Jan 05

Photo src: thetastingnote.com

Viagra, the popular anti-impotence drug, may stop working for many patients after 2 years, the results of a study suggest.

Dr. Rizk El-Galley of the University of Alabama at Birmingham and colleagues interviewed 151 men who had filled prescriptions for Viagra. Overall, 74% reported that 25 milligrams (mg) to 100 mg of the drug enabled them to initiate and maintain erections sufficient for intercourse.

The improvement rate ranged from 50% for patients with impotence caused by diabetes, to 78% for those with no specified reason for impotence, to 100% for those with suspected leakage in their veins.

3 years later, the investigators re-interviewed 82 of the men, of whom 43 were still using the drug. Sixteen of those 43 (37%) said they had needed to increase the dose by 50 mg to achieve an adequate erection. It had taken between 1 and 18 months for the treatment to lose its effects. There was no correlation between the need to increase the dose and frequency of use.

‘In general, 81% of patients who were still receiving treatment were satisfied, and 92% were able to achieve and maintain erections sufficient for sexual intercourse in more than 50% of attempts,’ El-Galley and colleagues wrote in The Journal of Urology.

Of the 39 patients who had stopped taking Viagra, 28 had initially reported a good response. Fourteen of those patients who stopped said the drug no longer worked, and six said they had regained the ability to have spontaneous erections.

There is notable disappointment about the fading powers of the ‘blue miracle pill’ in the professional world. ‘According to my observations, Viagra only helps half of all patients with erectile dysfunction caused by physical factors’, P. Derahshani, head of the urology department of the K├Âlner Klinik am Ring (Cologne, BRD) reports. A potential health-risk lies in the fact that for patients showing habituation effects, the dose can only be rised by the ones who have previously used 25 or 50mg, while for doses above 100mg, the risk of side effects such as circulatory weakness, nausea or headaches increases remarkably.

No substitute for psychotherapy or sex therapy

“One should not forget that Viagra is only indicated for erectile dysfunction for those men whose potency problems have physical causes,” the Viennese urologist Werner Reiter of the impotence clinic at the Vienna General Hospital said in an interview with the “S├╝ddeutsche” (SZ). Especially in older men who smoke a lot and suffer from high blood pressure or heart disease, Viagra often loses its effect after prolonged dosing. In men with stable health, on the other hand, there is rarely a (physiological) habituation effect.
“If the impotence is caused by mental factors, Viagra will just cover up the first symptoms for a while,” warns Reiter. For long term success, these patients could only be helped with psychotherapy or sex therapy.

Health risks often underestimated

Fatally, many men ignore or underestimate the risk of self-medication. But an alarming number of 40 percent of the men who visit a doctor because of erection problems, suffer from arteriosclerosis of the coronary arteries (which may, but is not always the cause of erectile dysfunction). Impotence ‘may nevertheless be a sign of a disease or an incipient disease. However, to simply cover up symptoms and to look away from the real causes, has never worked out on the long run, neither in medicine nor in psychotherapy,” says sex therapist Karl F. Stifter. It is important to keep the whole person in mind, which in this case would mean to check for physiological causes of the erectile dysfunction before considering any medication.

Underestimated by many men is the risk of suffering a heart attack. Like most drugs that interfere with the blood circulation of the body, Viagra & Co. involve special risks for patients (sometimes unknowingly!) suffering from heart conditions. In particular, patients who are taking nitroglycerin or blood pressure lowering drugs, which also relax the smooth muscles, may not take the pills to avoid potentializing their effects. Together with medications containing nitrate (eg for angina pectoris), the drug may lead to a fatal drop in blood pressure and heart diseases in men with circulatory failure. An examination by a physician is therefore absolutely necessarily before taking them.

In fact, no other medications are responsible for as many deaths due to negligent use as the new “erection helpers”. Worldwide, 616 deaths after taking Viagra were reported during the first 3 years after its introduction alone. The easy availability of the tablets over the Internet or on the black market poses a big problem, because they are extremely inviting for self-medication, and there is a relatively high risk to purchase harmful imitations. The ‘copycat’ market of the tablets, mainly India and China, is hard to control, with all the associated risks for the end user. Often enough the tablets are also not only taken at a far too young age, but also abused as kind of a ‘lifestyle drug’, completely ignoring the impact on the cardiovascular system – and probably also the production of our endogenuous ‘drugs’ that help to build and maintain an erection, as the study mentioned above could indicate.

So there is reason to expect a massive increase of the number of ‘Viagra Veterans’ during the next years who suffer from what I’d call ‘multisystemic erectile dysfunction’: psychogenic erectile dysfunction by men who furtheron developed organically caused erectile dysfunction either from resistance against the drug or by underproduction of endogenous drugs from longterm use of the supplementary drugs). These men may well find themselves suck in a dead end once they reach an age (or have to deal with side effects of physical illnesses) involving a natural decrease of the erectile function without many remaining options to treat their impotence.
It has been proved that in the vast majority of men under the age of 50, erection problems are caused psychologically – but even (and especially) at a higher age, a medical examination is necessary before starting to take medication. If there is no clear evidence for a physical cause, in the interest of one’s health (and perhaps also to keep the “Viagra trump card” for more difficult times), it is recommended to seek counsel from a sex therapist or psychotherapist rather than to reflexively grab one of the readily available “blue pills”.

(Sources: Reuters.com; Rizk El-Galley et.al., “Long-Term Efficiacy of Sildenafil and Tachyphylaxis Effect” in: The Journal of Urology – September 2001 (Vol. 166, Issue 3, Pages 927-931); Image source: creakyeasel.com)

Aug 10

Antidepressants are now the best-selling drugs in the USA – and their consumption has doubled in the last 10 years.

This was established by a meta-analysis of studies from 1996 to 2005 among 50,000 children and adults and published in the Archives of General Psychiatry. Currently 10 percent of Americans – about 27 million people – are taking antidepressants, approximately twice as many as in 1996.

Only half of these people, however, are actually treated solely for depression, the rest are taking the drug because of back pain, fatigue, insomnia and other problems. So the increased consumption doesn’t necessarily mean that more people are depressed, but that the drugs are used to manage or facilitate everyday life, and probably also as mood enhancers.

This also fits the other findings, namely that the proportion of people who take antidepressants and who are undergoing psychotherapy at the same time dropped from 31 to 20 percent. Presumably many feel insecure about dealing with the reasons for their psychological problems or are uncertain about whether psychotherapy could really help – while the belief in the effectiveness of drugs is increasing. Also, ‘dropping a pill’ is simple and costs less money – at least in the short run, especially since many American insurance companies don’t pay for psychotherapy, and doctors prefer prescribing drugs over dealing with their patients thourougly as this saves valuable time for other patients waiting in the queues.

The study’s authors argue that an essential factor for these changes may represent the enormous dedication of funds for advertising: for advertisements aiming at end users (patients), 32 million USD were used in 1996, but already 122 million USD in 2005. Only 14% of the proceeds from sales had been reinvested in research and production by the industry – the rest goes to marketing and profit distributions 1.

Update:
A reader of this post has sent me a graphic his company, MedicalBillingAndCodingonline.org, has created and released under the Creative Commons License. I think it illustrates the major aspects of the current trends just great. Please click here or on the image at the right or download a large version of the graphcic from the author’s site.

(Sources: New England Jornal of Medicine in an interview by The Nation, 20090809; “National Patterns in Antidepressant Medication Treatment” by Mark Olfson & Steven C. Marcus in: Arch Gen Psychiatry 2009;66(8):848-85)

Jul 22

At a conference organized by the Health Promotion Fund for a Healthy Austria, experts recently lectured on approaches to resolve critical future scenarios. One of the core points was the question of the affordability of health care.

Obesity is one of the most pressing health problems and is consistent across all age and social groups. One in five pupils between six and 15 years has an excessively high body weight, eight percent of them are actually obese. Of the adults between 18 and 65 years, almost half are overweight or obese. “One consequence of these developments is an increasing wave of disease and therefore costs to the health care system, because being overweight is a major risk factor for cardiovascular disease, type 2 diabetes and certain cancers,” said Ch. H├Ârhan, head of the funds.

Stress, on the other hand, is an indirect co-causing factor for cardiovascular diseases and mental disorders – albeit indirect and thus often underestimated by health policies. According to surveys, the percentage of Europeans feeling stressed out has raised significantly over the last 10 years. The number of prescribed psychotropic drugs has also increased, as has the number of sick days due to mental problems according to one of the contributors. Among the reasons for invalidity pensions, mental illnesses is already in second place with 29 percent.

Stress can not only be caused by heavy workload, but also by financial problems, difficulties within the social environment or worries about the future. In the past few years, the influence of social, economic and social factors on the health of the population has become clearer – but still with only little consequence on health policies.

Sidenote by R.L.Fellner: according to latest research, apart from other hormonal changes involved by stress, cortisol distribution increases – under certain conditions, this can be a contributing cause for obesity (Cushing’s Syndrome / Hypercortisolism [more]).

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06.01.16