Gleanings from the WCMH 2009
Article Outline
- WCMH 09: elements of success
- A policy program for the months ahead
- Key insights from the WCMH 09
- Prostate health, point of focus for men's health
- Dads are an undervalued resource
- Testosterone, the mystery “masculine” hormone!
- Sexual health
- Poor men die earlier (than poor women)
- More to come…
- Copyright
Siegfried Meryn
Editor-in-Chief of jmh and President of ISMH
Ridwan Shabsigh
Section Editor of jmh and President of WCMH
On behalf of the ISMH, we would like to thank all who attended the WCMH09. We have come a long way: the largest attendance in our history, the greatest number of nations represented, the widest breadth yet in our scientific program.
The 6th World Congress on Men's Health (WCMH) took place from October 9th to 11th, 2009 in Vienna, Austria. The theme, “Why men die earlier and suffer more,” established an outstanding platform for the exchange of information during the Congress and for the development of the field in the months to come. The Congress sessions provided deep insight into the best current research, updated us on men's health policy initiatives and agendas around the world, and charted an exciting course for the rapidly evolving field we call Men's Health.
WCMH 09: elements of success
Statistics from this year's congress indicate it was indeed an overwhelming success:
Much of the success of the WCMH 09 is evident in its rich, multidisciplinary program. Key thought leaders in the therapeutic and research areas, the social sciences, and the policy domain ensured cutting-edge analysis across a very wide range of topics. The overcrowded auditorium at the special workshop on “How to establish a men's health centre” reflects a rising global interest in men's health.
The packed Saturday evening gala at Vienna City Hall celebrated the advances in the field and acknowledged several of its stewards.
The ISMH has clearly emerged as the premier society in the world for the advancement of men's health among professionals in the research, practitioner, and policy communities as well as for the public at large. This is both a privilege and an enormous responsibility. You, dear reader, are an important part of the ISMH's strategic vision, critical to our fulfilling this obligation.
A policy program for the months ahead
The vulnerability of men is a reality underestimated not only in health care in general, but also in policy and advocacy domains, as outlined by several speakers during the WCMH 09. Therefore, one of the aims of the World Congress on Men's Health is to raise the awareness of male issues among physicians and policymakers. We have much to do! The first-ever Men's Health Report was published in 1999 in Vienna. Nearly a decade later, an important report by the World Health Organisation discusses gender inequities and refers only to Women's Health!
In a few countries, non-governmental organizations are pressing their political leaders to tackle the issue of men's well-being. Unfortunately, the majority of the world's nations have not yet begun to consider strategies to improve the health of men. Arguably, prevailing notions about men as strong and privileged have hampered the development of policies and strategies to promote their health. We must earnestly acknowledge male vulnerability. Then, health policy and practice can confront the reality of men's health experiences – the excess mortality and excess morbidity that occurs with consistency around the world. Recognizing the truth of male vulnerability also then permits us to take account of the health disparities among men of various social classes, ethnicities, ages, sexual orientations, and disability statuses. Our goals must be to integrate men's health into national and global health care policy and research agendas and to promote a more holistic approach to male health care.
Key insights from the WCMH 09
As we know, being male is the single largest demographic risk factor for early mortality in developed countries. However, public policies still mostly fail to appropriately address gender disparity. This is all the more devastating since men's health greatly affects the well-being of their families. Statistics show considerable differences in the life expectancies of European men, which range from almost 80 years in Iceland, to 59 years in Russia. In many areas of medicine, for instance cancer and cardiovascular disease, improvements have occurred, but the mortality rates from all causes are 40% higher in men compared to women. “There is an excess burden of cancer in men,” reported Prof. Alan White, from the Centre for Men's Health, Leeds Metropolitan University, UK. “Despite the absence of a biological sex-specific reason, both incidence and mortality rates are higher than in females.”
At the same time, men are almost twice as likely as women to lack a usual source of health care. “Men make fewer visits to doctor's offices, outpatient departments and emergency rooms,” said Prof. David Dodson, from Tufts University School of Medicine, Boston, USA. As Prof. Dodson pointed out, Women's Health policy and advocacy programs are very effective in terms of increasing awareness, building new collaborations between medicine, public health, and policymakers, and advocating policy changes at different levels. “There are seven federal offices for Women's Health in the U.S., but none for men.” Those initiatives could serve as an example for the provision of similar benefits.
Prostate health, point of focus for men's health
At the 2009 WCMH significant attention was paid to male gender-specific diseases and health problems. Several presentations were made on both benign and malignant prostate disease, addressing relevant issues from diverse viewpoints.
A thought-provoking session was conducted under the auspices of the European Association of Urology (EAU) that critically analyzed the state of the art data on the relationship between lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). At the oral abstracts session, the important CombaT study was presented by C. Roehrborn, who summarized the 4 year results of the effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic BPH. In a symposium dedicated to prostate health, new treatment strategies were discussed in detail, including new data on combination therapy.
Presentations on prostate cancer covered a broad range of topics from screening, to prevention and all the way to treatment of localized and advanced prostate cancer. Again under the auspices of the EAU, an update on prostate cancer addressed the controversy of screening and the value of prevention. At the oral abstracts session, M. Marberger presented a sub-analysis from the rEDUCE study showing that Dutasteride reduced the risk of biopsy-detectable prostate cancer and BPH complications among men at increased prostate cancer risk with concomitant BPH. There was a presentation on new findings from the HAROW study by the Stiftung Maennergesundheit on the treatment of localized prostate cancer. A. Yassin presented new data on the treatment of advanced prostate cancer with a GnRH antagonist. Quality of life issues of prostate cancer and its treatments were addressed in a symposium focusing on the treatments of urinary incontinence and erectile dysfunction after radical prostatectomy. Europa Uomo presented the patient view on prostate cancer and the role of support groups.
It is worth emphasizing that men's health affects the well-being of their families to a great degree. The increased mortality among aging men means that older women are more likely to live alone and in poverty, and to rely on public assistance. “The surviving spouse is at increased risk of dying over the course of the first year,” explained Prof. Jean Bonhomme, from the Men's Health Network, Morehouse University, Atlanta, USA. Indeed, a study showed a twofold increase in mortality from all causes in the first month after widowhood.
Prof. Bonhomme outlined recent discoveries relating to the direct impact of a father's health on his offspring. Advanced paternal age is associated with an increased risk of nasal aplasia, cleft palate, urethral stenosis, and other malformations. Older fathers are more likely to have children with autism, schizophrenia, and Down's syndrome. “Men, like women, have ticking biological clocks,” Prof. Bonhomme emphasized. However, being too young can be just as detrimental. The offspring of teenage fathers face an increased risk of premature birth, low birth weight, and death at birth or death shortly afterwards. “Men below 20 and over 30 years produce more abnormal sperm than men in their 20s,” Prof. Bonhomme explained. Babies of men exposed to solvents and other chemicals in their workplace are more likely to be miscarried, or to be stillborn or to develop cancer later in life. “Alcohol use in the father is positively related to the offspring's risk of ventricular septal defects.”
These phenomena can be explained by epigenetic changes, which occur in the way genes are packaged and regulated, keeping a record of events in the parents’ lives and handing down the effects to the next generation and beyond. “It is likely that the male parent shares experiences with descendants for generations to come, through epigenetic modifications of his DNA.”
Dads are an undervalued resource
Compared to mothers, fathers’ mental health problems tend to be more strongly associated with behavioral problems in children than with emotional problems. Most psychiatric disorders that affect fathers correlate with an increased risk of behavioral and emotional difficulties in their children, which is similar in magnitude to the risk due to maternal psychiatric disorders. Postnatal depression in fathers shows a significant association with psychiatric disorders in their children 7 years later. “Paternal mental health should be considered by medical and mental health professionals and policymakers as a factor in child development,” Prof. Bonhomme demanded. A loving father potentially contributes to a child's good physical health. The role of the father's love in child development deserves more attention. “Dads are quite possibly the world's most undervalued and underutilized natural resource.”
In spite of all this, there is a definite lack of information relating to the physical and psychosocial aspects that emerge when a man is struck down with a disease. Much of the scarce literature on families with members who have cancer deals with the mother or the child as the patient.
Testosterone, the mystery “masculine” hormone!
The role of testosterone in men's health was addressed in several sessions at the 2009 WCMH by a number of key opinion leaders and researchers from different parts of the world. G. Cunningham presented a unique preview of the soon-to-start NIH clinical trials on testosterone in the USA.
The 2009 WCMH Best Abstract Award went to R. Rosen and the New England Research Institute and was received by M. Miner. This abstract presented, for the first time, data on a new screener for hypogonadism in patients and controls. This ground-breaking research will help advance our clinical practice and effectiveness in dealing with the important condition of hypogonadism. In a session under the auspices of the ESAU, the link between hypogonadism and the metabolic syndrome was emphasized, along with its Men's Health consequences. This link was addressed at length by many researchers in several sessions. In addition, the relationship between testosterone replacement therapy and prostate cancer was discussed by A. Morgenthaler who highlighted the lack of evidence that testosterone might generate or progress localized prostate cancer. This issue was further addressed in the American Urological Association's (AUA) master lecture by R. Shabsigh detailing the relationship between hypogonadism and prostate health issues.
A. Heufelder presented results from his study showing that testosterone treatment enhances the beneficial effects of lifestyle changes on inflammation and pro-coagulatory markers in hypogonadal men. In addition, other researchers presented long term data on the efficacy and safety of various products for testosterone replacement therapy.
Sexual health
Under the auspices of the International Society of Sexual Medicine (ISSM), the diagnosis and treatment options for premature ejaculation were presented. New data on emerging treatment options depicted significant advances in this field. M. Perelman proposed that premature ejaculation (PE) might be the portal to young men's health. He pointed to the fact that young men usually do not seek prevention or health maintenance. The diagnosis and treatment of the most prevalent male sexual dysfunction, PE, may bring more younger men into the doctor's office and thus open the door to address their other health issues.
The link between erectile dysfunction (ED) and cardiovascular disease was highlighted and addressed in several sessions. G. Jackson presented new management guidelines for the healthy patient with ED and the ED patient with cardiovascular disease. In addition, several presentations showed data on new medical and surgical treatments for ED.
Poor men die earlier (than poor women)
Wealth is critical to health status around the world. A U.S. study has shown that the most deprived quintiles of men have the shortest life expectancies compared to the least deprived quintiles. “Also, UK adults in the poorest quintile are at much higher risk of developing a mental illness than those on average incomes,” said Dr. April M. W. Young, from the Collins Centre for Public Policy, Miami, USA. Remarkably, differences by income are greater for men than for women. Research suggests that stress impacts men differently: “In men it is more likely than in women to manifest as debilitating physical and psychological conditions.” Yet, appropriate concern is nearly non-existent in the international health policy community. On a national and international level, indicators of community well-being are primarily markers of maternal and child health: prenatal care, infant mortality rates, early childhood vaccination rates, adolescent and out-of-wedlock births, as well as breast cancer mortality and screening. Young reported facing resistance when she pointed out the importance of Men's Health at meetings in the U.S. capital: “I was told that women and children are the priority because of their status as vulnerable groups.” However, male vulnerability is very real, and these issues cannot be viewed separately. Men's well-being is intertwined with the wellbeing of women and children. “This is not a contest, but more properly a concert.”
More to come…
Inspired by your deep commitment and all your hard work, we have an ambitious vision for the future. We will have exciting new ways to realize the dream of better health for men, and exciting new ways for us all to work together to accomplish this. So, stay tuned. We look forward to the coming year and at the end of it, we will gather in the city of Nice for the 2010 WCMH. We will stay in close touch in the interim, though, and we will be inviting your ideas, building from your creativity, and encouraging you in your areas of work.
Congratulations to us all. Let us go out and continue the fight to make this a world in which men don’t suffer and don’t die prematurely!
We look forward to welcoming you at the 2010 WCMH in Nice!
PII: S1875-6867(09)00360-1
doi:10.1016/j.jomh.2009.10.002
© 2009 Published by Elsevier Inc.
