hospitals","section":"health","sub_section":null,"section_display":"Health","sub_section_display":null,"byline":"By PAULINE W. CHEN, M.D.","pubdate":"August 26, 2010","passkey":null}; function getShareURL() { return encodeURIComponent(articleToolsShareData.url); } function getShareHeadline() { return encodeURIComponent(articleToolsShareData.headline); } function getShareDescription() { return encodeURIComponent(articleToolsShareData.description); } function getShareKeywords() { return encodeURIComponent(articleToolsShareData.keywords); } function getShareSection() { return encodeURIComponent(articleToolsShareData.section); } function getShareSubSection() { return encodeURIComponent(articleToolsShareData.sub_section); } function getShareSectionDisplay() { return encodeURIComponent(articleToolsShareData.section_display); } function getShareSubSectionDisplay() { return encodeURIComponent(articleToolsShareData.sub_section_display); } function getShareByline() { return encodeURIComponent(articleToolsShareData.byline); } function getSharePubdate() { return encodeURIComponent(articleToolsShareData.pubdate); } function getSharePasskey() { return encodeURIComponent(articleToolsShareData.passkey); } </script> <div class="articleTools"> <div class="box"> <div class="inset"> <ul id="toolsList" class="toolsList wrap"><li id="facebook_item"> <a id="facebook_button"> <span>Recommend</span> </a> </li><li id="twitter_item"> <a id="twitter_button"> <span>Twitter</span> </a> </li><li class="email"> <a id="emailThis" onclick="s_code_linktrack('Article-Tool-EmailSignIn');" href="javascript:void(0);">Sign In to E-Mail</a> </li><li class="print"> <a href="http://www.nytimes.com/2010/08/26/health/26pauline-chen.html?_r=2&ref=health&pagewanted=print">Print</a> </li><nyt_reprints_form> <script name="javascript"> function submitCCCForm(){ PopUp = window.open('', '_Icon','location=no,toolbar=no,status=no,width=650,height=550,scrollbars=yes,resizable=yes'); this.document.cccform.submit(); } </script> <li class="reprints"> <form name="cccform" action="https://s100.copyright.com/CommonApp/LoadingApplication.jsp" target="_Icon"> <input name="Title" value="Can Concierge Medicine for the Few Benefit the Many?" type="hidden"> <input name="Author" value="By PAULINE W. 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Buzz</a></li><li class="permalink"><a style="background-image: url("http://graphics8.nytimes.com/images/article/functions/permalink.gif");" href="http://www.nytimes.com/2010/08/26/health/26pauline-chen.html?_r=2&ref=health#">Permalink</a></li><li id="shareMenuAd"><script src="http://www.nytimes.com/adx/bin/adx_remote.html?type=fastscript&page=www.nytimes.com/yr/mo/day/&posall=Frame6A&query=qstring&keywords=?"></script><br /></li></ul></li></ul> <div class="articleToolsSponsor" id="Frame4A"><!-- ADXINFO classification="button_120x60" campaign="foxsearch2010_emailtools_1225560c_nyt5"--><a href="http://www.nytimes.com/adx/bin/adx_click.html?type=goto&opzn&page=www.nytimes.com/yr/mo/day/health&pos=Frame4A&sn2=18af8609/8623460a&sn1=94ebfc55/dd44f055&camp=foxsearch2010_emailtools_1225560c_nyt5&ad=127hrs_120x60_08.25&goto=http%3A%2F%2Fwww%2Efoxsearchlight%2Ecom%2F127hours" target="_blank"> <img src="http://graphics8.nytimes.com/adx/images/ADS/24/04/ad.240479/127hrs_120x60_8kanim.gif" border="0" height="60" width="120" /></a> </div> </div> </div> </div> <div class="articleBody"> <nyt_text> <nyt_correction_top> </nyt_correction_top> <p> Earlier this summer a friend revealed that for the last nine years she has been a patient in a concierge, or boutique, primary care practice. For $350 each month, she is guaranteed around-the-clock access to her doctor, appointments within 24 hours of calling, longer office visits and the kind of personalized attention and care coordination she felt was missing with all her previous doctors. </p> </nyt_text></div> <div class="articleInline runaroundLeft"> <!--forceinline--> <div class="inlineImage module"> <div class="image"> <div class="icon enlargeThis"><a href="javascript:pop_me_up2('http://www.nytimes.com/imagepages/2010/08/26/health/26chen.html','26chen_html','width=520,height=457,scrollbars=yes,toolbars=no,resizable=yes')">Enlarge This Image</a></div> <a href="javascript:pop_me_up2('http://www.nytimes.com/imagepages/2010/08/26/health/26chen.html','26chen_html','width=520,height=457,scrollbars=yes,toolbars=no,resizable=yes')"> <img src="http://graphics8.nytimes.com/images/2010/08/26/health/26chen/26chen-articleInline.jpg" alt="" height="139" width="190" /> </a> </div> <h6 class="credit">Peter Dazeley/Getty Images</h6> <p> </p> </div> <div class="columnGroup doubleRule"> <h3 class="sectionHeader"><a href="http://well.blogs.nytimes.com/2010/08/26/having-your-own-doctor-on-call">Well</a></h3> <div class="story"> <div class="runaroundRight"><a href="http://well.blogs.nytimes.com/"><img src="http://graphics8.nytimes.com/images/blogs/well/well75.jpg" /></a></div> <p class="summary">Share your thoughts on this column at the Well blog. </p> </div><p class="refer"><a href="http://well.blogs.nytimes.com/2010/08/26/having-your-own-doctor-on-call">Go to Well »</a></p> </div> <div class="columnGroup doubleRule"> <h3 class="sectionHeader">Related</h3> <ul class="headlinesOnly multiline flush"><li><h6><a href="http://www.nytimes.com/top/news/health/columns/doctor_and_patient/index.html">More Doctor and Patient Columns</a></h6></li></ul> </div> </div> <div class="articleBody"> <p> “I love this doctor,” she said. “He really knows me.” </p><p> She recounted the details of a recent emergency room visit when a call from the doctor saved her from an unnecessary <a href="http://health.nytimes.com/health/guides/test/ct-scan/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about CT scan." class="meta-classifier">CT scan</a> and admission to the hospital. “I feel like I have a doctor who’s actually thinking about me and talking to other doctors on my behalf,” she added. </p><p> But over the course of our conversation, I also discovered that her husband does not share her enthusiasm. He goes to a doctor in a more traditional primary care practice because he’s uncomfortable with the idea that those who can afford it get better care, while those who cannot pay do not. “I just don’t think it’s right,” he told me. </p><p> The two of them had agreed to disagree. </p><p> Agreeing to disagree has been what most of us, doctor and patient, have done since concierge, or retainer, practices first appeared in the mid-1990s. Developed <a href="http://www.nytimes.com/2005/10/30/health/30patient.html" title="New York Times article on concierge medicine.">as an alternative to the constraints of traditional practice</a>, this new model allowed doctors to offer more personalized care that in turn increased patient and professional satisfaction. By decreasing the total number of patients seen in an office from well over 2,000 to as few as 500, doctors could offer longer visits, increased and immediate accessibility, personalized coordination of hospital care and, in some cases, even house calls and accompanied visits to specialists. In return for these services, patients would pay retainer fees, ranging from <a href="http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html" title="New York Times article on doctors opting out of Medicare.">just under $2,000 to as much as $15,000 per year</a>. </p><p> By 2003, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490281" title="Journal of General Internal Medicine article on concierge medicine trends.">according to a national survey</a>, the number of doctors practicing concierge medicine numbered fewer than 200. And while critics raised ethical concerns about the “abandonment” of patients left without primary care physicians while their doctors downsized and the creation of a “two-tiered” system that exacerbated disparities in health care access, little was done to address those concerns. These boutique practices were a relatively rare curiosity, and practitioners were left alone. </p><p> But over the years and particularly in recent months, the debate about the ethics of concierge doctoring has grown more heated, with more and more physicians unabashedly lining up to take sides. An <a href="http://www.annals.org/content/152/6/391.abstract" title="Annals editorial on concierge medicine.">editorial in the Annals of Internal Medicine</a> this spring, for example, questioned not only the ethics but also the quality of care delivered in such practices. The writer went on to urge other physicians to abandon “the neutrality with which the medical community has addressed” this issue thus far. </p><p> A month later, over a hundred doctors at a national meeting eagerly attended an event billed as a debate on the ethics of retainer medicine. But they weren’t jostling for places to argue the ethics; they <a href="http://www.acpinternist.org/im2010/friweb.htm#concierge" title="ACP Internist story on physician interest in concierge medicine.">wanted to hear about the experiences of physicians</a> who were already successfully practicing concierge medicine and to solicit advice. </p><p> As this issue becomes increasingly divisive, it’s hard not to wonder whether it is possible to practice in a way that reconciles concierge medicine with all the ethical concerns. </p><p> One group of doctors in Boston believes it is possible. And in <a href="http://journals.lww.com/academicmedicine/Abstract/2010/06000/Academic_Retainer_Medicine__An_Innovative_Business.16.aspx" title="Academic Medicine story on a new business model of concierge medicine.">an article published this summer in the journal Academic Medicine</a>, they argue that it can be done to the benefit of doctors and all patients, boutique or otherwise. </p><p> Since 2004, the primary care physicians at Tufts Medical Center have offered patients the option of being part of either a traditional general medical practice or a retainer practice. Patients in the retainer practice have longer visits, around-the-clock access to one of five physicians, comprehensive wellness and prevention screenings and on-time office appointments within 24 hours of a request. But unlike other boutique practices, the retainer fee of $1,800 per year that these patients pay does not go directly to the doctors’ coffers. Instead, it is used to support the traditional general medical practice, the teaching of medical students and trainees and free care to impoverished patients. </p><p> “I feel comfortable that this practice has been set up ethically,” said Dr. David G. Fairchild, senior author of the article and chief medical officer at Tufts Medical Center, who as a primary care physician sees patients at both the retainer practice and the more traditional general medicine practice. “No matter what practice patients are from, we treat them based on their medical need. But we also recognize that there may be a place for a higher level of service.” </p><p> That higher level of service, Dr. Fairchild points out, already exists across the country. Many <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/hospitals/index.html?inline=nyt-classifier" title="Recent and archival health news about hospitals." class="meta-classifier">hospitals</a>, for example, have long offered “V.I.P.” rooms or suites or have concierge wards for patients who are willing to pay more during their stay. In the case of the Tufts primary care retainer practice, the differences come down to “add-ons and the environment” that do not affect the quality of care. “Maybe you have a fish tank in one office and not in another,” he said. </p><p> This consistency in care across both practices was highlighted in <a href="http://www.ingentaconnect.com/content/adis/ptt/2009/00000002/00000002/art00005" title="Survey of experiences with concierge medicine in The Patient.">a survey that Dr. Fairchild and his colleagues conducted last year</a>. With responses from more than 300 patients, they found that patients rated the quality of interactions with their doctors similarly regardless of their affiliation. The only significant differences in responses had to do with the services offered — care coordination, physician access and interactions with office staff. </p><p> “It’s like going first-class in an airplane,” Dr. Fairchild said. “The experience of people in coach is a little different, but everyone gets to the same place at the same time.” </p><p> And at least in this model, more people may be able to board that plane as a result of increased practice revenues. The retainer fees from each new patient can support the physician costs for as many as 50 patients in the traditional practice; and retainer practice patients know from the start that their fees will be used to support teaching, service and free care in the community practice. “Some patients almost feel guilty about wanting this higher level of service,” Dr. Fairchild said. “Using their retainer fees for this type of support helps them see that they are actually making a contribution to teaching and community service, which are the mission of this hospital.” </p><p> While Dr. Fairchild is confident that the Tufts retainer practice addresses the ethical concerns of critics, he also acknowledges that concierge medicine is emblematic of larger problems in the health care system. </p><p> “This is not how any of us doctors wanted care to be set up,” Dr. Fairchild said, “but the system, as it is now, is broken. Patients are asking for more, doctors are under huge pressures, and there is not enough money in primary care.” </p><p> He added, “For the time being, this is a solution that seems to be working for doctors and patients.” </p><nyt_correction_bottom> <div class="articleCorrection"> </div> </nyt_correction_bottom><nyt_update_bottom> </nyt_update_bottom> </div> <!--cur: prev:--> <div class="columnGroup "> <div class="articleFooter"> <div class="articleMeta"> <div class="opposingFloatControl wrap"> </div> </div> </div> </div> <!--cur: prev:--> <ul id="toolsList" class="toolsList wrap"><li class="email"> <a id="emailThis" onclick="s_code_linktrack('Article-Tool-EmailSignIn');" href="http://www.nytimes.com/auth/login?URI=http://www.nytimes.com/2010/08/26/health/26pauline-chen.html">Sign In to E-Mail</a> </li></ul>Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-82636870066081521652010-09-01T08:42:00.000-07:002010-09-01T09:06:14.816-07:00Provenge (Sipuleucel-T) revisited<span style="font-weight: bold;">Unique Treatment Raises Tricky Bioethical Issues</span><br />Vaccine for advanced castration-resistant(hormone resistant)prostate cancer prolongs life by a median of four months, but at an extremely high cost<br /><br /><span style="font-weight: bold;">The question is whether it is worth it? </span><br /><br />The typical patient might be an "active, mentally acute man with prostate cancer..... twenty-two years after a radical prostatectomy, the man now has extensive disease, including liver metastasis, but continues to enjoy a good quality of life. The man is a strong and eager candidate for a brand-new treatment that could extend his life by several months with relatively few side effects that will allow him to maintain a pleasant existence."<br /><br />"The treatment is administered in 3 doses-one intravenous infusion approximately every two weeks-at a cost of about $31,000 per infusion, or $93,000 for the full regimen, and yields a 4.1-month median improvement in survival(25.8 months for treated patients vs 21.7 months in controls"<br /><br />"Balancing the cost to some degree is Provenge's favorable risk profile: The most common complaints are chills, fatigue, fever, back pain, nausea, joint ache, and headache, although more serious respiratory or cardiovascular disorders are possible."<br /><br />Medicare CMS is likely to issue a decision sometime around early summer 2011. Private insurance will likely respond similarly. The results will certainly be affected by the available dollars allocated for healthcare in this rapidly changing healthcare environment. <br /><br />Renal and Urology News August 2010 Volume 9, Numer 8Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-50153461591710443272010-09-01T08:01:00.000-07:002010-09-01T08:20:49.549-07:00LupronAbbott Laboratories has announced the upcoming release of LupronDepot as a 6 month 45mg preparation. It should become available soon.Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-59553660426645275482010-08-24T16:02:00.000-07:002010-08-24T16:03:49.020-07:00Cranberry juice and urinary infections<a target="_blank" style="color: rgb(0, 0, 0);" name="S2"> <h3 style="margin: 15px 0px 5px; font-size: 17px; color: rgb(0, 0, 0);">Cranberry Juice May Prevent Bacteria From Developing In The Urinary Tract.</h3> </a> <p style="margin: 0px;"> <a target="_blank" style="color: rgb(14, 77, 150); text-decoration: underline;" href="http://mailview.custombriefings.com/mailview.aspx?m=2010082401aua&r=3043208-62e8&l=005-7b8&t=c"><u>WebMD</u></a> (8/23, Woznicki) reported, "Scientists report that within eight hours of drinking cranberry juice, the juice could help prevent bacteria from developing into an infection in the urinary tract." Scientists at the Worcester Polytechnic Institute made that observation after growing "strains of E. coli in urine collected from healthy people before and after they drank cranberry juice cocktail." In short, investigators "discovered that in petri dishes, cranberry metabolites in the juice prevented E. coli from sticking to other bacteria, limiting its ability to grow and multiply." </p>Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-73336710085764305102010-08-04T13:42:00.000-07:002010-08-04T13:45:12.728-07:00Occupational risk for bladder cancerSomething I suspected all along (see article below)<br /><br /><div class="verticalcomponent first" id="spc_244049" align="center"><div style="font-weight: bold;" id="article_detail_header_alt"><div class="pageheader_box"><span class="pageheader">Painters Found to Have Increased Bladder Cancer Risk</span><subtitle><span class="article-subtitle">And risk appears to increase along with more time in occupation</span></subtitle></div></div><div class="clearit"><!-- --></div></div><script language="JavaScript" src="http://www.modernmedicine.com/modernmedicine/sitewide/js/spacing.js"></script> <script language="JavaScript" src="http://www.modernmedicine.com/modernmedicine/sitewide/js/articlepopwin.js"></script><span class="article-articlebody"><p><span class="article-articlebody"><div class="imagewrap"><img src="http://www.modernmedicine.com/modernmedicine/data/articlenewsfeed//modernmedicine/302010/679800//13350076.jpg" align="left" border="0" vspace="3" width="124" height="166" hspace="0" /></div><p>TUESDAY, July 20 (HealthDay News) -- Occupational exposures in painters are associated with an elevated risk for bladder cancer, a risk that increases with years on the job, according to research published in the August issue of <i>Occupational and Environmental Medicine</i>.</p><p>Neela Guha, Ph.D., of the International Agency for Research on Cancer in Lyon, France, and colleagues conducted a meta-analysis of 41 studies encompassing more than 2,900 incident cases or deaths from bladder cancer, including two cohort studies, nine record linkage studies, and 30 case-control studies. The researchers pooled data and adjusted for smoking and other occupational exposures. Results were stratified by study design, gender, and study location.</p><p>Compared to unexposed subjects, the researchers found that painters had an overall 25 percent increase in bladder cancer risk (based on all 41 studies), a 28 percent increased risk after adjusting for smoking (based on 27 studies), and a 27 percent increased risk after adjusting for other occupational exposures (based on four studies). After the researchers stratified by gender, study design, and study location, the results were still robust. They also found that bladder cancer risk was higher for those employed as a painter for longer periods of time.</p><p>"Because several million people are employed as painters worldwide, even a modest increase in the relative risk is remarkable. It is important for cancer control and prevention to design studies with more specific exposure assessment that quantifies individual agents or classes of agents to identify the underlying carcinogenic agents encountered in painting," the authors write.</p><p><br /></p></span></p></span>Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-83836878741716331412010-07-21T16:43:00.000-07:002010-07-23T10:40:16.376-07:00PCA3The PCA3 urine test is becoming a useful test for the diagnosis of prostate cancer. See article below. Refer to the website www.PCA3.org for the most up-to-date information.<br /><a target="_blank" style="color: rgb(0, 0, 0);" name="S9"> <h3 style="margin: 15px 0px 5px; font-size: 17px; color: rgb(0, 0, 0);">Cleveland Clinic To Use Progensa PCA3 Test For Prostate Cancer Screenings.</h3> </a> <p style="margin: 0px;"> The <a target="_blank" style="color: rgb(14, 77, 150); text-decoration: underline;" href="http://mailview.custombriefings.com/mailview.aspx?m=2010072101aua&r=3043208-45e7&l=016-eea&t=c"><u>Cleveland Plain Dealer</u></a> (7/20, Townsend) reports that even as "the quest for a better, more accurate prostate cancer screening test continues," the Cleveland Clinic "is the latest of a dozen centers across the country to offer the Progensa PCA3 test," which is "one of the latest, more accurate, such tests." PCA3 detects the presence of the gene of the same name, "which shows up in urine only when a man has prostate cancer." The gene is found "in more than 90 percent of prostate cancer cases," the paper says. Over 30 men have received the test and "about half of those tests" have indicated the need "for a follow-up biopsy." Clinical trials for the test "have ended," and Gen-Probe Inc., one of the developers, is preparing to file its regulatory application with the FDA by fall. </p>Dr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0tag:blogger.com,1999:blog-426161675963745256.post-45061886674483796102010-07-16T07:28:00.000-07:002010-07-16T07:34:19.667-07:00provengeSeveral patients have inquired about Medicare coverage for the recently approved drug, <span style="font-weight: bold;">sipuleucel-T(Provenge)</span> for the treatment of metastatic castrate-resistant prostate cancer. The Centers for Medicare and Medicaid is performing a "national coverage analysis to determine whether autologous cellular immunotherapy is reasonable and necessary under certain sections of the Social Security Act". More information will be forthcoming as it becomes availableDr. Ronald Frankhttp://www.blogger.com/profile/01888913218292876597noreply@blogger.com0