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I begin to think I will have no peace, my inbox gets another of those annoying spam messages telling me how wonderful Levitra is (or how many times Paris Hilton has had sex with the Boston Philharmonic Orchestra). Gone are the days when I could just tweak the filter to include the latest permutation on cheap Viagra. Now these ingenious spammers are into jpgs and all kinds of other tricks to get through the mail servers. Images are hard to filter out.

It’s not that I mind being reminded every now and then what the wonderful little blue pill can do. After all, there was that time a year or so back when I had a bad patch and found out how good Viagra is. But to have something every few minutes is just egregiously bad. Why this post? Let me tell you. When I was just starting out in IT, one of the standard tools was ASCII - a code for characters, numbers, symbols, etc. And what did we clever people do when we got bored? We made pictures out of all those characters. And guess what’s just popped into my inbox. You got it. It’s a headline, “Viagra - $1.10″ with the message built out of ASCII. So it made me sit up and take notice - just like taking Viagra really. Those clever spammers have found a new way to beat the filters.

Government now accepts that prescription medications are routinely abused. You only have to go into the emergency departments of hospitals to see the truth of this. In 2005, there were more than 2 million admissions caused by the non-medical use of drugs. One of the reasons for this is the easy availability of drugs that can give you a “high” both over-the-counter and through the internet. But it’s not helpful to see drugs as the only solution. Yes, xanax relieves anxiety, but you don’t want to become an addict. You need to change yourself. The way the world works today, people do need help. Drugs like xanax really do help them to cope with the stress. In the medium to long term, psychological support is the way to learn how to control your fear and worry. Live life the natural way, don’t pay endlessly for “help” through a bottle of tablets.

Every year, Xanax has been winning the prize in the “most prescribed” category. Naturally, Pfizer, the manufacturer, loves these annual headlines. They help customers believe this drug is so popular because it really works. Well, that’s true to some extent. If you take xanax for the right reasons and under proper medical supervision, it does reduce levels of panic and anxiety. But you can’t change the fact that it’s one of the benzodiazepines. That means it’s habit-forming. Take it for too long or at too high a dose and you’re likely to get hooked. So before you go down this path, think carefully.

All that we can say with any certainty is that those who are deprived of sleep do not do as well as those who sleep through the night. The sleepless so often end up demotivated, their sense of humour worn thin, their judgement warped. Some grow fat. Others find their immune system affected. Sleep seems so indispensable yet no-one can really control it. Greene describes everything she has tried over the years from relaxation therapies to medication like Ambien, but concludes that, like any intimate relationship, how we relate to sleep is always personal. Well, yes, I am going to tell you something about a new book. Appropriately enough for a site devoted to Ambien, it is Insomniac by Gayle Greene. So here is an autobiographical take on what it is like to live with insomnia by a woman who ought to know. She wins this prize even though not a medical researcher because she is the “patient representative” on the board of the American Insomnia Association, which operates within the AASM’s umbrella. In her spare time, she labours at the Scripps College, Claremont California as Professor of Literature and Women’s Studies. This latest tome adds to her impressive resume of academic publications.
This is a highly personal account by an articulate and intelligent woman who has been afflicted by insomnia for most of her adult life. In one sense, the only person who can really tell you what it is like in a foreign country is one who has been there. For those of us who have always been able to sleep without difficulty, insomnia is like a foreign country, and the idea of having to use a medication like Ambien as the passport to get into sleep is alien. Conventional wisdom always says that insomnia is somehow related to anxiety or stress levels, perhaps aggravated by drinking too many cups of real coffee. Greene comes up with a simple and practical explanation of what insomnia is. Insomnia means nothing more than you cannot get the number of hours of sleep you need to feel good about yourself and function efficiently. There is no reason for this. It is nothing more than a failure to sleep. There should be no pejorative implication. To use stress as an excuse is to blame the person for being weak or neurotic when there is no reason to blame yourself or anyone else. Instead of looking for some psychological explanation or a less judgemental physical cause, we should just accept that it happens to about 20% of the population at one time or another during their lives. Such a vast number of people yet so little is spent on researching the condition and its causes. Greene comments that the National Institutes of Health in the United States spent less than $20m in 2005, whereas Sanofi-Aventis spent more than $120m promoting Ambien in the same year. This is neither to praise nor condemn Ambien. It is all a question of priorities. Why bother to spend Government money on researching the cause of a condition when private capital has already invented treatment as a cure for it? She debates what we really understand about cause and effect. It is so easy to get the cart before the horse, or should that be the other way round? Perhaps conventional wisdom has also got things back-to-front. Instead of stress and anxiety being the cause of insomnia, perhaps living with insomnia makes you stressed and anxious. But was that actually the case? Who can say what the real biological norms were before electricity came along and gave everyone the chance to live through the darkness. As it stands, no researcher can actually explain why we have to sleep nor why some people sleep more than others. It is all guesswork. She is a passionate advocate for greater patient power to persuade disinterested bodies to research insomnia. For one who has had to depend on Ambien and the other medications for so long, she feels she and all other sufferers deserve better answers than those served up by the pharmaceutical companies. For one who has never had problems sleeping nor had to take Ambien, Insomniac was a riveting insight into the condition and the problems it causes. Required reading for everyone who reads this article.

It is object of the great interest to surf on the internet. There is always somebody thinking something interesting somewhere in the world. All you have to do is to find him or her. Take just one story from Minesotta as an example. It raises the difficult question of how you should dispose of “pills” you no longer need or which have expired. You could, of course, get in your car and drive down to your local pharmacy. Many offer a service to dispose of old and unwanted medications for you. But, the majority of us probably find the effort involved a deterrent. Why go to so much effort when you have a dumpster just outside your door? Or, if even that is too much effort, there is always the option to flush the problem away. Who would know? Who cares anyway? Do you ever wonder what happens after casual disposal? Your local waste management authority comes round to collect the refuse which is then dumped. There is little or no effort to sort the waste. Most authorities simply drive to the nearest landfill site and tip each load on to the growing mound of other rubbish. This pile then rots down as rain washes through it so, sooner or later, dissolved drugs end up in the watertable and potentially get recycled into your drinking water. The medications flushed go more directly into the water supply. So here is the worry. The rivers downstream from you supply water to the local towns and cities. That water supply contains what the experts call a “sub-lethal” cocktail of antibiotics, sedatives, painkillers, hormones and whatever else you so casually threw away. Perhaps you have no interest in the people downstream of you. I wonder what the people upstream think of you. But, back to Ambien. Ambien is, of course, a nonbenzodiazepine hypnotic. The DEA’s Office of Diversion Control aims to prevent the diversion of legitimately manufactured (or used) controlled substances into the illegal drug traffic. If there is no-one else immediately available to handle the disposal, the controlled substances should be collected by a law enforcement officer. So, if your local pharmacy has not registered with the DEA, their only way of disposing of your unwanted drugs is to call the cops. No wonder they looked so pleased when you asked. But San Mateo County, California has placed collection boxes inside the entrance halls of eleven police departments. Anyone can walk in and leave their unwanted medications and walk out - no questions asked. And is this a welcome service? Over the first fifteen months of the program, local citizens have deposited 1,800 pounds of medications. I am never reassured by the prefix “non”. In fact, Ambien works in exactly the same way as a conventional benzodiazepine and is probably just as addictive. For this reason, Ambien is listed by the Drug Enforcement Agency as a controlled substance in Schedule IV. You will be pleased and delighted to know that the US Government has your interests at heart. It always wants to protect you and the environment. State and Federal regulations limit the handling and disposal of controlled substances to DEA-authorised individuals and organisations. So there is clearly a demand for this kind of service. It is pure self-interest, of course. Who wants to get high from drinking tap water? And do we really want all those bacteria out there to get used to all those antibiotics in the water? If you don’t know the answers to these and other questions of social conscience, take an insomnia remedyand sleep on it.

But there are many who do respond well, moving away from reliance on drugs such as tramadol as they learn how to function within the limits set by their bodies (and minds). Unfortunately, this approach is expensive. A physician sees a patient for a few minutes, writes a prescription and moves on to the next patient. This is an “efficient” use of resources. Conventional hospital and health service models find this an uneconomic use of scarce resources (often choosing not to research the effectiveness of this approach to treatment). Nevertheless, there is a growing and substantial body of research now attesting to the effectiveness of this form of approach. If you have chronic pain, you should consider it. Learn more about tramadol pain relief medication from www.tramadolbliss.com

The research strongly suggests that a mixture of physical and psychological therapies offers the best chance for improving outcomes. One of the most common forms of pain pain affects the lower back. Yet it is often the case that there is no biological evidence of the cause of the pain. No apparent external injury. No x-ray or other scan image of internal injury. The most usual association is with changes in mood, variations in the levels of anxiety or stress, or social episodes which trigger the sensation of pain. In other words, the way you perceive pain cannot be divorced from you as a person and the collection of memories and experiences that define you as an individual. So if pain persists despite the standard medical treatments (including the use of drugs such as tramadol), it is time to expand the range of treatment to include therapy. The primary problem is that people quite naturally make their own condition worse. When they feel pain, they stop moving. They generally avoid doing the things most likely to cause the pain. More often than not, this means they rest. Unfortunately, when you rest, you lose muscle tone and tend to become stiff. This actually worsens the initial condition. Because you feel you cannot continue to function, you lose self-respect. Now confining yourself to bed, you lose your role as breadwinner or homemaker. This may impose financial hardship on the family or damage your relationship. As your mood darkens, depression can further amplify the symptoms. Physicians are trained to apply a “scientific” approach to patient care. They make a diagnosis and supply the treatment recommended. If the diagnosis is correct, the patient gets better. Psychiatrists and therapists do not deal with the world in such black-and-white terms. They take a more holistic view of the patient. If there is disability and distress, those symptoms should also be addressed. The intention is to improve the way in which anyone deals with the pain. It offers coping strategies, problem solving and giving people a way to resume activities and thus relieve frustration. The more people can be given back some control over their lives, the more likely it is that they will begin to think more positively about their situation. It is important to begin with physical therapy to improve mobility. Therapists will analyze activities and teach people how to get the same results by modifying their behavior. Add in relaxation training and stress management exercises, and you now begin to see a more complete route to recovery. This is a team effort with psychologists working alongside occupational therapists, physicians and nurses. Thus, if a physiotherapist gains some insight into the beliefs and fears a patient has about mobility, a program of reward and reinforcement can be established which teaches people about how their body works and why their fears are exaggerated. Noone can force you into anything. But if you are shown a better way, most will take it if given the right incentives. Not everyone does respond to therapy, resisting interference in the way “they” do things. It also relies on effective management of the team expected to deliver these results. So, it is easy for non-medical treatment to fail (which will often confirm the patient’s prejudices).

On 15th July, the Federation of European Pharmacological Societies Congress began a discussion of the medicinal role of cannabis. Why does this work? Because the human body naturally produces cannabinoids and has cannabinoid receptor cells in all parts. Science is now designing medications that focus on the parts of the body affected by disease and not the central nervous system. It is routinely used for controlling nausea among patients on chemotherapy and for encouraging appetite among AIDS patients. It is now licensed for the control of neuropathic pain in adults suffering from cancer and multiple sclerosis. So medical science has been able to strip away the “unwanted” psychoactive symptoms and use the cannabinoid components to target the specific diseases. So, for example, when the body is injured cannabinoids are naturally released in the affected area and reduce pain. Unfortunately, the effect is very short-lived. Thus, research is now aiming to produce more medications that maintain cannabinoid levels in the affected areas for pain relief and for the control of anxiety and depression. If you take cannabis as a weight loss medication, it really can help you to forget about food. So, medications like acomplia that block the cannabinoid receptors help to reduce addictive behavior and reduce appetite. The July conference heard news that one constituent of cannabis, THVC, may offer a better way to reduce appetite than acomplia and, more importantly, may be effective to treat neurodegenerative disorders like Huntington’s disease, Parkinson’s and Alzheimer’s. Why is more not heard about these advances? Possibly because of the prejudice that cannabis is a drug that should be banned. By coincidence, the French health authority Afssaps also released new statistics confirming the safety profile of acomplia in relation to depression. People with no history of depression show no adverse symptoms. Others only show an increase in depression at the beginning of a course of treatment.

Modern medical textbooks have all become so much more informative. It can tell complicated things in simple words. Yet, when you look at these books, you are confronted by mountains of facts about increasingly minute processes within the body. Students are expected to be impressed by the depth of knowledge because instead of one sentence approximating how a muscle works, there are now whole chapters devoted to the thin muscle filaments containing multiple proteins. This is my wood-for-the-trees moment.

Erectile dysfunction can now be described in terms of complex chemical interactions and illustrated with wonderful diagrams. There are still all kinds of analogies with hydraulic engineering, but the sophistication of the functional analysis is breathtaking. However, it is not a part of the medical books to observe and describe the entirely human context in which the erection is supposed to operate. A single male may masturbate. Multiple partners may engage in group sex. Many different social taboos would potentially be breached in any more detailed explanation. The greater the pleasure, the greater the incentive to engage in the activity and the greater the disappointment if success is not achieved.

Will medical treatment be asked for and a success? In part, this will be determined by the nature of the relationship. Where the relationship is socially disapproved, the man may well not seek treatment at all because of fear. A physical examination might reveal different types of sexual activity, or a chance remark in the consultation might expose the forbidden practices. This is ironic. Well-established sexual intimacy and commitment preserve the right level of desire and motivate everyone to getting a solution that works well. Were it not for online pharmacies and their willingness to supply medications like cialis without prescription, many partnerships might never be able to get appropriate treatment of any kind.

This is two completely different cultural imperatives in conflict. Men are socially conditioned to believe that they will always be able to have an erection. Any publicly acknowledged failure means shame. Yet they are only allowed to have erections in certain very carefully defined social situations. Step outside those situations and you are into potentially disapproved or even criminal territory. In theory, doctors are bound by duties of confidentiality, but the fear of exposure means that many men and their partners do not get treatment when the research shows that couples who are in love and share a strong commitment to their relationship are the ones who would most benefit from that treatment.

The number of causes of erectial disfunction is much more than you can imagine.

I suppose I’m coming to Diabetes slightly later than I should. Erectile Dysfunction is quite a common early symptom of Type 2 Diabetes, cardiovascular disease or both. If you read some books about this problem 12% of patients who are later confirmed as diabetic first appear in the consulting rooms complaining of ED. Putting this before the horse, the evidence is that treating ED in cardiovascular patients who are also diabetic significantly reduces the mortality rate. So some good can come out of treating ED, usually with Cialis, Viagra or Levitra although, it is better to prevent the onset of the Diabetes if at all possible, say, by reducing excess weight.

The cause of ED in diabetic men usually has both organic and psychological elements. Even if the first cause is not psychological, the onset of organic ED almost inevitably produces serious performance anxiety and, if not treated, depression. The combination inevitably affects the libido and this reinforces the disability.

Disease with decreased flow of blood into the penis through arterial narrowing, hardening and closure, high blood pressure, peripheral nerve damage, hormonal problems, say, because of decreased gonadal function, and obesity are all more common in diabetic men and each one may be the cause of your ED. Another cause of ED is diabetic desease.

So that leaves us with the question of how we treat both the ED and the diabetes.

• Try to control the level of blood sugar can prevent the nerve and blood vessel damage that leads to ED.
• Many of the medications used to treat high blood pressure and depression may cause ED. Sometimes, a simple change can restore function.
• Smoking and other uses of tobacco, (a) constrict and may block your blood vessels; and (b) can also reduce nitric oxide levels, both of which which may limit the flow of blood into your penis.
• Don’t drink to much alkohol.
• Performance anxiety and depression can cause ED. To keep your stress levels under control, you should review your current tasks, and set more reasonable goals and deadlines.
• Join the club or gym to prevent ED.
• If you sleep well, you are less likely to suffer from ED.

I can also consider Viagra, Cialis or Levitra, but these drugs are not safe if you are taking nitrates to treat heart disease or alpha blockers to treat high blood pressure or prostate enlargement This takes us into new territory for these articles. The vacuum constriction device works no matter what the cause of the ED. You also can stick a needle in your penis to maintain erection. Surgery and penile prostheses implantation are highly successful, but there are greater risks of infection when operating on diabetic men.

Thus, there are well-established systems for treating both diabetes and ED. There is no need to suffer in silence. Your sex life can be restored in most cases, albeit that sometimes, you cannot rely on a simple pill to solve the problems.

A few years back, the Massachusetts Male Aging Study (MMAS) of men aged between forty and seventy years found that 28% of men with diabetes had ED - about three times the incidence in the general population. Averaging out the later surveys over the age range, ED develops between ten and fifteen years earlier in men with diabetes. Above the age of 50 years, between 50-60% of men with diabetes will have difficulties with an erection. Above 70 years, it is almost certain that diabetic men will have some difficulty with erectile function.

At the meeting of the American College of Cardiology held in Chicago this March, Merck & Co released some clinical data from the Phase III trials for their proposed competitor to acomplia (rimonabant). This new medication, still going by its generic name of taranabant, targets the same cannabinoid system as acomplia. It is therefore interesting to compare results since, if it gains regulatory approval, it will be a direct competitor to acomplia.

The randomised, double-blind and placebo-controlled trials recruited more than eight hundred participants who all had at least BMI 27. Merck & Co disclosed the preliminary results calculated at the end of year one of what is intended as a two year trial. In conjunction with a diet and exercise program, 28% of those taking a 2mg dose of taranabant lost more than 10% of their body weight, while 57% lost 5% of their body weight. Almost 8% of those on placebo also lost 10% of their body weight through diet and exercise alone. In terms of averages, participants taking a 2mg dose of taranabant lost 14.5 pounds compared to 5.7 pounds on placebo. Depending on how you view these things, this could be viewed as a failure because Merck & Co announced in advance that it was aiming for a minimum 5% body weight loss in all participants taking their medication.

In 2004, Acomplia’s results were that 32% on Acomplia lost more than 10% of their body weight while 62.5% lost more than 5% of their body weight. But these results were obtained at the higher dosage of 20mg as opposed to 2mg taranabant. The reason for the difference in the dosage levels is that acomplia is a CB1 receptor antagonist that blocks endogenous cannabinoid binding to neuronal CB1 receptors, while taranabant acts as a selective cannabinoid-1 receptor inverse agonist, binding to CB1 receptors. I am glad we have got that clear.

Merck & Co also tested higher doses of 4mg and 6mg but admitted problems with psychiatric side effects. It confirmed that taranabant would probably only be brought to the market at the lowest 2mg dose. Because the FDA has already expressed concern about similar side effects in acomplia, the Merck trials looked more specifically for evidence of the effects. It seems that 28% of participants on the 2mg dose reported side effects but it is not known how severe they were.

Because both medications work in a similar way, it always seemed likely that they would have similar problems with central nervous system side effects. Given that acomplia was given a rough ride by the FDA, it would seem unlikely that taranabant will fare any better on the information so far made public. Although both seem to improve the levels of high-density cholesterol and to bring down the level of triglycerides which will help to reduce the risk of heart disease, the fact that both have been associated with feelings of depression and, in some cases, suicide will probably mean that neither will be approved in the US in the near future. Even if the current trials for acomplia produce results with few or no central nervous system side effects, the results of taranabant may still drag acomplia down. If taranabant is also producing unacceptable levels of psychological disturbance at 4mg, acomplia does not look so good at higher dosages.

Nevertheless, this must be placed in a proper context. Acomplia has, of course, been available on prescription in Europe for two years and there is no emerging evidence of problems sufficiently serious to justify withdrawing approval. Indeed, it has just been given a further level of approval in the UK. If acomplia continues to accumulate a positive safety record, this may offset any prejudicial implications in the US from the taranabant trials. What should be relatively uncontroversial is that the use of the cannabinoid system for the treatment of obesity should remain firmly on the research agenda. Acomplia continues to offer an effective supplement to diet and exercise regimes. As its effects are better understood, the reported side effects may be better controlled.