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Cover Story: Role Reversal

'Toughing it out' may be yielding to a men's health movement

By Russell Firor · July 29th, 1999 · Cover Story

A recent study reported widely on national news proclaimed that women and minorities are 40 percent less likely to receive aggressive intervention --angiogram -- for heart disease. In actuality, the differences were 85 percent versus 91 percent, a 6 percent spread. When further analyzed critically, the difference was largely applicable to African-American females.

The women's health movement has persisted and accomplished much for four decades. What the media hype above is covering up, according to the World Health Organization, is, "An equivalent movement has yet to champion men's health. The reality remains that men, particularly in adulthood, receive comparatively little attention from the health sector."

This is not to downplay the good that the women's health movement has done in bringing gender-specific issues to the fore, but in her doctoral thesis, Astrid Stuckelberger, a researcher in Switzerland, says that in most cultures men are made, from an early age, to view themselves as "indestructible machines" requiring minimal maintenance.

Our culture is no exception from this training, and might have been a leader in it. Men are much less likely, for example, to seek preventive care. In fact, studies are demonstrating that 60 percent of the increased usage by women of medical services can be accounted for by gynecological, health education and preventive services. As it turns out, women live longer than men, even though they experience more chronic illness. Only in Kuwait does the life expectancy of males equal or exceed that of females. In many countries, while the life expectancy of women is expected to increase, that of men is expected to remain where it is. In a few countries, the gap is expected to narrow due to better interventions.

So, focusing on us, what is the problem!? Well, as stated, men have had no coherent health movement. The World Health Organization's (WHO) first world congress on the aging male took place in 1998. At least there is a starting point, but we are three to four decades behind.

As men, our tendency to tough it out and silently bear pain has in many cases been to our detriment. Women were often overlooked in studying heart disease because in men it developed 10 to 30 years earlier. A 35-year-old male with chest pain is thus a statistically more deadly medical consumer than a 35-year-old female.

Instead of worse health, as it is claimed women have, men at an earlier age are far more likely to experience sudden death.

And when it comes to the major killers such as heart disease, lung cancer, HIV and so on, men are likely to wait until they are medically falling off a cliff before seeking help. This helps account for the often-noted finding that women live longer and have more disease, while men get a disease that kills them.

As to more exclusively male diseases, we might mention testicular cancer, erectile dysfunction and prostate disease. Ironically, until the introduction of Viagra, erectile dysfunction was clearly a hidden problem in terms of magnitude. Millions of men just toughing it out with all of the physical, psychological and marital problems, not to mention the lack of well-being.

The prostate gland is a potential disease jungle. Acute prostatitis (infection), chronic prostatitis, non-infectious prostatitis, prostate cancer and prostatic hyperplasia (swollen prostate) all afflict this one area of the male anatomy. Early detection is one attempt to deal with the cancer, although men are poor at seeking prevention and screenings. The other ailments have relatively mediocre solutions: surgery to remove the diseased glandular tissue, treating recurrent infections or ... toughing it out.

Certain diseases of aging have been largely attributed to women, and men have been sorely left out of the loop. To paraphrase a visiting endocrinologist speaking on osteoporosis, "If you're male and have osteoporosis, you are screwed." The fact is that men should have calcium supplementation as aggressively as women. Also, to quote the WHO again, "... interventions such as hormone replacement therapy may help to prevent the preventable and delay the inevitable. Evidence is available that such interventions may slow the progression of disease in women. There is an urgent need to obtain comparable information for men."

The Society for Advancement of Women's Health Research, taking a very aggressive stance regarding the "inequities" in research for curing women's diseases, lists the following targeted areas in which to improve our efforts: general health, cardiovascular disease, lung cancer, breast cancer, gynecologic cancers, violence against women, osteoporosis, menopause, mental illness, eating disorders, sexually transmitted diseases and HIV/AIDS.

This list, of course, is not wholly exclusive to women, and some of these conditions, although currently devastating to men, are not addressed in males. Other illnesses -- cardiovascular disease and lung cancer, for instance -- have taken a greater toll on the male population in the past, but seem to be taking over as leading killers of women as well.

Health differences due to gender get very interesting when looking at social and psychological factors. The type-A (becoming enraged) personality is a predictor of heart disease in men. Surprisingly, at least one study demonstrated a protective effect of type A-behavior in women. Men, married or otherwise, whose health decisions are influenced by women, have better health outcomes and stay healthier.

And good news for us nerds: Men who are "squares," who don't smoke, use alcohol or do any number of things to climb the corporate ladder, move into their 70s in a much healthier state and will outlive their peers. Women's health, on the other hand, appears to improve as women as a group are given opportunities to perform more vigorous exercise and activities, and -- guess what? -- climb the corporate ladder, if desired.

Does this mean that gender-specific medicine is pointing to role reversal? Actually, it is pointing to a greater choice in individual lifestyle. More men need to create time to be with family, to become nurturing and calm. More women need to get out of the house.

Another good effect of the women's movement is that it has stimulated an interest in men's health, something we were not going to do on our own. We are all in this together, men and women. And as gender-specific medicine gets a boost from this point-counterpoint, we may develop a fresher, clearer view of our world at large, and thus begin dealing with deeper health issues that affect us all.

RUSSELL FIROR, M.D., a doctor of internal medicine in Cincinnati, demonstrated his lack of bias by writing about women's health in CityBeat's Women's Issue in early June.


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