My Online Journey

Because diagnosis and treatments have been improving steadily over the last decades, more men than ever before are now living longer with cardiovascular disease. In the last century, heart attacks were the most common cause of death by a significant margin. Now with better drugs and lifestyle changes, deaths from cardiovascular disease have been falling. But this does not mean that these men have a satisfactory quality of life. The majority of men are now older, overweight, living in deprived areas and depressed. Many also find themselves affected by Type 2 Diabetes as the weight increases. It’s difficult to prevent this development because, with limited budgets, most men cannot afford healthy food options. Cheap processed food has a high fat content and excess salt. General risks are increased significantly if the men also smoke and neglect to take any physical exercise.

As a routine, men should be encouraged to monitor their waist measurements as a simple means of judging when the risks are rising. Anything over 37 inches for men (and 31.5 inches for women) is in the danger zone and suggests the need to check blood pressure. Once a person is at risk, there should be positive intervention to counsel lifestyle changes, starting with quitting smoking and eating a more healthy diet to reduce the cholesterol levels. However, there is a significant link between cardiovascular disease and erectile dysfunction (ED). It may be a side-effect of the drugs to control the cardiovascular problems, damage to the arterial system or nerve endings, or it may be linked to the depression many experience. The interaction between these factors can produce a vicious cycle. As the ED worsens, depression deepens justifying more powerful drugs that further affect sexual performance.

All men at risk should be asked a direct question, “Are you suffering from ED?” If the answer is, “Yes.” this should trigger a review of the drugs being taken, and the prescription of viagra to begin restoring sexual activity. However, to be effective, men must be convinced that ED is a symptom of cardiovascular disease and be prepared to answer the question honestly. Too many consider such a question to invade their privacy, and either lie or refuse to answer. In its own right, this process is difficult because those who live in poverty and in deprived areas are often not contacted as easily and are reluctant to come into clinics for any type of treatment. It may be necessary for local health providers to physically go into the community to provide health screening and health assessments. This is preventative medicine as it should be practised. The earlier ED is identified as a predictive symptom of cardiovascular disease, the more men may be saved the trauma of a stroke or heart attack. This will require a diversion of funding to community-based medicine and to state funding of medications such as viagra to help treat the ED. But it should save money in the long term.

Life is never fair. Even though the majority may avoid some of the worst possibilities, there are always the few who seem to have the worst of luck. Look around the media and it’s impossible to avoid the stories. Sometimes, it’s news of accidents and crimes where we are shown the victims and their suffering. Sometimes it’s the way of collecting charitable donations. Images of young and old are everywhere reminding us that there will always be some who need our help. One of the ways in which we prove we are human is through empathy. By our willingness to put ourselves in the position of others and to imagine what it would feel like to have their problems.

For both men and women, there are hormones and biological drives which guide physical growth and give us an interest in reproduction. Because of the physical gender differences, boys and girls are nurtured to have different functional expectations. Being a man means fertilizing the eggs. Being a woman means having the resulting babies. In later life, should something happen to interfere with reproductive abilities, those affected can at least look back on some life where pleasure and function worked together. But it is emotionally difficult when nature or an accident denies you the chance to experience sexual activity. Although those affected never know what they have missed, there is an underlying sadness and frustration.

For teenage boys, erectile dysfunction (ED) is not a common problem. As a result, there is little research. Most healthcare providers prefer a simplistic and dismissive diagnosis of psychological dysfunction and, where there is medical insurance to cover it, refer those affected for counseling. Such research as there is actually prefers formal assessment of the vascular system. A recent meta-research study examined research carried out between 1998 and 2003, looking for common factors in diagnosis and treatments for teenagers under the age of 19 years. On average the young men had suffered symptoms of ED for an average of two years with the most common causes being perineal and penile trauma, and surgery. Formal vascular examinations were carried out in 60% of all cases and almost half were found to have serious problems justifying further angiographic study or surgery.

In other words, half the teenagers given a formal test were found to have abnormal blood flow as the explanation for their ED. The practice of routine referral for counseling is expensive and ineffective because, in most cases, the usual consequence of recommending viagra will not represent the best treatment. Indeed, because of the expense, most healthcare providers simply write out a prescription for viagra and send the patients away with the reassurance that they will grow out of it, or everything will work out fine when they meet the right woman. At the very least, there should be a detailed survey of medical history to see whether there is evidence of traumatic injury as the trigger for haemodynamic testing. Our young always deserve the best treatment.

One of the reasons why marriages get into trouble is sex, or the lack of it. So when viagra came along ten years ago, a lot of men with erectile dysfunction thought they would all be able to save their marriages by being able to resume sex. Except, if you have a bad marriage, sex is not going to help. In fact, it may trigger an early departure. Now, let’s change the perspective. If a woman loses her sex drive, viagra is of no help to her. Ignore the myth on that score. Women who buy Viagra for recreational use get nothing in return.

There are a number of reasons why women find their libido reducing. Some drugs have that side effect so, changing the drugs or reducing the dosage can restore interest. But more usually, it follows surgery, say for a hysterectomy, or the natural menopause. Somewhat controversially, this loss of libido is called hypoactive sexual desire disorder. This labels a natural or surgically-induced decline in the levels of some hormones in a woman’s body as a medical problem to be “cured”. The theory is that a lack of testosterone and estrogen reduces the interest in sex. Thus, a topical cream or tablet can restore the hormone levels and improve desire. Unfortunately, there’s no real evidence to support the theory. Indeed, the FDA refused approval for a testosterone patch for women in 2004. The reason was a lack of evidence that this was a safe treatment.

The whole question is complicated because human relationships are complicated. Women may lose interest in having sex with a man for many different reasons. Although a reduction in some hormone levels may occur at the same time, this is no more significant than the fact that her hair may also be turning white as she grows older. More importantly, many women have excellent sex lives even with low levels of hormones. So the idea of developing a viagra for women is controversial. In the case of men, there was a more positive physical problem to treat. Obviously, completing the sexual act is difficult if the man fails to get or keep an erection. But, with women, it’s more complicated.

It’s always better to start off with the bad news first. Hopefully, by the time you reach the end, you will have forgotten this bit. The World Health Organization (WHO) estimated there were about 400m obese adults around the world in 2005. It expects this number to almost double to 700m by 2015. Since most people don’t want to have the gastric bypass surgery which almost always produces significant weight loss, this leaves a massive market of people who want an easy way to lose weight. They all want a magic pill. One they can take in the morning and be slim by the afternoon. As if. . . Anyway, all the major pharmaceutical companies have been laboring away. They see a golden pot at the end of the rainbow where people who don’t want to eat a less unhealthy diet and refuse to exercise can still lose weight. For the last few years, everyone was sold on the idea that the cannabinoid receptor antagonists were the answer. Although they were not the “magic bullet” because people still had to diet and, hopefully, exercise, the first results from their clinical trials and the experience on the ground when first released into the market were largely encouraging. Except there was one little worry. Some people who took these drugs got depressed. Now this is one of these tricky situations. I can imagine (even though thin) that some people who are overweight do get depressed if the weight shows no sign of going away. But over time, the evidence of a genuine cause and effect has emerged so now further development on these drugs has stopped. So this has an interesting effect. Until the next wave of drugs comes along promising to be the magic bullet, everyone will have to make do and buy phentermine. This drug is quite remarkable. In most fields of research, there has been such rapid progress that if anyone suggested people should use a drug more than twenty years old, they would look shocked. Old technology = bad technology. But phentermine has been an approved drug since the late 1950s. It came on to the market as an appetite suppressant. More than fifty years later, it’s still a sold as a reliable drug for the suppression of appetite. If you’re finding it difficult to stay motivated in your diet, you buy phentermine and it keeps the hunger pangs at bay until your stomach gets used to having less food inside. Sometimes, old technology is tried and trusted until something better comes along. In the weight loss field, phentermine is still waiting for that replacement.

One of the more fascinating things you can think about when you’re bored is why the spam is so different depending on where you have accounts. Perhaps I’m just lucky, but I get very little spam through my ISP. Mostly, it’s just to persuade me to buy viagra and other more obviously fake ways of producing sexual enhancement. I suppose the way I trawl the web to find stories to write about here sells my name as someone desperate to find a way of overcoming sexual inadequacy. But, when it comes to Gmail, my inbox is more evenly divided between viagra and gambling sites. And then come the yahoo accounts (I have several for different purposes). Almost without exception, I am flooded by the Nigerian scam mail. It seems the spammers target different user groups depending on the mail servers they use. A research team based at the University of California has been digging into the problem - it’s completely fascinating to see how some research teams spend their time. Anyway, this team decided to try estimating how much money the spammers made out of persuading people to buy Viagra. Their guess? $3.5 million a year. How did they come up with this number? Well, like cunning hackers, they wormed their way into the Storm botnet. For the uninitiated among you, this is one of the control centers for all those hacked computers around the world. Storm lets you send out millions of e-mails. To monitor responses, they set up two websites of their own to promote. One offered to sell viagra. The other was designed to mimic infecting the users with trojans - the same little bits of code that allow spammers to hijack machines in the first place. Both were actually harmless but counted the traffic and downloaded benign bits of code. Now comes the exciting bit. They sent out almost 470 million e-mails. There were 350 million to promote the viagra site with 10,500 people responding and 28 people attempting to buy Viagra in quantities worth more than US$100. So the low conversion rate did not mean low profits. By scaling up this hit rate, the research team arrived at their annual estimate for gross revenue. But it’s actually quite expensive to send out all this spam so the only way the operation pays is if the spammers also run the sites they promote. The infection site was more efficient, converting an average of 6,000 PCs a day to clones. OK, so now you know who to blame for some of that spam you have been receiving, you can all get your own back by e-mailing the research team which is based at the campuses at Berkeley and San Diego.