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    Wellness in urology: Consider non-drug measures up front

    Mark A. Moyad, MD, MPHMark A. Moyad, MD, MPHPoor lifestyle choices and obesity are prevalent among the U.S. population, but objective education on dietary supplements and lifestyle changes is equally poor, says Mark A. Moyad, MD, MPH. In this interview, Dr. Moyad discusses non-drug interventions for urologic conditions, the difference between prescription drugs and nutraceuticals, and why a heart-healthy diet is a prostate-healthy diet. Dr. Moyad is the Jenkins/Pokempner Director of Complementary and Alternative Medicine in the department of urology at the University of Michigan, Ann Arbor (an endowed position funded by patients). Dr. Moyad is on the speaker’s bureau for Abbvie and is a consultant for Farr Labs. Dr. Moyad was interviewed by Urology Times Editorial Consultant Philip M. Hanno, MD, MPH, emeritus professor of urology at the University of Pennsylvania, Philadelphia.

     

    Interest in patient empowerment has increased tremendously, and a large part of this is the popularity of nutraceuticals, the explosion of direct-to-consumer advertising of prescription drugs, and the move to bring more prescription drugs over the counter. How do you see these current trends?

    It’s a train on a track that’s going faster and faster. I don’t see any of these trends slowing down. I think a couple of things are happening in my generation that are going to increase patient education exponentially, not just in my field but other fields as well. Part of this comes from pressure on physicians to maintain patient volume. It’s different from when I used to watch my dad, who is also a physician, at the hospital. Today, it seems very much like a volume-based system. You have to see more and more patients, which means you have less time.

    Read: What websites do you recommend to patients?

    When I last checked, there are some 20,000 new medical papers coming out per month. Physicians have an exponential amount of education to digest and are supposed to see more people, so how can they possibly become more efficient? Doctors should not have to solve this issue by going to school even longer. Patients have to become smarter to make the visit more efficient. If I looked at current trends from Obamacare or elsewhere, it all leads to patients having to know more about their health than ever before; otherwise, the visit will not be its very best.

    I always tell people they should be reading relevant books and pamphlets before they visit the doctor so they can streamline their questions, because the visit is going to be very short. Efficiency is everything.

     

    “Nutraceutical” has no legal definition. One definition I’ve seen is “pharmaceutical products containing a concentrated form of a presumed bioactive phytochemical or zoochemical agent from a food and used with the purpose of enhancing health in dosages that exceed those that could be obtained from normal foods.” How do you see the difference between a nutraceutical, a functional food, and a drug?

    I don’t see a difference. We are playing a funny game, and the game is any active nutraceutical that has evidence, to me, is a drug and there’s no difference. It’s all perception versus reality. Some of our best-selling supplements are actually drugs from other countries. We just don’t know it.

    We’re playing a game and nobody’s winning. If a company sells a product over the counter, they cannot make a disease claim even though physicians will recommend the product for diseases. Even if a nutraceutical shows a benefit against a disease, the manufacturer cannot say that because that would be breaking the rules. The problem with that rule is not only is it a dumb rule, but nobody wins.

    I see no difference between a nutraceutical and a drug except a nutraceutical that’s effective can’t make a drug claim. I would argue that in conventional medicine, if we accepted that definition, it would bring more respect to nutraceuticals, and if the nutraceutical industry accepted that definition, they would do more to get exemptions whenever there were data.

    People frequently ask me whether nutraceuticals work. That’s like asking if prescription drugs work; it depends specifically on the situation and on the data and evidence. But we handle nutraceuticals differently. I get asked whether vitamin E works. Well, it’s really bad in some cases, and there are other diseases where it might help, so I treat it no differently than a drug.

    Next: "I think companies have to be rewarded for doing research."

    Philip M. Hanno, MD, MPH
    Philip M. Hanno, a Urology Times editorial consultant, is professor of urology at the University of Pennsylvania, Philadelphia.

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