Saturday, March 28, 2009

Prostate Cancer Screening. Is it Worthwhile?

March 28, 2009


Dr. Steven Horvitz- Reading between the Lines:
Bringing you healthcare information you can trust!
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There has been a recent hubbub about prostate cancer screening. For many years, men over the age of 40 have been advised to have an annual PSA (prostate specific antigen) blood test along with a digital rectal exam.

In theory, PSA screening would detect prostate cancer at an early and more treatable stage. If the PSA level was above normal, or increasing quicker than expected, further evaluation for prostate cancer was begun. Ask any man who has undergone further evaluation. It is neither fun, nor pleasant.
Yet screening for prostate cancer via the PSA test seems worthwhile, if the alternative is a higher risk of prostate cancer. But two recent studies raise questions concerning the PSA tests effectiveness.

The first involved over 76,000 men. These men were divided into two groups. The first group had annual PSA and digital rectal exams for six years, while the second group had usual care. Although more prostate cancer was diagnosed in the first group, they did not have more prostate cancer related deaths after both seven and ten years.

The second study, involved 182,000 men followed over nine years. The first group had PSA screening every four years, while the second group did not. There were 20% more prostate cancers diagnosed, and slightly fewer prostate cancer deaths in the first group. But as we look closer at the studies statistics, for every 1,410 men screened with the PSA test, only 48 would be treated, or just over 3%. Of the 48 men treated only one cancer death would be prevented, or just over 2%. Of the 1,410 men screened, prostate cancer death would be decreased by less than 1/10 of one percent. There was no difference in overall death rates between the two groups.

So let us analyze this conundrum by going from point A to point B.

Point A is PSA testing. We want to get to Point B, which is prevention of prostate cancer deaths, while causing little or no harm. Yet, neither of these studies showed a significant decrease in prostate cancer or other causes of death.

A (PSA testing) -----XXX------>>>> B ( Decreased Prostate Cancer Deaths)

Most men identified as having abnormal tests will probably never develop a prostate cancer that will kill them. Some will say that the risk is worth it, and that is a valid opinion. But tell that to the men who had an abnormal PSA test, underwent further testing, biopsy and/or treatment, ended up impotent or incontinent, and were found not to have prostate cancer. Sometimes the investigation and treatment of a disease is worse than the disease itself.



Now, by sending out this newsletter, I am not advocating for the end of the use of PSA testing. PSA testing is especially useful in men with a family history of prostate cancer. It may also be useful for men between the ages of 40-60, as prostate cancer at a younger age tends to be more aggressive. But we need to further understand who and how often we need to screen. Should we screen yearly, every 2-3 years or every 5 years? Should we screen men over 70 or 80 years of age, when their risk of dying from other causes is higher than their risk from prostate cancer? The decision to screen should be left to each individual. Diagnosis of any disease at an early stage is a worthwhile goal and is something I strive for in my medical practice. But it must be accomplished without causing harm. The two studies mentioned above indicate that a harmful outcome is just as likely as a good outcome in PSA screening for prostate cancer. So what do we do to improve our odds of not having a bad outcome from prostate cancer without causing harmful side effects? How about teaching lifestyle modifications that can decrease your overall risk. Let me point to another recent study. In this study, intake of 500mg of omega-3 fatty acids daily, like those found in dark fish like salmon, reduced the death rate from advanced prostate cancer by up to 63%. Eating salmon sounds a bit more pleasant than a prostate biopsy ; ) I, for one, will eat more salmon and continue with my omega-3 fatty acid supplementation.

On another note, our politicians are debating about an overhaul of our healthcare system. My fear is that they will try to change the system to a cookbook style that is more concerned with costs than on good health outcomes. If that turns out to be the case, a less expensive alternative for prostate cancer screenings may soon look like the picture below.

I can hear it now.

Attention Wal*Mart shoppers.

Please head over to aisle four for your free prostate check ; )


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Please note that next week, Julie Fischer will begin performing massage therapy in my office on Tuesdays and Thursdays. She performs Thai, swedish and deep tissue massage, as well as hot stone massage. For the month of April, Julie's massage services will be offered at a 10% discount. Wellness Plan members get even better pricing. Please click on the above link for more information.

If you have any suggestions about topics for future newsletters, or how to make the newsletter better, please send me an email at DrHorvitz@DrHorvitz.com.

To Good Health!!

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone: 856-231-0590
Fax: 856-294-0311

For more information about Dr. Horvitz and The Institute for Medical Wellness, please visit our website at http://www.drhorvitz.com/

To view upcoming Wellness Network Events, please click here.

Wednesday, March 25, 2009

Anniversary Newsletter

March 25, 2009

Dr. Steven Horvitz- Reading between the Lines:
Bringing you healthcare information you can trust!

It has been just over a year since my initial email newsletter, all of which are archived at my blog site located at http://drhorvitz.blogspot.com/ . What started out as a whim, has become enjoyable and fun. Being a science major in college, I never enjoyed writing. But I guess when you find the right topics, it can end up being fun. Thank you to everyone who has encouraged me to continue.

My newsletters are an easy 21st century segway to promoting a healthy lifestyle and serves as an extension of my practice, and of my philosophy of family medical care. A physicians duty is not just about treating the ill, but more importantly preventing illness from occurring. This takes planning and lots and lots of time. The majority of physicians in today's insurance and government dominated healthcare system do not have the luxury of time for prevention and wellness counseling. They are too busy "running the health insurance mill". I have overheard patient's say they were treated less like a number at the deli counter, than at their doctor's office. This is not a criticism of other doctors, but more of a criticism of the system in which they work. This dysfunctional system was the strongest motivating factor towards the evolution of the Institute for Medical Wellness.

On average, individuals visit their doctor's office about 3-4 times a year. During these visits, they are lucky to have 10-15 minutes in the exam room before the doctor is running to the next patient. Do you think this is adequate for healthy lifestyle promotion? I do not! Fifteen minutes is barely enough time to "put out the fires", let alone teach and encourage healthy behaviors. These time stressors made my transition away from health insurance contracts towards an individual patient-centered practice much easier. This style of practice puts the emphasis back on the doctor-patient relationship, and makes certain that this relationship is paramount. It limits the ability of any third party involvement in the decision making pertaining to your care. The strong doctor-patient relationship was the hallmark of medical care that past generations enjoyed, and is the practice style that I prefer.

To help promote wellness, I have continued to network with other like minded professionals. My website has a Wellness Network page that can serve as an introduction to their specialties, which includes a Naturopathic physician, personal trainer, yoga instructor, and Physical therapist. I am pleased to announce starting in April, Julie Fischer will begin performing massage therapy in my office on Tuesdays and Thursdays. As the need expands, so will Julie's availability. For the month of April, Julie's massage services will be offered at a 10% discount. Wellness Plan members get even better pricing.

I hope you will look to the wellness network within the Institute for Medical Wellness for more of your healthcare needs. If there are other areas of wellness that you feel would be a good addition, please let me know. As for the newsletters, I plan on continuing to write them as long as useful information pops up in the news. So it looks like you are stuck with them for quite a while! At the bottom of each newsletter is a "manage your subscription" link where you can opt out of receiving the newsletter if you choose. But then you would be missing out on a whole lot of my unbiased medical opinions ; )

If you have any suggestions about topics for future newsletters, or how to make the newsletter better, please send me an email at DrHorvitz@DrHorvitz.com.

To Good Health!!

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone: 856-231-0590
Fax: 856-294-0311

To view previous newsletters, please click here.

For more information about Dr. Horvitz and The Institute for Medical Wellness, please click here.

To view upcoming Wellness Network Events, please click here.

Monday, March 16, 2009

Are you ready for Spring ???

Dr. Steven Horvitz- Reading between the Lines:
Bringing you healthcare information you can trust!


It's almost spring. And after sitting around more during the cold weather season, we need to make sure we start our springtime exercise wisely. The most common visits to my office in the spring are for overuse athletic injuries. In other words, people overdoing exercise.

To help prevent this common malady. Andy Dick of Optimum Fitness has prepared the following.
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As warmer weather approaches, all of us in the Northeast get excited for a return to outdoor activities. Whether this means taking the dog for a walk, or training for a triathlon, it is important to approach this extra exercise sensibly.

First off, if you plan on trying something new, make sure it is something that you will enjoy and that it will help you accomplish your personal goals. You should also be careful not to pick a new activity that could aggravate an old injury. Someone with bad knees should not set out to run a marathon!

If you plan on picking up an old exercise that you know you enjoy, be sure to ease into the activity slowly. Your body is very good at learning your routine. This is why you tend to be very sore after your first workout in a long time, but someone who works out daily is rarely sore. However, your body learns specifics; therefore if you have been keeping active on an elliptical all winter, you need to let your body get used to running outdoors slowly. Otherwise, it could be uncomfortable for the days following your first few runs! Not only do we want to avoid being uncomfortable due to the soreness, but we don’t want to have to skip future workouts because you can’t get up off the couch! Although it doesn’t feel like it now, there will be plenty of nice days to get outside and enjoy the weather, so take it slow to start!

Although I will always preach the importance of a good warm-up, cool-down, and post-exercise stretch, it is especially important on the days you are starting something new.

· Always start off exercise with a 5 minute warm-up. This means that you start off slowly and slowly ramp up to your exercise pace over the warm-up time. This is important to get the heart pumping the right amount of blood to the right muscles. Otherwise, you may feel weak to start and you could be unfairly stressing your heart.
· Always end exercise with a 5 minute cool-down period. Slowly ramp your pace from what you have been exercising at to a moderate walking pace. This will allow your heart to slow down at a natural pace (which avoids blood pooling in your lower extremities due to the heart pumping too fast for your pace) as well as allow your body to rid the bloodstream and muscles of some of the waste products that build up during exercise. These waste products are a main cause of muscle soreness.
· Always stretch at the end of exercise! It is important to note not to stretch at the beginning unless you are loosening up an injured area. Muscles should not be too lax (or loose) before exercising. This can weaken them significantly, sometimes leading to injuries of the tendons, ligaments, or muscles surrounding the area.

Choose something that you enjoy! I cannot stress this enough. If you do not enjoy something, you will not stick with it and you will end up mad at yourself for quitting. Also, if you really can’t enjoy an activity for whatever reason, you will find yourself taking shortcuts to finish. Shortcuts are the easiest way to accidental injury.

Finally, don’t push too hard. Remember, most of us are not training for the Olympics. If you get out there with someone who is faster than you that is OK. Keep your eyes on your specific goals and don’t worry about trying to “win.”''

Andy DickOwner, Optimum Results(609) 304-7598
http://www.optimumresults.net/
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Good points Andy.

Thanks again!!

So I hope everyone starts thinking of how to get more exercise as the weather warms up. But if anyone is unsure of their ability to exercise, or has a sudden decrease in exercise stamina, trouble with chest discomfort, or shortness of breath, please stop exercising and give my office a call for evaluation.


Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057

Phone: 856-231-0590
Fax: 856-294-0311

For more information about Dr. Horvitz and The Institute for Medical Wellness, please click here.

To view upcoming Wellness Network Events, please click here.

http://www.drhorvitz.com/

Thursday, March 05, 2009

Medical Studies- We can't live with them, and We can't live without them?

March 6, 2009


Dr. Steven Horvitz- Reading between the Lines:
Bringing you healthcare information you can trust!

Medical Studies- We can't live with them, and We can't live without them?

I graduated from medical school in 1991 and completed my family practice training in 1994. At that time, I was just embarking on my medical career. I was still idealistic. I believed what I was taught in school to be 100% the truth. Part of our training involves keeping up with all the newest and latest treatments of disease. We were taught to believe in peer reviewed placebo controlled medical studies. These studies shaped the way I practiced my new profession.

Fast forward to March 2009. I am 15 years older, and no longer in the early part of my career. I have come to realize that my hairline will continue to recede, and I have also become more realistic about the diagnosis and treatment of disease. With these realizations, I have become more realistic about what it means to be a family physician. Being a family physician means treating each patient as an individual, and to treat these individuals as you would treat your own family member. Please note I am assuming that we all love our family members. If you do not, please insert your favorite pet or your best friend wherever you see the words "family member".

So what does this have to do with medical studies?

As mentioned earlier, by practicing for 15+ years, I realize that medical care is far from idealistic. There is a tremendous amount of bias, especially as it involves medical studies and guidelines. My problem is with how medical studies are performed, who funds the studies, how they find their conclusions, how they promote their results and how they are used for propaganda and profit. One of the biggest offenders are the pharmaceutical companies. They have a tremendous knack for transforming mediocre medical studies into billion dollar drug sales. The two biggest culprits are the statin cholesterol medications and the bisphosphonate osteoporosis medications. Both of these medication classes have been marketed as the best thing since sliced bread. As a low carb proponent, you know how I feel about sliced bread. But if you truly look at the study statistics, you will find the conclusions and recommendations to be heavily biased.

Example: a statin cholesterol medication is advertised to lower your cholesterol by 30-50%. And then they tell us that further studies show a 20% relative decrease in heart disease. Wow!!! I should run and start taking that pill. But if you look closely at the numbers you find out that the 20% relative decrease is a marketing ploy. So I look at it differently. The number that I like to look at is what is called the NNT, or the number needed to treat. It goes like this. If 11 people have strep throat, and I give an antibiotic to all 11, 10 people will be cured and 1 will not. The NNT is 10/11, or a 91% success rate. Pretty good!!! Now, let us look at statins. A Business Week article examined the NNT for a poplular statin drug Lipitor. The NNT of Lipitor to prevent a cardiac event was 1/100 or a 1% success rate. You need to treat 100 people with Lipitor to prevent 1 cardiac event. Wonderful for the one individual, but what about the other 99.

So as I grew older and balder, there is hope. Not for my hairline but the tremendous amount of bias in medical studies that is finally getting some press. A recent article in JAMA, the Journal of the American Medical Association, (2.25.09. vol 301. No.8), wrote about guidelines that cardiologists propose as evidence based, is actually based on weak evidence. I even read in other blogs how these guidelines have been used to increase the need for cardiologists. How is that for self-referral??

So in my practice, I trust less of what the so-called experts propose, and more on common sense, and personal professional experience. I still use guidelines, but not as the holy grail of medical care and treatment. As many of the standards of care that I used 10 years ago, are now obsolete, or even dangerous, I am not close-minded to believe that the treatments proposed today by the "experts" will still be around ten years from now. Instead, I look for the causes and triggers of disease. I look for treatments that work with the bodies normal activities and not against it. I treat each patient as an individual, and I do not use population based medical studies as the determining factor in treatment. I consider these studies as options, but I always try to understand how this treatment will affect the individual sitting across from me. I look for bias in all studies, and all marketing that comes before me. The only way to be true as a doctor is to be true to your patients. And that means not drinking the medical study kool-aid that others in my profession drink. Besides, I prefer water. It tastes better, has no artificial ingredients, and has been around forever.

I will end with one of my favorite quotes:

"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
http://www.drhorvitz.com/
http://drhorvitz.blogspot.com/
856-231-0590