Saturday, January 31, 2009



Since Viagra works well for erectile dysfunction in men, studies were conducted to see if it could work as well on women. Cosmopolitan and Redbook magazines long have claimed that every woman should always have orgasm.   Not so.  It is estimated that up to 70% of women premenopausal have absent or delayed orgasm, decreased arousal and lubrication and decreased libido.

Studies showed there is significant improvement in women with new sexual complaints related to antidepressant medication.  This use is an off label use of the drug Viagra and other the 5-phosphodiestrace inhibitors as vardenefil and tadafil).

These vagus inhibitors increase blood flow, engorgement, and lubrication to the genitalia, resulting in increased vaginal sensations and arousal.

The drawback:  It will not work if there are spouse relationship issues, underlying depression that results in  a low libido, or the woman has  thyroid problems or low testosterone.  It is also contraindicated in pregnancy.  Contrary to expectations, Viagra decreases uterine blood flow in healthy pregnancies.  It also is detrimental on the fetal blood flow and on the fetus.  Pregnant women should never use it.

Sources: Nurnberg Jama 2008:300, pg-395-404,   Miller, Am. Journal OB-Gyn, Jan 2009        

What do you think?  Visit for more blogs on medical controversial issues. Visit June 23, 2008 blog on “Who Regulates Off Label Drug Use?”

Monday, January 26, 2009



Our society is not working. Lets revive our can-do–spirit.  We must affirmatively protect individual freedom in our daily choices.   We don’t need to change our public goals.  Let’s just make them easier for us free citizens to achieve these goals.

Today, we don’t feel we can reach inside ourselves and really make a difference.  We think we are powerless.  Bureaucracy and rules don’t make things happen.  Your accomplishment is personal.  It is a great feeling knowing you did a good job. 

We have become a nation of rule followers.  Modern law teaches the lack of authority. Our everyday choices, are paralyzed by litigation and regulation.  We try to solve all our  problems in terms of legal risk and existing law Everything has a legal risk and a warning..  When you are  in doubt, don’t. Our normal instincts are to get things done..  We hesitate; doubt and our convictions are weakened.

One feels discouraged dealing with the public .  You can’t be kind to people for fear of legal action. No longer is government a noble calling. No longer does a physician encourage his child to a medical calling.  No longer do teachers encourage their children  to educational careers


Health care is a nervous breakdown in slow motion  Doctors don’t encourage their children to go into medicine.  Costs are out of control, yet the doctors order whatever tests the insurance will pay for.  It is no longer courageous to take risks, for this is reason enough to get sued.  How can you control high medical costs, when the doctor is thinking about who they can defend themselves if the sick patient sues


Teachers can’t pu t an arm around a crying child.  Disorder disrupts learning all day long in many schools.  Kids can’t run in recess for risk factors.  Exercise is a no-no, and obesity is rampant in our children.

Let schools be run by values and instincts of the humans we put in charge, not by micromanagement of governments.  Let the schools be accountable for how they do.

Ordinary choices by doctors, teacher, officials, managers and yes, volunteers, are paralyzed by our legal self-consciousness.  You can’t  talk off the cuff for fear it might be used against you   Our first questions are: Did you check the rules?  Who will be responsible if there is an accident?


Freedom is no longer a personal power.  The focus today is on the rights of whoever might disagree.  With all our problems in society, we remain paralyzed. We used to take a problem and fix it.  No longer can you feel free to do anything.

Our freedom has a formal structure in laws that tell us what we can and can’t do.  You steal, you pay the penalty.  But we forget that the law also defines an area that frees us from legal interference   Today, our laws provide no protection and no boundaries.    In our daily lives, any disagreement at work, any accident, any touching of a child all create legal risks.


We must abandon the idea that freedom in our dally choices requires picking the right answer.  We need to affirm social norms on what is reasonable and what is not.  The feeling and demands of our community must is heard.

The cure is how we look at freedom.  Freedom today does not include the power of personal conviction and the authority to use our common sense.  We need freedom in our daily choices. The individuality of  our accomplishments  are not honored.

We accomplish things by focusing on our goals and letting our subconscious instincts get us there.  Very few people know how they got  things done.  Trial and error lead them  to success. 

We need to affirm our social norms of what’s reasonable and what is not.  They should correspond with the actual feelings and demands of our communities.  The common good must be balance with appeasing someone’s rights.

Source:,, wsj.Jan 26,2009

What do you think? 

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Saturday, January 24, 2009



Nationwide electronic medical-information system is coming soon.   To lower the costs and raise the quality of health care, there is a rush to processing patient records digitally by 2014.   Changing the coding system that doctors and hospital use to bill insurers is also to undergo complete overhaul within the next three years. 

Only 4% of U.S. doctors are using fully functional electronic health record systems today.  Medicare this month is  bribing doctors to move swiftly with electronic prescriptions by offering them a 2% bonus if they use the system. 

It’s not enough to just install new IT systems in doctor’s offices.  The systems must talk to each other, so hospitals and doctors, and probably insurance companies, will have all relevant information to share with each other.

Congress has just appropriated twenty billion dollars for health care information technology.  Bringing in so much money so fast may result in waste, as we have seen in the TARP money the banks recently got.

The money will go to fund regional electronic systems, train technicians and give incentives to doctors to cooperate.  It will be a massive task to install rapidly large numbers of electronic record systems.   

Will this rapid training lead to unqualified technicians putting erroneous information about you? If wrong, will it be easier. for you to reconcile what is right than it is  trying to change your credit report. We are spending money on technology that is still not developed and it may result in a piecemeal system.  

Our fragmented health care system results in unnecessary tests and decisions are made without knowing all the patient’s relevant medical information. 

New standards make it easier for systems that are sold by different vendors to communicate with each other.  Older systems will need to be replaced.  Many states still don’t even have regional systems in place to handle patient information.  How will Congress safeguard your privacy?  When patients are treated in various states, how will the privacy issues of each state get reconciled?

A new coding system will result in more billing errors.  You the patient will be overcharged, the insurance company will be able to deny your doctor’s claim stating it didn’t have the proper code.  There will be more billing fraud and you and the doctors will not be paid quickly.  You will need to give the doctor more medical details, and each insurance company will want all the different details of your life.

We all agree on having some information sharing, but many bad experiences may be created that will create a mess and anger you the voter.  Will your privacy be compromised and will you get the prescriptions you need when your past medical history is on the table.  Will it force the doctors to be more defensive against legal suits?  What do you think?  Ask your doctor what he thinks about all this?

Sources: wsj nov. 11, 2008, NEJM 2008

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Friday, January 23, 2009



Medicare started paying doctors a bonus if they switch their prescriptions to electronic prescriptions.   It amounts to 2% of the of Medicare charges, or about 2k extra for the doctor.   Some health care companies are giving free software, and digital handheld devices.  This has doubled this past year with these incentives.  Now 12% of office-based doctors are using electronic prescriptions.  It costs the doctor 25k to 45k.

A secure Internet goes directly to pharmacies.  It has reduced errors in prescriptions and saves money for the insurance companies.  Patients don’t have to wait for their prescriptions.

Federal law still will not allow narcotics, sleeping pills and anti-depressants to be done electronically.  The software checks your drug history, wrong doses, and possible harmful reactions from the other drugs you take. The software pushes generics with a smiling face, and a frown when the doctor uses an expensive drug.  The doctor is encouraged to find a select generic low cost medication. 

The doctor also finds out all the drugs you never told him you were taking from other doctors.  A history  is displayed of all your medications and which ones are covered by your health plan. 


President Obama wants to modernize our U.S. health care record system.  But are our electronic record systems able to talk to each other or will this fragmented systems make things worse than they are.  The current crop of electronic programs if implemented will stifle innovation that is needed to make the electronic record system useful.  It certainly will increase clinical and administrative errors with the medical user interface complexity.

Doctors are reluctant to adopt electronic records because most of the rewards go to the insurance companies instead of the doctors.   In the office, it will cost $50k per doctor, and this does not include the lost productivity as the staff learns the new technology.  The doctors will save 11% by using the system.   It is a high-risk venture that puts doctors income at peril. 

Will this help you?  Now about 20% of all prescriptions are never filled.  Do you want the doctor to prescribe the drug he thinks will help you, or should he give you a low cost generic drug? 

(SEE MY BLOG:  PROBLEMS WITH GENERICS (Jan 22, 2009).  Visit for more information on controversial medical subjects.  Your comments are always appreciated.

Thursday, January 22, 2009



Over half of all the prescriptions in the U.S. are filled with generic drugs.  Brand name manufacturers make half of the generic drugs.   Do you get what you pay for? Buying new cars, clothes, or computer upgrades may hurt your budget, but buying the newest drugs could hurt both your wallet and your health. For prescription medicine, “classic” drugs may be the way to go.

What are generic drugs?

Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, and route of administration, risks, and safety, strength as the original drug, and maybe side effects.

Why are generics cheaper?

Generics manufacturers haven’t paid for developing a drug, so they can sell their product at reduced prices generic drugs are only cheaper because the manufacturers have not had the expenses of developing and marketing a new drug.

 When a company brings a new drug onto the market, the firm has already spent substantial money on research, development, marketing and promotion of the drug. A patent is granted that gives the company that developed the drug an exclusive right to sell the drug as long as the patent is in effect.  As the patent nears expiration, manufacturers can apply to the FDA for permission to make and sell generic versions of the drug.  Without the startup costs for development of the drug, other companies can afford to make and sell it more cheaply.

 Many generic drugs are now manufactured in China and India where quality control standards are far less stringent than in the U.S.  Insurance companies steer patients to generics to keep their costs down, even if customers wanted to switch to a brand name.  You have to pay the brand name co-pay, which may be double or triple or significantly higher than the generic ones.

Are generics the same as brand drugs?

Today, virtually all generic drugs are essentially the same as the innovator drugs they copy.   They must meet stringent FDA requirements to get approved.  Essentially, a generic company must show unequivocally that the generic drug contains the identical active ingredients as the innovator drug in the same amount and must behave in the same way in the body.  For all practical purposes, they are the same drug.  And it is thus assumed that the generic will have the same therapeutic effect.

But generic drugs are also different.  They typically use different inert ingredients, binding chemicals and colorings.


Excipients include fillers, binders, colors, and coatings, may differ in various versions of a  drug. Due to trademark laws, generic and brand-name drugs cannot look identical, so generic pills are often a different color or shape from their counterparts.  It’s possible that an individual could be allergic or sensitive to a specific excipient. There aren’t that many excipients, so drug manufacturers choose excipients from the same limited pool.  It is the final form of the generic that is tested against the brand, so if an excipient reduced absorption, the generic would fail in the comparative test with the brand. 


False data submitted by several generic drug firms

In their applications to FDA for approval to sell new generic drugs. For example, one generic company admitted to submitting the brand-name maker's drug as its own in an effort to win swift approval of its generic copy.


 Officials of some generic drug firms offered illegal gratuities to FDA employees in the FDA generic drug program. Regrettably, three FDA employees — now former employees — accepted the offers.


Some generic drug firms have violated the good manufacturing practice regulations that govern overall production procedures and techniques that help guarantee the safety and effectiveness of drug products.  Many are now made in India and China where poor regulations are unenforced.


The term "therapeutic equivalents" applies only to products that are pharmaceutical equivalents, not to different therapeutic agents used to treat the same condition. The increasingly common and controversial practice of allowing one product with a similar, but not identical, active ingredient to be used in place of another product is more commonly referred to as therapeutic interchange.


A generic drug must be as therapeutic as its brand name alternative.   These studies involving the measurement of plasma drug concentrations are very expensive and time consuming and can fail.   To solve this high expense, alternative approaches are used as pharmacodynamic measurements instead of plasma concentrations.   Some products result in disagreements between the scientific community and the FDA.  

Generic drugs are graded for bioequivalence.  To assure scientific rigor in their evaluation and because, they involve  a small proportion of drugs, bioequivalence issues do arise.  They arise largely because the testing available today is very sophisticated and can detect even small differences in, say, the rate at which a drug is absorbed or the quantity of its breakdown products in the body.  Some of the differences these tests pick up may be meaningful and some are not.  The FDA decides  The FDA can approve generic products that, although plainly not identical to the reference product as required, are viewed by the FDA as close enough.


The law of the land in the US is there can be a plus or minus of 20% of bio-availability of the active ingredient!   The FDA still uses the plus-or-minus-twenty percent test to determine blood serum bioavailability (i.e., the amount of active ingredient in the blood over a period of time has to come within plus-or-minus twenty percent of that which is observed when the innovator’s drug is ingested.".   Many generic medications don't meet their 20% bioequivalence standard.


 If you started out on a generic and don't have any problems with it, great!  Stay with it.  But if the pills changed colors and the meds don't seem to be working correctly any longer, then see if you can get your pharmacist to order your meds from that same manufacturer.

Many elderly take 5-10 medications.  Many find they don’t work the way they were told.  They increase or stop the generics.  This may be why we have more chronic illnesses in our elderly.

 What do you think?  Visit for more information on controversial medical subjects.


1. Food and Drug Administration, Orange Book web site, preface, introduction and ratings explanation,  Accessed Feb.14, 2002.  Lynda Welage et al, “Understanding the Scientific Issues Embedded in the Generic Drug Approval ProcessJournal of the American Pharmaceutical Association, Vol. 41. No 6 (November/December 2001), pages  856-867. Don Hare and Thomas Foster, “The Orange Book: The Food and Drug Administration’s Advice on Therapeutic Equivalence,” American Pharmacy Journal, Vol. NS30, No 7 (July 1990), pages 403-405.  James Knoben et al, “An Overview of the FDA Publication: Approved Drug Products with Therapeutic Equivalence Evaluations,” American Journal of Hospital Pharmacy, Vol. 47 (December 1990), pages 2696-2700.  FDC Reports (The Pink Sheet), “Zenith-Goldline Clozapine Bioequivalence Study Suggested by FDA,” (February 5, 2001), page 29. NIHCM Foundation June 2002 

Wednesday, January 21, 2009



Sun worshipping may be dangerous to your health.  Aging is not so much diet, exercise or heredity.  Of the many theories about aging, none consider sunlight. The long-lived biblical patriarchs, as Methuselah, lived in a different environment.  They were shielded from strong sunlight by a canopy of ice that let them live long lives. They had the secret magic bullet to longevity.  The bible gives clues to man’s early life on this planet.

What  happened?  First the water separated with water below the earth and water above the sky’s canopy of ice. There was insufficient sunlight and rain could not form.  The flood occurred as the windows of the heavens opened. and the ice canopy broke up.  With strong sunlight visible, the first rainbow was seen.  Ten generations after Noah, the stars appeared. 

It is scientifically accepted that the surface of the earth once was 2000 degrees Fahrenheit.  It was an extremely hot surface.  But the question is “Where was the water?”  Asimov in his book “Science” poised the same question.

When the earth was so hot, only 50 miles above the earth the temperature was far below zero, over one hundred degrees below zero. . Prior to the floods, there were no cave carvings of sun, moon, or rainbows.  It is assumed that there was a frozen filament of ice in the clouds that filtered strong sunlight, moon, and rainbows.  The water on the earth was in the sky. 

A canopy of ice was over the earth, out of reach of the pull of gravity.  It could not rain because there was not enough sunlight to pull vapors up into the air.  Rainbows need bright sunlight to form.

Today we have become an enclosed society.  Stadiums are domed.  Tennis and sport events are held often inside.  Buildings are using more glass.  We screen the sun with sun block lotions.  We use polarized sunglasses. 

How do we age?  Wrinkles and cataracts are influenced by sunlight.  We use ultraviolet light to kill germs and bacteria and kill life, and million of us love sun bathing.   We age where we are most exposed, on our face neck, and hands.  Our fingernails grow ten times faster than our toenails because of more sun exposures.  The fastest growing cells are on the top of your head, excess sun causes dandruff flakes. 

Ten percent of your blood is always in your skin at all time and affected by ultraviolet rays.  One square inch of your skin has 19 feet of blood vessels. We start with 79 million cells and over time water temporarily replaces the many lost cells. As we age, millions of cells are dying and we lose weight.  We become like waterlogged Swiss cheese.

Where do most of the oldest people in the world live?  In the mountains!  Mountains run north and south, and the sun rises in the east and sets in the west.  People live in the valleys of the mountains that shade and protect them from the sun and weather.    Utah has the oldest average age in the nation because they are next to the continental divide.

Men die earlier than women because their hobbies and work are outside, while woman work and have indoor hobbies.  Hunting, fishing, golfing and work occupations cause men to spend more time out of doors.

Northerners live longer than people in warm climates, since they are further from the sun and protected from the sun.  Swedes and Icelanders have long life spans while the people o the equator have the lowest life expectancies.   Animals like turtles and elephants live a long time because they have thick hide. Why do burrowing animals and bats that avoid sunlight live longer?

Once the industrial revolution came, we work indoors and our life spans have doubled from 40 years in 1900 to 80 years today.  People who work indoors like musicians, doctors; CPA’s all outlive today’s farmers. 

Our doubling in life expectancy in this last decade is due to Henry Ford and the automobile.  The auto reflects 98% of ultraviolet light.  The car has a roof and windows.  We live inside our houses and in air conditioning; we work in a building and return home to spend the evening inside their house.  We get less sunlight than ever before, and our radiation is reduced. 

Your body shrinks and loses weight as you age. Aging is the slow loss of cells.  It is the loss of strength, loss of mobility, loss of immunity, loss of perception, loss of memory and finally loss of life itself.  


Source: Why You Age, Arthur Edwin Brown, Eagle Publications 2000  

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Tuesday, January 20, 2009



President Obama in his video interview on Arabic Tv, stressed his Muslim roots and appealed for peace on behalf of all the children in the Middle East.  The style was the same he used in his inaugural address by using the traditional method of forgiveness used in his native Hawaii. 

Native Hawaiians call the process of forgiveness ho’oponopono, meaning “setting to right”.  This ritual is used to maintain harmony and solve conflict within a family.  H’oponopono starts with a prayer (pule) asking god to help in solving the family trouble.  The family sits in a circle and discusses the problem.  They share how they have felt and why they acted as they did. 

The problems are traced from beginning to end.  Wrong doings and restitution are confessed.  Then they forgive one another, releasing each other and themselves.  Finally the problem is declared closed (patni).  They seek to reestablish harmony with God and ask God’s forgiveness.

President Obama knows that to forgive means to let go of our nations pain and fear.  By forgiving people who wronged him, he knows it is the only way to retain his power to influence others, and close the matter.  He has taken the initiative rather than wait for the others to make the first move.

We are bound to people we can't forgive.  It also holds  us in their vise grip.  By forgiving Hilary, Bush, Gov. Blago, and other competitors, President Obama  is halting the cycle of blame and pain in our nation.   He has release us a nation, freeing each of us.  Our resentment was clinging to the past, reliving it over and over, picking each healing scab so our wounds could never be  healed.

Those of us who forgive are the first to be healed.  We see prisoners freed, and then find that we are the prisoners freed.    The stranglehold of guilt is released from the perpetrator.  Forgiveness may seem to us undeserved and unearned.  But it lets the burden of guilt melt away.

Let us indeed look at the future as “The Joy of a new beginning”. 

Thank you President Obama for your forgiving attitude.

Source: Yancey, “What’s so amazing abut grace” 1998, Zondervan Publishing House

Are you also ready to forgive and move forward?

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