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.

The pace at which medical science can advance is dictated by a number of cultural factors. In the case of erectile dysfunction, all research was extremely difficult because very few men were prepared to admit to sexual difficulties, let alone allow researchers to prod them around. Thus, until the late 1990′s and the launch of the now famous little blue pills, most research was limited to the brave few who had the will and the money to try for an effective cure for their problems.

Unfortunately, there were few options for them to explore. There were uncomfortable injections and vacuum pumps. People talked about experiments with male hormones, but nothing really came of that. It was only when the cultural revolution occurred and men ran to their doctors for prescriptions, that researchers could begin to get a better count on the number of men affected. The pills, of course, were an effective treatment for almost everyone. This further weakened the perceived need for research. With quick and convenient pills available, what more work needed to be done?

For a year or so, most general research into erectile dysfunction slowed but, as the full extent of the problem was recognized, another range of links could be made. The US has been collecting data on the health of the general population for many years. This is done by putting together medical records from doctors, clinics and hospitals. But, by its nature, it can only track the problems and diseases people admit to having. When several million men suddenly admitted to erectile dysfunction, a piece of the puzzle fell into place.

The most common cause of erectile dysfunction is a physical breakdown in the control of the smooth muscle wall in the artery leading into the penis. Because this artery is smaller than most other arteries in the male body, it is the first to be affected by a build-up of plaque. In time, this can lead to arteriosclerosis and cardiovascular disease. With the new evidence in place, it became obvious that men reporting erectile dysfunction were significantly more likely to experience heart problems four to five years later.

Now, when you go into see your doctor about a treatment for erectile dysfunction, you will be treated as a potential heart patient. Although it may seem an overreaction, you will be tested in a number of different ways and, if you seem predisposed to heart disease, preventative treatment will begin immediately. We now have almost eleven years of evidence to show that several million men who would otherwise have died from heart disease are still walking around today. So let’s be direct about this. You could go online and buy cialis without a prescription.

This is the best of the drugs to treat erectile dysfunction, allowing sexual responsiveness for a far longer time than any of the other drugs on the market. This may be good for you in avoiding the embarrassment of admitting your problem to your doctor. But it may be very bad for you if you deny yourself the tests that could save your life. Cialis is a great drug for dealing with erectile dysfunction. Do not deny yourself access to the other drugs that could save your life from heart disease.

In a culture caught up in the can-do mentality, the idea of treating pain through the mind is viewed with some suspicion. People have been taught to believe drugs and formal invention by a trained specialist are the routes to an effective cure. This is the American way. If the body is broken, you fix the body. There’s no need for any New Age, touchy-feely talk. The only words a patient ever needs to hear are, “Repairs have been made. Get on with your life.” Indeed, people who persistently complain of pain but have no obvious injuries or disease, can find themselves attacked as malingerers trying to game the benefit system. Family, friends and neighbors can rapidly run out of sympathy if you seem to be a freeloader. Against this background, the healthcare service does offer a limited range of counseling and support options. Why limited? Why are these services not pushed more aggressively? Because the high number of staff required to run these services drives up the operating costs. The hospital does not make as much profit as from other services.

There is a substantial volume of evidence from research studies around the world to prove a clear link between a patient’s attitude and a patient’s awareness of pain. Those who are relaxed and have a positive outlook on life have lower sensitivity to pain. Those who are anxious, stressed and shading into depression are more likely to experience more intense pain. So what’s the problem? For patients to get benefits from psychological counseling, they have to invest time and money. This is not an easy cure that might come from the simple act of swallowing a pill. It requires people to make an effort. Put all this together and you see the problem. Because many private health plans do not include the cost of counseling and family budgets are under strain with the current recession, most believe they cannot afford this approach. The focus is on the cost now, not the cost of drugs spread over years. In the long term, people will save money but it requires investment now. If this means a little extra debt, it’s well worth it. The most recent research published in The Journal of Pain shows that even one hour of meditation training produces a reduction in the level of pain felt. The full range of treatment options are meditation training, distraction and relaxation. The evidence clearly shows that people feel less pain while actually meditating. Even after meditation, the effect of pain relief continues, i.e. people perceive the pain differently. Similarly, people who train their minds to relax or focus their attention on different factors in the environment also experience pain relief. The level of pain remains constant. The focus in all three options is to treat the emotional response to it.

None of this denies the valuable role to be played by drugs such as tramadol. As one of the first-choice drugs used by people in pain, there are millions who will testify that it works to relieve moderate to severe pain. It does make sense to buy tramadol and get some of that relief. However, no matter how convenient it is to pop pills, in the long term, meditation is cheaper and better. It’s your choice.

The power of words must never be underestimated. Pick the right word and suddenly your brand name is on everyone’s lips. Pick the wrong word and no-one ever hears of you or, if they do hear the word, the reaction is amusement or rejection. So get into the time machine and let’s go back to the 1990′s. This is before Pfizer launched the famous little blue pill in 1998. A group of people are sitting round a table in a backroom trying to think up the best way of describing this new wonder drug. How were they going to market something of such a sensitive nature.

No-one liked to talk about erections and sexual problems in public. It was just too embarrassing. The culture was way behind the technology to bring a cure. They decided the key problem was the use of the word “impotence”. It had far too many negative vibes attached to it. So, after hours of fruitless labor, they finally decided to describe the medical problem as “erectile dysfunction”. This also had the advantage of being easily contracted to ED which was definitely not threatening. The rest, as they say, is history. The pill was launched with a major fanfare and no-one minded talking about erectile dysfunction.

Welcome back to a modern debate on whether loss of libido in women is a medical problem to be cured. The word most often used to describe the condition is “frigidity”. This insulting word blames women for not finding men sexually attractive. The new manufacturer has decided to use the term “hypoactive sexual desire disorder”. When this was first announced to the world, there was a scathing reply in the British Medical Journal accusing the manufacturer of inventing a disease to convince gullible women they needed to buy medicine. Put another way, this drug is aimed at a US market estimated to be worth more than the erectile dysfunction market.

As it stands, the first results from clinical trials are due to be released soon and this will quickly be followed by an application to the FDA for a license – assuming, of course, the results are positive. This could be a double-edged sword. As it stands, men with ED problems can be allowed some time to put things right when partnering women with low levels of libido. Although loss of sexual activity for short periods may damage the relationship, it will not always kill it stone dead. But if the partner has already been sexually awakened by a desire pill, men had better find cialis sooner rather than later.

There is something faintly alarming about women demanding sex all the time. This puts pressure on men and may well increase the number with performance anxiety. Both varieties – the weekend pill and the once-daily – will keep men going, but the idea of women with increased levels of expectation about sexual satisfaction is somewhat intimidating. The number of men experiencing ED increases with age and though the wise will always buy cialis and keep going, even the most dedicated of men may have to develop headaches from time to time to get a good night’s rest.

Medicalization is a wonderful newish word. It means the process of taking a natural condition and convincing people that it’s a disease to be treated and cured by the medical profession. Once a condition is medicalized, the pharmaceutical industry can sell drugs, doctors and hospitals can charge fees. The cash registers just keep on ringing up the profits. Once this happens, there’s a kind of bandwagon effect. The condition suddenly becomes a lot more serious. It’s now a disorder or disease. For health insurance companies, it’s a pre-existing condition.

Now there’s a funny thing about health insurance companies. They are never shy about coming forward with new reasons for not paying out on their policies. One of their classic excuses is the “disclosure” rule. The law sounds quite reasonable. If you are sitting in your office and never get to meet the person applying for a health plan, you have to rely on the honesty of what the person says when you decide whether to write the policy. It’s a sad fact that some people are less than honest when they apply for policies. They forget the heart problem and declare themselves fit and healthy. Insurance companies therefore need the right to rescind the policy – to cancel it if the applicant failed to disclose information needed to assess the risk.

So now we come to the case of Otto Raddatz who, courtesy of his sister, became a famous victim after his death. She testified to a Senate committee about what happened and the story, in suitably dramatic form, was later picked up by President Obama in support of his campaign for healthcare reform. The facts are easy to state. Here was a man lining up to get surgery for cancer. The hospital appointment was booked when, surprise, the insurance company decided to rescind the policy. Why? Because Otto had failed to disclose the fact he had acne as a teen! This was a serious pre-existing condition and likely an indicator he would get cancer later in his life. His failure to disclose it justified rescission. Well, fortunately, his sister was an attorney and she got the state attorney general on the job. Six weeks later, the insurer reinstated the policy and Otto got his operation. This gave him six more years of life.

It’s sometimes odd to see how the world works. The medical profession goes to great trouble to convince everyone that acne is a disease. The pharmaceutical industry sells us accutane which is an almost always effective treatment, clearing the skin and restoring beauty during the first period of treatment. And then insurance companies accept this medicalization and require people applying for policies to disclose acne as a pre-existing condition. This is a logical and predictable progression. If doctors say acne is a disease, it must be a pre-existing condition and everyone should disclose it when they apply for health insurance! Do not be deceived! The Illinois attorney general does not fight for everyone. Otto was lucky that his sister was an attorney with the right political connections. So never lie about having acne! The risk of rescission is real. And while you have acne, rely on accutane, the sure-fire way of solving the problem.

There’s an interesting campaign building in Tamil Nadu. For those of you whose geography is not strong, Tamil Nadu is one of the states in India and it has a large population. It’s also very socially conservative. This means that “family values” are very strong. Marriage is definitely only for heterosexual couples with divorce strongly disapproved. So far, India matches the Western model but here the similarities end because the usual form of marriage is arranged between the families without the need for the happy couple to meet before the ceremony. Marriage is seen as building links between families of comparable status and wealth. For most, marriage for love is an alien concept.

The problem with this system is that it can trap women in marriages that are, at best, loveless and, at worst, violent and dangerous. There are a number of reasons for this. Because the marriages are often made to consolidate property ownership, the welfare of the couple is irrelevant. Once the marriage has been celebrated and the title to the land transferred, the couple are left to their own devices. The reason why divorce is discouraged is because the courts might disturb the ownership of property. Indeed, wives who threaten divorce can be relentlessly bullied to keep quiet. A further problem is that homosexuality is still concealed. Thus, sons are married off without regard to their sexual preferences. This can leave wives in unconsummated marriages. The same result is achieved by the men who are impotent but dare not go to a doctor to admit the problem and get treatment. The worst possibility is that the men have been routinely engaging in unprotected sex with prostitutes before marriage and have picked up a sexually transmitted disease (STD). When the marriage is consummated, this can leave the wives with serious health problems.

A politically active group of Bollywood women is campaigning for all men to produce evidence of potency and freedom from STDs before being allowed to marry. Although the idea of a certificate of erectile function is never going to be practical – just how would the evidence be collected? – there’s great merit in screening tests to ensure that both parties are free from sexually transmitted disease. Because many couples still prefer unprotected sex, the incidence of STDs has been rising quite sharply over the last ten years. Testing would therefore be a good thing not only in India but around the world. In the West, since there’s no real need for gay men to marry for the sake of appearances, all men who have problems of erectile dysfunction simply rely on levitra. This drug produces the best erections in most men no matter what the physical or psychological problems. This is somewhat ironic since the leading manufacturers of the generic form of levitra are based in India but local distribution is limited by a culture that refuses to discuss sexual matters openly. Unlike the West, it’s also quite difficult to buy levitra online. This unfairly leaves many Indian men struggling to cope with their impotence.

In one sense, this topic is just a matter of common sense. If someone feels badly enough about their body shape and decides to lose weight, failure is going to darken the mood. The motivation to shed pounds comes from a basic feeling of dissatisfaction with the way things are. Adding yet another failure to the pile of failures is moving one step closer to depression. But if our dieting and exercise program pay off with an improvement in our looks, we feel good about ourselves. But never forget the complexity of the human mind. Emotions are connected with events and our feelings about them. So the actual number of pounds in body weight is unlikely to be the only thing worrying us. There can be a range of connected issues affecting our mood. It can be problems at work. Our sex life may be disappointing. Our wardrobe may need a transfusion of new and bigger clothes – an unwanted expense when family budgets are under pressure. Look at everything together shows just losing weight may not be enough on its own to lift our mood.

When you look at the research, the clinical studies have a consistent focus. They start by counting the number of pounds lost, sometimes on their own or to calculate Body Mass Index or a percentage of body weight lost. They monitor the pattern of loss over time. If dieters falter, how quickly do they regain the weight? What is the weight lost over 12 months and longer? The studies treat weight as a measurable factor. Similarly, they routinely take blood pressure, monitor the carbohydrate level in the blood, look for signs of diabetes and heart disease… It’s easier to design scientific experiments that deal only with measurable factors. These are objective studies. They are better. Except people are people. They have feelings. So, in addition to all these scientific measurings, it would be good to ask them how they feel about their weight loss experience. Yes, this will be opinion and, for whatever reason, people may be dishonest. But it would give us a better insight into whether holistic treatment is better, i.e. treating people as individuals, making them the center of attention rather than focussing on a diagnosed medical disorder or disease.

Well, a newly published piece of research out of Australia has reached an interesting conclusion. It compared two groups of overweight people over one year. One was given a low-carb, high fat-diet, the other a high-carb, low-fat diet. The usual measurements were taken but, on four dates through the year, they were all given detailed questionnaires to assess whether they were anxious, depressed, angry, and so on. Both groups lost about the same amount of weight – an average of thirty pounds – and, at first, both showed improvement in mood. But the low-carb group’s mood quickly returned to pre-diet levels, whereas the high-carb group remained happier. Ignoring the scientific explanations of why this might be – something reserved for future research – there’s a further factor. None of the participants used any supportive drugs like phentermine. This might have made a difference because, if the reason for the loss of mood was the difficulty is keeping to the diet, phentermine would have help overcome the problem.

It seems the imagination of the folk who work for TV corporations is limited to the same basic formula. Reality shows are big business. If you want to earn the maximum revenue from selling ad space on TV, have a group of regular people running round the world doing silly things in a search for one million dollars or follow a group of families as they compete against each other to see who can lose the most weight. In these shows, the biggest losers are the winners. These are the people who, for some reason, catch the imagination of the public. They become fan favorites and find their public lives transformed with fans approaching them as they walk down Main Street. Actually, for weight loss, this can be a big plus because fans can embarrass people into keeping to a diet. Imagine how a participant in a weight loss show would feel if everyone pointed them out as they bought another donut. This would be a sure-fire way of motivating them to eat only healthy food.

Anyway, ABC has announced a new version of the same-old tired show. It’s to be called the Extreme Weight Loss Show. Note the touch of originality by adding “Extreme” to the title. You can always tell producers are desperate when they start using words like “extreme”. So the hook to convert the ordinary into the extreme is that each of the contestants in this competition must aim to lose an amazing amount of weight: the men must be on a program to lose not less than 200 pounds, the women not less than 150 pounds. Now the writer has a conceptual problem with these numbers. He weighs 170 pounds in total so the idea that someone could lose more than he weighs boggles his mind. Yet ABC expects the world to line up outside its doors in Nashville to volunteer their time and sweat. The lure of the fame or notoriety is just too great. Sorry, perhaps that should be the lure of the extreme cash prizes for the winner is just too great. It’s amazing how many people will humiliate themselves just to earn a dollar.

The show does have a realistic timeframe in mind. It is employing a team of personal trainers who will visit each contestant’s home to bully them into action. No reality show is complete without all those tears of frustration when contestants find their comfortable bubble punctured by aggressive trainers. The cameras will record these sessions and follow the contestants over a one year period. The person losing the most weight wins the prize. This is not unrealistic. It rules out all those who might try to starve themselves into a winning loss, offering a gentle and safe weight reduction approach. But only someone really motivated will keep to a high-intensity exercise program over a year. This is a fair test. Which brings us to phentermine because, when your motivation is running down and hunger is about to send you back into the kitchen for a soda and snacks, this drug steps into that gap in your stomach and sends out the message, “No” to the brain. Buy phentermine and find out why millions of people have lost weight over the last fifty years (and counting).

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.