Ghana is a nation of pluralist medicine hence you have different options to choose from. I know you are used to Urology- the mainstream practice medicine but what about holistic urology?
Holistic urology is an approach to care that takes into account the “whole health” of the patient, including factors that can have an impact on urogenital health, but which may involve other areas of health and wellness. Holistic care forms an important part of an integrative medicine approach, which combines the best evidence based conventional medicine with traditional and scientifically validated alternative therapies. Holistic urology can be especially important for patients who have only explored mainstream medicine and who have thus far had unsatisfactory results.
Today more alternative medical practitioners are well educated in Complementary and Integrative Medicine (CAM). The argument was that an assumed lack of efficacy, potential side effects, and a lack of objective studies which validate the therapy in question. These cited concerns are reasonable questions. However, to be balanced, we must also consider that the conventional standard of care has similar limitations. The therapeutic norms are often not as scientific as we would like to assume.
The diagnosis of conditions such as benign prostatic hypertrophy (BPH) and prostatitis are often based on collective symptoms rather than documentable scientific studies. In addition, pharmaceutical applications are frequently applied off label. That is, in a manner that is not approved by the FDA. Therefore, it is not possible to objectively quantify efficacy in the context of the theoretic gold standard of a double blind, placebo controlled, crossover trial.
In contrast, applications of integrative models can be more appealing in some situations. Most natural therapies, integrative treatments, or phyto-pharmaceuticals are unapproved in the United States. However, they are the standard of care in many European countries such as Germany. Studies have shown that, in Germany, more than 50% of urologists prefer the natural or CAM therapies in their practices. In Ghana, Urologists are prescribing natural remedies for prostate disorders. Natural remedies such as Sawpalmeto, croton membranaceus et al.
This preference is based on reduced side effects, an improved clinical response, and reduced cost. In support of this preference there are numerous studies which document the combined synergistic efficacy of many ‘natural medicine’ options. It should be noted that not all therapies falling under the umbrella of CAM are necessarily well studied.
There are, however, many evidence based CAM therapies that show clear benefit to patients in the field of Urology. For example, phytotherapy for BPH has demonstrated significant benefit. Extracts of the African dwarf palm, Serenoa Repens, have been subject to several peer-reviewed scientific research studies likewise Croton Membranaceus.
Also, beta sitosterol, rye pollen extract(Cernilton), stinging nettle (Urtica Dioca) have shown benefit. Saw palmetto, known in the herbal lore as “the old man’s friend”, has been a popular treatment since the 19th century.
It was named after the Harvard botanist, Sereno Watson. Standardized extracts have been shown to be very helpful in BPH, and may be inhibitory to prostate cancer cell growth. Studies comparing saw palmetto to standard therapies such as Finasteride have shown approximately equal efficacy. A significant advantage is that Serenoa Repens is less costly and has negligible side effects. Another helpful therapy is beta sitosterol.
This is a plant sterol which is structurally related to cholesterol. It is shown to be significantly helpful as well in BPH voiding symptoms as well as cholesterol reduction. Also, rye pollen extract(Cernilton) has been shown to help with urethral pressure. Green tea extract has also demonstrated inhibition of prostate cancer cell growth as well as the hibiscus tea.
Vitamin D3 is another nutrient that is shown to be very helpful. Some studies have shown that greater than 50% of Americans are deficient in vitamin D, with 22% being severely deficient. In laboratory studies, vitamin D increases cellular differentiation and decreases proliferation of prostate cancer cells, helps control inflammation, and enhances the immune system. Also Vitamin D deficiency and prostate cancer risk has been established in black men and men diagnosed with prostate cancer have more aggressive form of the disease.
More specifically, today urologists have become increasingly interested in men’s health. Not surprisingly, this has met with some skepticism as a branding effort rather than a new paradigm of health care delivery.
But is there an opportunity for the specialty of urology in Ghana to refocus their educational and practice efforts to a more holistic approach that caters to the needs of men?
I would enthusiastically say they have to consider now because if they don’t, urology is in danger of falling behind as an optimized specialty in health care delivery for men. We need a more collaboration between Urologist and expert in holistic urology to have a cordial relationship in Ghana to transform the system.
For instance, Urology Times has embarked on the development of #LetsTalkMensHealth, a novel new section focused on men’s health, and I am excited to champion men’s health in the country with Men’s Health Foundation Ghana, the NGO that championed the convention of father’s day as a national prostate cancer awareness day in Ghana because we believed it is a form of preventive medicine and not curative medicine. We are interested in preventive medicine to save more lives. We believe Ghana should invest more money into preventive medicine than curative medicine.
Why men’s health now?
Patients who suffer from various aspects of metabolic dysfunction are overwhelming the health care system. In large part, this is due to the crisis of obesity, which is related and secondary to decreased exercise, poor diet, and the cumulative effects of environmental stress. Obesity is an enormous public health problem in the U.S. and worldwide, and is associated with numerous comorbid illnesses and chronic conditions. This is coupled with escalating cost and significantly impacts the quality of life in affected individuals.
Chronic diseases associated with obesity include type 2 diabetes, heart disease, sleep disorders, musculoskeletal pain disorders, and cancers of the colon, esophagus, gallbladder, and kidneys. Type 2 diabetes is approximately four times more prevalent among obese men, and twice as many have high cholesterol or heart disease compared to normal-weight men.
Moreover, associated urologic disorders, including benign prostatic hyperplasia, hypogonadism, erectile dysfunction, prostatitis, and nocturia are all more common in obese men.
In other words, men’s health should focus on the unique health needs and accompanying services that must be implemented to address this phenomenon. Chief among these needs is a gender–specific approach (this applies to women’s health as well) that encompasses and affects change in research, advocacy, government policy, and allocation of resources. Ultimately, this is all designed to optimize health services delivery.
In general, men seek health care professionals almost 25% less than women. In large part, this is secondary to social norms, that is, men are tougher and should endure. Not surprisingly, these traits are associated with unhealthy behaviors such as poor diet, excess alcohol consumption, smoking, and high-risk activities.
Men’s health centers emerge
Men’s health centers are beginning to emerge in Ghana; currently, Men’s Health Foundation Ghana is leading the way established at Dodowa Akoto House. Some are geared toward sexual health and often (unfortunately) as a branding tool rather than as a comprehensive preventive, diagnostic, and therapeutic center.
We are evidence that the concept works, as we have been very successful in patient engagement and have surpassed all our subjective and objective measures.
Why not replicate this for urologists across the country?
Additionally, this is the time.
Numerous government and insurance domains have accepted, advocated, and funded initiatives in gender health. This includes creation of the International Society for Male Health, established at the first World Congress on Men’s Health in Vienna in 2001. Numerous countries including the U.S., Canada, Australia, and several in Europe have established, funded, and advocated multidisciplinary centers for excellence in men’s health. These ideas and concepts are best described by the group in Australia, which defined six priority areas:
• optimize health outcomes for men
• promote health equity between groups of men
• create strategies for health improvement for men at different life stages
• focus on prevention
• build the evidence base for future policy
• Improve access to care (Nat Rev Urol 2013; 10:606–12; Australian Government Department of Health and Ageing, 2010 [http://ow.ly/AitDI]).
A mental picture for urology
Eventually, the vision for urology should be to lead men’s health, setting the policy and research agenda by ensuring urologists remain at the forefront of providing specialty care for men’s health needs. Moving forward, the urologist will be the authority and coordinator of care for men navigating through the health care system. In an era of telemedicine, digital informatics, and preventive care, Urologist can take a foothold at leading health care institutions and providers in delivering quality, information, and trust. This is especially true given that many of the most common conditions for which men enter the health care system are via urologic portals, ie, the symptoms of voiding and sexual dysfunction and cancer screening.
With the issues of Prostate cancer screening, a very controversial subject but some countries have a well -laid down policies on screening such as the UK, Australia, Jamaican and others. The question is do we have a special policy for men in Ghana concerning prostate cancer screening and the disease itself?
Urologists in Ghana and their professional organizations must take ownership in educating, advocating, and delivering the best information and care to their members, professional collaborators, and the general public on the urology-specific and non-urologic health issues facing men.
We as a charity have pushed for the convention of father’s day in Ghana as national prostate awareness day and if this is done we would have more policies to follow on men’s health. The Men’s Health Foundation has expert and with collaboration we can do so many for men in Ghana.
But the question now is where is medicine heading in the future, and specifically, where can urology drive a stake in the ground to maintain and even increase its role in health care delivery? Urologist need to think beyond their historic role as pelvic care specialists and take a much more holistic, patient-oriented, and gender-based approach in all aspects of their specialty.
This includes education, research, advocacy, policies, collaboration with other expert in evidenced based alternative medicine practitioners and patient care. This should begin with training medical students, residents, and fellows and sharing this knowledge on holistic Urology with current practicing urologists and alternative medical practitioners in the field of men’s health in Ghana as holistic medicine has come to stay and recognized in Ghana.
The Men’s Health Foundation Ghana in a prime position to lead this initiative on men’s health policies formulation but it will require collaboration from mainstream Urologist, bold vision, resources, and most important, commitment.
Mainstream Urologist have a unique opportunity to help improve the quality of health care delivery for men in a more efficient, comprehensive, and scalable fashion. Men’s health can be and should be incorporated into existing models of clinical practice. Otherwise, with more experts and registered alternative medicine practitioners practicing holistic urology, Mainstream Urologist ultimately fulfill the prophecy of one of their forefathers in the field, Paul Peters, MD, who predicted that urologists would “once again become clap doctors.”
I know Urologist can do better, they should do better, and they must do better. The Men’s Health Foundation Ghana believes that Ghanaian men deserve better treatment for prostate cancer and we need policy on prostate cancer and screening now. The declaration of father’s day in Ghana as national prostate awareness day is the key to start the campaign and policies.
The Men’s Health Foundation Ghana pleads to Urologists in Ghana to take a bold, fresh, and determined pathway and lead in improving the lives of men throughout the country as men are receiving wrong treatments for prostate cancer likewise wrong information regarding prostate cancer screening all because of lack of awareness and policies.
Chronic urologic conditions that can be treated with holistic medicine?
Holistic medicine has a role to play if patients see the right practitioner in the field of alternative medicine. Most chronic conditions can be treated holistically; those that tend to respond especially well include:
• chronic cystitis (urinary tract infections)
• chronic pelvic pain syndrome
• painful sex
• erectile dysfunction
• chronic prostatitis
Is holistic urology better than mainstream approaches to urologic care?
No, not superior – just special. Mainstream medicine can be very effective in treating acute issues, but when it comes to managing long-term or chronic issues, it sometimes falls short. Holistic medicine shifts the focus of treatment from a disease-centered or symptom-centered approach to a patient-centered approach in which the patient’s whole health and lifestyle are considered when prescribing treatment.
Does holistic urology mean you don’t use medicine?
Not at all; while holistic care does help patients tap into the body’s own healing processes, it includes a variety of science-based tests and treatment methods aimed at achieving optimal health and wellness throughout the body.
In my practice in holistic medicine when prostate cancer patients are on conventional drugs I don’t ask them to stop but help them to address the side effect of conventional treatment been it irradiation, hormone therapy et al. This integrative approach improves the quality of life of the patient and rate of survival.
Treatments holistic urology includes
There are many potential treatments that may be used, including and I coined this ‘the practice of brilliance medicine or Naturopathic Allopathic Medicine:
• holistic-based medical interventions
• botanical and dietary supplement consultations
• nutritional assessment and consultation
• wellness and lifestyle consultations
• intravenous treatments
• bio-identical hormone replacement therapy
Ghana currently needs father’s day as a national prostate cancer awareness day. Thank you.
Source: Dr. Raphael Nyarkotey Obu