The World On My Fingers

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It's hard to go anywhere on the internet without encountering some of these ads for products to produce "enhancements". The English language is a wonderful tool for describing something indirectly. Pity the poor marketer stuck with a language that only has one word meaning erection. Life would soon become so boring for all concerned. With English, the current in-word is enhancement. This manages the capture the idea you can take something relatively ordinary and, with a little help, make it extraordinary. The usual hook for all these magic products, whether they come as pills, liquids or creams, is that they transform a man into a sexual stallion who will be able to keep a woman satisfied the whole night through (and then some if she's not physically damaged). They are always described as natural. It's strange how we are supposed to trust something more because it's made out of grasses, berries, cactus and roots ground together, and doubt anything with artificial chemicals inside. But you will always see lists of Latin names for different plants and extracts, impressing us with the magic of names and labels. The final preparation will be shipped to us at high price but, we are assured, results are guaranteed.

Well, one of the happier tasks entrusted to the FDA is to monitor and control the way these products are marketed and sold. A dedicated team of researchers slaves away in laboratories, identifying all the ingredients and ensuring everything is as described on the label and not in the least bit dangerous for us to take. If the FDA finds a product misdescribed, it can instruct the manufacturer to change its ads. If the product is unsafe, it will be withdrawn from the market. Which brings us to Stiff Nights - a dietary supplement that, through its name and the advertizing copy, suggested it had magical properties in the bedroom. Those lab people have prodded and tweaked all the molecules in Stiff Nights and emerged with a list of all the ingredients. First, though, a slight diversion from the main thrust of this article. A question: did Stiff Nights work? Remarkably it did. In fact, users were impressed their sexual performance was very definitely enhanced. They kept ordering more. Why? Because the main ingredient identified by the FDA was sildenafil. For those of you not up with names, this is the generic name for viagra. Yes, those cunning manufacturers in Grand Rapids, Mich. were grinding up those little blue pills and mixing them in with all those natural, healthy plants and berries.

It's a sad fact of life that some unscrupulous people will buy cheap sildenafil and sell it on as expensive enhancement pills. Ignoring the excessive profiteering what with sildenafil being so cheap and Stiff Nights being so expensive, this was actually dangerous. Here was a product described as "all natural". Yet, if you took it at the same time as any other drug containing a nitrate or which reduced blood pressure, you could end up in your local emergency room. So the FDA has made the world safe for us yet again. The moral of this story? Never pay the high prices demanded by those who sell all natural dietary products to enhance your manhood. Buy viagra or its generic analog sildenafil and get a better result at a fraction the cost.

The health story that had everyone's attention at the beginning of the year was the threat of swine flu. We all watched as the threat level inched up to pandemic. The number of people dying was like watching the latest lottery numbers to see how many lost. Yet, although millions of people have caught this flu, only a few tens of thousand have died. Our attention shifted elsewhere. But there is still interesting news about the pattern of deaths. The people most likely to die are young and, almost without exception, they are obese. Frankly, if you carry excess weight, this flu is a killer, which raises a more general question for you to chew on. No matter what you might choose to believe, the majority of people are overweight because of their lifestyles. They eat too much and exercise too little. So, the US is a country where individual liberty is the most important quality of life. It's up to every one of us to take personal responsibility for what we do and the consequences of those actions. So what personal responsibility should we take for our own health? Further, if we are against big government, should people who do not take care of their health just be allowed to die if they do not have enough money to pay for health insurance?

The latest statistics show that, as a nation, we spend about 16% of the gross domestic product on health care. This includes the cost of medications and is double the average in countries around the world. But we are not a healthy nation. Counting the number of prescriptions fulfilled through real world pharmacies, we consume more sleeping pills and antidepressants per head of population than any other nation. That's before we start guessing how many drugs are purchased on the internet. We are seriously overmedicated. The results are easy to see. Many drugs cause insomnia as an unintended side effect. So we all walk around like zombies and beg our doctors for relief. So now comes the difficult decision. Do you reduce the dosages of the drugs you are taking, or add ambien to the mixture to offset the side effects? The rational answer is to do without the first drug altogether. If it is interfering with your sleep and making you feel worse, you should stop taking it. Adding a second drug to balance out the side effects of the first is more expensive and potentially going to make you dependent on one or both drugs.

When there is very clear scientific evidence showing meditation and relaxation techniques as a completely effective treatment for insomnia, there should never be a need to take sleeping pills. People should go through the simple training program and emerge better able to control their sleep patterns. As a result, their general health will improve. But, as with everything, there are problems. The marketers have managed to convince the majority of us that drugs are the best form of treatment. We are taught to dismiss psychology as a waste of time. Worse, private health insurance often will not pay for the training sessions. At a time of recession, this leaves many with no choice. There is only enough to buy ambien and not enough to pay for training in something we do not trust.

For some reason, anxiety has become one of the most common medical problems of our age. It seems to have overtaken depression. One explanation is that people are less judgmental if you admit anxiety. There is considerable prejudice and some discrimination against people suffering with a depressive disorder. It's considered only one step away from madness and insanity which justifies locking up those affected in a hospital or institution - the public safety argument is that these people are a danger to themselves and others. The reaction of family, friends and employers is the unsympathetic view that depression is a sign of weakness, that with a little effort, people can snap out of their despair and turn their lives around. But we have all experienced some anxiety at some point in our lives and so are more accepting. It's strange that a change of label can make such a big difference. In many cases, there is nothing to choose between anxiety and depression, i.e. the depressed are often anxious and the anxious get depressed. But society feels less threatened by anxiety and is prepared to be more caring and supportive.

The results of a clinical trial in the north of England have just been published. It involved almost 4,000 patients with anxiety and depression. They were referred to a stepped program of psychological counseling. The majority received low level cognitive behavioral therapy (CBT) delivered over the telephone. Their progress was carefully monitored and those who did not respond well were referred to higher levels of CBT on a face-to-face basis. Over a twelve month period, the participants each received counseling lasting an average of 2 hours 45 minutes. The results show that 75% were either in remission or recovery. This is yet another piece of scientific research confirming psychological therapy to be the most effective way to treat anxiety disorders and depression. What is particularly interesting about this latest English study is that about two-thirds of those who improved only received therapy by telephone. Even a disembodied voice offering comfort and advice delivers effective treatment. As a result of this latest research, some 75,000 patients have now been enrolled in a national program of telephone therapy. The initial results are promising.

Now is the moment when we all put our prejudices aside. Yes, the British have socialized medicine and are treated by Stalinist-trained doctors, but this research is not unique to Britain. There is a rising tide a evidence to show talk-talk is better than a drug-based approach. The reason is not hard to find. People can self-medicate. They go online to buy xanax, the most advertized and so most popular of all the drugs used to treat anxiety. There is no need to produce a prescription. This cuts down the cost to a minimum. No hassles with the health insurance company in arguing whether psychological therapy is accepted, no co-payments and hospital bills. Just a few minutes online brings welcome relief a few days later. But there are just as many clinical trials showing xanax and the other drugs work best over the short term. People must either talk themselves better or get help. Therapy brings lasting cures. If the British are correct in finding telephone delivery just as effective as expensive face-to-face sessions for the majority suffering with anxiety disorders, we should be looking for this service in the US.

Once formed, habits are difficult to break. It always just seems easier to go on as you have before. This can become a serious problem when science gets in the way of the habits. If you look at the world of adverts in print and the media, you will see opioids recommended as the sure-fire drugs to use as painkillers, no matter what the pain. It carries on in the venerable tradition of the slogan, "Beecham's Pills cure all ills". The idea of a panacea - one pill to rule them all, as The Dark Lord of Mordor might have said - has been around since the beginning of time. This is fair game for the marketers to use when talking to the public, but the same thinking has entered the training manuals for the medical profession. Sit in lectures for student doctors and you will hear the same story that opioids are the first line of defense when it comes to moderate to severe pain. Once you have the source of the prescriptions in on the group think, the habit is almost impossible to break.

The monitoring and review process put in place after a drug is released into the market is designed to catch any unexpected side effects. If evidence of problems emerges, the FDA can require the manufacturer to change the warnings on the label or, in the worst cases, withdraw the drug from the market. But this monitoring process is not designed to catch the drugs that are ineffective. If no-one has an adverse reaction when taking it, no report is filed with the FDA. It's safe so who cares whether it works. All this brings us to the Cochrane Collaboration. This is a non-profit group where researchers sift through and analyze existing published medical research to see whether there are any consistent patterns - what might not be apparent in one clinical trial involving two hundred participants might be identified when you compile the results from fifteen different trials, each involving two hundred participants. Two recently published Cochrane Reports have concluded that opioids should not be routinely prescribed to patients even with severe pain from hip and knee osteoarthritis.

In both Reports, the independent conclusions were that the adverse side effects outweighed the benefits and that tramadol, as the leading opioid, was no more effective than the strongest NSAIDs. The first Report consolidated the results from ten trials involving a total of just over 2,250 participants and concluded that there was little pain relief and minimal improvement in mobility. With higher dosages, one in twelve participants experienced adverse side effects. The second Report consolidated the results from eleven trials involving 1,020 participants and found little difference between the effectiveness of tramadol and the placebo. This leads to a somewhat controversial conclusion. That doctors should not routinely prescribe opioids for the treatment of hip and knee osteoarthritis. There should be a careful discussion of treatment options including weight loss, physical therapy and exercise, and a detailed explanation of all the adverse side effects to be expected. This new research does not change the general acceptance of tramadol as an effective painkiller. All it does is confirm that there is no such thing as one pill to cure all ills.