Men's health care showing disparity

By Roni Rabin
NEW YORK TIMES NEWS SERVICE

November 14, 2006

In recent years, women's health has been a national priority. Pink
ribbons warn of breast cancer. Pins shaped like red dresses raise
awareness about heart disease. Offices of women's health have sprung up
at every level of government to offer information and free screenings,
and one of the largest government studies on hormones and diet in aging
focused entirely on older women.

Yet statistics show that men are more likely than women to suffer an
early death.

Now some advocates and medical scientists are beginning to ask a
question that in some circles might be considered politically
incorrect: Is men's health getting short shrift?
The idea, they say, is not to denigrate the importance of women's
health but to focus public attention on the ways in which men may be
uniquely at risk - and on what a growing men's health movement has
termed the "health disparity" between the sexes and its most
glaring example, a persistent longevity gap that has narrowed but still
shortchanges men of five years of life compared with women.

"We've got men dying at higher rates of just about every disease, and
we don't know why," said Dr. Demetrius Porche, an associate dean at
Louisiana State University's Health Sciences Center School of Nursing
in New Orleans, and the editor of a new quarterly, American Journal of
Men's Health, that will publish its first issue in March.

The Men's Health Network, a nonprofit educational foundation based in
Washington, D.C., has called for creating a federal office of men's
health to mirror the office on women's health within the Health and
Human Services Department, and it is backing a bill sponsored by Sen.
Mike Crapo, R-Idaho, and Rep. Vito Fossella, R-N.Y., to do so. Several
federal offices on women's health were recently established to
compensate for years in which women were often excluded from medical
research, but there is no federal office of men's health.

Men's health advocates say men are silently suffering through what may
be a serious health crisis. "We keep throwing out lifestyle as an
explanation for the differences in longevity, saying that men come in
later for care and have unhealthy behaviors, but I'm not sure we really
know the reason," Porche said. "And we haven't answered the
question: Is there a biological determinant for why men die earlier
than women?"

It is a question that has piqued the interest of some medical
scientists, including Dr. Marianne Legato, founder of the Partnership
for Gender-Specific Medicine at Columbia University. Five states -
Maryland, Georgia, New Hampshire, Louisiana and Oklahoma - have
either established or plan to establish offices or commissions on men's
health, and the Nov. 15 issue of JAMA, The Journal of the American
Medical Association, is entirely devoted to studies on the topic.

But the mere suggestion that men need their own health bureau or that
they must advocate for their rights like a victimized minority rankles
some women's health advocates, and some politicians are reluctant to
take men's health on as a cause, for fear of alienating women.

"Saying we need an office of men's health ignores the fact that men's
health always was the main focus of medical research," said Cynthia
Pearson, executive director of the National Women's Health Network in
Washington, D.C., a membership organization for improving women's
health.

"During the first half-century of our nation's investment in medical
research, the majority of resources went to studying men and the
conditions that affected men disproportionately," she said. "Is
their health perfect? No. But they don't need a movement."

By just about any measure, men's health is abysmal. American men have
an average life expectancy of 75.2 years, and even less - 69.8 years
- for black men, compared with 80.4 years for women overall.

Men die of just about every one of the leading causes of death at
younger ages than women, from lung cancer to influenza and pneumonia,
chronic liver disease, diabetes and AIDS. One notable exception is
Alzheimer's disease: More women than men die of it.

Topping the list for both sexes is heart disease.

But while the American Heart Association has been conducting an
aggressive public education campaign to raise awareness about heart
disease among women, called Go Red for Women and featuring pins in the
shape of dresses, progress among men has been slipping, said Dr. Steven
Nissen, chairman of the department of cardiovascular medicine at the
Cleveland Clinic and president of the American College of Cardiology.
Yet, he added, the illness exacts a disproportionate toll on men.

Although heart disease occurs in women in their 30s and 40s, he said,
it is "extremely unusual," while severe heart disease in men that
age is "not exceptionally rare." Heart disease in women increases
as they age, he said.

"We've got to put it all in perspective," Nissen said. "Coronary
heart disease has a devastating impact on men, particularly on men who
are in the prime of life - 45-year-old men with major heart attacks,
who may never work another day in their life, who may have children."

Cancer also strikes men disproportionately: one in three women at some
point in life; one in two men. In part, that is because more men than
women smoke, and possibly because of occupational exposures.

But experts and advocates say that when it comes to government
financing for the most common sex-specific reproductive cancers, breast
cancer financing exceeds prostate cancer financing by more than 40
percent, with breast cancer research receiving $710 million in 2005 and
prostate cancer research getting $394 million. The figures, for
financing by the National Cancer Institute and Defense Department, were
provided by the nonprofit Prostate Cancer Foundation.

More women die of breast cancer than men do of prostate cancer: 40,970
women will die of breast cancer this year, compared with 27,350 deaths
of men from prostate cancer, according to the American Cancer Society.

Breast cancer also strikes young people more often. But men's chances
of receiving a prostate cancer diagnosis are high, with about 234,460
new cases expected to be diagnosed this year, compared with 212,920 new
cases of breast cancer.

Nevertheless, said Dr. Peter Scardino, a prostate cancer surgeon and
chairman of the department of surgery at Memorial Sloan-Kettering
Cancer Center in New York, "there are still more people doing
research on breast cancer than on prostate cancer, there's more
industry support for research on breast cancer drugs, there's been more
attention to the quality-of-life effects of breast cancer and we have
more-effective chemotherapy agents for breast cancer because more
trials have been done."

Men's vulnerability appears to start quite early. More male fetuses are
conceived, but they are at greater risk of stillbirth and miscarriage,
scientists find. Even as infants, mortality is higher among newborn
boys and premature baby boys.

As children, boys are at higher risk for developmental disabilities and
autism. Boys and men are more likely to be colorblind, suffer higher
rates of hearing loss and are believed to have weaker immune systems
than women. They may also recover more slowly from illnesses.

"It's not that we 'could be' the weaker sex - we are the weaker
sex," said Dr. Robert Tan, a geriatrics specialist in Houston who is
on the advisory board of the Men's Health Network.