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Men’s Health: Breaking the Resistance

Posted in Uncategorized on June 17th, 2016 by MMS Communications – Comments Off on Men’s Health: Breaking the Resistance

Resistance by men to medical care and treatments remains a vexing challenge as evidenced by the presentations of five clinicians at the Massachusetts Medical Society’s 14th Annual Symposium on Current Issues in Men’s Health on Thursday, June 16th.

The annual symposium is sponsored by the MMS Committee on Men’s Health, currently co-chaired by Frederic S. Schwartz, M.D. and Michael B. Bader, M.D., and seeks to promote awareness of men’s health issues and improve the overall health of men through education and information for physicians and other healthcare providers, researchers, and the public.  Some 60 health care professionals attended this year’s event, held during National Men’s Health Week.

Dr. Frederic Schwartz, Co-Chair, MMS Men's Health Committee

Dr. Frederic Schwartz, Co-Chair, MMS Men’s Health Committee

The opening presentations, on the treatment of Hepatitis C and alcohol dependence, were followed by a discussion on erectile dysfunction and its relationship to cardiovascular disease, and a presentation that reported how a cohort of male patients responded to questions about access to health care. The symposium concluded with a presentation about the health and identity issues transgender patients face when seeking medical care.

In his introductory remarks, MMS President James S. Gessner, M.D. underscored the urgency that surrounds these topics.

“Statistically, we face numerous challenges with regard to male patients,” Dr. Gessner said, “because men continue to be more likely than women to make unhealthy lifestyle choices. One in every five men will suffer a heart attack before they reach the age of 65. We must adopt a dual role as practitioners and catalysts, to treat men and to motivate them to live healthier lives.”

George Abraham, M.D., in his presentation titled Citius, Altius, Fortius: The New Standards of Hepatitis C, declared that “the saddest statistic we face is that while we have conquered HIV, the prevalence of cirrhosis is quite high, and men are increasingly the victims.” He said that liver transplants have increased and liver cancer is common among male patients. The good news, however, is that we are now headed to help cure this problem more rapidly than ever, thanks to medical and pharmaceutical advancements. Yet male patients must make a commitment to recovery and that practitioners must urge them to embark on this path, he said, or reinfection is possible.

Drawing on two American authors – Ernest Hemingway and F. Scott Fitzgerald — as examples of men who battled and later succumbed to alcoholism, Kenneth Hetzler, M.D., in his presentation, Alcohol Dependence and Best Practices for Treatment, explored alcoholism symptoms and treatments. Noting that both Hemingway and Fitzgerald paid a high price for their alcohol dependencies — depression, cirrhosis and, in Hemingway’s case, suicide — he urged physicians to engage in frank dialogues with their patients about their drinking habits so patients can grasp the risks of alcohol dependency and turn to resources for sobriety.

Martin Miner, M.D., cited another American author, Mark Twain, in his presentation, Erectile Dysfunction and Cardiovascular Function: What We Know.  Twain’s remark, “You can’t break a bad habit by throwing it out the window. You’ve got to walk it slowly down the stairs,” illustrated what Dr. Miner said is an effective approach to discussing and treating erectile dysfunction, a subject men find difficult to broach. Male patients must take small steps to change their lives, Dr. Miner said, which often include lifestyle changes. Noting that the relationship between erectile dysfunction and cardiovascular health is being clinically explored, Dr. Miner said that working with men to change slowly and understand the implications of their health challenges over time remains a key imperative.

James E. Leone, Ph.D., in his presentation Advancing Health Behaviors in Men: Understanding Men’s Perceptions Regarding Accessing Health Care, urged physicians to work with male patients to “unpack the behaviors” that lead to their resistance of healthcare. These include fear, control, time/convenience, trust, and other issues that emerged from his research as examples of resistance by men to seeking healthcare. “We need to create a more robust dialogue with men,” Dr. Leone said, “to bring men back to being active participants” in their own well-being.

Dr. Kevin Ard, the recipient of this year’s Men’s Health Award from the MMS, followed with a presentation entitled Transgender Identity and Health Issues, noting that LGBT patients have traditionally felt marginalized by the medical profession.  He encouraged practitioners to “make their clinical settings more welcoming,” and to use preferred names and pronouns, to ask patients about their identity and sexual orientation, and to remain open to them by avoiding assumptions about their health issues.

—Robert Israel

Editor’s Note: The slide presentations of  Dr. Abraham, Dr. Hetzler, Dr. Minor, Dr. Leone, and Dr. Ard are available here. 

 

 

 

 

 

 

 

 

 

 

Shattuck Lecture: A Better Way to Drug Development

Posted in NEJM, Uncategorized on May 6th, 2016 by MMS Communications – Comments Off on Shattuck Lecture: A Better Way to Drug Development

The pharmaceutical and biomedical research industry have had many successes over many years, curing and eradicating diseases, prolonging and enhancing life. Such success has entailed years of testing and trials and millions and even billions of dollars.

Woodcock_SLL

Dr. Janet Woodcock

Today, however, the development and costs of new drugs have become two of the most difficult – and sometimes controversial – topics in medicine today.  The cost of developing even a single drug can run into the billions of dollars; the cost of one life-saving therapy can erase the life savings of a patient.  Such conditions have brought the pharmaceutical industry under scrutiny and under fire.

However, even with so many triumphs, says Janet Woodcock, M.D., “the biomedical research enterprise is surprisingly ineffective at improving health and treating disease, given our level of investment in it.”

Dr. Woodcock, Director of the Center for Drug Evaluation and Research at the Food and Drug Administration, shared her thoughts on drug development programs as she delivered the 2016 Shattuck Lecture, Lost in Translation: The Path from Scientific Discover to the Clinic, presented by the MMS Committee on Publications and the NEJM Group as part of the MMS annual meeting today.

She offered her perspectives – and some recommended solutions – to improve scientific discovery based on her 30 years of observing thousands of attempted drug development programs, both commercial and academic, while at the FDA.

Dr. Woodcock was clear and direct in her analysis: “Multiple systemic flaws impede generational knowledge,” she stated. “Medicine must take back ownership of clinical evidence development.”

The shortcomings in the system, she says, are the result of three problems in biomedical research: a lack of reliable basic scientific information to support development program; the absence of a robust translational infrastructure to develop and assess tools and drug candidates; and the inability of clinical medicine to create effective systems to generate evidence.

Despite the flaws, Dr. Woodcock believes opportunity for change and improvement exists.  “The system we have successfully operated for many years is under severe stress,” she declares, “and transformative change is needed.  New structures and technologies will provide opportunities.”

“Transformation of clinical research would be challenging with many obstacles,” she notes, “but the payoff might be worth it.” Among the benefits would be rapid and efficient generation of clinical evidence, patients as active participants in the clinical research enterprise, the integration of research into healthcare, and more effective and clinically relevant evaluations of new products and other interventions.

For more observations from Dr. Woodcock and a sampling of her recommendations for a better way forward, view her presentation here.

 

 

March Physician Focus: Common Skin Disorders

Posted in Uncategorized on March 22nd, 2016 by MMS Communications – Comments Off on March Physician Focus: Common Skin Disorders

The skin is the largest organ in the human body and serves to regulate our body temperature and provide protection from bacteria and SKIN DISORDERS EDITED 3_editedviruses.  Yet the skin is subject to a number of diseases and conditions – from acne to eczema, rashes to rosacea, to various types of skin cancer.

The latest edition of Physician Focus features representatives from the Massachusetts Academy of Dermatology discussing the most common skin conditions and what patients can do to protect their skin.

Guests are Ira L. Skolnik, M.D., Ph.D., (photo, right) president of the Massachusetts Academy of Dermatology, and a physician with Family Dermatology in Concord, Mass., and Pamela Weinfeld, M.D., (center) vice president of the Academy and founder of Dermatology and Skin Care Associates in Wellesley. Hosting this edition is family physician Mavis Jaworski, M.D.(left).

The conversation includes the risk factors for skin disease, including the dangers of tanning; differences among the three most common types of skin cancer; and the causes and treatments of acne and eczema.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and online at www.physicianfocus.org, www.massmed.org/physicianfocus, and YouTube.

Download Your Copy of the MMS Physicians’ Guide to Social Media

Posted in Uncategorized on March 21st, 2016 by Erica Noonan – Comments Off on Download Your Copy of the MMS Physicians’ Guide to Social Media

social media guide coverThe evidence is clear: Your patients are seeking, and often sharing, health information across a variety of platforms on the Internet.

Physicians can use the new platforms and communities to share valuable information, provide context to health stories in the popular media, and even dispel dangerous health myths.

In doing so, physicians who are active in social media will simultaneously strengthen their own online reputation and digital footprint, as well as that of their practice or employer.

The MMS Committee on Communications  has created a new guide to help physicians engage in and manage social media tools in ways that will provide optimal benefit to their patients and practices.

Download the 28-page .pdf free of charge here.

Erica Noonan

Patient Experience is NOT Patient Satisfaction: Why Focusing on Great Patient Experience Delivers Safe, Quality, High-Value Care

Posted in Uncategorized on August 28th, 2015 by Erica Noonan – Comments Off on Patient Experience is NOT Patient Satisfaction: Why Focusing on Great Patient Experience Delivers Safe, Quality, High-Value Care

 

By Katherine Schauer

Do you know the difference between patient experience and patient satisfaction?

If you’re not sure, you’re not alone, according to Adrienne Boissy, MD, chief experience officer at the Cleveland Clinic.

“Patient satisfaction measures if they were satisfied, (i.e. happy) with the results of their stay. To look at it this way makes patients seem like consumers at a store…But health care is more emotional than that,” said Dr. Boissy.

Dr. Boissy is one of the featured speakers at a two-day Patient Experience Summit: A Physician Leadership Certificate Program, focusing on the patient experience. It will be held on September 30 and October 27, and was developed by the Cleveland Clinic in collaboration with the MMS.

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Adrienne Boissy, MD

Dr. Boissy said that patients aren’t really consumers because under most circumstances, they don’t want to be in the hospital. To call them satisfied and treat them like consumers is a mistake, she said. “Our goal isn’t to make them satisfied or leave them feeling happy. Our goal is to help them navigate through the process of getting better or dealing with a lifelong sickness. We want to make that experience a little easier for them. That is patient experience, an emotional journey that we can try to make better.”

Dr. Boissy defines patient experience as delivering “safe, quality, high-value care” and notes that everything a physician does in front of the patient influences their experience. “It matters because the patients choose where they want to be treated based on their past experiences and through the experiences of their friends and family,” she said.  “It also matters because at one point we are all patients. It isn’t “their” experience; it is “our” experience.”

The patient experience has many aspects, cleanliness of room, discharge speed, doctor/nurse attitude and more.  But Dr. Boissy thinks physicians are one of the most important influences on the experience.

“They (physicians) definitely have control over the experience. The problem is that some of them do not see their accountability. The physicians don’t feel as connected to some parts of the patient experience, like the cleanliness of the room. They are accountable for everything they say and the impression they give their patients,” she said.  “A doctor may be a phenomenal heart surgeon but if the patient feels they weren’t listened to then it doesn’t matter how good of a doctor he/she was.”

Health care teams are looking towards physicians to lead the patient experience movement, she said, and physicians must become more engaged with the idea of patient experience to get their teammates on board.  “Health care has shifted from being doctor-centered to relationship-centered care,” she stated.  Hospitals and practices know that patient experience is a key metric and will receive more focus in the future, as hospitals are increasingly reimbursed for quality patient care.

Many physicians believe they are leaving their patients with great impressions, but sometimes they’re mistaken, Boissy said. “Doctors need the transparency of the survey results to see their patient experience blind spots, to become self-aware.”

Dr. Boissy said systems that compare doctor-patient experience evaluations within a group or system can be more effective than traditional private evaluations. Seeing his or her scores in comparison with a colleague can motivate a physician to improve or to seek advice from others.

The Patient Experience Summit: A Physician Leadership Certificate Program is designed to help physicians improve their practice of patient experience and relationship-centered care. Registration is now open. It will be held on September 30 and October 27 at the Massachusetts Medical Society’s headquarters in Waltham.

 

MMS Statement on Today’s Supreme Court Decision Upholding ACA Subsidies

Posted in Uncategorized on June 25th, 2015 by Erica Noonan – Comments Off on MMS Statement on Today’s Supreme Court Decision Upholding ACA Subsidies

 

Statement from Massachusetts Medical Society President Dennis M. Dimitri, MD, on King v. Burwell:

The Massachusetts Medical Society welcomes today’s Supreme Court decision safeguarding access to crucial health care service for millions of patients, said Massachusetts Medical Society President Dennis M. Dimitri, MD.

“The physicians of the Massachusetts Medical Society applaud the decision to uphold Affordable Care Act subsidies in states that do not have their own health care exchanges,” said Dr. Dimitri. “Patients across the United States will not lose access to the care they need and deserve.”

 

Sports Medicine: Emerging Technologies and Procedures

Posted in Uncategorized on June 24th, 2015 by Erica Noonan – Comments Off on Sports Medicine: Emerging Technologies and Procedures

 

By Nicholas Sargent, MMS Communications Staff

 Brian McKeon, MD, the Chief Medical Officer and Head Team Physician for the Boston Celtics opened his presentation at the 2015 MMS Men’s Health Symposium last week by discussing how rapidly the technology of medicine has advanced.

“This is a totally different talk than I would have given in January,” said Dr. McKeon. Still, even with medical technologies advancing as quickly as they are, he did not see an end to the simple problem of human aging and wearing out the body anytime soon. Because of modern medicine, people are living longer than ever before, instead of “struggling to 42, then getting eaten by a bear.”

People are lasting longer, but we’re still wearing out our bodies, and because of this the need for orthopedic surgery has skyrocketed in recent years, and it won’t slow down anytime soon, he said. The demand for knee arthroplasties is expected to grow 673% by 2030, and modern medicine can’t do much to stop the decay and loss of cartilage, especially the meniscus cartilage in the knee.

mckeon

Surgery, Dr. McKeon said, can only do so much. Patient dissatisfaction with meniscus surgery reaches 100% after 10 years, and repeat surgeries can’t do much to help if the tissue is completely worn away.  He said the most attractive prospect is a new implant, invented by a team in Israel, which imitates the meniscus and can be inserted with a very simple procedure.

He said another problematic surgery is patching up rips in the rotator cuff. Clinical studies show that there is a 30 to 50% chance of a rotator cuff repair failure, either from the patient re-opening the tear or from lack of blood flow to the affected tissue, which slows the healing  process.

Dr. McKeon has begun using stem cells to promote tissue growth at the site of the surgery, with great success. While the cells can be harvested from the patient’s own bone marrow and mixed with graft material, the best results are had with amniotic stem cells.

Amniotic cells are currently expensive due to the limited number of companies that provide them, but Dr. McKeon was confident that this will change within a decade. “They’ll be popping up all over the place.”

See slides From Dr. McKeon’s presentation here.

MMS Talks to Dr. Andrew Kowal: Addiction and Men’s Health

Posted in Uncategorized on June 16th, 2015 by Erica Noonan – Comments Off on MMS Talks to Dr. Andrew Kowal: Addiction and Men’s Health

In advance of the 13th Annual Symposium on Men’s Health on June 18 from 8:00 a.m. to 4:00 p.m. at the Massachusetts Medical Society in Waltham, we reached out to several of the panelists and faculty who will be attending for interviews about their areas of expertise. Here is the fourth of a series of short interviews with the event’s presenters.

Dr.  Andrew G. Kowal, director of Pain Management Center, Lahey Hospital & Medical Center, will present a panel on pain management and addiction.

 

By Katherine Schauer

MMS Communications Staff

 

MMS: Pain management is not usually seen as a gender-specific condition, are there any complications or issues that only arise in men? Are men more likely to suffer from chronic pain?

Dr. Kowal:  Men are not more likely to suffer chronic pain; however it can be more difficult to diagnose chronic pain syndromes in men; for example fibromyalgia. Also high dose chronic opiates affect them {men} even more negatively than women secondary to their effect on hormones such as testosterone.

 

MMS: What is your stance on medical marijuana regarding pain management?    Kowal

Dr. Kowal:  Medical marijuana with pain management is not a good idea. We will go into great detail and review this at the symposium.

 

MMS: What do you hope to achieve at the symposium?

Dr. Kowal: I will highlight THC and opiates in the context of chronic pain management and recent evidence about both, or lack thereof! I will also briefly cover new opioid guidelines.

 

MMS: Is there any message you want to be sure everyone attending the symposium hears?

Dr. Kowal: The message I want everyone to hear is that opioids do not help chronic pain; they cause more problems and dangers with escalating chronic use.

 

MMS: What’s the next frontier in the field of pain management?

Dr. Kowal: The next frontier is using functional imaging studies of the central nervous system to diagnose/guide therapies. Also there are new non-opiate pain medications on horizon.

 

Dr. Kowal is clinical assistant professor of anesthesiology at the Tufts School of Medicine in Boston and director of the Interventional Pain Management Center at Lahey Clinic. Dr. Kowal spent 10 years in active duty for the United States Army Medical Corps where he was involved in leading the development and implementation of Department of Defense clinical practice guidelines for pain management.

Read more about the event’s program and panelists.

Register here to attend the 13th Annual MMS Symposium on Men’s Health on June 18.

 

MMS Talks to Dr. Brian P. McKeon: Men’s Health and Orthopedics

Posted in Uncategorized on June 15th, 2015 by Erica Noonan – Comments Off on MMS Talks to Dr. Brian P. McKeon: Men’s Health and Orthopedics

In advance of the 13th Annual Symposium on Men’s Health on June 18 from 8:00 a.m. to 4:00 p.m. at the Massachusetts Medical Society in Waltham, we reached out to several of the panelists and faculty who will be attending for interviews about their areas of expertise. Here is the third of a series of short interviews with the event’s presenters.

Dr. Brian P. McKeon, chief medical officer and head team physician to the Boston Celtics, will present a panel on orthopedics, sports medicine and sports related injuries.

 

By Katherine Schauer

MMS Communications Staff

 

MMS:  Sports medicine is a broad topic and I understand you will discuss knee and shoulder injuries. Will you cover your work with the Boston Celtics?

Dr. McKeon:  I think I’ll bring up relative issues but by contract and by my agreement I’m not allowed to name any players or their specific issues. But part of my talk is going to pertain to some of the latest things that we are doing for all sorts of people, to get everyone to heal better. Also to understand the anatomy better, basically trying to understand the loads on the tissue and to try and get the tissue to heal.

MMS: Do you feel a lot of pressure working for a high profile sports team?

Dr. McKeon:  You know I think part of being a doctor in this situation is pressuring. I’ve been doing it for 17 years now so I’ve developed a comfort level. But I mean I try to turn it around and make it more fun but I know I am under tremendous scrutiny. How I take care of a pro athlete is kind of my template for how I take care of everybody else, to some degree. And I think it has made me a much better doctor.

 MMS: What have you learned through your time with the Celtics?      mckeon

Dr. McKeon:  I have learned that you can take the human body to another level, you can push it. But you can also manage the stress with techniques like proper rest, hydration, etc. There’s always a false sense (from fans) that were doing something special back there in the training room, but we’re really not. It’s just the ABCs of general healthcare and trying to create good habits

MMS: What can a basketball player do before practice or a game to prevent injuries?

Dr. McKeon:  I’d stick to the basic principles. The biggest issue I see is that people get tired, they just aren’t strong enough. You cannot avoid traumatic injury, if a guy just plows you over then fine that’s bad luck. But most injuries are strains and pulls, injuries that can be avoided based on an athlete listening to his or her body. It’s all about getting the right rest, staying hydrated and a lot of pre-game strengthening.

MMS: What is your opinion on concussions and professional sports? What do you tell players that have suffered from too many concussions?

Dr. McKeon:  I think that the professional leagues have done a lot to handle concussions. The NBA was the last to follow because it’s not a contact sport like hockey or football. Concussions are a lot more objective now, especially in professional sports. It’s no longer a fuzzy line or a game time decision. To me it’s about bringing in the right consultant, getting the right help to make the decision with the very powerful baseline testing that we have. If I had a high school kid come in with several past concussions but he says he still wants to play, I would say ‘You’re done, you’re really done.’ You can have 15 normal MRIs, 10 normal CAT scans and you can even do some functional testing. But it’s the unknown, what is another hit going to do to the kid long term? It really isn’t worth it at that age.

MMS: What do you hope to achieve at the symposium?

Dr. McKeon: To define what a stem cell is, in the perspective of an orthopedic surgeon. It is one of the most misunderstood words. And I have been using stem cells now in treating patients for quite some time and I want to define application and the potential benefits there are relative to orthopedics. And there’s an issue of insurance. Some people have the same injury and I can help one with stem cells and another one I can’t.

MMS: What’s the next frontier in the field of sports related medicine or orthopedic surgery in general?

Dr. McKeon: Tissue engineering. Arthritis is a disease that affects the whole world. Medical doctors are good at keeping us alive; controlling our blood pressure and making our hearts work. But the big issue is maintaining the frame. People’s bodies are breaking down but their organs are fine. The challenge for us is finding a way to keep the body mobile. Looking at arthritis, I don’t think we are going to cure it in my life time but we can try to have a better understanding of it. And the key is earlier intervention. I am going to highlight all of this at the symposium.

 

Dr. McKeon currently participates in clinical trials and funded research studies related to articular cartilage and synovitis. His primary clinical interests lie in sports medicine and the treatment of sports-related injuries, with an emphasis on performing minimally invasive surgery on shoulders, knees, elbows, and ankles.

 

Read more about the event’s program and panelists.

Register here to attend the 13th Annual MMS Symposium on Men’s Health on June 18

MMS Talks to Dr. Peter C. Albertsen: Men’s Health and Prostate Cancer Screening

Posted in Uncategorized on June 12th, 2015 by Erica Noonan – Comments Off on MMS Talks to Dr. Peter C. Albertsen: Men’s Health and Prostate Cancer Screening

 

In advance of the 13th Annual Symposium on Men’s Health on June 18 from 8:00 a.m. to 4:00 p.m. at the Massachusetts Medical Society in Waltham, we reached out to several of the panelists and faculty who will be attending for interviews about their areas of expertise. Here is the second of a series of short interviews with the event’s presenters.

Dr. Peter C. Albertsen, chief and program director at the University of Connecticut Health Center in the Department of Surgery (Urology), will present a panel on prostate cancer screening.

By Nicholas Sargent

MMS Communications Staff

MMS: Your topic is prostate cancer screenings. What do you hope to discuss regarding this cancer specifically?

Dr. Albertsen:  We will be discussing the United State Preventative Services Task Force’s suggestion that physicians not perform prostate-specific antigen (PSA) testing and deciding where we should go next. The Task Force’s decision was based on the PSA tests being overly sensitive or not specific enough.  This does not happen all the time, or a majority of the time, but it has happened a sufficient number of times to become a problem. While I respect the USPSTF and the effort they put into reviewing all the literature, I disagree with their decision to stop PSA testing altogether. We need to identify the correct men who will benefit from PSA testing and go from there.

MMS: Do you feel that enough men are getting screened for prostate cancer?    Albertsen headshot

Dr. Albertsen:  Too many older men are getting a PSA that they don’t need, and young men are not getting tested enough. Ideally, men would start getting tested in their late 40s and early 50s.

MMS: What do you hope to achieve at the conference?

Dr. Albertsen:  I want to help people have a more sophisticated understanding of PSA tests—people see it as a miracle screening, but the story is a lot more complicated than that.

MMS: What’s the next frontier in the field of prostate cancer or urology in general?

Dr. Albertsen: I’ll be discussing this in more detail during the panel, but genomic testing and MRI imaging to test for cancers has begun recently. It’s not being done everywhere, but it is definitely on the horizon.

 

Dr. Albertsen has an international reputation for his work on prostate cancer and is the author of numerous publications. He is on the editorial board of several journals and frequently reviews manuscripts for the major urological journals. He is a trustee of the American Board of Urology and a member of the Residency Review Committee of ACGME for Urology.

Read more about the event’s program and panelists.  Click here to read an interview with Dr. Lawrence Jay Epstein on sleep apnea in men.

Register here to attend the  13th Annual MMS Symposium on Men’s Health on June 18.