Friday, February 19, 2016

George Gurley's New York: Dr. Steven Lamm

Dr. Steven Lamm in his office at NYU’s Preston Robert Tisch Center for Men’s Health.
by George Gurley

There are well over 400,000 primary care physicians in the United States and among the 35,938 in New York, Dr. Steven Lamm is one of the best known. You may have seen him on The View or Oprah or YouTube, heard him on the radio, or read one of his bestselling books like The Virility Solution, The Hardness Factor, No Guts, No Glory, and most recently, Fighting Fat: Break the Dieting Cycle and Get Healthy for Life!

Then there were his tongue-in-cheek yet informative advice columns in Maxim magazine (“Ask Dr. Maxim”) and The Daily, in which he tackled a wide variety of topics such as holiday gluttony, peanut allergies, bread-free diets, circumcision, deviated septums, chronic burping, intimacy issues, the best sunblock, the pros and cons of threesomes, spontaneous erections, adolescent depression, massage for seniors, having “the Talk” with your kids, and “an apple a day.”

Dr. Lamm's latest book. Click to order.
I know Dr. Lamm as my family doc, the cool, upbeat guy I starting seeing in the early 1990’s when his office was on East 86th Street. I would often show up without an appointment. After a checkup I would hang out with Dr. Lamm in his office for a half hour, catch up, discuss neuroses, buy a bottle or three of vitamins and immune boosting liquids. I was also on a first name basis with his devoted staff, Grace and Lucille, and his mother Lucy who filled in on occasion.

Dr. Lamm has always been great for a quote, for articles I’ve done about Ambien, Viagra, my fear of flying, and what to pack in your survival kit. When it was time for my then-girlfriend, now wife and I, to see a couples therapist, he referred us to Dr. Harold W. Selman who stuck with us throughout our five year engagement (and allowed our 50-some sessions to be fodder for a newspaper column and then a memoir).

Another big reason to see Dr. Lamm was for a pep talk and his never failed to leave me feeling inspired and optimistic. When he became the medical director of NYU’s Preston Robert Tisch Center for Men’s Health and moved his practice thirty blocks south, I found that it wasn’t as easy to swing by and shoot the breeze. That was okay, though, because the new place turned out to be pretty swank, more spacious, with comfy sofas, a big flat screen TV, good water and magazines. You could spend hours there. And it definitely feels like you’re in a sophisticated medical environment. On a recent afternoon, Dr. Lamm was in his corner office with a large window overlooking the Sony Building, and happy to chat.
The swanky, spacious, and comfy waiting room at NYU Langone Medical Center.
GG: How long have you been at 555 Madison?

SL: The center opened in January 2014 as a result of an amazingly generous donation from the Tisch family which has always been linked with NYU. They had created the women’s center a few years earlier and it was very successful. They realized that men are endangered species and if you wanted all of these successful women to have partners, maybe we needed to start to pay attention to the men. It was a great idea and a wonderful opportunity for me. But this is beyond my expectations. I mean, they found the right real estate, you know, ‘location, location, location’really makes a difference. Honestly, I feel like Mad Men looking out this window every day.

GG: You could people watch all day.

SL: Clearly. And in the summer it’s painful because I’m looking at the patients and they’re looking outside. They’re the ones that are distracted rather than the doctor.
The view from Dr. Lamm's office.
GG: Not all of your patients are men, right?

SL: Seventy percent. Women realize this is a great place to get care, and you’re not gonna stop them from coming. First of all, they love the doctors, the location, and everything the men like about it. Plus, they can go downstairs and go shopping, go to Christian Dior. So that’s why we say it’s the most expensive center in New York because even though there’s a small co-payment for your services, when you leave here and you go to Bergdorf’s, that’s a lot of money!

GG: What’s something unique you’ve brought to the center?

SL: As a result of 40 years of experience, I’ve realized that I’m not going to cure a lot of patients but I can care for all of them. I think that philosophy really does permeate here, the sense of caring and of service. It’s an integrated center. We have all of the specialties—cardiologists, orthopedists, psychiatry, physical medicine, and the link is everybody is a faculty member at NYU. Everybody uses the same computerized system, which is the most advanced of any university, second to none. Everybody has to have special training in EPIC, it’s called, which links all of the patients and all of the doctors in one very current and modern system.
Dr. Lamm, director of the Preston Robert Tisch Center for Men's Health, with a patient.
GG: What used to happen?

SL: The information was not instantaneously available. You’d have to wait for some doctor to send you a note, or a letter. You’d have to search your own office for laboratory tests. When I was in my solo practice, I could not spend 100% of the time on the patient. I could spend 50% of the time on the patient, and 50% of the time worrying about whether Verizon was giving me my phone service, the landlord was providing heat, and my staff was going to be showing up at work. You know, medicine is hard enough that I should be spending 100% of my time in the practice, and not in the business of medicine.

GG: How else is this a better set up than 86th Street?

SL: The beauty of our center is the fact that as a physician, you can go down the hallway and speak to another physician in real time. So let’s say you, a typical man comes in and says, ‘I feel a little short of breath.’ I examine you, and I can hear that you have an irregular heart rate. Well, I have three cardiologists down the hallway. I don’t have to say you need to set up an appointment — we can walk down the hallway. The cardiologist can look at the EKG and say, ‘Steven, it’s not atrial fibrillation, it’s just a typical’ — so you can get instantaneous feedback and the specialists do the same thing with the primary care doctors. They can come to us ... So it’s not only safe for patients — because remember, people want to be in an environment they feel they can be taken care of — it’s safe for doctors. Physicians like to be around other doctors.

GG: So they can get second opinions, too?

SL: Instantaneously. And in the last two years we’ve been so successful that the Tisch family has given us some additional funds to double our space. It’s also the first center that emphasizes the entire male patient, as opposed to the typical men’s centers which are primarily dealing with their prostate and their erection. We’ve gone way beyond the erection.
Preston Robert Tisch Center for Men's Health reception: Veronica Apphia, Roger I. Emert, MD, Steven Lamm, MD, and Sara Barhak.
GG: Gotcha. You know, I kind of miss your old office.

SL: Well, I think I had a mom and pop store. It was also a chaotic place because patients would just come into the office whether they had an appointment or not. Hello, I’m here!I think for those times, it was great but it could not meet the needs of the current health care system where so much of it requires technical expertise. You need electronic medical record keeping. There’s pre-approval of everything. I write ‘aspirin’ and we have to get pre-approval from your insurance company. It became impossible ... I really love medicine, and I didn’t want to limit what I do to a hundred individuals who could pay me an exorbitant amount of money. That is what I was going to face over the ensuing few years.

GG: So then NYU contacted you out of the blue?

SL: I’ve always been on the faculty at NYU. I was the Director of the Medical Student Health Service. I taught at the medical school. But as time went on, I distanced myself because I had a private practice, I wrote books, did TV, stuff I found entertaining. But I still had a connection with the Medical School and the deans appreciated that I had done a lot of work in men’s health. I had written some books on sexual aids, I was talking a lot about male testosterone and a lot of subjects that dealt with men’s care and they felt this would be a really good position, and I agree with them – this is a really good position for me.

Being named professor of medicine at NYU was "my proudest moment."
GG: I’ve always thought of you as a specialist and a general practitioner.

SL: I’m an internist. I think this has been an area of medicine that has not attracted the most number of graduates because there was a trend in the 80s and 90s and even today where you graduate medical school, and become a specialist. You gravitate towards being a cardiologist or a gastroenterologist, and so we’ve created wonderful specialists, terrific physicians who take care of your thyroid, your heart. They are specialists in diseases. Where we started to fail is we forgot the patient. I like that aspect of medicine and the challenge for me was to take care of patients, but at the same time preserve my expertise in the disease management, and that’s what I bring here.

GG:
The website says one of your specialties is treatment for alcoholism. You’re a big fan of the anti-drinking drug Naltrexone, right?

SL: I’m a big fan of effective treatments whether it’s for your blood pressure, your cholesterol, your sexual function, and one area that I think I was ineffective in managing was alcohol and substance abuse. I was very knowledgeable, because as a result of my training at NYU and at Bellevue hospital I had already seen the ravages of alcohol, which is considered the most dangerous of all the substances, when you rate the danger to the individual and to society. It became clear that treating alcohol withdrawal, which is relatively easy to do, is not the same as preventing people from drinking, and it was extremely frustrating. Some time in 2007 I came across the medication Naltrexone, which offered some hope. Now I wish I could say to you that I help 100% of people. I don’t. But I help at least 30% and that’s more than I ever helped before.

GG: When Naltrexone works for someone it really works?

SL: It’s a very important biologic agent that dramatically reduces the cravings and use of alcohol. I think it’s underutilized but is starting to gain much more traction now when it became clear that the alternatives were often dismal failures. When prestigious journals such as JAMA write about it, then you know that you’re in mainstream. You either take a pill or you take an injection and it’s also approved for opioid addicts. I think that’s even more impressive. It literally blocks the opioid receptor so it is impossible for them to get high from the drug.

GG:
What else are you interested besides substance abuse?

SL: I’m really interested in obesity which I think is the greatest driver of diseases. Once again, we viewed obesity for most of my medical career as a character flaw, that somehow if somebody just had enough willpower, they wouldn’t be overweight and it was clear to me once again that this was a biologic process. I believe that the majority of the medical profession in this society is really coming around to agreeing with that.
Dr. Lamm On The View.
GG: What’s the best way for me to lose twenty pounds?

SL: Reduce dramatically the white food in your diet like bread, rice and noodles.

GG: What about someone like me who can’t live without bread, pasta, crackers, bagels, pizza?

SL: Then you’re not gonna lose twenty pounds.

GG: What kind of things do you eat and drink on an average day?

SL: This would be a perfect example of telling people, Do as I say, not as I do! This morning I started out in a healthy fashion. My wife found this yogurt that’s actually quite tasty, it has a circular container where you can put a little jam in it. Then I added some Chia seed to the yogurt. Chia is a very healthy kind of supernatural food. I put a tablespoon in it. I had a little juice and coffee—they've actually shown that coffee’s okay for you. Then at lunchtime I had a grilled chicken salad with some avocado, and balsamic vinegar.

Dr. Lamm and his wife Kiki, who is "tremendously supportive, not critical, understanding ... warm, sensitive, loving. It’s fantastic."
GG: Any vitamins?

SL: Yeah, I took a little Vitamin D. I actually took a dose of Crestor, a lipid-lowering agent. My mother had had a heart attack in her late seventies. I just thought it might be a good idea to optimize my cholesterol, and I took a baby aspirin this morning.

GG: Is the Mediterranean diet any good?

SL: Yeah!Fruits, vegetables, nuts. It turns out the diet that has won the greatest acclaim, that nobody has ever heard of, right, is called the Dash Diet. [Dr. Lamm starts tapping away on his keyboard] One of the things I do every day in medicine, is I have to learn, either from patients, colleagues, or research. Every single day without fail I go to certain websites and see if I can learn something. So MedScape is one of my favorite sites. Today there was a very good article on the Dash diet and I sent it to everybody at the facility. It;’s always been known for helping people lower their blood pressure. Look at this!‘Dash Diet ranks best for sixth time.’We constantly have to learn.

GG: What’s something you haven’t eaten in decades?

SL: I haven’t had a White Castle in a long time. And I haven’t been to Wendy’s in a long time.

GG: Ever had a hot fudge brownie delight from Dairy Queen? Or any kind of sundae lately?

SL: Maybe tonight, maybe tonight.

GG: The last time you overindulged?

SL: Probably last night and then tonight.

GG: What’s for dinner?

SL: We eat out every night and although I want to try to keep my carbs down, I’m not always successful. It’s really hard to give up rigatoni alla vodka sauce. Tonight I’m gonna be eating at the Metropolitan Club but one of my favorite restaurants is Il Mulino on West Third Street. I’m probably a little excessive at dinner. But then I figure I ate a terrific breakfast and lunch, I do work out, and it gives me a bit of leeway so I can have some quality of life.
Dr. Lamm with Kiki.
GG: What constitutes a binge?

SL: Drinking too much. If I have more than two drinks, I don’t think it’s in my best interest. I don’t have a drinking issue, nobody in my family does, but I know if I have more than two drinks, it’s not a good idea.

GG: I’m with you. Last night, I had a half a shot of Fernet Branca and another half later on. Slept like a baby.

SL: Yeah, because alcohol essentially puts you to sleep, but then when you metabolize alcohol, it wakes you up. At three in the morning, you jump out of bed. I don’t think I have ever in my entire life had more than four drinks. I did it once and my physician friends actually had to bring me home and when my wife saw me and said ‘Oh my God,’ and they said, ‘It’s the lighting.’ I never did it again. It was a guys’ night out when I was about 38. I had four drinks. I think it was a combination of vodka, wine and then brandy.

GG: Do New Yorkers tend to drink too much?

SL: I think New Yorkers live a very dynamic and full life, and I think of New York as a bipolar city, and with bipolarity comes excess. So there’s excess partying, excess drinking, excess gambling. It’s just part of New York. I try to temper it. I love New York without a doubt. I think if you really want to pursue life, liberty and the pursuit of happiness, you want to live in New York. But if you have an issue, you could fall prey to this bipolar city, and can end up getting in trouble.

GG:
Words of wisdom. Are you from New York?

SL: I was born in Rome, Italy. My father [Arnold Lamm] was a physician. He was Viennese, but because he was Jewish, he was put in a concentration camp. [Dr. Lamm pauses and regains his composure] And so he started his studies in Vienna, and ended up in Bologna which is one of the oldest European universities. After the war, he lived in Italy, and practiced medicine. When I was about 4, he realized that it was probably not the best place to live, and he had a sister in New York, so with my mom, he left Italy to a new country where he had to learn the language, had to study. It was a major move. They realized this would be a much better opportunity and it was, clearly. So I’m very grateful for what they did.

GG: Where did you first live in the city?

SL: West End Avenue in the 70s and later we moved up to 106th Street off of Broadway where my father had a large practice and a very nice life. But I think that their entire existence, I felt, was focused on my studies, without a doubt.
When not playing doctor.
GG: What did you learn from your father?

SL: I appreciated how happy he was as a doctor because there was no business at that point, it was all about medicine. There was no HMO, no electronic medical records. We had an apartment where part of it was the office and part of it was our private residence. That was called a professional apartment. Can you imagine that in New York City today where a doctor lives in one half? So I would come home from school, and I would be in my half of the apartment, and my mother worked with my father, they would be in the other part of the practice. I would see him all the time, and he would introduce me to the patients. It was interesting seeing this old school caring for patients. The therapeutic alliance meant everything. He was an expert at caring for patients and they truly appreciated the personalized service, the simplicity. I learned that from him.

GG: What else were you into growing up?

SL:
I had two areas of interest: sports and my school. I went to Stuyvesant High School. My entire focus was to get good enough grades to get me to the next level, so I was obsessed – as was my family – in my success. It was almost as though my parents’ survival was focused on my becoming a doctor one day, and believe me, that’s pressure.

GG: Did they sit you down and say how things were going to be?

SL: You just knew it. We’re in it together.

GG: Did you feel success was inevitable, guaranteed?

SL: It was just the opposite. It was not entitlement. It was extremely hard work. It was focus. It was delayed gratification. It was a single mindedness. Every test, every exam mattered to me. Getting into Columbia was a tremendous sense of accomplishment for me, and getting into NYU Medical School was – I was euphoric. And then when I was named professor of medicine, that was it, done!

GG: When did you start working with your father?

SL: Probably soon after I was circumcised. About 1978, ‘79. I could have had an academic position from the minute I graduated, but I couldn’t disappoint my father. It wasn’t possible. He spent his whole life dedicated, just waiting for me to go into his practice. So I had actually no choice.

GG: What do you say to men coming to the center for a checkup?

SL: I ask what do they plan on doing in the next six months to improve their health. I think one key thing is ensuring that they’re getting adequate sleep. In our city, it’s so easy to get entertained and distracted, and we’ll go to sleep at one and get up at six. Sooner or later that’s gonna bite you and affect your thinking, your weight, your erections. So sleep is as important as food and water. Light may be extremely important, too. If you are prone to seasonal effect disorder, you can get a lamp, so when you wake up in the morning you turn it on. Light therapy can be very helpful. Also, hang around people that make you happy. Don’t make excuses — there are people that just make you unhappy and drain you. Just get away from them. They’re not gonna change. Don’t think you can fundamentally change people. You can’t. There are plenty of people who are going to make you feel better. Don’t hang around toxic people.
The early years with Kiki.
GG: Can you say something about Kiki?

SL: Kiki and I have been married for twenty years. She’s a textile designer, enormously talented from a creative side, and tremendously supportive, not critical, understanding ... warm, sensitive, loving. It’s fantastic.

GG:
Don’t you two have big Halloween parties and wear elaborately themed, matching costumes?

SL: It’s part of the escape and appreciation for life that I was telling you about. The joy of being alive. I want to keep people alive because I think they can have a good time and part of what we do is we have an annual Halloween party, and what I’ve told everybody is what you’re seeing right now is actually my costume. That’s who I really am.

[Dr. Lamm points to a framed photo of him and Kiki dressed and heavily made up as a lion and lioness]

SL: It looks like we’re from ‘Cats.’ You have to show that picture. I’ve done everything. We’re a good team and our kids are part of it, I’m very proud of all five of them.
Dr. Lamm and Kiki on their favorite holiday.
Just a night out with the Addams family. "Sometimes I am unclear if what I wear in the office is my Halloween costume."
Another casual Friday.
GG: Do some patients come here just looking for hope and a pep talk from you?

SL: I think a significant percentage are part of ‘the worried well’ and they’re seeking some validation. But they’re uncomfortable. They’re distressed. They’re worried. And I think what I and other physicians at this center do is try to put patients’ complaints in perspective, and not overdo things.

GG: Is there anything not better in moderation?What should you do a lot of?

SL: Smile. Hug your children. Smile. Laugh. Honestly, laughter is amazing medicine.

Dr. Lamm with his two daughters.
GG: Any other advice? Mantras you use for yourself?

SL:
Don’t view yourself as a victim. Always look forward. Don’t look back. Worry about things you can control, that you can change. You can’t control the weather but you can control whether you have candles or snowshoes at home. Really think in terms of what you can ultimately change, and you can change yourself, your thinking, your behavior. But if there was a way of learning optimism, that would be what I would hope for everybody. If you could teach your patients to be optimistic, that would be the greatest gift I could give you.

GG: Thank you, you did it again.

SL: Really, you’re inspired?

Suddenly, Dr. Lamm’s phone erupts with a ting. He studies the text message.

SL: So I had a patient, this guy came in because he needed to get some surgery on his neck and after I saw him, I said, ‘Look, I think you need to go see a cardiologist now.’ He walked over to the cardiologist’s office, and said, ‘By the way, I didn’t tell Dr. Lamm something. I didn’t tell him that in the last two weeks every time I walk a certain distance I get severe chest pains. And Dr. Lamm’s gonna kill me because I didn’t tell him.’ So the man got a cardio catherization today which showed severe coronary disease. They’re going to do an emergency bypass. The problem was if he had gone somewhere else, he wouldn’t have said anything. He might not have done it! He just might not have done it. The fact is that he was able to walk down the hallway. It made it easy.

GG: So wait, the text was from the patient?

SL: No, this is the doctor who just got the report!

GG: This just happened?

SL: This is happening right now!
"In reflecting on what it takes to be a great doctor ... It is humility and curiosity. Trust me, medicine humbles me every day."