The Harvard Medical School Guide to Men's Health: Lessons from the Harvard Men's Health Studies [Hardcover]

While it may not be as hot as the latest issue of Maxim, this new health guide should be required reading for any man between the ages of 18 and 80. The book's success is rooted in the no-nonsense approach of author Simon, the founding editor of the wildly successful Harvard Men's Health Watch newsletter, who has long been urging men to get in shape and stay that way. Simon uses the results of three Harvard studies of more than 95,000 men over the last 25 years to provide five main "answers" (diet, exercise, aspirin and other supplements, moderate alcohol, and behavior modification and stress control) to five main "maladies of men" (disorders of the genital area, sexuality and reproduction, benign prostate disorders, prostate cancer, and kidney and bladder disorders). Along the way, he discusses other topics such as reproductive anatomy, vitamins, depression, Viagra and herbal medications. Though it's packed with provocative data (e.g., "every one of the ten leading causes of death in America is substantially more common in men than women"; "even committed teetotalers who review the data will have to agree that light to moderate drinking appears to reduce a man's risk of angina, heart attack, sudden cardiac death, and ischemic stroke"), the book stays focused on Simon's main message: "Above all, men should concentrate on the basics, on the core issues that remain constant in a sea of change." (Sept.) Forecast: Neither overly serious nor laced with chirpy beer-and-babes humor, this tome should remain a steady seller after trendier books are gone.
Copyright 2002 Reed Business Information, Inc.

While this excellent men's health guide stands on its own, its research is based on the Harvard Men's Health Watch newsletter and shares common goals with the Harvard Family Health Guide. Simon (medicine, Harvard Medical Sch.; Staying Well), the newsletter's founding editor, aims to empower men to improve their health and to motivate them to change lifestyles for the better. Basing his advice on three long-term Harvard studies that have tracked more than 96,000 men for many years, Simon reviews programs of diet, exercise, supplements, stress control, and medical care, and addresses frequently asked questions (e.g., should I take a daily aspirin?, is wine really good for me?, and should I have a PSA blood test?). Much like a very caring family doctor, Simon presents both sides of issues and lets the reader know what the evidence recommends as best practice. This comprehensive, informative, engagingly written guide is a standout among a slew of similar titles. Highly recommended for most consumer health collections. James Swanton, Harlem Hosp. Lib., New York
Copyright 2002 Reed Business Information, Inc.

Simon's comprehensive, informative book is based on three major studies of U.S. men's health carried out during several decades. The subjects studied were mostly white, well-educated, and well-to-do, so the results aren't broadly applicable, yet they provide a solid base from which the book's users may benefit. Major areas covered include the prostate, vitamins and supplements, depression, and the very fine line between healthful and hazardous drinking. The contents are disposed in three parts on basic information, what keeps men healthy, and what can go wrong. Occasional illustrations and tables clarify and emphasize important points. Simon is optimistic throughout, sometimes almost overly optimistic--for example, in his discussion of potential diagnoses and treatments of Alzheimer's disease. Also, he seems to suggest that longevity is more important than quality of life, an attitude with which many readers may differ. Still, he offers much that will help many men and the members of their families who may need to do a little arm-twisting to make them seek help. William Beatty
Copyright © American Library Association. All rights reserved

"The Harvard Medical School Guide to Men's Health" is the ultimate state of the art in men's health, assembled into a single volume containing a quarter-century's worth of hard-won knowledge -- knowledge that men need to lead longer, healthier lives. And it's assembled here because more than twenty-five years ago, researchers at Harvard Medical School and the Harvard School of Public Health began what have become the largest aggregate studies ever of men's health: the Harvard Alumni Study, the Physicians' Health Study, and the Health Professionals Follow-Up Study. Tracking the behavior and health of more than 96,000 American men over decades, the studies have regularly generated front-page health news, such as demonstrating the health benefits of low-dose aspirin, documenting the reduction in heart disease enjoyed by men who consume large amounts of dietary fiber, scientifically proving the life-prolonging effects of regular exercise, showing which supplements help and which do more harm than good, and much, much more. These studies represent the ultimate resource on what keeps men healthy -- and what doesn't. And it's a resource that's never been needed more than today: ? An American man will be diagnosed with prostate cancer every three minutes this year. ? Two hundred thirty-five thousand men will die from heart disease during the year. ?One-quarter of all sixty-five-year-olds have erectile dysfunction. ? More than half of all American men are overweight or obese. ? Every one of the ten leading causes of death in America is substantially more common in men than women. American women live nearly six years longer than American men. What are men doing about it? ? One-quarter ofAmerican men say they handle worries about health by waiting as long as possible before seeking help. One-third do not have a regular doctor. ? One-half of all American men have not had a physical exam or cholesterol test in the past year. Sixty percent of men older than fifty have not been tested for colon cancer in the past year, and 41 percent have not been tested for prostate cancer.

That's the problem. The solution is "The Harvard Medical School Guide to Men's ""Health." It features the best and most current information on the health-preserving functions of diet, exercise, and over-the-counter drugs and supplements -- the ones that really work, the ones that don't, and the ones that are dangerous. It gives straight answers on when drinking alcohol is beneficial and when it's not. It incorporates programs and advice on behavior modification and stress control. The Harvard Medical School Guide to Men's Health is the most comprehensive, easy-to-use reference to the diseases that are particularly important to men, including prostate cancer and testicular cancer, erectile dysfunction, kidney and bladder problems, and more. And it even features an easy-to-navigate guide to the health-care system that can help men work with their doctors to achieve better health. With the authority that only the world's largest and best-known medical school can provide, and the lively, clear presentation that is the hallmark of Harvard Men's Health Watch, the monthly newsletter edited by Dr. Simon, "The Harvard Medical School Guide to Men's ""Health" is an essential reference for every man -- and for everyone who cares about a man's health.

Advance Praise for THE HARVARD MEDICAL SCHOOL GUIDE TO MENT'S HEALTH:

"Cardiovascular disease is the #1 killer in our society, causing death in one of every two men in the United States. Just as importantly, through the development of problems like heart failure and stroke, it is also the #1 cause of disability as men age. Based on the newest and most up-to-date information, Dr. Simon explains these issues clearly and accurately. As a cardiologist, I’m particularly impressed by Dr. Simon’s lucid program to prevent heart attacks and strokes. This guide can help keep men 'heart healthy.' I highly recommend it-if American men would adopt the straightforward suggestions made by Dr. Simon, we would truly be able to make progress in preventing the heart disease epidemic."
--Valentin Fuster, M.D., Ph.D., Past President, American Heart Association

"I have always called men ‘ostriches’ when it comes to their health care because they have their heads in the sand. Men need to take their heads out of the sand, put on their glasses and read this informative book by Dr. Simon. The book not only gives an easily understandable description of the major diseases that men experience but it also discusses treatment and, more importantly, prevention. The book is easy to read, informative and comprehensive."
--E. Darracott Vaughan, Jr., M.D., President, American Urological Association

"Dr. Simon’s men's health guide reads like a novel. It is logical, it is scientific and it poses all of the questions men should ask or are asking. He combines science with humor and wit. It truly is about time for men. If we really are going to see increasing survival and life expectancy in men, following the recommendations in THE HARVARD MEDICAL SCHOOL GUIDE TO MEN'S HEALTH is the means to do it. The chapters dealing with reducing career risk and understanding prostate cancer couldn’t be clearer. Every man needs to read this book."
--David S. Rosenthal, M.D., Past President, American Cancer Society

Chapter Six: The Answers: Aspirin and Other Supplements

"If only there were a pill."

Every man would like an easy way to stay healthy. Good nutrition and regular exercise are the keys for preventing illness, but diets take discipline and exercise takes time. Is there a shortcut? Can a few pills do the trick? Can "all-natural" supplements replace the physical activity and healthful eating that should be part of human nature?

If you look for the answer on the Internet or listen for it on TV or radio, you are likely to come away with a resounding "yes." That's mostly because vitamins, herbs, and other supplements are not subject to the jurisdiction of the Food and Drug Administration. Congress took care of that in 1994, when it passed the Dietary Supplement Health and Education Act. As a result, the supplement industry can tout its products without having to substantiate their claims for efficacy and safety. With billions of dollars at stake, the hype is relentless. In all, more than 50 percent of all Americans take supplements, spending upwards of $4 billion a year to buy health in a bottle.

Most doctors have been skeptical of supplements, pointing out correctly that anecdotes and testimonials can never be relied on in place of sound scientific studies. In the past few years, though, good studies have started to appear. While few herbs have been scrutinized, research by the Physicians' Health Study, the Health Professionals Study, and other investigations suggests that some supplements may be helpful while others are wasteful or even harmful. Surprisingly, perhaps, one of the most promising of all is not a vitamin or an herb, but an inexpensive, old-fashioned, medicine chest standby: aspirin.

Aspirin

Its name is more than a century old, but its parent compound has been in use for thousands of years. The ancient Assyrians, Egyptians, and Greeks all used willow leaves to treat inflammation, fever, and pain. The practice was popularized in England by Reverend Edward Stone in 1763. The active ingredient was purified from willow bark in Germany sixty-five years later. At the tail end of the nineteenth century, scientists at the Bayer Company succeeded in producing the modern derivative, acetylsalicylic acid, or aspirin. The very same drug has been used for fever and pain ever since. In the past thirty years, it has gained new importance in the management of heart disease and stroke, and current studies suggest it may someday assume a role in preventing colon cancer and possibly even Alzheimer's disease. And just as aspirin is finding new uses, scientists are finding out exactly how it works. It is important research that is likely to result in a new generation of even better drugs. But even in the dawning era of "super-aspirins," the original drug is certain to retain much of its value.

How It Works

Aspirin does its job by inhibiting the body's production of prostaglandins. Although you may never have heard of them, prostaglandins have a wide-ranging impact on human health. For example, they keep the stomach lining healthy, they regulate blood flow to the kidneys, and they enable platelets to trigger blood clotting. But prostaglandins also contribute to disease; in the brain they cause fever, and in joints and other tissues they can produce inflammation and pain.

Aspirin is not the only drug that inhibits prostaglandins. In fact all the nonsteroidal antiinflammatory drugs (NSAIDs) act in similar fashion (see Table 6.1, page 168). But although acetaminophen (Tylenol and other brands) fights fever and pain as well as aspirin, it does not inhibit prostaglandins. As a result, it does not share either the antiinflammatory benefits or the major side effects of aspirin and other NSAIDs.

Aspirin and Atherosclerosis

Aspirin does not prevent or even minimize atherosclerosis, but it can help prevent heart attacks and some strokes. It sounds like a paradox, but it is not. Aspirin cannot prevent cholesterol-laden plaques from building up in the wall of an artery, though it may be able to reduce the inflammation that perpetuates the damage (see Chapter Three and Figure 3.1). But while plaques narrow arteries, rarely do they produce the complete blockages that cause heart attacks. Instead, the culprit is a blood clot or thrombus that forms on the surface of a ruptured plaque. The clot completes the blockage, and aspirin exerts its protective effect by inhibiting clot formation.

Clots are triggered by platelets, fragmentary blood cells that are produced in the bone marrow, and then pour into the bloodstream. A man's blood contains a total of 100 million platelets, but because each platelet only lasts about ten days, the marrow must produce them continuously at a prodigious rate. Aspirin does not reduce the number of platelets in the blood, but it does inhibit their ability to trigger clots.

Platelets are extremely sensitive to aspirin. In some studies, doses as low as 10-30 milligrams can inhibit all the platelets in a man's body. Once platelets are inhibited by aspirin, they stay inhibited, but since new platelets are entering the blood continuously, the aspirin dose must be repeated every twenty-four to forty-eight hours to keep the majority of platelets under control.

Primary Prevention of Heart Attacks

You would probably call it staying healthy, but doctors call it primary prevention. By either name, it means heading off a problem before it makes its first appearance. Can aspirin prevent a first heart attack in men without diagnosed heart disease?

This is the question that the Physicians' Health Study set out to answer in 1982. A total of 22,071 male physicians volunteered to be subjects in a randomized clinical trial of low-dose aspirin. Half the men were assigned to take 325 milligrams of aspirin every other day, while the others each were given an identical-appearing placebo tablet every other day. To eliminate bias, the assignments were made randomly and neither the subjects nor the researchers knew which men were taking aspirin and which the placebo.

The researchers had planned to continue the trial until 1990, but it was terminated three years ahead of schedule. That was because an independent Data Monitoring Board that was tracking the results declared it would be unethical to continue the study since a clear winner was already evident. The winner was aspirin.

In the Physicians' Health Study, the men who took aspirin had a 44 percent reduction in the risk of suffering a heart attack. Benefit did not depend on a man's family history of heart disease or on his cholesterol, blood pressure, blood sugar, body fat, amount of exercise, or his drinking or smoking habits. But one risk factor did predict benefit: age. Aspirin was highly effective in men older than fifty, but not in younger individuals.

The results of the Physicians' Health Study were published in the same year as the report of the British Doctors Trial, which found no benefit from aspirin. Does that mean men should take aspirin in America but not in Europe? Not at all. The British trial was much smaller than the U.S. study, involving just 5,139 men. It was also less carefully controlled. But the biggest difference was in the dose of aspirin; the British doctors took 500 milligrams every day, the Americans just 325 milligrams every other day.

When you have a headache or a fever, you are likely to take two 325 milligram aspirin tablets every four to six hours. Even the British doctors' dose is tiny in comparison, but it may still be too high to produce maximum protection against heart attacks. That is because tiny doses of aspirin will inhibit only thromboxane A2, the enzyme in platelets that triggers the clotting process, but higher doses can also inhibit prostacyclin, an enzyme in blood vessels that reduces clotting. In theory, at least, low doses of aspirin will reduce clot formation, but even slightly higher doses might lessen that benefit. Two 1998 studies found that 75 milligrams of aspirin a day can reduce the risk of a first heart attack by about one-third, and a 2001 investigation found that 100 milligrams a day reduced the risk of cardiovascular death by 44 percent, but none of these reports investigated varying amounts of aspirin. However, a 1999 study from six European countries compared four aspirin doses and found that low amounts (81 or 325 milligrams a day) were actually better than higher doses (650 or 1,300 milligrams a day) in preventing strokes.

When it comes to aspirin for prevention, less is more.

Although the Physicians' Health Study demonstrated that low-dose aspirin could help prevent heart attacks in healthy men fifty or older, its 1989 report did not link aspirin use with a reduction in overall cardiovascular deaths. The aspirin trial was terminated early, and its five-year span may have been too short to discern an effect on mortality. But even after the randomized clinical trial was terminated, 11,010 of the subjects continued to take the drug on at least 180 days a year, while 3,849 took little or no aspirin. In 2000, the study reported that over a seven-year period, a low-dose aspirin was associated with a 35 percent reduction in cardiovascular deaths and a 36 percent drop in total mortality.

The Physicians' Health Study trial has provided additional information about aspirin's effect on the heart. The drug seems most effective in the early morning hours, when platelets are particularly likely to stick together and produce clots. It is a good thing, since that is when heart attacks are most likely to occur. Aspirin begins working rapidly and it remains effective as long as it is being taken. That is because the very first dose will inhibit all the platelets in a man's blood, but the body does not build up resistance to the drug. Aspirin was effective in preventing heart attacks in men who had angina, but it did not prevent healthy men from developing angina. That's because angina is caused by plaques that produce partial blockages, but heart attacks are the result of clots th... --This text refers to the Paperback edition.