My Writings. My Thoughts.

DIRECT-TO-CONSUMER DRUG ADVERTISING

More people are using prescription drugs at a younger age, for more conditions, and for longer periods of time. An aging population and more complicated medical conditions fuel an increase in drug expenditures. Between 1995 and 1998, drug expenditures in the United States more than doubled. In 2001, Americans paid $208 billion for prescription drugs, double the amount that was spent in 1996. Some 20 percent of employers’ health care dollars are spent on drugs. Medicare beneficiaries spent an average of $813 in out-of-pocket expenditures on prescription drugs in 2000 and $1,051 in 2002. An estimated 45 percent of those 85 years or older have no prescription drug coverage. The increasing cost of drug usage is painfully evident to consumers, many of whom are forced to choose between medicine and food because many patients without prescription drug coverage cannot afford to spend several hundred dollars each month on needed drugs. The inability of many senior citizens to pay for needed drugs has entered the political arena as a campaign issue. Both political parties have drafted bills to provide such coverage. Congress has also considered a proposal that would make it easier for Americans to import prescription drugs from Canada, where drug prices are lower than in the United States. The pharmaceutical industry continues to spend massive amounts of money in an attempt to derail or limit such legislation.

To further stimulate demand for expensive drugs, pharmaceutical companies spend astronomical amounts on “direct-to-consumer” advertising. Spending on such advertising rose to $2.8 billion in 2001, up 35 percent from $1.8 billion in 1999. Drug advertisements are a powerful voice in the American health care scene. The nightly network news appears to be largely funded by advertising for drugs for the treatment of acid reflux (Nexium and Prevacid), osteoarthritis (Celebrex and Vioxx), allergies (Clarinex), osteoporosis (Fosamax), high cholesterol (Zocor and Lipitor), anemia accompanying chemotherapy (Procrit), bladder control (Detril), and high blood pressure and stroke (Altace). The number of prescriptions for the 50 top drugs most heavily advertised to patients grew at a rate six times that of other drugs.

Of some concern is the fact that two-thirds of the new drugs approved from 1989 to 2000 were modified versions of existing drugs that the FDA has determined do not provide significant benefits over those already on the market. Some companies seem more interested in “gaming” the system to extend their exclusive marketing rights on existing drugs by strategies such as slightly altering the formula just as the drug’s patent is expiring. Intense marketing by the pharmaceutical companies has promoted the sale of reformulated drugs such as Nexium (a modification of Prilosec), Clarinex (a modification of Claritin), and Sarafem (a modification of Prozac). In some cases, brand-name drug manufacturers have entered into collusive agreements that provide payments to generic drug manufacturers to keep generic equivalents off the market. As the pharmaceutical companies transform themselves into marketing companies, more expensive drugs with no clear advantage to patients are promoted over existing cheaper alternatives.

It is not surprising that the pharmaceutical industry, whose profit margins surpass those of almost every other economic sector in terms of return on revenue, assets, and shareholders’ equity, is opposed to any form of price controls. The high price of drugs in the United States is subsidizing sales abroad because most other countries have imposed price or profit controls on the sale of drugs. Many residents in border states such as Maine, Vermont, and California routinely travel to Canada and Mexico to purchase drugs. To protect themselves, consumers should question whether they

SHOULD CHILDREN BE GIVEN PROZAC

It Can Stunt Growth, Damage Young Brains and Even Trigger Suicide. Yet Now This Most Controversial Antidepressant Is about to Be Prescribed to Youngsters of Just Eight . . .

prozac and children

prozac and children

JAMES was ten when he was first put on the antidepressant Prozac. His mother was an invalid, and after his father left home, the pressure of caring for his mother had become overwhelming.

Sometimes James would sit and stare into the middle-distance, not responding to anything; other times he’d lock himself in his room. He cried a lot.

Increasingly, he refused to go out because he was being bullied at school.

‘He started showing signs of depression,’ says Jude Sellen, a children and adolescent mental health consultant at the charity Young Minds, who was involved with his case.

‘His situation was very difficult and he badly needed psychological help.’

But there was an 18-month wait for therapy, so what he got instead was long-term treatment with an antidepressant.

Two years later he is still on Prozac – even though it causes him stomach problems, including diarrhoea and painful cramps, and makes him feel ‘funny’.

He also suffers from painful headaches.

He wants to stop taking the medication, but when he does, he becomes violent – a potential-side-effect of withdrawal from drugs such as Prozac – and his mother insists that he goes back on the pills.

James is now being seen by a psychologist and his medication is being reduced. But as Sellen points out, his case shows ‘how important it is to monitor patients on the drug carefully – and only use it short-term’.

The tragedy is that stories such as James’s could become increasingly common. Last week, in a controversial move, the European Medicines Agency announced that depressed children as young as eight could be given Prozac.

This is one of a class of drugs known as selective serotonin reuptake inhibitor, or SSRIs – and in America, children as young as three are already being prescribed them.

These drugs have already been linked with a raised risk of suicide and patients becoming dependent on them. But some experts are now concerned about giving these drugs to younger children because almost nothing is known about how these drugs might affect their growing brains.

‘This is ignorance in the broadest sense of the term,’ said Dr Glen R.

Elliott, a child psychiatrist at the University of California at San Francisco. ‘We don’t know if this is a good idea or not.’ The drugs might also stunt growth.

One trial, reported two years ago, found that children given Prozac between the ages of eight and 17 were, on average, 1cm shorter and 1.1kg lighter than those on a placebo.

In fact, we don’t really know exactly how SSRIs work to treat depression in adults or children – we believe they increase the amount of the ‘ feelgood’ chemical serotonin in the brain, but evidence for this theory is surprisingly thin on the ground.

The latest research suggests that they work by encouraging the growth of new brain cells. But whether this is good for a young brain that is already growing fast is also unknown.

What is known is that childhood depression is a growing problem in the UK.

About 1 per cent of children aged five to 11 and 3 per cent of adolescents aged 11 to 18 are thought to suffer from depression in any one year – with 80,000 five to 16-yearolds suffering from serious depression.

Some experts believe that the increase is partly to do with children’s high expectations – they expect life to be rosier than it is.

Others suggest that children are being exposed to increasingly stressful and emotional experiences, such as sex.

Whatever the cause, the difficulty for parents is knowing if their child is depressed or just feeling a bit down.

And giving medication to children who are not seriously depressed is a cause for concern.

The new guidelines from the European Medicines Agency recommend that the first line of treatment for moderate to severe depression should be psychological therapy.

Only after four to six sessions can fluoxetine – the name of the chemical in Prozac – be prescribed, and even then it should be combined with therapy.

HOWEVER, there is a drastic shortage of therapists as the case of James shows. He has been on Prozac for two years without having any counselling.

Provision of psychological services across Britain is notoriously patchy.

A recent report estimated that 10,000 more therapists were needed to provide effective treatment for depression in all age groups. As a result, the problem of medication without counselling is increasing.

David Cottrell, Professor of Child and Adolescent Psychiatry at the University of Leeds, says: ‘Far more prescriptions are written for children than there ought to be, and many GPs are not so good at monitoring the effects.’ But there is a more deep-rooted problem.

In 2003, the Medicines and Health Products Regulatory Authority advised that most SSRIs were not suitable for children, and that only fluoxetine should be given to them.

However, research by the Mail has found that doctors are still prescribing the other SSRIs.

In other words, while we worry about children being given Prozac, many of them might be receiving other antidepressants that the health authorities have said are not suitable for children.

In a written response to a Parliamentary question by Liberal Democrat MP Paul Burstow, the Department of Health revealed that four SSRIs which the drug regulator has said should not be used are still being widely prescribed.

One of these is Venlafaxine (Effexor), which, not only is unlikely to produce any ‘clinically important improvement’ but, astonishingly, has a rate of ‘suicide-related events’ 14 times greater than a placebo, according to a major review published in The Lancet in 2004.

THIS study looked at all the evidence for the safety and effectiveness of the five SSRIs most commonly used to treat children. And its conclusion about one of them, Citalopram (Cipramil, Celexa), was equally worrying: ‘It is unlikely to produce a clinically important reduction in depressive symptoms’ and doubles the risk of suicide.

One of the authors of this study was Professor Cottrell, who at the time explained that the review was unusually reliable because it combined published with unpublished trials. The conclusion of The Lancet review was that only Prozac was suitable, while the others – including Paroxetine (Seroxat) and Sertraline (Zoloft) should be avoided.

The intention of the trial was to provide information to guide doctors.

But, clearly, GPs did not heed the alarm bells – for as the Parliamentary figures reveal, only around 30 per cent of antidepressant prescriptions written for children under 18 in 2004 were for Prozac.

Another 35 per cent were for one or other of the four ‘banned’ drugs (the cost to the NHS for Prozac was [pounds sterling]407,107, and for the other SSRIs, [pounds sterling]1.6 million). The remainder of the prescriptions were for other forms of antidepressants.

‘Doctors do seem to be flouting the guidelines,’ says Professor Cottrell.

‘Doctors are allowed to prescribe drugs that don’t have a licence for that use, and while there will be a small number of cases where these drugs could be relevant – such as anxiety or obsessive compulsive behaviour a large percentage of these prescriptions should not have been written.’ Dr Jim Kennedy, prescribing spokesman for the Royal College of General Practitioners, questions whether doctors are prescribing medication without therapy.

‘But these figures do raise the question: are there any hotspots where more are being prescribed than should be?’ he says.

‘I think we should be looking in detail at how doctors are prescribing, and if we find a problem, we should re-educate GPs in those areas.’ The Department of Health, while noting the guidelines state that antidepressants should ‘be used rarely in the five to 11 age group’, says that ‘it is for clinicians to decide which of these drugs, if any, to prescribe to their patients.

‘It is important to note that some drugs which may be classified as antidepressants are used for other disorders such as nocturnal enuresis [bedwetting], anxiety, obsessive compulsive disorder and phobic states.’ Most clinicians agree that when faced with the pain of a child who is severely depressed, the benefits associated with antidepressants outweigh the risks.

‘Most experts recognise that psychological support is very important and should be tried first, but there are cases where a drug can help,’ says Professor Cottrell.

However, he adds: ‘Prozac has been the only drug recommended for children here since 2003.’ Meanwhile, if children like James are ever to have a real chance in life, much more attention must be paid to providing the kind of psychological support that everyone agrees is needed, and there should be a serious attempt to stop prescribing drugs that are known to be ineffective and dangerous.

The natural alternatives

PARENTS concerned about the use of SSRIs such as Prozac, the natural question is whether there is an effective alternative for children with mild depression.

There is some evidence that the herb St John’s Wort, available over the counter, can be effective in adults. One study suggested it might help children.

However, it can interfere with other drugs, including medications for asthma, epilepsy and migraine, and should not be taken without first consulting a doctor.

In a book published last year, the French neuroscientist Dr David Servan Schreiber claimed the quickest way to deal with depression was via the body.

In Healing Without Freud Or Prozac, he outlined a number of physical approaches for dealing with depression. Some are relatively familiar, such as nutrition and exercise, others more exotic such as ‘circadian therapy’ and ‘EMDR’ (but all, he claims, with evidence supporting their use).

They all capitalise on the mind and brain’s own healing mechanism for recovering from depression, anxiety and stress, he says.

Some experts believe that the key to tackling depression lies in diet.

Even though mainstream psychiatry is highly sceptical of the benefits of the nutritional approach to this, or to any other mental disorder, there are a few professionals who believe it can be valuable and a couple of centres that specialise in it.

According to Dr David Wheatley, a consultant private psychiatrist and previously director of the Maudsley Stress Clinic, it is ‘an infinitely preferable first line treatment option for those who feel mildly to moderately depressed’.

The nutritionist Patrick Holford suggests that parents should move their child onto a low-sugar diet and boost their intake of Omega 3s (found in oily fish and fish oil supplements).

Other options include a chromium supplement.

DEPRESSION DIET; Junk Food Link to High Risk of Mental Illness

SHUN fruit and veg in favour of fast food and you won’t just get fat – you’re more likely to end up feeling blue, too.

junk food

junk food

Research has found that gorging mainly on fried food, processed meats, sweets, chocolate and fatty dairy products increases the odds of you getting depression.

But eating a diet rich in fresh vegetables, fruit and fish can protect against the mental illness.

The study is the first to look at overall diet and depression.

Previous research in this field has tended to focus on individual nutrients. A research team at University College London quizzed nearly 4,000 Whitehall civil servants, with an average age of 55 about their eating habits and whether they suffered from depression. They found that those who ate the most whole foods were less likely to report symptoms of depression.

And the opposite was true of those who ate the most junk food. Experts believe the high levels of antioxidants in fruit and veg, and of the B vitamin folate in broccoli, spinach and cabbage, may help to lower the risk of depression.

And fish contains polyunsaturated fatty acids – a major part of neuron membranes in the brain.

But it is not clear why junk food increases the risk of depression.

Dr Andrew McCulloch of Mental Health Foundation said: “Studies like this are crucial because they hold the key to us better understanding mental illness.”

18st.. I have to be obese

EIGHTEEN stone is the average weight at which people recognise obesity is a crisis, research shows.

It is the tipping point at which many seek surgery to turn their lives around.

Weight op experts The Hospital Group explained the obese “suffer in careers, family life and health”.

Fewer than one in five weighing above 18st earns more than pounds 20,000, a study of 2,056 obese adults questioned by YouGov found.

Four in 10 of those hitting 18st suffer back pain and one in five have diabetes.

BUN TO AVOID Fatty burger

Depression: A New Sexually Transmitted Disease

Nearly every discussion about sexual education focuses on preventing sexually transmitted diseases and pregnancy. However, recent research published in the American Journal of Preventive Medicine finds that, especially for girls, the discussion needs to include a third negative possibility: depression.

Most medical and mental health professionals would agree that there is a link between depression and sexual and drug using behavior in adolescents. However, it is commonly assumed that depressed teens use sex and drugs to “medicate” their depression. Thus, when faced with a depressed, sexually active teen, adults may overlook sexual or drug using behavior with the hope that the risky behavior will cease once the depression is gone.

Although the depression followed by sex and drugs link seems to make sense, a new study, which followed over 13,000 middle and high school students for two years in a row, found that depression did not predict risky sexual or drug using behavior.

Instead, the study found that depression often follows risky behavior. Lead author of the study, Dr. Denise Hallfors told me in an interview that her research team found evidence that heavy drug and alcohol use significantly increased the likelihood of depression among boys. For girls, the findings are stunning: Even low levels of alcohol, drug or sexual experimentation increased the probability of depression for girls.

Breaking down the results, Dr. Hallfors found that 25 percent of surveyed teens were complete abstainers, meaning they were virgins and used no substances, not even tobacco. Only 4 percent of these teens experienced depression.

Another group of teens could be considered dabblers in that they had experienced sexual intercourse and engaged in some kind of substance usage during the first 12 months of the study. For the boys, there was no increase in depression from this pattern of behavior (for boys, the significant risk was heavy drug use). However, for girls, the study revealed a more troubling pattern. Girls even experimenting with drugs were slightly more than two times as likely to be depressed (8-10 percent). Those experimenting with sex were three times more likely to be depressed than abstainers (12 percent versus 4 percent). For sexually promiscuous teen girls, the results are staggering: 44 percent of girls with multiple sexual partners during the study period experienced depression.

Did depression ever come first? Boys and girls were no more likely to begin or increase their sexual and drug use behavior when they were depressed than when they were not. In fact, depressed girls who were also abstinent were much less likely to engage in risky behaviors during the second year of the study. However, if they were already “dabbling” with substance use, depressed girls were more likely to go on to very risky sexual behaviors.

In other words, the sex and drug use are not only associated with depression but most often precede it. As a public policy matter, the drug use findings are not surprising and hardly controversial. For any teen, who advocates drug use of any kind?

On the other hand, for opponents of a strong abstinence message in schools, this study may be difficult to reconcile with their public policy activities. For instance, two groups opposed to abstinence education, Advocates for Youth and Sex Etc., are now sponsoring a contest for teens to promote condom usage. Teens can craft an e-postcard to send to their friends (and potential hook-up partners?) extolling the virtues of condom use. One such card has a picture of a heart and a condom with the caption: “Dream Team.” According to Dr. Hallfors’ research, for many teen girls, the caption should read: “Sad Nightmare.”

More research is needed to isolate the causes and cures for the link between experimentation and depression. However, there is no reason for policy makers to wait to encourage abstinence given these research findings. Citing the devastation and feelings of worthlessness that accompany depression, Dr. Hallfors warns, “Parents, educators and health practitioners now have even more reason to be concerned about teen risk behaviors and to take action about alcohol, drugs and sex.”

Instead of cheery postcards, teen girls need to know that their sexual behaviors may put them at risk for more than STDs and teen pregnancy. “Once a girl crosses that boundary, she puts herself at risk for a spiral of negative effects,” says Dr. Hallfors.

It seems to me that the evidence is consistent that teen sex is not a good idea, especially for girls. Why can’t everyone get behind that message?

Teens are nearly united in this sentiment. According to a poll conducted by the National Campaign to Prevent Teen Pregnancy, nine out of 10 adults and teens want society to send a clear message that abstinence is best for teens.

Whatever we think about the morality of sexual behavior, can’t we agree that teens should be given a clear and consistent message that it best to wait to engage in sex until they are ready to accept the financial, relationship and emotional consequences of making that choice? For nearly all teens, this would be adulthood.

My suggestion for a postcard? A picture of a gold nugget and a heart with the caption: “I’m worth the wait.”

Warren Throckmorton is associate professor of psychology and fellow for psychology and public policy in the Center for Vision and Values at Grove City College in Pennsylvania. He is past-president of the American Mental Health Counselors Association.

10 Vital Signs Your Doctor Might Miss

MEDICAL CONDITIONS

SOME MEDICAL CONDITIONS CAN BE MISDIAGNOSED OR COMPLETELY MISSED, SO IT’S VITAL TO KNOW ABOUT MORE UNUSUAL SYMPTOMS

1 Ovarian cancer

THERE are 4,000 deaths from ovarian cancer in the UK each year, according to the charity Cancer Research UK. If it’s detected early, survival rates can be up to 80 per cent. But, tragically, in 60 per cent of women, the condition isn’t diagnosed until in its advanced stages.

Recent research reveals that symptoms appear earlier than once thought but are often mistaken for minor conditions such as irritable bowel syndrome. So be extra vigilant if you have a personal or family history of ovarian, breast or colon cancers, are post-menopausal and you’ve never had children.

Watch out for: Stomach pain, bloating, diarrhoea, constipation, back pain, tiredness and needing to pass water more often than usual.

Check it out: See your GP as soon as possible. You should be given an internal examination and possibly diagnostic scans. If you have a family history of the disease, ask about screening.

2 Underactive thyroid

THIS affects one in 50 women and one in 1,000 men, and may be hereditary or triggered by stress, infection, pregnancy or medication. Symptoms are often put down to depression, especially postnatal depression, or other hormonal problems.

“Confusion arises when thyroid hormone levels test normal but the body can’t use them properly,” says Professor Nadir Farid, of London’s Welington Hospital.

Watch out for: Tiredness, weight gain, mental fatigue, dry skin, thinning hair, depression, constipation, heavy, irregular periods and sensitivity to the cold.

Check it out: This is easily controlled with medication but if not diagnosed it can lead to heart disease, infertility and anaemia. See your doctor for a blood test. If results are normal but you still have unexplained symptoms, ask for a referral to a hormone specialist.

3 Whooping cough

FAR from being an “extinct” disease, a recent Oxford University study found that 40 per cent of children visiting their GPs with persistent coughs showed signs of the disease. And, according to the Health Protection Agency, one in four youngsters admitted to hospital didn’t receive correct treatment.

Watch out for: A persistent cough with a whooping sound and possibly vomiting.

Check it out: Make sure your baby is fully vaccinated as whooping cough is most dangerous in children under a year old, potentially leading to pneumonia and death. Vaccination protection isn’t life-long so if you or your child gets the above symptoms, ask your doctor for a blood test.

4 Carbon monoxide poisoning

LEAKS from faulty gas appliances, fires and central heating result in 30 carbon monoxide poisoning-related UK deaths a year. “You can’t hear, see or smell it and the symptoms of mild poisoning may be similar to cold viruses,” explains GP Dr Rob Hicks.

Watch out for: Headaches, nausea, dizziness, sore throat and dry cough, followed by tiredness, confusion, difficulty breathing, memory loss and co-ordination problems.

Check it out: Poisoning can be confirmed by a blood test. Prevent leaks with a carbon monoxide alarm and have chimneys, flues and gas appliances checked every year by a CORGI registered fitter.

5 Hepatitis C

THE symptoms of this potentially fatal liver disease often don’t show for years. According to the Hepatitis Trust, 500,000 Brits are infected but only one in seven know it.

It’s passed on through infected blood so you could be at risk if you had a blood transfusion or organ transplant before July 1992, I injected drugs, had a tattoo, piercing or acupuncture with dirty instruments. You can also catch it from unprotected sex.

Watch out for: Tiredness, sore muscles, headache, nausea or loss of appetite. Around a third of the patients develop cirrhosis of the liver up to 20 years after the virus has been caught, leading to liver failure.

Check it out: If you’re at high risk, get a blood test. Drugs cure 60 to 80 per cent of sufferers.

6 Heart disease in women

WOMEN complaining of chest pain – a key heart disease symptom – are less likely to be given investigative tests and more likely to die of the disease than men, according to a study by University College London.

It’s traditionally thought of as a male ilness despite the fact that it is responsible for the deaths of one in four women, whose symptoms can be mistaken for stress or depression.

Watch out for: Dull chest pain and feeling generally unwell are more common in women. Men are likely to get the “classic” sharp chest pain and pain down the left arm. Other signs include breathlessness, nausea and anxiety.

Check it out: “See your GP for a heart health assessment if you have a close relative who suffered from heart disease before 55 if a man or 65 if a woman,” says cardiac nurse specialist Michaela Nuttall.

“Other risk factors are high blood pressure, high cholesterol, obesity, smoking, drinking, fatty diet, inactivity and stress.”

Seek medical help if you experience symptoms listed above.

Treatment may involve drugs or a procedure called an angioplasty to widen blocked arteries.

7 Parkinson’s disease

FIVE to 10 per cent of patients with this degenerative disease of the nervous system, are misdiagnosed with other conditions such as rheumatoid arthritis or frozen shoulder, according to medical journal Neurology. And the Parkinson’s Disease Society claims that only one in four GPs has any expertise in the condition. Risk factors include age and exposure to pesticides. It’s also more common in men and can be hereditary.

Watch out for: Trembling on one side of the body, such as the hand when at rest, stiffness, stooped posture, difficulty walking, poor sense of smell and depression. However, 30 per cent of sufferers may not experience a tremor.

Check it out: Ask your GP to refer you to a neurologist for a definite diagnosis. If the symptoms don’t improve with medication, get a second opinion.

8 MS

MULTIPLE sclerosis destroys nerves and damages the brain’s messaging system, affecting movement, speech, sight and memory.

There are 85,000 UK sufferers and diagnosis is difficult as symptoms may come and go. There’s also no definitive test and it’s often confused with other auto-immune diseases (where the body attacks its own tissues) or chronic fatigue syndrome. If a close relative has MS, your risk may be slightly higher.

Watch out for: Blurred or double vision, fatigue, tingling, dizziness, lack of co-ordination, tremors and concentration problems, typically between the ages of 20 and 40.

Check it out: Early treatment can slow the disease’s progression. You should be given an MRI (magnetic resonance imaging) scan and be referred to a neurologist.

9 PCOS

UP to one in four women have, polycystic ovarian syndrome -multiple cysts on the ovaries – but it only causes problems in 15 per cent. The condition is due to a hormonal imbalance that sometimes prevents ovulation, reducing fertility. However, it’s often missed because it tends to start in teenage years and many of the symptoms are common in puberty.

Watch out for: Weight gain that’s difficult to shift, irregular periods, acne, infertility, excess body or facial hair.

Check it out: Correct diagnosis through blood tests and ultrasound is important because PCOS can increase the risk of miscarriage, coronary heart disease, diabetes, depression and fatty liver.

According to Prof Farid: “The contraceptive Pill is often prescribed to control symptoms but it doesn’t address the real problem, which is insulin resistance. If sufferers lose weight, they’ll lessen this resistance and the drug Metformin can further lower’ it.”

10 Meningitis

BACTERIAL meningitis causes inflammation of the brain and may lead to blood poisoning. It’s easy to miss because early symptoms are similar to flu – prompt treatment is vital. Children under one or young adults aged 15-19 are most at risk and it’s more common in winter.

Watch out for: High temperature, fever, vomiting, headaches and tiredness. Babies may make a high-pitched moan, have a blank expression, blotchy complexion or bulging fontanelle (soft spot on the head). Children or adults may have a stiff neck, aches and pains, confusion and dislike of bright lights. Another possible symptom is a rash that doesn’t go when you press on it with a glass. Check it out: Go straight to your nearest accident and emergency department if you’re concerned. If you’ve seen a doctor and are still worried, don’t be afraid to ask for a second opinion as the condition can be fatal. Emergency treatment with antibiotics and hospital visits are vital. Log on to meningitis-trust.org or call the 24-hour helpline on 0800 0281828.

Fake viagra

Email Systems, a company that measures spam emails on the INTERNET, reports that in the first three months of 2005 two in five spam emails were offering drugs for sale. As the volume of spam is now almost 90 per cent of all email sent, that means one out of every three emails sent is offering you cut-price drugs over the net.

fake viagra

fake viagra

In September 2003, Dr Nic Wilson, a researcher at the University of London, announced to the British Pharmaceutical Conference in Manchester that she had been testing samples of internet-bought it accurately measures the ingredients in each tablet. The result was that half of the pills were lakes. ‘The user runs the risk of poor quality and possible toxicity, not to mention the fact that there is a high probability that the tablets have no clinical effect,’ she told her audience, who probably looked around the room to see who was blushing – Brits being the largest consumers of Viagra in Europe.
It’s comparatively easy to set up a Viagra factory, and some crooks have gone into the business in a big way: an example is 44-year-old Londoner Allen Valentine, convicted in November 2004 at Harrow Crown Court and sentenced to five and a half years in prison for supplying class C drugs. In effect, he was sentenced as if he had been supplying large amounts of cannabis.
His factory in Wembley was more than just a cement mixer: it could create 500,000 tablets a day. On the side, he was also making steroids and anti-stress medication, and a great deal of cash: the day before his arrest in April 2004. he had offered cash for a £1.25 million house and bought a new jeep.
Valentine knew how much people wanted Viagra – he was previously a rep for Viagra’s manufacturer, Pfizer.
The little blue pill is a common find for the drugs squads of Europe, the US and Asia. In January, £1 million of fake Viagra was found in an abandoned car outside Glasgow. ‘It is quite common to recover one or two thousand fake Viagra pills. They are usually found along with Class A drugs like cocaine, heroin and ecstasy,’ said Detective Sergeant Ken Simpson of Strathclyde Drugs Squad.
This is no cottage industry: Richard Widup recalls a case from his time at the FDA: ‘It was over the Christmas holidays 2002, in Southern California…  There were 700,000 counterfeit Viagra.

Life after phentermine

Doubtless many of the millions of Americans who have been using dexfenfluramine (Redux) or or fenfluramone (Pondimin, better known in combination with phentermine, as fen-phen) to lose weight will regard this week’s withdrawal of both drugs from the market as bad news, indeed. The cloud, however, is not without its silver lining.

There were, after all, very good medical reasons to remove the drugs from public consumption. The reason the FDA asked manufacturers to stop selling the drugs – and the reason the manufacturers, including the French company that distributes the drugs internationally, complied – was because there is strong evidence they cause heart-valve problems. The FDA reviewed the records of 291 patients and found that echocardiograms, which measure heart-valve function, showed abnormalities in the valves of 30 percent of them – none of whom had yet experienced any symptoms. Thirty percent is a very high percentage, much higher than the FDA expected to find. And heart-valve damage is no laughing matter. So, the good news is that the withdrawal will most likely save many people from some very serious damage to their health.

Of course, there are people whose health is seriously endangered by obesity itself, and who have had so little success losing weight through diet and exercise that Redux and fen-phen have seemed the last, best hope. For them, there are other medical possibilities, including the appetite suppressant phentermine, which is the “phen” part of fen-phen. And new diet drugs are in the offing, including one that inhibits the absorption of fat by the body.

Unfortunately, all diet drugs, new and old, including even so-called “natural” fen-phen, which contains the potentially dangerous ephedra, could be dangerous in one way or another. And, while Redux and fen-phen have unquestionably been helpful to dieters, even if only as a sort of reassurance and reminder to stay on the diet and keep up the exercise, diet drugs are no magic bullet. As doctors who have prescribed them clearly understand, even with the drugs, the keys to successful weight loss are diet and exercise.

The depressing truth is that for all people looking to lose weight, a restricted diet of some kind and strenuous exercise of some kind are absolutely necessary, drugs or no drugs. And for most people looking to lose weight, they are, simply, sufficient. Though the danger of diet drugs will pose a dilemma for doctors treating the dangerously obese, it is not the end of the world that the non-dangerously overweight and the not-at-all overweight, those afflicted with the American obsession to (almost literally) get down to the bare bones, are left once again with those two dreadful old standbys.

Overweight and Life Expectancy

Applicants for life insurance usually undergo a medical examination. In the Build Study of 1979,136 weight was measured in 86.1 to 88.5 percent of the 3,997,650 men and 592,509 women on whom policies were taken out. The analysis of such data, with all of its limitations, provides the major retrospective studies on the effects of body weight on mortality and morbidity. One limitation is that persons who buy life insurance may not represent the American population. They earn above-average income, are Caucasian, are free of serious medical diseases, and are usually engaged in “safe” occupations. The mortality rate among insured individuals is only about 90 percent of the rate for the entire population at all ages between 15 and 70.17

The information obtained from analysis of the life insurance experience is valuable for two reasons. The sample size is large, comprising several million individuals. Second, the individuals are continually followed until death, an event in which the life insurance companies have a financial interest. Figure shows the relation between excess mortality and deviations in body weight. The overall mortality rate—that is, the ratio of deaths to the total population of insured lives—was taken as 100. The

insured individuals were subdivided into subgroups based on the percentage deviation from the mean for the entire group. The death rate in each subgroup was then compared to the population as a whole and expressed as deviation from the overall mortality of 100. The minimum death rate occurred at a body weight that was slightly less than the average weight for the entire population. As body weight, expressed as the BMI (kg/m2), increased, there was a progressive increase in “excess mortality.” There was also a small increase in excess mortality with very low body weight. This was more pronounced in the younger age group than in the older one and may reflect a higher number of smokers. The excess mortality among those with life insurance was due to diabetes mellitus, digestive diseases, hypertension, cardiovascular diseases, and cancer.

Comparison of the Build and Blood Pressure Study of 1959135 with the Build Study of 1979136 reveals several facts. Body weights of insured Americans were higher in the recent study. However, the curvilinear relation of excess mortality to BMI was evident for all age groups in both studies. Unfortunately, few grossly obese individuals were insured in either study. The implications from the life insurance studies is that obesity is hazardous.

Drenick and associates36 provided a clear insight into the effects of gross obesity on life expectancy. They reviewed two hundred morbidly obese men whose average weight was 143.5 kg, who were admitted for a weight-control program and followed for an average period for seven and a half years. Of these men, 185 were followed until death or termination of the study. The age range was 23 to 70 years with a mean of 42.7 years. The mortality rate was higher at all ages when compared with the mortality expected for the general population of U.S. males. In men aged 25 to 34, the excess mortality was 1,200 percent! In those aged 35 to 44, the excess mortality had declined to 550 percent, and in men 45 to 54, it was 300 percent. In men aged 55 to 64, the excess mortality was only double that of the normal U.S. population. This study showed that the excess mortality associated with obesity is greatly increased in the younger age groups and that excess mortality is substantially higher in grossly obese persons.

Effects of Obesity on Health and Happiness

The medical and social problems identified with obesity can be manifested in many ways. Obesity may decrease longevity, aggravate the onset and clinical progression of maladies, and modify the social or economic quality of life. On the positive side, weight loss can reverse all or most of the disadvantages of obesity.

Most of the data relating health and obesity have been collected and analyzed in terms of overweight. Overweight refers to deviations in body weight from some “standard weight” related to height. Being overweight, however, does not necessarily mean being obese. This distinction is most obvious in athletes but may also apply to other groups and individuals with body weights only slightly above the upper limits of normal. The correlation between measures of body weight such as weight divided by height, percentage overweight, or body mass index (wt/ht2), have a correlation of between 0.7 and 0.8 with body fat measured by other more precise laboratory methods. Of these indices, the body mass or Quetelet index has the highest correlation with body fat. In this chapter the following definitions will be used.

Penile Injection

Puncturing one’s penis with a needle is not for the squeamish. Piercing the penis with a needle and then injecting a chemical to enhance one’s sexual potency sounds more like a bizarre, sadomasochistic nightmare from the annals of Krafft-Ebing Psychopathia Sexualis than a doctorrecommended treatment of impotence. Nevertheless, many men, with guidance from their physicians, practice self-injection of the penis to achieve an erection. Three types of medications — phentolamine (an alphablocker), papaverine (a smooth-muscle relaxant), and alprostadil (a prostaglandin) — may be loaded into syringes and injected directly into the penile erectile chambers to provoke an erection.

Phentolamine, papaverine, and alprostadil are all effective in stimulating erections because they overcome neurologic signals that normally keep the penis in a limp or flaccid state and help encourage the release of intrapenile chemicals like nitric oxide and cyclic GMP to increase blood flow into the corpora cavernosae. Neurologic control of erections is vested in the sympathetic nervous system.

To understand how the sympathetic nervous system works, it is useful to create a simple scary example. Imagine that you are alone at night walking down a dark street. There is no sound. Then, as you are absorbed with your thoughts, someone comes up behind you and says, “Boo!”

Your sympathetic nervous system immediately swings into action to cause, among other reactions, an increase in pulse rate and blood pressure. The change in pulse and blood pressure is caused by internally produced adrenalinelike compounds with unique properties designated “alpha” or “beta.” Beta forces cause you to have palpitations and an increase in pulse rate, while alpha influences raise your blood pressure.

What does this have to do with erections? The penis is richly endowed with extensions of the sympathetic nervous system, specifically nerves of the alpha type. Alpha signals either facilitate or inhibit normal erections.

When the alpha forces dominate, the penis remains at rest. An injection of a medication that blocks the erection-inhibiting alpha nerves makes it possible for a full and unrestrained flow of blood to be directed into the

erectile bodies of the penis. Medications like phentolamine, an alphablocker, and prostaglandin El, a muscle relaxant with probable alpha-blocking activity, cause erections by blocking the nerve signals that maintain the penis in a limp state.

It is somewhat more difficult to understand exactly how papaverine works. There are no papaverine receptors in the penis. Papaverine, unlike alpha-adrenergic compounds or prostaglandins, is not made by the body. However, papaverine has one characteristic that is useful in inducing an erection; it is a smooth-muscle relaxant.

The body has two types of muscles, striated and smooth. Striated muscles are literally striped in appearance and are, for the most part, under voluntary control. The muscles of the arms, legs, and face are striated muscles. Smooth muscles are not under volitional control. For example, the muscles in the intestines are smooth muscles. The muscles lining the penile blood vessels that must dilate for an erection to occur are also smooth muscles. It is presumed that papaverine induces an erection by causing these intrapenile smooth muscles to relax, thereby allowing or encouraging increased blood flow into the penis.

To be fully effective, alprostadil (Caverject) or other similar medications must be injected directly into one of the penile erectile bodies, the corpora cavernosae. (The medication will naturally migrate over to the other side of the penis so that symmetrical erection is acquired.)

A cross section of the penis illustrates the corpora cavernosae surrounded by the thick outer fibrous sheath (tunica albuginea).

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